Last week, I posted the fourth pop quiz regarding how much A and M look alike in some photos. M is in the top photo, A in the bottom one. How did you do?

Tags: M, A

Okay, so it is a little weird (and gross?) to be posting about chancre, chancroid, gonorrhea and chlamydia between posts about my family and pictures of my babies. My Random Medical Facts section was started as a way for me to reinforce stuff that I have trouble remembering, but it often ends up being awkwardly placed among other, more pleasant, themes in my life. In some ways, that is how med school fits in with my family life, forcing its way into and in between a much different world. And I do enjoy them both, but they are really quite different, and equally demanding. But, no time to worry about that now. One day, when M and A are reading about what life was like when they were really little and mommy was a medical student, they might also be fascinated by the occasional random medical fact. Maybe not so much with this one though.

One common treatment of gonococcal cervicitis is ceftriaxone 125-250mg intramuscularly. We are always taught to look for and treat both gonorrhea and chlamydia together (they often coexist). Chlamydia treatment is azithromycin 1g orally or doxycycline 100mg twice daily for 7 to 10 days. Remember to treat partners too.

A is becoming more mobile every day, but he hasn't really started to crawl just yet. He is, however, able to move around quite a bit by rolling. Since he can roll from front to back and back to front, he's figured out that if he does that enough, he can get around the room. He can also pivot on his tummy quite well, so he usually has a good view of his surroundings. He can pull himself forward too, sort of an army-crawl, which is pretty cute. He's very active, and J likens changing his diaper to a round of Greco-Roman wrestling, although technically it's more like freestyle wrestling, since Greco-Roman is all above-the-waist. He can also sit up (but cannot pull himself up to sitting yet) and loves to sit in the high chair (review in progress, we LOVE our high chair) at the dinner table with us.

Here he is lying on the outdoor play blanket (another review to come soon):

Tags: A, travel

When I was shopping for play pens for M, I was bothered by how small most of the standard "Pack 'n Play" pens seemed. So when I came across this 38" x 38" square one from Graco, I was hooked. Brief Review

Tags: gear, toys

You know the drill. I think M and A actually look different in this one, whereas in some of the older quizzes, they look like the same baby. The similar pose is uncanny though. I will post the answer in a few days.
And if you missed them the first time, here are quizzes 1, 2, and 3.

Tags: A, M

We pretty much never put shoes on M until he started trying to walk (around one year). For his first shoes, we went with Robeez.



They were one of the original soft leather shoe brands for babies, and were pretty much what every baby at our daycare was wearing. Since then, a variety of soft-soled shoe brands have popped up and I recently started thinking about picking up a pair for A. Robeez are cute leather shoes with lots of cute designs, but they didn't really wash that well and came out kind of stiff and cracked. Functionally, they are still great, but I've started looking around for alternatives just to see what is out there. In my search, I found Pedipeds, and thought they'd be worth a try. They have velcro closures instead of the elastic that Robeez uses, which might be better for A since he has chubby feet. They are also very cute and comparable in price (most baby shoes are in the $20-30 range). We'll probably still try to reuse some of the old Robeez shoes that are in good shape, but I think it's nice for him to have some new shoes as well.

Our usual online shoe store (Shoebuy.com) carries Robeez but not Pedipeds, so I had to look elsewhere. I've recently purchased shoes and other items from Endless.com, which is an Amazon.com company and have been happy with their service. They offer free overnight shipping and free returns, and while their prices normally aren't better than Shoebuy.com, they are currently offering a promotion where you save $5 off every order, which is great for kids' shoes, and results in the best prices I could find on Pedipeds. I'm not sure if they have all the newest styles, but that's not really an issue for us and I picked out a pair of "Liam" loafers for A. After the promotion, the total came to under $24 shipped, which was a great deal for these shoes. We got them in the mail last week and I must say that I am quite impressed with the quality of shoes (and the box they come in for that matter). I'll definitely consider buying them as presents in the future, as they are very nice shoes indeed. A hasn't started wearing them yet (I bought them in a larger size) but they are as flexible as Robeez and very soft and well-made. I'll post a full review once he starts wearing them in the fall.

