Check out Kidsurplus.com. If you've never shopped here, be warned that you may end up spending a lot of time and money because the deals are so good. I just placed a large order of various toys and clothing from them, including some fantastic pricing on Stride Rite shoes. I picked up some cute sandals for $18 (priced at least $30 elsewhere in my comparison searches), as well as a bunch of toys and books. They even beat my usual favorite, Amazon.com, in terms of pricing, for many items. If I wanted to just buy one or two things, I'd still go with Amazon (fast, free shipping), but since I was picking up a lot of things, this deal worked out well for me. Also, they currently carry many items that Amazon does not (or that they do through third-party sellers, which can have high shipping rates), so I tried to stock up.

I have ordered from them once before and while there were a few things that ended up being out of stock, the experience was very positive. They even upgraded my shipping (for free, without prompting) to make it in time for Christmas, which I think is a nice touch. Their stuff goes quickly, so if you see something you like, you'll have to act fast. Shipping is a flat rate of $7.95, which, if you are placing a large order, is offset by the deep savings. However, two days after I placed my order, I got an email newsletter that had a free shipping code for orders over $75 (which mine easily was). The code is Little. I have since emailed them to ask if they can waive the charges, but I'm not holding my breath. It was still a great deal for me, and I am hoping to pass on the additional savings to another savvy shopper. The coupon expires on July 3.

Other items that I bought: Melissa & Doug Stacking Construction Vehicles, Elmo Swim Ring, several hard-to-find Woody Click Hape toys, a bunch of Priddy and DK books, and various other toys that I wanted to stock up on.

Whenever I have some extra time, I try to stock up on toys that I anticipate M and A being able to play with over the next several months, so that we'll always have something fun to pull out of the closet on those rainy or otherwise difficult days. I also like to have a bunch of small toys and books available for the boys to play with in the car, at friends' homes (if they don't have young children), or in restaurants. I never know when I'll have another chance to sit down and shop for toys again, so I tend to make a couple of larger toy purchases throughout the year and then store them away until we need them.



The site is packed with stuff and can take a long time to navigate because of the very broad categories and large inventory, but there is a good search function. So if you have any idea about what you're interested in buying, punch it a key word or two and see what you get. Otherwise, it might take over an hour or more to sufficiently browse the site.

Remember to use coupon code "Little" for free shipping on orders of $75 or more (Ends July 3). You may even get your Christmas shopping done really early this year!

Tags: clothing, toys, books, shoes, gear

Performed during the second trimester (~16-18 weeks) of pregnancy, the triple marker screen includes maternal serum alpha fetoprotein (msAFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG). The markers are relative predictors of risk for abnormalities like neural tube defects and Down syndrome. Combined with maternal age and ultrasound dating of gestational age, the detection rate can be as high as 75%, with a 5% false positive rate.

As a medical student, it's important to remember some general trends. For example, hCG is usually elevated in Down syndrome, while msAFP and uE3 are decreased or normal. All three are decreased in Trisomy 18 (Edwards syndrome). For neural tube defects, msAFP is usually elevated. And the markers are not useful for detecting Trisomy 13 (Patau syndrome).

A quadruple marker test is also available, which adds inhibin A to the triple marker screen, and results in a higher detection rate (81%) for Down syndrome (inhibin A is increased).

I'm still trying to figure out how to disable the Trackback, and it's been fun reading the comments from our friends, but J and I have temporarily decided to hold off a little bit longer before setting up the comments box, for a variety of different reasons. Thanks for being patient and you can always feel free to write me by clicking on Contact Me in the right sidebar.

Tags: website

A few Saturdays ago, we went to my classmate J's baby shower. She's due in a few weeks and we're all excited to meet the new addition to her family. Men were invited too, which I think is great (why shouldn't dads be included in the fun?). Her home was beautiful, the food was to die for, and there were plenty of baby-themed chocolate desserts to sample as well. Babies were welcome too (you mean a baby shower doesn't mean you have to bring a baby to the party?).



