Diesel Face

Enough of Poker Face (although it is one of my favorite songs), this song is dedicated to one of the all time loves of my love, my baby, Diesel Face….

Start Poker Face song by Lady Gaga..

Pit-pit-pit-bull…

Pit-pit-pit-bull….

He wants to play with you, do tricks, give him his treats,

Roll over, play dead or tug-o-war, he’s got you beat (he loves it),

A crazy puppy gets worked up if he can’t run,

So walk him with his sunglasses, too squinty in the sun..

Oh whooaaa oh oh, whoooaa oh,

Hes got big ears, two big crazy ears,

Oh whooaaa oh oh, whoooaa oh,

Hes got big ears, two big crazy ears!

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy),

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy).

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na,

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na….

I wanna walk him, but he pulls too much for me,

A big spike collar ’round his neck and he will see (no tugging),

He looks so tough, beware of dog, you’d better run!

But he’s so sweet he’ll treat you like you are the only one…

Oh whooaaa oh oh, whoooaa oh,

He’ll love you so, pet him and you’ll know,

Oh whooaaa oh oh, whoooaa oh,

He’ll love you so, pet him and you’ll know!

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy),

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy).

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na,

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na….

He will greet you at the front door, make you adore,

Cause he’s panting, and he’s franting,

He’s not angry hes just runnin with his bone and jumpin,

Just like a puppy in the kennel, throw his ball before he jumps on you,

He’s happy, ecstatic, so play with him for long hours…

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy),

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy).

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na,

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na….

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy),

Cant be mad, cant be mad, no you cant be mad at the Diesel Face (He is a happy puppy).

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na,

Da-da-da-Diesel-face, da-da-Diesel Face! Na na na na….

You Know You’re a Healthcare Provider when….

So today I got to have my first “Harrell Center Experience.” To clarify, the Harrell Center is a teaching center for nurse practitioners and medical students to get practice with different skills either on virtual simulation patients, or on a paid model “patient”. What we went in for, was to get our first experience with performing pelvic exams (pap smears), and prostate exams. In my profession, half the time is performing pelvic exams, and I have had plenty of experience with those working in labor and delivery. The prostate exams on the other hand….I was more than a little uncomfortable with that. Not that I was nervous about performing it, but the whole thought of the “inserting a finger into the rectum and palpating your prostate” just seemed like such an uncomfortable experience to the person receiving it, that it made me feel awkward just thinking about it. What was even more confounding/astonishing, was that they actually PAY these people to let us do exams on them. Not just like they were pulled off the road for crack money for this, but they are actually paid professional instructors that are experts on getting these exams to teach you the best ways to do them. Crazy, I had no idea that kind of a profession existed. That would definitely be something to watch on Dirty Jobs.

The female exam went great. Being the only OB/GYN specialty student, I was nominated from my group to go first and be the guinea pig on the lesson. Awesome. Fortunately, I found the cervix and all the other organs without any problems, and it was a piece of cake; I wouldn’t have expected any less.

Then came time for the male exam, dun dun dunnn. Based on previous opinions from my other colleagues that have gone before me, they all advised to avoid the younger guy, and go with the old “creepy” looking guy. Based on the younger dude, he looked like a super creeper to me, so once I saw which exam room he went it, I made a beeline for the other room. So happy I did. Our instructor/patient was an older gentleman that has earned a living doing this kind of thing, traveling all over to different medical schools, get paid the big bucks, and keeping up an easy beach bum life style. I knew I was going to like him from there, but oh man this guy was HYSTERICAL! He had a great sense of humor, and by cracking so many jokes, totally relieved all the awkwardness. He also really clued our group (3 out of 4 of us were females) on what kinds of things go through a guys mind during these exams: that they are totally terrified of anything and everything, and want to run home at the first opportunity. Poor things. So when its my turn for the prostate exam, I was not as nervous as I thought I would be, just worried that my tiny little fingers would never be able to reach high enough to feel the prostate. The rule of thumb is pretty much that if you cant feel anything, then thats pretty much normal (usually problems result in these structures becoming larger). So as I was in there…feeling, the guy kept saying well, “I feel like you are putting downward pressure too soon, just point your finger farther forward,” which was exactly what I was doing. Then he says to me, “well I don’t know what it is, but do you have your thumb in there?” Panicking slightly, because fingers are always notorious for being in the wrong places at the wrong times during these exams, I checked my hand position, which was exactly how it should have been. So I told him “No, I think its just how my finger bends…” and he tells me I shouldn’t be bending my finger, to keep it straight and forward. I told him it was that too. The guy must have thought I was an idiot. I guess I had forgotten to mention that my fingers are double jointed. See picture. So after the exam, I removed my gloves and showed him, and he goes, “WHOAAAAAA!!! I have never seen anything like that!”