Tags: shoes

I can never remember the difference between chancre and chancroid. They are both sexually transmitted infections (STIs) but I always get them confused. Maybe typing this up will help me remember.

A chancre is the initial lesion of syphilis (primary), which is caused by the spirochete Treponema pallidum. The typical ulcer is painless, red, round, firm, with indurated borders. It arises three weeks after inoculation and disappears after two to six weeks without therapy. T. pallidum can be identified by serum antibody tests (MHA-TP, FTA-ABS), and material expressed from a chancre reveals motile spirochetes under dark-field microscopy. Treat with intramuscular benzathine penicillin G (alternative treatments are tetracycline and doxycycline).

Chancroid is also sexually transmitted, manifesting as a tender ulcer. It is more common in males, is usually painful, has ragged edges and a necrotic base. Tender inguinal lymphadenopathy is also common. It is caused by Haemophilus ducreyi, a small gram-negative rod and usually diagnosed clinically but can be confirmed with biopsy and/or culture (difficult). Treat with oral azithromycin or intramuscular ceftriaxone.

So, how will I try to remember the difference? A friend of mine suggested that "chancroid" could remind me of the word "android" (more common in males). A "lad" is male (common abbreviation for lymphadenopathy, which is painful). I could name the android "Duke," which might help remind me about H. ducreyi. Silly, I know, but sometimes this stuff really works!

We're always looking for fun things to do on the weekend that aren't too far or costly. Today, we decided to take the train two stops to a neighboring city's Farmer's Market (right on the train line). M loves trains, so it was especially exciting for him (his first time). Both boys were kind of scared when the actual train came by, since it's pretty loud up close, but I think they enjoyed it anyway. It's been a bit drizzly here, but fortunately, the weather held up and we only got a few droplets of rain while we were there. I haven't been to the Farmer's Market in a while, since our local one is kind of a pain to get to and has terrible parking. It's also super-crowded, even though we're out and about pretty early (both boys almost always get up around 6:30am). We weren't planning on shopping, but picked up some frozen homemade dumplings, naan, paratha, and some really yummy homemade cookies. M scored a balloon animal clown fish too. We'll pick up produce the next time we go, since we're pretty stocked at home right now. The strawberries were amazingly tempting (I love strawberry season) and there were farm-fresh eggs. Next time, I'll bring an insulated bag to carry our stuff home. I was pretty impressed at the variety of available produce, as well as international goods. I was planning to make chicken curry for dinner tomorrow night, so it was great that we found the Indian breads. We had the pork and napa cabbage dumplings for lunch and they were the best we've had in a long time. Needless to say, we'll probably be working this trip into our Sunday outing rotation from now on, along wth the local children's museum and the zoo.

Here's M looking thoughtful on the train:


We decided not to bring the stroller since we weren't sure how we'd manage it on the train and at the market. I carried A in the sling (which he likes) and he quickly fell asleep (which he often does when we're out):

Tags: travel, M, me, A

The other day, I posted about a good sale for these awesome baby blankets (use code mom20 for 20% off), and it looks like they've now extended the sale through Sunday. These brands hardly go on sale unless the items or colors are discontinued, so if you've been eyeing anything recently, you might want to consider getting it now. I'm dying to get an adult-sized Little Giraffe throw, but it's a bit much for our budget right now, even after the 20% off. I didn't end up replacing my Barefoot Dreams hoodie, only because the color I wanted was out of stock. I'll just wait for the next big sale (usually a few times each year I think).

Anyhow, here's a photo of A snoozing under his Little Giraffe blanket (it's really cozy and warm):

Tags: A

M has a lot of fun at daycare, and some days it can be hard to get him to leave. Not today though...wheee!

Tags: M, daycare

One of my good friends sent M a Little Giraffe chenille blanket (in a gorgeous sage color) when he was born, and it's now his favorite. Of all the blankets he has, it's the thickest and warmest, not to mention the softest. He likes to run his fingers along the satin border and it's the only blanket he looks for at bedtime. I have since purchased one for A (in blue), in anticipation that it will become his favorite as well.

