I admit it, I'm a dork. Originally, I tried to think of some kind of line from the Karate Kid, but it made me feel old. Oh what the heck. First learn stand, then learn fly. Or maybe Wax on, wax off.

Tags: A

Congratulations Larry from NV! You are the winner of the $10 Amazon.com e-gift certificate. Thanks for reading!

Tags: website

I can totally relate to this scenario.

Tags: M

They sure do love to push around their toy cars.

Tags: A, M

Hey, what's this?


What does this remind me of?


Why yes, it appears to go here!


Thanks mommy, I knew it looked familiar.

Tags: shoes, A, me

Just a quick reminder that the last day to email me to be entered into winning a $10 Amazon.com e-gift certificate is November 30 (Friday). No strings attached - it's just a thank you for all the reader support. You can read more details at the bottom of the Shopping Resource page. Good luck!

Tags: website

The TST is a widely used test for detecting latent tuberculosis infection, and requires 2-12 weeks after primary infection for conversion to occur.

The Mantoux method (intradermal) is used in the United States, where 0.1mL (5 IU) of purified protein derivative (PPD) is injected into to volar surface of the forearm. The test should be interpreted 48 to 72 hours after administration of antigen by measuring the induration (not erythema) surrounding the injection site, in millimeters.

Interpretation
Induration greater than or equal to 5 mm: positive in highest risk population (HIV; recent contacts of TB-infected patients; patient with radiographic changes consistent with prior TB; immunosuppressed or taking >15mg/day prednisone for one month or more)
Induration greater than or equal to 10 mm: positive for individuals with an increased risk (recent immigrant (5 years) from Eastern Europe, Latin America, Asia, Africa; injection drug users; high-risk employees at hospitals, prisons, homeless shelters, nursing homes, laboratories; children exposed to adults at high risk, or any children under 4; patients with silicosis, chronic renal failure, hematologic disorders or other malignancies, weight loss of 10% of ideal body weight, gastrectomy, jejeunoileal bypass).
Induration greater than or equal to 15 mm: positive in low risk populations.

Outside the U.S., the two methods commonly used include intradermal injection of 2 IU of PPD (RT-23), or using a multiple puncture device (Heaf or tine test) on the volar or dorsal surface of the forearm. Individuals who have a history of BCG vaccination or previous tuberculous infection often test positive. Even so, tuberculin skin tests are not contraindicated in BCG-vaccinated persons and skin test reactivity should be interpreted and treated as for unvaccinated persons.

A new whole blood interferon assay (IFN-gamma, QuantiFERON-TB Gold) has been approved by the FDA and can be used instead of the TST. It is much less subjective, and only requires one patient visit.

We went to a local park yesterday, and on the way home, both boys fell asleep in the car. Naptime is such a peaceful time.

Tags: M, A, travel

Tags: A, J, M

It's Black Friday, and according to my CNN news feed, people are flocking to the malls to shop. Parking lots filled at 11pm last night. I can't even imagine what that must be like. I hate crowds, and I don't have that kind of time. Besides, I bet that most items that people really want are probably not even going to be on sale. And the last thing I need to do is buy something we don't need. The only things I think I am going to buy today are diapers, since we're running low. I did check out Amazon.com just to see what was going on, but it seemed pretty tame as well. Now I'm hearing that "Cyber Monday" is supposed to be the big online shopping day. I guess it never ends. I think I'll try to refrain from spending more than we have to, even though it can be tempting at times.

Regarding diapers for those of you who have newborns, there is one more week to save. Diapers.com is ending their newborn diaper sale (20% off all newborn diapers) on November 30, 2007. This is a fantastic deal on diapers, so stock up. If you are a new customer, save $10 off your first order over $50 with code AFFL10 (they increased their usual promotion from $3 to $10 just for the holidays, now through December 31, 2007). I'm buying size 5 Pampers Cruisers, since they have excellent prices, and free delivery if I order two boxes at a time. I'm also going to pick up some bigger sippy cups for A's lunchbox.

Tags: diapers

I can't believe how time flies. Or how much the boys grow in a year. Here's M wearing a hat I picked up during a conference in Toronto (Go Canada!). I love this photo - he looks like he's ready for a hike.