Hahaha, so apparently that was the problem we were having. He was feeling my middle knuckle giving downward pressure, as the rest of my finger pressed onward. This gave him quite a laugh, and of course, I always end up with some sort of story to talk to much about.

 

Caesarean Deliveries and the Development of Childhood Allergies and Respiratory Issues

As medical advancements make more and more contributions to the way patients receive treatment, there seems to be an all time high in the rate of Caesarean sections amongst normal births. Reasons for this include the desire for quick, uncomplicated labor, and fears and lack in confidence regarding natural childbirth (Childbirth Connection, 2007). As a result of this increased incidences of C-sections, there has been more research exploring long-term effects of this method of birth on the children. The most significant findings have been increased rates of asthma, allergies, and chronic bronchitis amongst children delivered by c-section versus those delivered vaginally. In a retrospective cohort study, children that had been recently diagnosed in the past decade with any respiratory disorders, including allergies and dermatitis were investigated on their birth statistics, including birth weight, delivery method, gestational age, and maternal behaviors (Renz-Polster, 2005).  This investigation found a significant correlation between delivery by c-section and incidence of respiratory problems and allergies later in life. The pathologic process is thought to be due to the lack of microorganism exposure during the birthing process (Renz-Polster, 2005). The thought rises from the idea that decreased exposure to environmental organisms in the first few days of life leads to increased rates of allergy development; the normal intestinal flora of the newborn is generally acquired as it is exposed to organisms in the vaginal tract during the birthing process. This phenomenon is thought to be one of the most important factors contributing to this study, because it is associated with the necessary introduction to environmental organisms that leads to the development of immune system tolerance outside the sterile fetal environment (Renz-Polster, 2005). When the infant is removed by c-section, there is no contact with the maternal vaginal flora, and microbiotic exposure is experienced differently through skin contact over the next few days, with introduction of a different type and quantity of microorganisms (Renz-Polster, 2005). Furthermore, natural mechanical processes of a vaginal birth allow the expulsion of amniotic fluid from the lungs of the infant as its chest is compressed through the birth canal. In this manner, the infant’s lungs are better primed for the first breath, as opposed to during c-sections, where there is no mechanical compression of the chest, and fluid removal is often extracted by suction mechanisms, often leaving the infant with fluid still in the lungs, making it harder for it to begin breathing on its own.

With these findings, it is imperative that as health care providers we stress the importance of avoiding birth by Caesarean if at all possible. We need to provide out patients with the education necessary over what to expect during the birthing process, and how to appropriately manage delivery without surgical interventions. This is probably the most critical factor to implement, to explore delivery options before maternal stress and exhaustion from labor is experienced. This will lead to better informed consent, and will likely reduce the incidence of delivery by c-section. Furthermore, it is also important to inform our patients that subsequent deliveries after a c-section are often routinely performed as c-sections, further increasing the amount of risk for developing allergies and respiratory problems in the family later in life.

References:

Childbirth Connection (2007). Choices in childbirth. The New York guide to a healthy birth.

Renz-Polster, H. (2005). Caesarean section delivery and the risk of allergic disorders in childhood. Clinical & experimental allergy, 35: 1466–1472. doi: 10.1111/j.1365-2222.2005.02356.x

Graft Versus Host Disease and Procrastination at its Finest…

So its about 1:30 am, and I am pulling my first all nighter in actually quite a while. Had to be in Jacksonville ALL DAY for orientation, and my ARNP pathophysiology midterm is in about….6.5 hrs. So in order to elicit a little more motivation on the part of studying the process of disease right now, I will tell you my very illustrated version of Graft Versus Host Disease (GVHD) which I would like to attribute to my little brother Dominick for his vivid imagination in war and fighting and stuff. Here we go!