Here's L (who helped plan the event) showing M her adorable baby girl (maybe she thought we had to bring babies too!):



As a fun activity, the guests painted various-sized white onesies, which turned out to be a riot. I'm always amazed at the creative talent of my friends and classmates. Impressively, medical school is just one of many accomplishments in their lives.

One of my favorite onesie designs was by B, which stated "I survived the womb, and all I got was this lousy onesie." Very cute. Our onesie contribution was a simple but cute dinosaur that J painted. His artistic talent is much more impressive than mine. Just take a look at this comic he drew for me two weeks after we met:



Needless to say, fun was had by all!

Tags: friends, M, me, J

I'm trying to enable comments for the site, but for some reason, I can't seem to get rid of the Trackback link (not exactly sure what that is). So I guess you can just ignore that for now, until I figure it out. Depending on whether people actually comment or not, or if there ends up being too much spam, I may disable the comments. Also, I will remove any offensive material, or comments that have no purpose being on this site. Differences in opinion are welcome, but common courtesy rules apply.

I also added a link to contact me (see sidebar), so that you can send a message to me directly. I'm usually pretty good about responding to email, but if I am super busy, it might take a few days. If you do leave your actual email address, it will of course be kept confidential, and used only for me to respond. I don't sell, share, rent or otherwise use your address for anything. Believe me, I have plenty of other things to worry about.

Tags: website

I've been tinkering with this website and am thinking about changing the design a little bit. Bear with me while the pages look different for a little while, and feel free to tell me if you love or hate any of the changes. Font too small? Images too big? Let me know what you think. I've added tags, or sub-categories, that I've used to identify common topics, which you'll see in the sidebar. The word size represents the number of posts filed with that tag. In any case, don't be surprised if the site looks different every time you check in, at least for a little while. All suggestions are welcome.

This may take some time, since this whole weblog thing is still new to me. Only recently did I figure out what a Permalink was (it's like a bookmark for a specific post that you want to link directly to). In this current web design, you can access the Permalink by clicking on the title of the post, which will open the post alone in your browser window. You can then save the bookmark and go back to the post whenever you want to, which is a lot easier than trying to find it in the archives.

Tags: website

A while ago, I posted a photo of A wearing a striped "outfit" of various clashing colors. Being cute certainly has its advantages. Take winking for example. Winking is not something that most people can pull off, at least not well. A, on the other hand, looks totally adorable doing it, at least in my humble opinion.

Tags: A

Many nursing moms have difficulty finding a clean, discreet place to pump milk. While some might feel comfortable pumping in public places (waiting areas at airports, for example), I've always sought out more private locations. It's a tragedy that in this day and age, there aren't more designated areas in workplaces for women to pump and/or nurse. This is particularly unfortunate in hospitals, where you would think there might be more emphasis on creating such environments. Other than the newborn nursery, there aren't really many places in our university hospital that welcome nursing moms. There is a "lactation room" in the medical school building, but it is really a converted closet with two tiny spaces separated by a huge vinyl curtain. The spaces are no bigger than a shower stall (seriously), and can barely fit a chair and small stool to place your pump on. It's a struggle to set up and a challenge to avoid spilling milk all over the place because it's so easy to knock everything over. Also, with only two spaces to accommodate the school and hospital staff, it is usually occupied every time I go (usually around lunchtime). And it's not like I have that many opportunities to run off and pump during the day.

I am actually not rotating through the university hospital for my Ob/Gyn rotation, and instead, am spending 6 weeks at an affiliated private hospital about 20 minutes away. Coincidentally, I did one half of my Internal Medicine rotation there as well, during which I was pumping milk for M. The lactation room is larger, but it is also where nurses unofficially store their lunches, so it was pretty awkward to keep getting interrupted (since I usually pump during lunch) with people coming in to pick up their food. The last time I was there, I just ended up pumping in my car under a nursing apron my good friend Sofi gave me. Not cool. But it seemed more private, even though I'd get occasional looks from people parking nearby who probably wondered why I was sitting in my car for such a long time. There is a new hospital facility that is being finished, which is gorgeous and spacious, and I have clinics and ambulatory surgical cases there. There aren't any designated lactation rooms there that I know of (yet), and when I asked the controller desk nurses in the OR, the sympathetic woman there told me she used the shower stall in the women's locker room (which I had scoped out and initially rejected because 1) It was tiny and 2) there wasn't an electrical outlet (and I hate going off of batteries - it just doesn't pump as well)). I asked a good friend of mine, who is a transitional intern there, where she pumped (she had a baby several weeks before internship - gutsy!) and she gave me some good leads (individual study rooms, unoccupied clinic rooms). I guess maybe I should be more aggressive in finding appropriate locations.