I love doing these flashback posts. Not only are they relatively quick and easy, but I have a chance to look back at all the great photos of the boys, and see how much they've grown in such a short time. If you're only used to being around adults, you don't really notice how quickly times passes, at least not in the sense that you see it in the way people age. But if you have any friends or family with kids, you'll know what I mean when I say that every time I see a new photo of someone else's children, it's almost as if they are completely different people. They grow so much in such short intervals, that it almost makes it tough to recognize them.

This is particularly true during this time of year, when we get lots of holiday cards with new family photos. The parents generally look the same, but the kids have grown several inches (or more). It's crazy how fast time flies.



I hope you all have a safe and wonderful Thanksgiving!

Tags: M, A, J, holiday

If you're looking for a great present for a toddler, or tired of shopping for an appropriately sized (and comfy) backpack for your preschooler, look no further. Read more

Tags: gear

Light's criteria is a traditional method used to determine whether pleural fluid is an exudate by measuring serum and pleural fluid protein and LDH. At least one of the following three criteria must be true for the fluid to be an exudate.
* Pleural fluid protein/serum protein ratio greater than 0.5
* Pleural fluid LDH/serum LDH ratio greater than 0.6
* Pleural fluid LDH greater than two thirds the upper limits of the laboratory's normal serum LDH

Light's criteria are often criticized for being redundant, and other diagnostic criteria are often used (with similar diagnostic accuracy), because they do not require concurrent measurement of serum protein or LDH.

Two-test rule
Pleural fluid cholesterol greater than 45 mg/dL
Pleural fluid LDH greater than two-thirds the upper limit of the laboratory's normal serum LDH

Three-test rule
Pleural fluid protein greater than 2.9 mg/dL
Pleural fluid cholesterol greater than 45 mg/dL
Pleural fluid LDH greater than two-thirds the upper limit of the laboratory's normal serum LDH

Merry-go-rounds make me dizzy, but the boys really love riding them. The one we usually go to has sea and shore creatures rather than horses, which is kind of strange, but no one seems to mind.

Tags: M, A, J

This Friday is "Black Friday," historically known as the biggest shopping day of the year. I've never been one to stand in line at 5am outside a big box store in order to score a great deal, and I'm not about to start now. I love great bargain but I don't have the luxury of time. Will I be awake? Probably. Perhaps making breakfast or unloading the dishwasher before the boys wake up.

If I find myself with some spare time, I might try to do some Christmas shopping online. I just got an email today from Amazon.com (marketing wizards those guys), reminding me to check out their great deals this Friday. It'd be great to get most of my shopping done early this year. I'm sure it'll be an interesting day!

Tags: toys, clothing, gear, books, shoes, Amazon, diapers

Ah yes, Play Doh. Sticky stuff.

Tags: A

I recently placed an order for new shoes for M, and I've come across a new coupon for those of you who need to spend a bit more than $30. Shoebuy.com is currently offering a promotion where you can save $20 off $50 when you pay with Paypal. Certain restrictions apply, so see the site for more details.

Tags: shoes

A few months ago, I started a new segment in the About Us section, called "Assumptions." I still haven't decided if I'll keep it permanently, but it's still here for now.

The first post in this topic had to do with the assumption that one or both of my parents must be physicians. Another common assumption that many people (including classmates) make about me: that because J is a resident (actually, he's a fellow now, and if I don't hurry up, by the time I post this he'll be an attending!), my life as a medical student must be a lot easier. That being married to someone who has been a medical student and is a physician-in-training gives me an edge or advantage over my peers. This was particularly true during my preclinical years. It's only been brought up minimally during my clinic years, probably because people have gotten to know me better. And also, perhaps people now feel that the time it takes to care for the kids outweigh any advantage I might have previously had.

I've heard it all. "Oh, you're so lucky. J can teach you everything." "No wonder you did so well on your test - J's a resident." "It must be really nice to have someone to answer all your questions at home." Um. Okay. If living with someone who was in the medical field meant automatically having an easier time in medical school, then the majority of my classmates should be coasting through school. After all, many of them have had decades of experience living with parents and/or siblings who are also physicians.

