Calls, that is. At least for the next four weeks. Whew. Pediatrics call is probably the longest call that medical students take here. Thirty hours on the wards, sleep not guaranteed. It was a busy night and my feet are killing me. But I am on a great service, and the people are all really nice. It would be unbearable if they weren't. So I don't mind that much that we only got about 2 hours of sleep (and boy, what good sleep that was!). Twenty-eight hours of straight work is pretty crazy. To be fair, we are fed breakfast and lunch during morning report and noon conference, so it could be a lot worse.

A shower never feels as good as the one I take post-call. Now it's time to read about retinoblastoma, hypoplastic left heart syndrome, cystic fibrosis, and study for my CPX exam. I can't wait to see the boys in two more hours.

Tags: school

I always forget the details about the different types of hemoglobin, which are important to understand when it comes to diseases like thalassemia.

I know, I know - too easy, right? It's Monday, it's still dark, and I'm on call tonight, so I have to go round up some gear (pump). Be back soon.

Tags: M

J has been on a very tough rotation this month, and I have had an interesting time playing single mommy. I loved spending more time with the boys, but it was pretty tough at times, especially around bath/dinner/bedtime. I know that single parents everywhere do this full-time, so I wonder how they manage. I think it'll be a lot easier when the kids are a little bit older (at least three). Perhaps it'll be easier once A can walk on his own.

I start a four-week rotation of inpatient pediatrics tomorrow (call on the first night!), which I am sort of looking forward to, but not in the sense that I feel like I just need a bit more time to study for Step 2 (scheduled at the end of August).

J only had two full Sundays off during this month, and I think he started to (finally) feel the same way I do when I am on a tough rotation. Good thing it's almost over, except I guess it's my turn again.

Here are the boys out in the playground chalking up the sidewalk (I think M is continuing a giant squid that J started to draw):



The excitement must have been too much for A!

Tags: J, M, A

The Parkland formula is used to estimate fluid repletion in a burn patient during the first 24 hours.

4 x patient's weight (kg) x %body surface area involved. Give 50% of the fluids over the first 8 hours, and then the rest over the next 16 hours.

I've gotten several questions about what baby carriers I used with the boys (Baby Bjorn, Ergo, and Peanut Shell). We were lucky enough to borrow the Baby Bjorn from a friend, and while it was great when M was little, both J and I agreed that it really hurt our backs once he got bigger (over 15 pounds). Also, the minimum weight requirement was 8 pounds (M was not 8 pounds for several weeks after he was born). The Ergo is a great carrier overall (the weight is on the hips), but can be bulky to carry around (and needs a separate insert for newborns). This review is for the Peanut Shell sling, which I bought when A was born. Read more

Tags: gear

How weird is this? A and I are standing next to a baby portrait of M that is displayed at the daycare. Kind of reminds me of the pop quizzes.

Tags: M, A, me, photography

To determine intravenous fluid rate in ml/hr:

Use 4 ml/kg/hr for the first 10 kg, 2mg/kg/hr for the second 10 kg, and 1 ml/kg/hr for any weight over 20 kg.

So, for a 25 kg child: 4 x 10 + 2 x 10 + 1 x 5 = 65 ml/hr

Okay, time for a cute photo break! A tried to drink the water (out of his Euro Tub) and this is what happened. Life doesn't get any better than this.

Tags: A

I forgot to post this photo the other day when I updated M's pictures. Miffy, George and Mr. Wilcox usually live on or near his bed. You can see all his photos here.

Tags: M, toys

This is a popular method to calculate daily intravenous fluid (IVF) maintenance requirements in pediatrics.

For the first 10 kg of weight, give 100 mL/kg fluid.
For 11-20 kg, give 1000 mL + 50 mL/kg for each kg over 10 kg.
For children over 20 kg, give 1500 mL + 20 ml/kg for each kg over 20 kg.

Example: For a 25 kg child, you'd give 1500 + 20 x 5 = 1600 ml/day, or 66.6 ml/hr (if divided over 24 hours).

For some reason, A never really crawled on his hands and knees like M did. He started by pushing himself off the floor, and then he continued to learn how to move around that way. It's very cute to watch, and he can do it reasonably quickly too. Look at him go!