I also bought M a Barefoot Dreams Pocket Buddy blanket (frog, which is no longer available) that he could take to daycare as a "lovey." I bought A one too, in the puppy design (grey when I bought it, but now it's offered in pink). I picked them up during one of Nordstrom's big sales for about $17 each.

In the past, I have purchased from www.whatshebuys.com, which is an actual store in San Gabriel, California, that also sells products online. They have excellent service, free shipping (very fast), free gift wrapping (very cute), and no sales tax (except in California). Their prices are competitive, especially since Little Giraffe and Barefoot Dreams products hardly ever go on sale. I would definitely buy from them again. I have also recently discovered another online retailer of these plush blankets, www.sleepytimestore.com (actual store in Decatur, GA), which has similar prices and free shipping over $50. They also occasionally offer 20% off inventory during big sales events, and there is one going on right now for Mother's Day. Use code mom20 at checkout and you'll save 20% off your entire order, which is a great deal and a rare find on these products. They also carry a bunch of other popular baby brands that you may want to check out soon, since the sale ends tomorrow (Friday) at midnight Sunday at midnight (EST I think). While you're browsing, if you're thinking about ordering Stephen Joseph toddler backpacks and snack bags, I would highly recommend ebay seller tuscanvilla24 and will be posting about her again very soon, as her prices are slightly better and she offers free embroidered personalization. I'm thinking of picking up some Pocket Buddies or Barefoot Buddies for upcoming gifts I'd like to give, and I am contemplating replacing my very worn Barefoot Dreams hoodie that I spoiled myself with after M was born (he loved to snuggle with me when I wore that sweater). I have pretty much worn that zip-up on every call night I've had at the hospital (great makeshift blanket) and it has seen much better days.

These are all somewhat more luxurious and pricey than I would like, but they are fantastic, well-made products and ones I've clearly thought have been worth the money. I'm sure the boys would agree.

Here's M napping under his Little Giraffe blanket when he was three months old:


Here he is at 15 months, holding his Barefoot Dreams "froggie" Pocket Buddy after sharing a smoothie with J:


Here I am wearing my hoodie, carrying A in his sling:

Tags: M, J, me, A

Since I am on ob/gyn next, I'm reading a bit about it now. You would think that having gone through it (twice) would mean I knew most of this stuff already, but it's really different experiencing it from the other side. I really wasn't thinking like a medical student when I was going to my appointments, and whatever upper hand I might have had as a medical student in terms of exposure has clearly now been outweighed by my "mommy brain." And that doesn't even include the sheer lack of time and energy to read anything at the end of the day. You'd be amazed at what people have said to me regarding how much easier rotations must be because I experienced childbirth and have kids. Seriously? Perhaps in terms of patient empathy, but being a medical student mom doesn't make it any easier to remember things like the BPP (I don't remember ever having this assessed, and if it was, I certainly didn't get a hands-on lecture about it).

The Biophysical Profile (BPP) integrates 5 parameters as a tool for antenatal testing of fetal well-being, using real-time ultrasound:
1) nonstress test (NST) two or more episodes of fetal heart rate acceleration greater than 15bpm above baseline for at least 15 seconds, over a 20 minute period
2) breathing one or more episodes greater than 20 seconds long, within 30 minutes
3) movement two or more discrete body/limb movements or episodes within 30 minutes
4) tone one or more episodes of active extension with return to flexion of fetal limb(s) or trunk
5) amniotic fluid volume one or more pockets of fluid greater than 2cm in vertical axis, not to be confused with amniotic fluid index (AFI)*
Source: Manning FA: Fetal biophysical profile. Obstet Gynecol Clin North Am 1999 Dec; 26(4): 557-77

A score is assigned (0=abnormal, 2= normal) to each parameter, with a total score of 8-10 being reassuring for fetal well-being. First Aid includes a little mnemonic to help remember the parameters:
Test the Baby, MAN (tone, breathing, movement, amniotic fluid, nonstress test)

I have seen slight variations of the BPP in terms of scoring criteria, but are all pretty much the same in terms of assessing fetal well-being.

