Running Total: 23 hours
I did not shadow this week, but promised to go next Wednesday for the whole day since it's spring break. That way I can go in the morning and see more of the new born babies. It is then that i'll finish my hours and get my evaluation sheet filled out by Dr. Kelly.
For now, I have to read up on 5th Disease and the other 4 as well, including Roseola.
Saturday, March 30, 2013
Wednesday, March 20, 2013
Capstone Log 12
Today: 2 hours
Running Total: 23 hours
Today was sweet and short. When I got in, Dr. Kelly and I went to see a 2 year old with a rash on her nose and a diaper rash. The mom thought the rash on the nose was a rash, but it actually was just the remains of a small scratch that's healing and probably collected some bacteria. It will go away in a couple of days. The diaper rash was quite large however and covered a large portion of the bottom. Dr. Kelly renewed a pre-existing prescription and changed it to 2% Hydrocortisone. The girl also received a measles vaccine because they are moving to Germany, where there is an outbreak of measles.
We then saw a girl who was sick with a high fever, and was very miserable; coughing a lot with a sore throat and deep breathing. We know right away that it isn't strep because cough is not associated with it. So Dr. Kelly checked her up and came to the conclusion that she probably had the flu. He did a flu test which involves a nasal culture. It looked very painful and very uncomfortable because the swab had to be shoved way up into the nose. I felt really bad for the girl, but it was absolutely necessary.
Dr. Kelly then had a physical with a teenage boy and I wasn't allowed to go in, so instead I went with Dr. Pickering for a pre-operation.
A 9 year old girl explained how when she was 5, she was running on the beach and stepped on something sharp, but thought nothing of it since there was no trace of anything stabbing through the skin. 4 years later, she feels more pain and can barely walk on that side of her foot. Her mother showed us x-rays which showed she had a piece of metal in her foot and it had snapped in half. We all came to the conclusion that it could be a hypodermic nail. The surgery is a simple outpatient surgery, and they'll put the girl under anesthesia, but the real concern is the chance of getting Hepatitis B, Hepatitis C or HIV. However, if the needle had those traces, the girl would've been infected long ago. And she has already had her Hepatitis vaccinations, so she's immune. But a blood test was taken to reassure that the girl has no disease. What surprised Dr. Pickering and I however, was the fact that the needle left absolutely no trace and no presentation until 4 years later. And it was never infected or swollen when the girl first got it.
Dr. Kelly and I then talked a bit about rheumatic fever and how it can come from strep and could cause rheumatic heart disease as well as brain damage and swollen joints.
I was also able to ask Dr. Kelly about Elephant Man, since we're watching the movie in class. He said that the movie and play were very wrenching and emotional compromising, but it's actually not completely rare to get this genetic disorder where your child ends up growing up with large tumors and sever deformity. It's called neurofibromatosis and Dr. Kelly actually has a patient with this genetic disorder who is 20 years old now and very severely deformed. The worst part is that there is no cure and no treatment.
For next week I have to read about the "5th Disease", which is literally called the 5th disease. I have to read on the importance of the other 4 diseases as well and focus on Roseola.
Running Total: 23 hours
Today was sweet and short. When I got in, Dr. Kelly and I went to see a 2 year old with a rash on her nose and a diaper rash. The mom thought the rash on the nose was a rash, but it actually was just the remains of a small scratch that's healing and probably collected some bacteria. It will go away in a couple of days. The diaper rash was quite large however and covered a large portion of the bottom. Dr. Kelly renewed a pre-existing prescription and changed it to 2% Hydrocortisone. The girl also received a measles vaccine because they are moving to Germany, where there is an outbreak of measles.
We then saw a girl who was sick with a high fever, and was very miserable; coughing a lot with a sore throat and deep breathing. We know right away that it isn't strep because cough is not associated with it. So Dr. Kelly checked her up and came to the conclusion that she probably had the flu. He did a flu test which involves a nasal culture. It looked very painful and very uncomfortable because the swab had to be shoved way up into the nose. I felt really bad for the girl, but it was absolutely necessary.
Dr. Kelly then had a physical with a teenage boy and I wasn't allowed to go in, so instead I went with Dr. Pickering for a pre-operation.