It's not that I can't understand how one might come to that conclusion. It does make sense - having someone close to you in the same field might help in some circumstances. It certainly is convenient to be able to chat about some things. Like textbook recommendations, or questions about ERAS. But it's really no different than polling any of my senior classmates or doing a quick internet search. Preclinically, I had a great study group that I really enjoyed working with, and the rest of the time, I preferred reading independently. J and I have different enough study styles that we really don't like using the same textbooks. And ERAS has changed quite a bit since J applied for residency. So really, we can chat about interesting cases and whatnot, but he's certainly never been my private tutor, which is what most people seem to imply.

There are a few things that annoy me about the assumption. First, it implies that we have nothing better to do at home than to work on ways to improve my fund of knowledge or grades. Believe me (and I have said this before), at the end of a long day at school/work, the last thing we want to do is to have a long discussion about glycogen storage diseases, or p53. J would be the first to say that he's tutored a lot of medical students in the last several years, and I am not one of them. Not necessarily because I didn't need it, but because we don't have that kind of time. And any time that we did have, we'd prefer to chat about or do something else. After all, there is more to life than medicine (gasp!).

The second thing that annoys me about the assumption is that it implies my success was dependent on my relationship with J. That it wasn't a direct result of my own personal merit and hard work. I don't care who you are married to - medical school is not easy. Maybe I was being overly sensitive, but it really did seem like my achievements were simply explained by the fact that my husband was a resident. I'm pretty sure that my classmates were keen enough to know that realistically, I must also have been a diligent student, but I suppose that having an easy explanation makes some people feel better. It's probably the same reason people told me that my pediatrics rotation would be really easy for me because I had kids (having M and A teaches me about osteomyelitis and the 4-2-1 rule?). Never mind that I only have 9 hours to myself to shower, study, and sleep every night (in addition to laundry, cooking, and cleaning). Of course being a mom had its perks (so I knew my developmental milestones, big deal), but the costs outweighed the benefits, at least in terms of having an academic edge. If anything, being a parent really helped when it came to more practical matters of parenting (breastfeeding, sleep, diaper rash) and being able to empathize.

In the grand scheme of things, it doesn't really matter, since people are free to believe whatever they want to. But I guess I thought I'd finally try to clarify that being while being married to a resident might be convenient at times, it certainly doesn't necessarily make it easier to be a medical student (especially when it comes to fund of knowledge). And being married with two children definitely doesn't make it any easier.

Tags: me

Actually, when this photo was taken, M had never even tried chocolate before. He's since had a couple of peanut butter cups and M&Ms from Halloween (great for a potty training treat). He's very reasonable about it too. After about four M&Ms, he'll say he wants to save the rest for another day. Don't get me wrong though. Like most kids, he's got a total sweet tooth (especially for cookies). I wonder where he gets that from?

Tags: food, M

I just added an update to the About Us section. It's only taken me over a year to do that. Hopefully, it won't be so long before I write the next one.

Tags: website

Many weekend mornings, Jason lets me sleep in a little bit by taking care of the boys when they first get up (at some ridiculously early hour). After he dresses them and changes their diapers, he often brings them by to wake me up, which is always a welcome treat. The boys like jumping on the big bed, and I like waking up to sounds of them giggling while they are rolling around.

Tags: A, me

M has finally started using the potty consistently. He expressed some interest over the last year, but we decided not to push him too much and let him decide when he was ready. From what we've heard from friends, it's a challenging time, especially if you are stressed out about it. Lots of parents start potty training their kids quite a bit earlier (we tried, he wasn't interested). I think diaper technology is so good at keeping kids dry, there really isn't much incentive (except flushing the toilet and underwear) on their part to use the potty. With a diaper, you don't have to stop whatever you're doing to go to the potty and you get personal attention with every change.

He's a big boy now, complete with big-boy fire truck underwear. And to think, it seems like just yesterday that he was drinking from a cup for the first time. Soon, we can cut our diaper costs in half. Thank goodness.

Tags: M, me, diapers

A few days ago, I posted about the Deluxe Baby Keepsake Kit at Redenvelope. While the free personalization offer has expired, they are now offering free shipping through through November 26, 2007. Use code PFXSHIP at checkout.

Tags: toys, clothing, gear, photography

I've added a new section of the site, called "Shopping Resource." It's also located in the right-hand column of this page for future access. These are links to online stores I have shopped at (often quite recently), with any current sales or promotions that I am aware of. I will add more stores soon and try to update as frequently as I can. Suggestions are always welcome.

