Black Friday Fun

Today, Kelli and I decided neither of us wanted to sit around the house, so we headed to the mall with fingers crossed. We got to the closest mall (not the biggest - we weren't feeling that adventurous!) around 10am and easily found a parking spot - good start! Then when we got into the mall, it wasn't too crowded. Whew! We spent a couple hours trolling the stores, where I bought some Christmas gifts (and some gifts for myself). I was able to take care of 3 family members' gifts and purchased a couple pants for work. I also learned I look kinda cute in some felt hats - thanks to Kelli :) I couldn't pass up the deal on the pants - they were from Ann Taylor - originally $110, on clearance for $40. Plus they were having a promo where you got 40% your entire purchase before noon, so when I checked out at 5 minutes til noon, I got my $110 pants for $23.93 for a grand total of 80% savings! Quite possibly the best deal I've ever gotten on clothing, especially clothes of that quality. I also bought myself a potato masher (see previous post) to help with future mashed potato ventures. We finished off our shopping trip with lunch at Panera and good conversation. All in all, it was a great way to spend my day!

My first turkey!

So yesterday I made my 2nd entire Thanksgiving (last year was my first for Corey and I down in Hilton Head). This year was different though, because I made my first turkey! Although there was only going to be 4 of us at dinner, I figured I'd try a whole bird instead of buying just a turkey breast or a roasting chicken (like I did last year). I was a little worried, but felt okay because I had a recipe and it seemed pretty easy to follow. Well, as I was readying the turkey for oven, I decided I wasn't too sure about the recipe (it called for paprika and I wasn't sure about that) and there were small logistics I wasn't sure about. So what did I do? Did what any girl would do - I called my mom! She very patiently answered my questions and helped me get the turkey in the oven.

Later in the day, Kelli came over to help make the rest of dinner, including mashed potatoes, stuffing, brussel sprouts, corn, and bread. I tried to make the mashed potatoes in my food processor thinking it would cut down on mashing time ---bad idea! We ended up with what Kelli and I dubbed "potato paste." So we boiled a couple extra potatoes, hand mashed them and mixed them in with the paste in order to salvage the mashed potatoes. The turkey was nicely browned and the correct temp when I took it out of the oven. It had to sit a little longer than I'd planned, so it probably was a little cooler than I would have liked, but it tasted okay. I still have some practice to do before being able to replicate the turkey my mom makes. Everything else turned out well! My favorite part of the meal? The pumpkin pie! I used a Paula Deen recipe which used cream cheese and half-and-half --needless to say it was rich, but rather fluffy. I liked it much better than the traditional pumpkin pie.

Kelli and her dad joined Corey and I for dinner and we had a great time. We swapped stories and had great conversation, including Kelli's dad's jokes. Despite not being with family on Thanksgiving, I had a wonderful day!

Now its on to prepping for Christmas - we're putting up the tree and other decorations tomorrow and I've already started some Christmas shopping. Whew - hard to believe its less than a month away!

What's with these cancer screening recommendations?

So this week was a busy week for women and cancer recommendations - and they came from very different sources. First was the mammogram controversy: a US government task force recommended against routine yearly mammograms for women under the age of 50, citing the facts that "only" 15% of women are diagnosed with breast cancer between the ages of 40 and 49, and that many others experience false positive mammograms which result in stress and extra tests (ie biopsies of lesions). The other part of this recommendation was that women get mammograms every 2 years rather than yearly. The biggest concern with these new recommendations is that private insurance will no longer fund routine mammograms for women in their 40's. The other concern is who made up this task force - according to CNN not a single physician on the board was an oncologist .....wait a sec..these people are making recommendations regarding CANCER and there is no oncologist's input??? How does that make any sense?

This frustrated me greatly - first what about those 15% of women who are diagnosed with breast cancer in their 40's? Because they fall outside of the "common" age of women with breast cancer, they are not included in these recommendations? I'm not sure I feel comfortable about that. Also, now that my mother was diagnosed with breast cancer (at the age of 56) her oncologist recommended that my sister and I begin routine mammograms at 40. Now it is very possible that I will have to pay for every single mammogram out of pocket until I reach 50. The other thing is breast cancer can be very aggressive - the difference between a normal mammogram one year and an abnormal mammogram 2 years later can be astounding. All this made me wonder what other countries recommend for mammograms, so I looked it up on Canada and England's national health websites.

Canada recommends mammograms every 2 years for women between 50 and 75. (They do recommend you get a second mammogram one year after an abnormal mammogram with other normal testing like a normal biopsy). In England they have what is called the NHS Breast Screening Programme which women over 50 must be invited to participate in. You get your first invitation after you turn 50, but they don't guarantee that you will be invited at that time - however you are assured an invitation by your 53rd birthday at the latest. They give free screenings every 3 years under this program until you reach the age of 70. By 2012 they plan on expanding the age limits to 47-73. According to their website they set their age limits based of ease of mammogram readability and the lower incidence of breast cancer in women younger than 50. In pre-menopausal women, breast tissue is much more dense and mammograms are not as reliable. Since the average age of menopause in England is 50, they set their recommendation at that age. They do, however, point out that with the advent of digital mammography, mammograms can be better performed and interpreted on those women with denser breasts.