Tags: A

A while ago, I reviewed our kids' tub, the Primo Euro Tub. I highly recommend it, if you have the space to store it. Despite the fact that our bathroom is tiny, we have room under the sink (there is no cabinet). The tub also has a hole for hanging. M is using the grown-up tub and showering now (but he often still likes to stand in this tub), and A uses this every day.

I also reviewed the baby monitor that we have, the Angelcare Movement Sensor and Sound Monitor. It really works, and has given me a lot of peace of mind. We are still using it for A, and I can't say enough good things about it.

They are both now available at Amazon.com (tub here, monitor here). In fact, they are both on the baby product bestseller list. This is where I'd buy them now if I had to. Amazon has really great prices, free shipping (over $25), and no tax. If you have Amazon Prime, you get free two-day shipping. Also, there is a current promotion for the Angelcare Monitor (until August 15, 2007), where you get a coupon code (placed in your Media Library) for a free 20-page casual photo book (a $12.99 value) from Shutterfly. Not bad. I've purchased other items with similar Shutterfly promotions in the past, and it's totally legitimate, not to mention a really nice bonus.

If you are planning on buying the tub and it is under $25 (the prices can fluctuate a little bit), and you don't have Amazon Prime, I'd pick up a small board book to make the regular free shipping (it's a big tub, and shipping can add up).

Tags: Amazon, gear

Looking back at my post yesterday morning, I can't help but wonder if I overreacted. I've been in several situations where I've seen drivers behaving recklessly, but this situation was pretty scary. I think some people don't really think about the consequences of simple actions sometimes. We were very fortunate that there weren't any bicyclists or other cars in our immediate vicinity (lots of buses often drive down that road as well) because I would not have had room to veer right, and he would have crashed into us for sure.

I guess I get pretty annoyed when I see drivers doing things that aren't really effective, but put other cars at risk of getting into an accident. I don't know how many times I have been driving next to someone who is swerving and speeding down the road, only to catch up to them at a traffic light several blocks later. I do think that there traffic rules can be rather conservative (65 mph on the freeway is much slower than then general flow of traffic these days), but they are there for a reason. And maybe I've just become extra cautious now that I have two little boys to worry about, but I'd like to think that we all share the road (and the privilege of being able to drive). I mean, many cars don't even stop at crosswalks around here, and it's a college campus!

I don't know what it is about being inside your own vehicle, but it seems like people have different personalities on the road. Something about enclosing yourself in a private box must feel very empowering and encourage behaviors that wouldn't otherwise be acceptable in an open face-to-face environment. When my dad was teaching me how to drive, he'd always say that a monkey can figure out how to step on the gas and speed, but it takes more skill to slow down and stay in control of your car.

Anyhow, that's enough ranting for now. It was pretty scary. I could feel my heart pounding at the stop light after that happened. If the kids hadn't been in the car with me, I would have gotten out of my car at that light and given the guy a piece of my mind. For all he knew, I could be the neighborhood carpool van this week, and his kids could have been inside my car.

The police department did follow up and Sargeant H. left a message on my phone, stating the driver was going to get a letter from the police. He also apologized for the inconsiderate driver (which really wasn't necessary) and thanked me for the report. There is actually a form online to report these types of incidents, and he said they often had to rely on regular citizens to report erratic behavior in case the police weren't around to see it. I didn't really know what to expect when I emailed them (I had read online that many states do send letters), but I guess that's the best we can do.

On the way home from picking up the kids, I saw one car run through a red light on a very busy street, screeching to avoid hitting cross traffic, and another one (driving next to me) run right through a stop sign that I was slowing down at, causing the pedestrians to scurry back onto the sidewalk. Sheesh.

Tags: safety

M is continuing to improve his photo-taking with our older Sony digital camera. He's getting pretty good at it, in my opinion, especiaily considering he's not even three years old yet. Check them all out here.

Tags: M, photography

Here's part of an email I submitted to the local police today:

I have never reported before, but this situation was so severe that I thought it was necessary. I was driving my two young children to daycare this morning and was exiting --- (going northbound) onto --- Ave. I was in the right lane, and as I neared the branch point (concrete divider), a gentleman in a white Toyota Celica (plate ---) in the second lane immediately veered across the lanes towards the exit (as if he had just realized he was about to miss his exit). I had to pull right to avoid being hit along the side of my minivan (where my infant was sitting), and I honked at him at length, to let him know I was right there in case he didn't see me. He made no motion except to veer a little to the left between myself and the divider, around my car and sped forward to the red traffic light. As I was sitting behind him (we were both waiting to turn left), I jotted down his license plate and car description to report. At that time, he was impatiently inching forward through the red light, perhaps late for work/class, or just knowing I was right there behind him. When the light changed, he sped off to the left towards the university and I turned as well. I made a right turn at --- Road towards the daycare, and he continued on towards campus.