I think I will try to pump until A is one year old. I've got nothing against formula (I can't stand the breastmilk vs. formula debates). Moms should quit judging other moms and be more supportive of all our choices. I've thought about switching A to formula now, but part of me prefers not to have the additional transition to cow's milk in a few months. It's only a few more months (and then it's bye bye to the pump!). Plus, I did the same with M, and that seemed to work out well for us.

As if pregnancy, labor and delivery were not hard enough - moms just don't get any breaks!

Tags: breastfeeding

Tags: J, holiday, A, M

A few months ago, I posted about the Biophysical Profile. I just revised the post because I had incorrectly included amniotic fluid index (AFI) as one of the criteria, when it is in fact, not part of the BPP (amniotic fluid volume is). Oops.

A long time ago, I posted about the Foodsaver vacuum sealer at Costco. We have a slightly older model than the one Costco is offering now. I still haven't had time to review it yet (two-word review: it's great!), but I wanted to post about what I think is the best place to buy refill bags. I just ran out of them while sealing up some pizza slices for freezing, and checked to see if my regular household goods supplier, Amazon.com, had them. Not only do they carry them at a great price, but they are currently offering a special promotion where you buy 4 items for the price of 3. I'm not sure when it expires but many of their household goods are eligible, so be sure to browse around the site. I picked up 4 boxes of refill rolls for about $50, an additional savings of $18 below their already competitive prices. They also carry a few models of the vacuum sealer itself. Free shipping, no tax, done in 5 minutes. It's no wonder I hardly shop in stores anymore.

Tags: Amazon, food

A's quite sick with some bug. J's taking his boards on the other coast (good luck sweetie!). I am taking a sick day from ob/gyn to be with A. Crossing my fingers that I won't have to take him to get an LP (lumbar puncture). Wish me luck. I'm a single working mom this week (how in the world do you all survive?).

Here are two new photos from M (you can see them all here too):

Tags: health, A, me

I'm really lucky that I don't have to commute most of the time. The exception is when I rotate through other nearby hospitals like I am doing on Ob/Gyn. My door-to-door commute takes about 25 minutes with no traffic, which is not bad. But since I am so used to not having to drive to work/school, it seems like a long time to be in the car. And I hate the time I lose with my family because I have to leave earlier to get to the hospital. I usually give myself 30 minutes to get there (which is cutting it close - one little traffic jam and I'd be late), but that means I can miss up to 40 more minutes per day with the kids compared with my usual 10-minute route to the university hospital. And while it might not seem like a lot, it really is. I'm not a fan of commuting. But M might disagree.









I start my last weekend call on this rotation today, and I am definitely looking forward to it. I'm not exactly sure why there needs to be a continuous 26-or-so hour shift on labor and delivery, but it is what it is. And it's not usually the kind of call where you get to sleep either. So, I'll be glad to be able to check on my babies and cover them up in the middle of the night again once this weekend is over.

Tags: M, travel

Definitely worth running through when forming a good differential diagnosis:

Vascular
Infection
Neoplasm
Drugs
Inflammatory/Idiopathic/Iatrogenic
Congenital
Autoimmune
Trauma
Endocrine/Metabolic

When we decided to get M an art easel for his second birthday last fall, I started looking at all the possibilities out there. There are so many brands and models for sale and a wide range of prices, so it was after a lot of research that I decided to go with this one. Read more

Tags: toys, Amazon

Before I started my Ob/Gyn rotation, A came down with his second ear infection. He's a pretty robust little baby, but he's definitely had his share of illnesses over the last few months. Unfortunately for us, he never really has any symptoms (no fevers, ear tugging, etc), so it makes it hard for us to know when to take him in.