So how do these practices correlate to death & survival rates? These numbers must be taken with a grain of salt because they represent different years and lengths of time but it's the best I could find. Here are the 5-year survival rates for breast cancer based on country:

US (cancers diagnosed between 1999-05) 89.1%
Canada (cancers diagnosed between 1996-98) 86%
England (cancers diagnosed between 2001-03) 80%


Makes you wonder why our country is leaning toward what these other countries are doing?

If you ask me (which no one is, but I'll give my 2 cents anyway) I think we should be doing more to expand access to breast cancer screening like clinical breast exams and mammograms to the US people rather than creating more restrictions. It is shown that survival rates vary among SES and race in the US, so the best way to increase survival is to increase access to those who women don't have it, rather than restricting those who do have access. Okay, I'll get off my soapbox for now.

I'll address the cervical cancer recommendations in another post at another time...too many stats for me for one day!

Adventures in the kitchen

I've come to realize something about myself recently...I'm a bit of a kitchen-gadget addict. I have a kitchen full of fun stuff including (but not limited to) my Kitchenaid mixer, a full-sized food processor, a mini food processor, an ice-cream maker, a George Foreman grill, a waffle-maker and even a fondue pot. And I enjoy them very much - even if I don't use all of them all the time. I also have a ton of cooking pans, pots and dishes. The sad part about all this - I look longingly at all the gadgets I find in various kitchen supply catalogs. I think I might have a problem :) I need a bigger kitchen just to store all my stuff!

On a similar note, I like reading cookbooks + cooking magazines and browsing cooking/recipe websites. A couple years ago I found out that my grandmother was similar - she would buy cookbooks and spend all this time reading through them without ever making a single recipe from them. After she passed away, I was lucky enough to get a lot of her cookbooks, which I cherish greatly. Lately, I've decided to expand my recipe repertoire and actually start trying some new recipes. Some come from my cookbooks, but most come from cooking magazines and the internet. Some I try aren't exactly big hits, but for the most part I've been successful. Last week I made a super easy, super delicious and healthy dinner - Beef, Barley and Veggie soup. It earned such good reviews from Corey that I made a variation on it last night - Chicken, Barley and Veggie soup. And the best part about the soup- it gets Corey to eat vegetables!! I really like experimenting in the kitchen and hope one day I'll have the time and the skill to come up with my own dishes. Until then, I'll continue my cookbook, magazine and recipe collecting ways :)

Are there babies in my future?

I think so! Not my own baby, but perhaps working with kiddos. After 3 weeks in the peds office I came to a conclusion that I want to work with kids. Not sure if I'd enjoy private practice pediatrics because well-child visits get old pretty quickly, but I'm almost positive I want to work with primarily peds - perhaps in an inpatient setting or even in a pediatric specialty. I've known for a long time that I have an affinity for kids - I really enjoyed babysitting for several years in college and genuinely miss the little girl. Also, whenever I see a baby I get this urge to hold them and love on them. I even went through a phase shortly after moving out here where I honestly wanted to have a baby of my own. Of course that freaked Corey out and luckily I had enough sense to realize despite my strong desire to have a kid at that time, we were (and still are) in no position to be bringing a life into the world. Anyhow, that's all to say that despite my love for being around kids, I never thought I'd actually like having kids as patients. I always thought about all the poorly behaved kids and their over-bearing parents that we saw in the ER. But I've seen that was definitely not a correct characterization of pediatrics as a whole. There's just something about making a child smile when they are sick or calming them down when they are freaked out about the visit to the doctor that makes me smile.

So, now my list of "likes" is expanding. I've enjoyed every rotation I've been on and can see myself in each area (with the exception of psych - too much sadness/anger). And I haven't even done the big rotations (surgery, inpatient and outpatient). Oi - I'm in trouble! But, looking on the bright side, I can apply for all kinds of jobs and be happy with what I get, rather than being restricted to a couple areas because that's all that interested me, right?

Great Day!!

So my Monday morning started off knowing that TCU is ranked #4 in the BCS AND that ESPN's College GameDay will be broadcasting from my alma mater's campus on Saturday. Good start to the week, eh? Then traffic was light on the way in and I had time to get some hot tea from Starbucks before getting to work.

The morning was nothing exciting, but nothing terrible either. After lunch though was when it got really good. I did a well-child visit on a very chatty 6 year old boy with his rather humorous father in the room. It took some time because this little guy wanted to tell me story after story, and any question I asked him resulted in another story being told. Needless to say the history and physical took a bit longer than one usually does. One of the great things about being a student is I can take that time because they aren't expecting me to be super fast when it comes to seeing patients. After making it through all that and presenting to my preceptor she asked me to get some information for the father. As I went back in the room to give it to him he asked me if I was planning on going into pediatrics. I told him I was keeping my options open and wasn't really sure what I wanted to do. He told me if I did decide to work with kids he was sure I would be great at it - he could tell by the way I interacted with his son. Ooo-wee! I almost asked him to tell my preceptor the same thing but thought that my be kinda tacky (and who knows he may have mentioned it!)