I have been driving for 15 years (and have never gotten any traffic tickets whatsoever), and have experienced many near misses at the expense of reckless drivers, but this was the scariest, as his speed was very high and he missed my vehicle (and children) by mere centimeters. This is why I thought this instance was important to report. As a member of the --- and university communities, I am appalled at such recklessness when it comes to traffic safety in this neighborhood. I'm not sure how this information will help, but I am hoping it does something, if only just to let the driver know that his intent to save seconds off his commute time was at the expense of the safety of others.

Dear Toyota Celica driver,
You are a total jerk. I don't care if you want to risk your own life, but you are not the only one on the road.

Tags: safety

Until recently, I had forgotten how good cheese pizza can be. I don't know why, but for a very long time, I had not had plain cheese pizza. Maybe it was the allure of gourmet toppings and fancy chicken pesto pies, but I'd never order it if there were other options (and there always were). But since it is M's flavor of choice, I've re-experienced the sheer bliss of a simple slice of cheese pizza. And I daresay it might be my new favorite as well.

Tags: food, M

I started a new segment in the About Us section, called "Assumptions." I'm not sure if I'll keep it permanently, but for now it's where I'll post interesting tidbits of misinformation that people often mistakenly assume about me. Or perhaps, to be more positive, they are tidbits of information that most people didn't know about me.

One extremely common one that often comes up with almost everyone I meet: that because I am a medical student, one or both of my parents must be physicians.

Now, I have nothing against people who have dual-physician parents (heck, my kids will certainly fall under that category), but that is pretty far from the truth when it comes to me (and J, for that matter). Many, if not most of my classmates have physicians in their family (so that assumption isn't really an outrageous one), but it doesn't really apply to me at all. In fact, not only are neither of my parents physicians, but with the exception of one aunt (out of 38 aunts and uncles), no one in my entire family is (or ever was) a physician. And with the additional exception of one uncle who is a pharmacist, no one in my entire family works in the medical field (not unless you count working in lab supply factories as being in the medical profession). About the 38 aunts and uncles, my folks both have large families (19 siblings total) and I am including their spouses in the tally.

I've gotten questions from pre-medical students in the past about how it's so hard to get into medical school and that you have to have parents or close relatives in the field to do so. While it is true that it is hard to get into medical school (at least I thought so), it's not a prerequisite that you have firsthand experience as the offspring of a physician. I'm not sure if it makes it any easier to get in if you did (I used to think it would be, but then again, how would I know?), but it's not impossible if you don't.

That is not to say that it isn't difficult. It is totally difficult. I had no idea how the medical field worked. I had no idea what the differences between MDs and PhDs were. I didn't know what "attendings" were, or what the difference between "internship" and "residency" was. The jargon was extremely foreign to me. Everything was really foreign to me. In fact, I still feel rather out of place whenever I am surrounded by physicians. I am just not used to being around people who have had decades of intense academic training. My experience with physicians was primarily limited to interactions with my own doctors (which was pretty limited).

That said, I'm really glad that I picked this profession. It's really, really hard, but it's also such a privilege, and I truly find it to be quite rewarding. Of course, that doesn't stop me from having days where I want to throw my hands up in the air and quit so I can stay home with the kids. Life is funny that way, I guess.

Tags: me

Dressler Syndrome, also called postcardiac injury syndrome (PCIS), postpericardiotomy syndrome, or postmyocardial syndrome, is an autoimmune pericarditis that usually occurs as a late (weeks to months) complication of an acute myocardial infarction (MI). It can happen in other settings, like after cardiac surgery or pulmonary embolism (PE).

Signs and symptoms include malaise, pleuritic chest pain, pericardial friction rub, fever, leukocytosis, pleural effusion, and pulmonary infiltrates. The pathogenesis is believed to be related to immunologic factors, where myocardial injury stimulates an antigen-antibody reaction, forming complexes that are deposited into tissues and elicit an inflammatory response.

It is mainly a clinical diagnosis based on the manifestations mentioned above. Erythrocyte sedimentation rate is often high as well.