(I apologize in advance if you don’t know what GVHD is. In a nutshell, it is basically a complication of like a bone marrow transplant for example, where instead of the body attacking the foreign invader, as what sometimes happens in other kinds of organ transplants, the donor tissues actually attack the host. Here is why…)

It makes sense to consider WHY the donor T-cells attack the host, and why this complication can be more serious than other kinds of graft rejection. When you think about the irradiation or chemotherapy procedure the recipient must have prior to the transplant, all forms of defense have been virtually abolished from the body, leaving the host vulnerable to a wide variety of immune insults, only to be bombarded by the defending immune cells of the donor. After the transplant, healthy, active donor immune cells are introduced to the host’s weak, susceptible body. With no cellular line of defense available to combat the attacks of the donor immune cells, the donor invaders wreck havoc in the body before they ultimately conquer the fallen immune system of the recipient. Its easy to imagine the kinds of damage and tissue injury the recipient must endure after a violent battle of strong versus weak immunity in GVHD. As the body makes attempts at regenerating its normal cellular functioning, a multitude of harsh symptoms and manifestations may be experienced in the process:

-Skin rash, loss or increase in pigmentation, and/or acanthosis (thickening of the skin).

-Liver damage in the bile duct and hepatomegaly.

-Oral ulcers, dry mouth, infections.

-Severe diarrhea.

-Red, burning eye irritation.

Thanks for reading. Hope you learned something. I should probably get back to the workload. 12 essay questions, Lord help me!!

Eyes, are the windows to my life…

Hello all.

Second blog today, maybe I will be successful with this after all. Today in lab, our topic was Neuro, and our SOAP Note assignment (practice taking health history, review of systems, physical exam, diagnoses, etc.) had to do with investigating a headache, associated with nausea and vomiting. Amongst the many other things to review and rule out, I immediately recalled my past, thinking of my own experience of headache, with nausea and vomiting. I realized (though not for the first time) that there are some aspects of certain periods in my life, that have rendered me very sensitive, emotional, and deeply affected. After some pretty thorough experience in the field of psych, I know that although it is ok to feel that way about these things, because they were very significant events in my life. I also know even though I have accepted things, that repressing everything will lead to more emotional distress, so that being said, I am going to talk about these things. This is my story…

When I was about 10 years old, I was diagnosed as having glaucoma in my left eye, which is a disease that is rarely seen in young people, especially kids, and it occurs when the drains in your eyes fail to adequately drain the fluid that is constantly being produced. This causes the pressure in the eye to increase. If the pressure gets too high, it will damage the optic nerve, and can lead to blindness.

 

This is how glaucoma vision looks, what it still looks like to me.

 

So with this diagnosis, I was started on a type of eye drop to help with the pressures. Over the next few years, I was put on more kinds of drops, and more frequently. When I was 14, they finally concluded that the drops were no longer working to control my pressures, and that I needed to have surgery, or I would go blind. The day after Easter that year, my mom, dad and I drove down to Bascom Palmer Eye Institute in the University of Miami, and what they did was place a tiny tube in the back of my eye to facilitate drainage out the back way, and removed all the jelly-like substance in my eye, to prevent it from blocking the drain. Well that sucked. When I woke up, I was laying on my left side, in excruciating pain, and as much as I screamed at the dumb nurses, I don’t think they spoke English, and didn’t give me anything for post-operative pain. Idiots. For the first couple days, things were ok. Then, one night after I ate dinner, I couldn’t stop throwing up. My head was pounding, and my eye felt like a golf ball. Finally after non-stop dry heaving, my mother and I made the hour long trip down to UM once again, where they had some very bad news. Usually when they perform this surgery, they place stitches to hold the tube that dissolve on their own. This is usually in older people, that do not heal as fast, and don’t have as high a fluid production rate as younger people. I was a 14 year old, healthy, athletic girl, and I evidently had started the healing process much faster than they imagined. So the stitches that were holding the tube were blocking the drainage, and my eyes were still producing fluid, and it was building up. A normal eye pressure is like 15-18, mine was in the 50’s. The problem was that these stitches were in the back of my eye, so there rose the problem, how do we get them out?