So, I'm on cloud 9 right? Then, as my last patient of the day, I see a patient who probably has Kawasaki's Disease. It's funny because I remember learning about it in class and thinking I would never see a patient with it - Boy was I wrong! Kawasaki disease is interesting because scientists don't yet know what causes it. Pretty much it presents as a high fever lasting >5 days, red/swollen lips, rash including the hands and feet, conjunctivitis (irritation of the eyes), and enlarged lymph nodes in the neck. The most serious complication is development of vascular damage in the arteries supplying heart muscle which causes coronary aneurysms. It is the most common cause of acquired heart disease in kids younger than 5 (surpassing rheumatic heart disease - a complication from strep throat). So to diagnose this patient we ordered some labs that look at white and red blood cell count and markers of inflammation. Then we sent them to a cardiologist to get an echocardiogram done to look at the coronary arteries to determine if there is any inflammation or damage to them. If the diagnosis is made, the patient is started of IVIG (immunoglobulin) and high-dose aspirin to prevent damage to the coronary arteries. So cool! I'm pretty curious to find out if that is indeed the diagnosis.

And on another note - some more good news. My mom had her first chemo treatment last week and things are going well so far. She did have a bad reaction causing some problems with her hands and feet, but was able to take some meds which helped with that. She said she was feeling tired yesterday, and is having some metallic taste in her mouth, but all things considered seemed to be doing pretty well. Keep her and my dad in your thoughts and prayers please.

Would you like some cheese (and perspective) with that whine?

Talk about God's timing...just about 5 minutes after whining on Facebook about our inability to be in Ft. Worth for College GameDay's broadcast from TCU this weekend the NBC Nightly News comes on. And what's the first story? An update on the Ft Hood shootings in which the anchor talked about the deceased, wounded and their families as well as what the community is doing to lend a hand to all those affected by the senseless brutal acts of one man. Then there's a story about the 20th anniversary of the fall of the Berlin Wall and how restrictive and controlling the East German government was during the Cold War.

Talk about putting my life into perspective! I'm sitting around in my warm, comfortable apartment with my wonderful husband and crazy pup bemoaning my lack of time and funds to fly last minute to a college football game when there are parents, spouses, siblings and children mourning the loss of a loved one while survivors are wondering what happened and why they are the lucky ones to survive. And people in Germany are remembering the day that they were finally allowed to travel from one side of a city to the other without being stopped by guards or threatened with violence.

Thanks God for pointing out my silly and selfish ways. Sometimes I need to stop whining and start appreciating all that I've been blessed with!

Peds - not as easy as you'd think

So, I've been working in a private practice Peds office for the past two weeks, and - I've actually enjoyed myself! I was a little worried initially, thinking I would hate dealing with snotty-nosed kids and their parents. On the other hand, I absolutely LOVE working with little kiddos, so I thought maybe it wouldn't be too bad. Well, despite the snotty-noses and coughing all over me, the kids are adorable! Some are screamers, but surprisingly most are extremely well-behaved, especially considering most are sick and feel like poo. And then some are just downright cute :) However, I feel like the medicine is either boring or hard - not much in between. Often its just the run-of-the-mill flu, upper respiratory infection or well-child visits. But there's things you have to remember like congenital abnormalities and other illnesses that are unique to children. I always kind of thought as kids as miniature adults - not so! Luckily I don't give vaccinations to the kids, so at least I don't have to deal with pissed off kids after they get stuck with a couple needles :)

The biggest downside so far - I got sick. After only one week in the office I came down with a cold. Not a terrible one, but when commuting an average of one hour each way and not so short days, I was pretty exhausted all the time. Plus I felt bad sniffling while examining a patient. I did tell my preceptor that I wasn't going to see any of the kids under 2 months old because the risk of giving them my cold was just too high for my comfort. (I'm pretty sure she appreciated that) I finally kicked the cold after almost a week and having to take a day off. Still better than the flu, though! After seeing so many kids with presumed H1N1, I'm very glad I got my vaccine! Plus I've managed to stay away from pink eye so I'm pretty happy about that.

In other news, this week we found out that my sister-in-law (Tess) is most-likely having another girl for her 2nd child. The sono tech told them she was 75% sure it was a girl, but apparently the baby wouldn't spread her legs for the sono, so they are having another at the end of Nov to get confirmation. That means, come spring, I'll have 6 nieces (5 on my side and one from Corey's side)! That's a whole lot of estrogen! Now the question is, will Corey and I buck the trend and have all boys, or will we continue it with having a girl? That question won't be answered any time soon though - still lots for us to do before having babies!