*An AFI measurement is the sum of highest vertical pocket of amniotic fluid (in cm) in each of four quadrants; <5cm = oligohydramnios, >25 = polyhydramnios. Along with the NST, it comprises the modified BPP.

Tags: school

Okay, so I am a bit behind with the photos. We take so many (hundreds each week) that I have a hard time sifting through them all. The great thing about digital cameras is that you can take multiple shots under different settings to see which one turns out best, but that means there are a lot of duplicate images to go through and compare afterwards. Hopefully, once we gain some more experience with manual mode on the SLR, we can take more winners with fewer tries.

I already posted a photo of M in his bunny ears, but we also participated in a school-sponsored egg hunt as well. "Hunt" is a bit of an exaggeration as you can see from the photo below (it was for the three-and-under crowd). That's one of the many perks about having an active graduate student organization here - there are many events that we can participate in if we don't have time to plan a party of our own. A, in typical A fashion, slept through much of it, but was able to catch a glimpse of the excitement before he dozed off.

Tags: holiday, M, J, A

Subscribe & Save is a relatively new program that Amazon.com started earlier this year. I didn't sign up right away since I didn't really have a good sense of how much stuff we went through in a given period of time, so I've been trying to pay more attention to how quickly we go through household items. Now that I have a better idea, I've signed up for a few things. It's really convenient and the pricing is very competitive (discounted around 15% off Amazon's regular prices). Not only that, but you get free shipping no matter what it is (no minimums), and if you have Amazon Prime, then it delivers in 2 days. You can change the schedule at any time, and there are lots of products available (laundry detergent, nutrition bars, diapers, shampoo, and more).

Here are the details according to Amazon.com:
• automatically receive a new shipment of the item in intervals you select--every one, two, three, or six months
• get a discount on our everyday price
• get free shipping on every Subscribe & Save shipment
• pay for each order only when the item is shipped
• have the option to cancel at any time

We are currently signed up to get Pampers, Aquaphor, and Braun shaver cleaning refills that J uses. They all have different delivery schedules (I think I may have to tweak them at some point), but it's easy to change settings or cancel and resubscribe. I'm worried that we're becoming very dependent on Amazon.com since we buy so much from them, and hope they don't drastically change anything anytime soon. We've also gotten to know our UPS delivery men every place we've lived for the last few years, which is kind of neat. Thanks for lugging our diapers up the stairs at our old apartment Darren! We miss chatting over iced tea with you. And thank you Paul for knocking so softly when you deliver late at night! And thanks also for bringing the packages inside the door when I have my hands full with the boys. (Take a hint, FedEx delivery man - I jump out of my skin every time you bang on our door. Why do you even knock? It's not like you wait for the door to be opened).

Tags: Amazon

Tags: holiday, M

A is several weeks into eating solids now, and has tried a variety of fruits and veggies in addition to cereal. He's has carrots, peas, banana, mango, papaya and summer squash. And he's eaten all of it. I guess since he's had milk for the last 7 months, he's ready to eat anything. I'm amazed at the changes in baby food that have happened even in the short time since M was an infant. Back then, I made some food to freeze and use, and we also used Earth's Best and some Gerber products. Now, there are a ton of pre-made pureed refrigerated and frozen varieties, most of which are organic. They can be pricey, but certainly time-saving.

The first one we tried was Happy Baby Yes Peas & Thank You Carrots which J picked up at the local Whole Foods. We also tried Smart Squash & Wiser Apple from the same brand. A liked the squash and carrots, but he wasn't a big fan of the peas. I tasted them all too, and found the peas to be very gritty with a lot of undigestible pieces. The food is frozen in plastic trays of 12 cubes, sealed with cellophane (10oz total) for about $5. It was hard to take them out without running them under some water, and I found that the cellophane was not water-tight, so liquid would spill out (and in). I also wanted to try Homemade Baby Food that I saw in the refrigerated section, but the expiration dates seemed awfully near (perhaps they were older batches at the supermarket).