Treatment is with NSAIDs (corticosteroids in refractory cases) and recurrence may occur.

We sold our Zooper Boogie. It served us well, primarily as M's stroller (see photo), but A used it as well. And I am feeling a bit happy-sad, because thinking about the stroller reminds me of how my life has changed so drastically since having the boys, and how quickly they are growing up.

I walked M to school in it every day after he was born. I parked it in the back of lecture hall, and he snoozed while I tried to absorb as much renal physiology as possible. We took it to the mall and grocery store, where the massive basket made shopping a breeze. It had all the great features of a high-end stroller without the exorbitant price tag (it was expensive, but not outrageous).

Others must agree, because within minutes of posting it on craigslist, I got several email messages from enthusiastic moms wanting to buy it. Not only was it in impeccable shape (we are pretty good at taking care of our belongings - they've got to last a while), but we tend to underprice. We do this for two main reasons: 1) to sell it quickly, and 2) we know how much gear can add up in terms of cost. We've definitely benefited from secondhand purchases of high quality at great prices from the local parents club as well as craigslist, and we've felt grateful and happy to pass on similar savings to other parents.

We sold it because we bought a double stroller. I had been trying to avoid buying another stroller, since they are so expensive. But it was clear that we needed one. My big plans for M to use it while I carried A just didn't work out. A is getting quite heavy and we aren't getting any younger. Plus, M can walk much of the time, but if we go out near naptime, it's nice to have a place where both boys can snooze comfortably at the same time.



What did we get? Well, after much research and deliberation, we decided to go with the BOB Revolution Duallie. J will be writing a comprehensive review at some point, though it may take a while since he's on a crazy busy rotation right now (I'm playing single mom again, but this time for a whole month). If it was possible to like a stroller more than our beloved Zooper, this would be it. It's so smooth that it hardly feels like you have to push it. My only gripe is that while it can be folded quite easily, it is difficult to move when folded up (hard to explain here, but you'll see when the review comes out). We bought it when REI had their annual Member Sale a few months ago (20% off any one item) and used some leftover REI dividend credit as well. It was well worth the money, as I am sure we'll put it to good use (I have high hopes that I'll go jogging with the kids at some point). And I'm pretty sure it'll be as easy, if not easier, to resell once the kids have outgrown it.

In the meantime, I'll cherish all the memories we had with the Zooper and look forward to all the new ones we'll have with the Duallie. I know I say it a lot, but my, how time really flies!

Tags: gear, M, J, A

What a silly baby you are.

Tags: A

It's supposedly the biggest wedding day in years. Here's M, about to reveal the lucky number:

Tags: me, M

This is the face A makes when he is hungry and wants more:



This is also one of the many reasons why we hardly watch any television.

Tags: A

Isovaleric acidemia is a rare disorder involving deficiency of isovaleryl-CoA dehydrogenase, which is needed in the leucine oxidative pathway. It is an autosomal recessive condition that can be diagnosed in utero. Symptoms include poor feeding, protein intolerance, metabolic acidosis, seizures, and an odor of sweaty feet during the first few days of life. Coma and death can result if not treated. Some patients have a more chronic course, with symptoms of vomiting, lethargy, hair loss, and pancreatitis. If suspected in a newborn, a urine organic acid chromatography test can consistently detect isovalerylglycine for diagnosis.

Treatment involves a low-protein, low-leucine diet. Conjugation with glycine or carnitine can help maintain metabolic stability.

M's latest. See them all here. Happy Fourth of July!

Tags: M, photography, J, holiday

Like for most baby-related items, I was pretty overwhelmed when I started shopping for high chairs. There are just so many brands and styles that it was mind-boggling to sift through all the products. It can be really frustrating, when you want to make the right purchase, but have little to go on. Most of our friends had gone with traditional standing high chairs, but we had the particular problem of having very limited space (and a tight budget). After using this Chicco high chair with both boys, I can honestly say that even if we had more space and an unlimited budget, I would still buy this chair. Read more

Tags: gear, food

In the past, I've mentioned how adding ears to a baby's outfit can really increase the cuteness factor. Well, the same can be said for adding chickens to increase the funny factor. There's something about chickens that just makes everything a little bit funnier. Hence, all those chicken jokes, I guess. And then when you take chickens and add a chubby, giggly baby, well that's just plain hilarious!

Oh, and Happy Canada Day everyone!

Tags: A, me