While you're there, be sure to read the note about affiliation at the bottom of the page, as I'm offering a $10 Amazon.com gift certificate to one lucky reader this month, to thank you for the referrals. Good luck!

Tags: clothing, shoes, toys, gear, website

Tags: M, A, J

TORCHeS, a well-known mnemonic for the most common congenital newborn infections:

T: toxoplasmosis
O: other (HIV, parvovirus)
R: rubella
C: cytomegalovirus (most common)
H: herpes
S: syphilis

It's always fun to pick up the kids at daycare, especially if they've been painting.

Tags: A, J

I haven't purchased shoes for the boys in a while, so M only has two pairs in circulation right now, and none in the next size. I was browsing through the children's shoe section in Nordstrom for the very first time yesterday and checked out their selection. They were supposed to be having a big sale, but everything still seemed pretty expensive, and none of the shoes I liked were on sale.

I think they work on commission there (tough job) since two salespeople approached me within 3 minutes of each other and proceeded to follow me around even though I said I was browsing (and you wonder why I shop online so much). In any case, I saw a pair of Merrell shoes that I thought would be great for the boys, but they were regularly priced at $36, which I think is a bit steep (at least for us) for shoes that will only be worn for a few months. They also only carried them in black, which I didn't want.

So, I just checked online at Shoebuy.com, which has great prices on shoes. They carry the Merrell Jungle Moc Junior for just under $35, but currently offer a promotion for $10 off $30 with the code BESTGIFT07. Since I have purchased from them within the last 60 days, I got another 10% for being a repeat customer, so the total came to $22. Not bad. I hope he likes them. I'm hoping that they'll be easy for him to put on himself.

Tags: shoes

Reynold's pentad consists of the symptoms from Charcot's triad, plus shock and altered mental status. Presence of all of these symptoms suggests severe cholangitis.

You can find all my random medical facts here.

Charcot's triad consists of right upper quadrant pain, jaundice, and fever. The symptoms are present in 50 to 75% of patients with acute cholangitis.

I've posted about sleepytimestore.com before. They have sales a few times a year on great gift items that are hard to find deals on. The most current one is for 10% off all purchases made between today and midnight on Sunday, November 18th. Just use the coupon code save10. Or, if you are spending over $200 in a single purchase (which is not hard to do if you are doing some Christmas shopping), use the code save15 to take 15% off your entire purchase. M and A love their Little Giraffe blankets, and they make excellent gifts as well.

Tags: gear, clothing, toys

Amazingly enough, this was not a posed photo. M was just horsing around climbing benches in the park.

Tags: M

He's been walking on his own for several weeks now, but I am only just now getting around to posting the first photos. He's very cautious when walking alone, but if he sees me nearby, he'll try to run over, and of course the momentum of his head and body are difficult to control. That usually leads to a fit of giggling, which further adds to his imbalance, and he'll collapse in a giggly pile in my arms (or just in front of me if he doesn't quite make it). Look at him go!

Tags: A, me

When M was a week old, his pediatrician said the best advice he could give us was to make a handprint and/or footprint before he got too big. It was one of the best pieces of advice we've gotten. Read more

A

Tags: photography

Tags: A, holiday

A is growing up to be a little boy now. He's not really a baby anymore, which makes me a tiny bit sad. He's starting to babble and form words, has at least ten teeth, and walks on his own. And M, well, he's practically running off to college at this point. Sigh.

Even though being a medical student can be pretty demanding at times, I am really glad that I was able to spend time with the boys when they were babies. There were definitely weeks where I missed seeing them while they were awake, but for the most part, I haven't missed any milestones or felt I haven't seen them to the point where it's had an effect on them. I don't know how this would be possible if I had them during residency. I'm not sure I could handle it if I just handed them over to babysitters, relatives, or a nanny for most hours of the day, and only saw them on my day off.

But I will soon be done with medical school, and starting a rigorous residency program which will change a lot of things. I am still hoping to retain quality family time, but it's going to be a challenge. If you thought I was organized now, just wait until next June. Streamlining our life and saving time will have to go into superdrive.