 

Sort of what I had done...

 

One of the most significant things I remember was how terrible I felt. Every few minutes I would need to vomit (due to the imbalanced equilibrium), I couldn’t even drink water, and I had the worst headache I could ever imagine. So the doctors wanted to try to give me some relief, the only way by removing the fluid. Yes, they had to suck it out with a needle. Cross my heart, hope to die, I have had a needle stuck in my eye (this was my mom’s attempt at humor at the time). They told me it wouldn’t hurt, but do you think they even had a needle in their eye? Doubtful. Anyways, that helped tremendously, and for the first time in a couple days, I was able to eat something, McDONALDS. I was pretty much in heaven. Unfortunately, my bliss at being able to eat was short lived, and before I knew it, I was back to my misery. For the next several days, everyday, my mom and I made many trips back down to the hospital, without much luck. There were crappy resident doctors, that wanted to practice talking and asking questions, and didn’t realize how miserable I was. I felt like punching them. There was one doctor in particular, that was amazing. His name was Herbert, and my mom (again in an attempt at humor) nicknamed him Herbie, and his physical apprearance matched the name perfectly. Nerdy, glasses, the works. But he understood my despair, and did everything he could to help. For that I will be forever grateful. Now, the last resort to getting these stitches out was to try to laser fry them. That was just annoying as hell. It felt like I was looking a a blinking red light for hours. At last, that did not work either. This was a Thursday. I don’t recall how many days it had been, but the docs had run out of ideas, and they said OK tomorrow, if there is STILL no improvement, we need to do surgery. Obviously devastated. Come Friday morning at the crack of dawn, I recall not feeling AS sick on the way down there. They checked everything out, and by the grace of GOD, a freaking miracle, the stitches had totally vanished. Gone. Can you imagine the sense of relief? After so long of not eating, I had drastically lost weight, when I came back to school after being out a few weeks, I can’t imagine the assumptions. I missed a lot during this time, had apparently won a trip to Bush Gardens, missed a lot of work, and my grades did suffer (who wants to do homework when you’re heaving every few minutes??) But things got better, life was great, I met my wonderful boyfriend, had the best times with my best friend Ashley, yada yada. UNTIL…..

Roughly about a year later, after no problems with anything, my right eye got kind of inflammed, probably due to my contacts or something, and we went to the doc, he gave me some anti-inflammatory drops and told me to be EXTREMELY careful to not let the infection spread. So I did, and by the end of the week, it went away. Then one night over the weekend, I woke up about 2am, because my left eye was so watery, I couldn’t even sleep. When I looked in the mirror, I saw my left eye had become very pink. I was like OH SHIT I let it spread, so I put the drops in, hoping it would go away and I wouldn’t get in trouble. I had a headache, thought I was hungry, so I made some spaghetti O’s. After a bit, I started to feel kind of nauseous, but I tried not to think any thing of it, and laid there and tried to sleep. The nausea got worse, so I grabbed a bowl or something to keep by my bed, just in case. At about 4am, I just remember thinking to myself, oh no, oh no, oh no, and blehhh. Yep. That sucked. A few minutes later, blehhh. Finally I was like shit, I woke my parents up and they started making all sorts of phone calls to the doctor, the ER whatever. I could not believe this shit was happening again. Went to my normal eye doctor, and as he was checking it out he’s like “Yep, your pressures way up there, but its weird because usually the eye gets really red when this kinda thing happens.” Oops, I wasn’t about to admit I had poured the bottle of anti inflammatory drops in my eye. Whatever. Things happened pretty fast after that, went back down to UM again, and what appeared to happen was that there had been some of that jelly stuff left over from the last surgery, and over time, it found its way to the drainage tube, got stuck, blocked the drainage, and there I was. It was looking like I was going to need another surgery. Shit! This was on a Saturday. The surgeon didn’t operate until Monday. Double shit! I obviously couldn’t stay in that misery again until then so what did they do? Yup, you guessed it. Slurrrrp. Sucked out the fluid again. The next couple days were pretty uneventful I think, had some explaining to do about why I would be mysteriously missing from school again, and then Monday morning, I went in for surgery. Now what really annoyed me about this was that since my mom was pissed about my recovery room experience the last time, they (and I point out I was not included in this decision) decided it would be best to do a local anesthetic since it wasn’t a “major” surgical procedure. The nurses made me drink this terrible pink drink from a syringe that was the worst thing I have ever tasted to this day, and I couldn’t even chase it or wash it down with water. Terrible. The last thing I knew, the lady that was preparing me for surgery in the OR says to me “Don’t tell your Dad, but this is what two beers feels like” She injected something into my IV and I was out. Turns out they ended up putting me under general anyway, without proper consent (wtf??) but nothing really terrible happened after that.