Finally, I tried Baby Cubes, and we've been hooked ever since. I must warn you that it is by no means the budget method for getting baby food, but it is really the most convenient way that I can feed A fresher, healthier food (short of making it myself). I still plan on making food for him, especially when he's ready to eat more rice, pasta and meat, but for steamed fruits and veggies, this is a great method for us. It's just under $5 per 9oz bag, and each bag has a number of cubes (at least 10). I have stocked up on several bags for the freezer and whenever it's time to feed A, I take out 2-3 cubes (I thaw them if I can remember to take them out beforehand, or microwave at 50% power for 15 seconds per cube if I want them served cold, 30 for warm) and he's got a yummy meal in just seconds. I'll add a tiny bit of cereal if it seems too soft, and he loves it all.

I've tasted them too (including the peas, which are not gritty at all) and they are really yummy. Really. M had a papaya cube the other day and declared "I like it!" I'm going to try adding a few carrot and broccoli cubes in the next smoothie we make just to get an extra dose of veggies in (he's hit or miss, depending on his mood). It really tastes fresh, and there is nothing added. Even the water is reclaimed water from the steaming process (not something I ever even thought of before, but seems like a nice detail). And it encourages us to try stuff I wouldn't normally buy (like rutabaga and golden beets). Assuming that everything is reliable and clean, it's the most convenient way I can imagine feeding A right now, as long as we can afford it I guess. And so far, it seems like we can (luckily, this semi-solid period doesn't last forever). It's convenience (at a cost) and healthy too. I can also use the cubes when I cook meals (toss a few in spaghetti sauce or dips). I'm already blending in homemade steamed carrots into macaroni and cheese for M (it's already orange from the cheddar cheese blend anyway). I suppose I could continue making them myself, but wow, this is so easy. What a great idea. I wish I could have thought of marketing frozen baby food when I was steaming and blending M's meals way back when. Oh well, I guess I'll have to keep my day job.

Here's M after his first cereal meal:


Now A:


Here's M waiting for some squash:


And then eating some:


And finally, here's a photo of A eating some peas and summer squash after his bath. J said he'd already combed his hair, but then used a hair dryer to dry it some more, and then forgot to comb it again. I think he looks tough and cute - grr!

Tags: food, A, M

I rotated through General Surgery almost a year ago, but here is an summary of my experience. I was about 4 months pregnant at the time. Read more

Tags: school

This is one of the few obscure named diseases that I actually already knew about when I came across it in my studies. It is a nodular fibroblastic proliferation of palmar fascia, which leads to contracture of (most commonly) the fourth and fifth digits. It typically affects older men of Northern European heritage, can be hereditary, and has also been associated with chronic liver failure. Not too much more is known about the pathophysiology at this time, but there may be an association with certain genes (MafB), and myofibroblasts play a role in this disease. Treatment is surgical (fairly simple), but recurrence is common.

Basically, the patient will come to you because their ring and pinky fingers are curled and can't be fully extended. You can feel nodules in the palm and can often feel cords in the fingers. It is more common than I thought (saw quite a few cases on my hand surgery rotation). I also saw it a lot when I rotated through the Veterans Health Administration, which makes a lot of sense.

Oops, I just noticed that I never posted the answer to the third pop quiz. A is the baby in the top photo, M is the one below. Pretty crazy huh? A has a more prominent chin and M's head is more round. At least I think so.

I absolutely cannot believe that it is April already! Even though I am not technically on a rotation right now (ob/gyn right around the corner though), I still feel busy with tons of stuff to do. I think when I am on a rotation, I sort of just ignore a lot of the stuff that I need to work on at home, and so it doesn't seem so overwhelming. And then when I have a break (and think that I'll have all this free time), all the stuff I've been putting off when I am on the wards comes creeping out. I am working on some major schedule changes right now, trying to coordinate the next year with J's fellowship (which will be busy for him). So, coming up in the next several months, I've got Step 2, some research projects, a couple of rotations and J's residency boards to figure out. Eek. I'd like to get our schedule coordinated through graduation pretty soon (J's vacation schedule is planned out way in advance) so it's keeping me busy at the moment.

Some of you couldn't see A's teeth in my post a few weeks ago, so here's a better one of him (he loves to scratch his face and we have to clip his nails every other day just to keep him from hurting himself too much):

Tags: A