I'm not really looking forward to residency in that sense, since it'll be busy, but I'm hoping we can make it work somehow. My goal is to have dinner together more days than not - in some aspects, residency might be easier because I won't have to study in the same way I do as a student. And I won't have to take my work home (for the most part). We'll just have to wait and see.

Tags: A, M

We used our early-entry ticket for the last day of our trip to Disneyland. I figured we'd have two days of scoping out what rides we wanted to go on by then, and it worked well for us. We left the park around 1pm, pretty late into what should have been nap time for the boys, and they were starting to get tired. We stopped by the gift shops for a souvenir.

A had already picked out a small stuffed baby Pooh bear at a store we had stopped into earlier, so he was set. I told M he could pick out something small, and he picked out a set of small toy cars (from the Cars movie). There was a large, wide open area outside the park, so we opened the package of cars for M to play with as we were leaving. He shared a car with A, and the two of them spent at least 10 minutes having a blast pushing their little cars around outside the entrance to Disneyland. Never mind that we had just spent over $300 in tickets to see the happiest place on earth, these guys were perfectly content rolling around $10 plastic cars outside the park. They were completely oblivious to their surroundings and were totally engrossed with playing with their cars. Who knew that possibly the most fun at Disneyland would be had just outside the park? It was a great way to end the trip.

Tags: travel, M, A

Formerly known as Reiter syndrome, the classic triad of spondyloarthritis-related symptoms includes arthritis, nongonococcal urethritis, and conjunctivitis. Associated with HLA-B27, it can often follow an infection (Chlamydia trachomatis or pneumonia, Yersinia, Salmonella, Shigella, Campylobacter, or Clostridium difficile). Superficial oral and penile ulcers are not uncommon.

Diagnosis starts with laboratory testing to confirm a preceding or ongoing enteric or genitourinary infection, and to exclude other causes of mono- or oligoarticular arthritis. There is no single definitive test. The prognosis is usually good with most patients recovering spontaneously. In addition to treating any infection, NSAIDs (naproxen 500 mg three times daily or indomethacin 50 mg three times daily) may help as well. For those who don't respond to NSAIDs, intraarticular injections of glucocorticoids may be used. Completely refractory patients may be started on a trial of sulfasalazine (beginning with 500 mg twice daily and increasing, as tolerated to 1000 mg twice daily) or a trial of etanercept (50 mg subcutaneously weekly).

Tags: A

This one is a little bit blurry but I thought it was a fun photo.



Whenever someone else takes a photo for us, we often have to do some major cropping to get the photo centered properly. Unfortunately, most people tend to leave lots of space above people and not enough below (poor Dumbo got cut off). We were grateful for the assistance though - sure beats bringing a tripod to Disneyland. It's a lot like working in the hospital - you learn to travel really light.

Tags: travel, M, me

Look at this line. It's one of the many lines you have to stand in to spend a day at Disneyland. This one happened to be the early entry line, and we were shocked at just how many people had early entry tickets. We decided to buy the 3-day park hopper pass even though one or two days would have been plenty of time, only because you get a day of early admission to the park when you buy the 3-day tickets (marketing genius). That one extra hour you have is truly a golden one, as you can get on quite a few rides in an hour. I would happily have paid more for a day ticket that had early entry to the park. With two young children in tow, standing in line after line was not an option. In any case, there were several lines full of people with the same plan as ours, but luckily it didn't take that long for all of us to get into the park. And while we did have to stand in a lot of lines, they weren't nearly as long as they could have been.

Tags: travel, J, M, A

Like last year, Halloween was a fun event. I know it's already over, but we are just now downloading the photos off the camera from the past week (two full memory cards). And with the DSLR, they can take a while to process (we shoot in RAW, then convert to JPG after backing up all the original photos).

M was adorable in his firefighter costume (which he loved) and A seemed to enjoy waddling around in his shark costume (the tail even swayed from side to side when he walked). M quickly got the hang of treat-or-treating, and A had a blast picking up candy or stickers and then dropping them in M's bucket (he loves transferring from one container to another right now - I should have him reorganize the kitchen for me). A had an early nap at daycare that day, and the excitement really tired him out, so he dozed off near the end of our route. I'm already looking forward to next year!

Tags: M, A, me, holiday, cute