Wow, what a long story. I have probably left out a few things, (like I said, I have tried to kinda forget about that stuff) but if something seems confusing, let me know, I’ll explain better. I haven’t had any problems since then, thank the Lord, and I hope I never will again. My left eye vision is decent with contacts, but without them, its kind of like opening your eyes under water. I laugh when people tell me they are blind without their glasses. They have NO IDEA! I see my doctor every six months, and I make my mom go with me every time. She has been there with me through everything, and even though I’m an adult now, whatever, she was my life line during the worst times of my life, and in my gratitude (although she doesn’t feel this way) I make her come with me to all the appointments. I need her; she’s my best friend, my sense of security, my life line, I wouldn’t have come so far with out her. So this is my story, I always feel like there is an elephant in the room, when people are afraid to ask. Although I don’t mind explaining why things are the way they are now, it always felt too overwhelming to think about what happened, but I think it also helps people to understand who I am today, and why. 

In the beginning…there was a cat…

Hellooo

So this is my first time doing a blog, I’m not sure how well I will be able to keep up, but I guess I needed some kind of a project, other than pathophys, so here we go. I’m Kaitlyn, I’m 22, and a grad student at the University of Florida getting my Masters in Nurse Midwifery. I can’t wait to deliver babies and be YOUR next nurse practitioner! Its about 8:45am, and I’m impressed I am even up right now; if I don’t have class, I’m usually still sleeping till 10am at the earliest, even when there is construction right outside my window. Me being up probably had something to do with Lio (the little cat) jumping on me and waking me up. I heard the toilet running, and since the chain inside has been coming off a lot lately, I figured it had been running for hours, so I got up to fix it, but found the chain was in place, and the toilet had actually just been flushed. My immediate thought was someone must have broken in and used my bathroom, since I don’t have roommates, but after getting into ninja mode and finding no intruder, the only possible toilet flushing culprit was, strangely, the cat.

Yeah say what you want, cats can’t flush the toilet, whatever, who says they can’t? He was probably climbing on it, maybe trying to drink from the bowl (I wouldn’t be surprised) and I’m sure his foot hit the handle. It probably scared the crap out of him, causing him to run and jump back into bed. He is such a funny cat. The last few nights he has been such a pain in the ass whining, and crying, and wailing, jumping at the front door, begging to go out side. So I hook his leash on him, and we walk around the neighborhood. Yup, I walk my cat. I half expect him to just lift his leg and pee. When people see me with an animal on a leash, they seem to assume it is a small dog at first, and then they get closer, and I can hear the surprised comments “Hey, she’s got a cat on that leash!” Yeah, well he if he fetches a ball, does tricks for treats, and apparently barks (per my parents, but I have yet to hear it) so he might as well go for walks too. If it walks like a dog, and acts like a dog, then…? I’ll be taking him and Diesel for walks together before you know it. Ok so, I guess its time to get up and start the day with some Yoga X, then study a few hours before class, three hours in the lab, then study a few more hours till Greys. Thanks for reading my very first blog, we’ll see how this goes. Have a great day!!