The first time the pediatrician told us A had an ear infection, I got mad at myself for not checking his ears myself. I think it's hard to see, especially in babies, and it's even tougher to look in my own baby's ears, for some reason. I can do it comfortably if J holds him really still. I always firmly hold A's head to my body when the pediatrician looks so there is no chance A can squirm around. It was always really hard to look in ears on my pediatrics rotation when parents would just lightly hold their toddlers and babies, and I ended up having to hold them still myself.

I do check now, even if we are going to bring him in to see the doctor anyway. It helps give me a baseline so that I can follow-up and see if the treatment is working.

Here we are waiting for the pediatrician to see us:

Tags: A, health

Remember, you can see all his photos here.

Tags: M, photography, J, A

We take the train to the Farmer's Market every now and then. Even though M loves trains, he's a bit scared by the loud screeching sounds they make as they brake at the station. A gets scared too. But they both still stop whatever they are doing every time a train goes by and we end up standing beside the tracks for a while to watch them at the station. Maybe it's like watching horror movies, where you're scared but can't look away.

Tags: M, travel

Before lecture one morning, a few of the students were comparing notes about different hospital sites and what time they had to come in and pre-round. Times ranged from 5am to 7am, depending on the Ob/Gyn service. Generally speaking, 5 am would be considered fairly early, and 7am is pretty nice for a busy inpatient service. The attending, who had been setting up the digital projector, overheard some of the discussion. "I have to laugh," she said. "Do you know what time we had to pre-round when I was a student?" She held up four fingers. "With the 80-hour maximum, the residents and students don't know how to be good physicians because they don't spend enough time in the hospital being a doctor."

Hmm. What exactly is her definition of a "good physician?" She kind of continued to go on about how it's a problem that starts in the medical schools now, and I don't think she was aware that she sort of just alienated herself from the class. Not a great way to introduce yourself to a bunch of people you don't know. I wasn't mad, but I did feel a bit awkward bacause she implied that anyone who trained under the new work rules would not be a good physician (myself included). I don't really agree with that statement (if I did, I might as well quit medical school now).

While it can be true that in some circumstances, limiting work hours might result in less training, it also serves a function to protect the patients and residents from situations that might arise because of work overload or sleep deprivation. I believe that success is not measured by quantity, but is instead dependent on quality of effort. But then again, I'm just a med student - what do I know? I also believe that much can be learned within the confines of an 80-hour week, especially if precious time is not wasted doing things that don't contribute to training a young physician. Like photocopying or rewriting orders because the system is so archaic. Or entering redundant data into the antiquated computer system. Or spending precious time tracking down paperwork, or doing things that should really be more streamlined in a modern-day hospital setting. It's important to know how to do that stuff, but I don't think time is well-managed and allocated when it comes to training, especially since there is a finite period of time in a day, week, or residency training program.

If we are going to limit resident training hours to 80 hours each week, then they should be 80 of the most efficient hours possible. But since most hospitals have a shortage of support staff, residents have to pick up a lot of administrative busy work, rather than getting more medical/surgical training. And most residents I know actually work more than 80 hours each week, but because of loopholes in the rules, can manage to slip under the radar. I know there is a lot to learn, but I wouldn't want a surgeon who is on their 78th hour of weekly work doing an appendectomy on me, would you?

Unfortunately, I don't have a solution for this. If it was easy, I'm sure it would have been done already. But it's not something I look forward to. And I'll have to figure out how to juggle everything together when the time comes. In the meantime, I think it's just not cool to tell a bunch of doctors-in-training that they're not going to be good physicians. Take it up with the ACGME!

Tags: school

Can you believe it's June already?

I recently posted about my parents getting a computer for the first time. Here's a screenshot of what we see when we chat with my mom.
"Everyone wave good night to grandma!"

Tags: grandparents