A 9 year old girl explained how when she was 5, she was running on the beach and stepped on something sharp, but thought nothing of it since there was no trace of anything stabbing through the skin. 4 years later, she feels more pain and can barely walk on that side of her foot. Her mother showed us x-rays which showed she had a piece of metal in her foot and it had snapped in half. We all came to the conclusion that it could be a hypodermic nail. The surgery is a simple outpatient surgery, and they'll put the girl under anesthesia, but the real concern is the chance of getting Hepatitis B, Hepatitis C or HIV. However, if the needle had those traces, the girl would've been infected long ago. And she has already had her Hepatitis vaccinations, so she's immune. But a blood test was taken to reassure that the girl has no disease. What surprised Dr. Pickering and I however, was the fact that the needle left absolutely no trace and no presentation until 4 years later. And it was never infected or swollen when the girl first got it.
Dr. Kelly and I then talked a bit about rheumatic fever and how it can come from strep and could cause rheumatic heart disease as well as brain damage and swollen joints.
I was also able to ask Dr. Kelly about Elephant Man, since we're watching the movie in class. He said that the movie and play were very wrenching and emotional compromising, but it's actually not completely rare to get this genetic disorder where your child ends up growing up with large tumors and sever deformity. It's called neurofibromatosis and Dr. Kelly actually has a patient with this genetic disorder who is 20 years old now and very severely deformed. The worst part is that there is no cure and no treatment.
For next week I have to read about the "5th Disease", which is literally called the 5th disease. I have to read on the importance of the other 4 diseases as well and focus on Roseola.
Wednesday, March 13, 2013
Capstone Log 11
Today: 2.5 hours
Running Total: 21 hours
Today was slow-paced, but still very exciting nonetheless.
When I got in, we talked about headaches and how vomitting is sometimes caused by headaches. Dr. Kelly explained to me how too much pressure in the brain will push down and hit the brain stem, which is the source of many functions including eyes, ears, and several physiological aspects, and cause vomitting. He told me that there are ways to relieve pressure in the brain through steriods and medicines. But another way to get rid of pressure on the brain is to drill a burr hole, also called trepanning, and to release blood and therefore release pressure.
We first saw a 7 month boy who had a fever. However, when we walked in, he was very happy and cheerful, playing with his toys which is a good sign. His throat was red and he had sporatic, painful coughs, but he was completely healthy. Just a small cold to set him back.
We then saw a boy who had hit his head very hard on the concrete. He remembered everything that happened which was a good sign, and there was no bleeding from the spot of impact, nor from the ears and areas around the head. No broken skull, not even a visible bruise. He was nauseous, but we concluded that it was probably from the stress of the injury.
I was able to sit in with a normal 18 month checkup, and during this checkup, several questions are asked about milestones and progression of the child in order to sort of test for autism. MCHAT is the name of the questionnaire, but even Dr. Kelly didn't know what it stood for. It won't directly determine if the child has autism, but it's mandatory now to take the test either way. This boy, however, was very active and very responsive and definitely not a candidate for autism. He's healthy and smart, increasingly improving motor skills and learning abilities, and he loves to run around and climb on everything. The hills of San Francisco will definitely be a fun place for him to roam.
To end office time, we saw a boy who had a low grade fever, but was very cranky and irritable. He was teething as well which made everything worse. And to top it off, he had Roseola. It's a viral infection that results in a fever and a rash. The boy had small pink spots on his back and torso which indicated that he had this infection. It's not contagious though, and with proper care, it will go away within a few days.
I was then allowed to go with Dr. Kelly to the CPMC on California Street to witness a checkup for a newborn baby, which was very exciting. I walked into the nursery and was able to see some of the babies in care there. Dr. Kelly and I discussed some of the paper work, making sure the delivery was okay and the baby came out okay. She had a 6/9 Apgar score, which is good, and she was very healthy; 7 lbs, 21 inches long. The labor was 16 hours and the baby was born today at 2:18 pm. We then went in to see the baby. Dr. Kelly checked the head, which was swollen, but it was okay. He checked for broken collarbones, checked the lungs, posture, and muscle tone. The baby hadn't eaten yet, but that's actually normal for the baby to not eat for the first 48 hours. She was just extremely tired, so she slept a lot of the time. Ultimately, she was very healthy.
For next week, I have to read about the Apgar test performed on babies when they're first delivered.
Running Total: 21 hours
Today was slow-paced, but still very exciting nonetheless.
When I got in, we talked about headaches and how vomitting is sometimes caused by headaches. Dr. Kelly explained to me how too much pressure in the brain will push down and hit the brain stem, which is the source of many functions including eyes, ears, and several physiological aspects, and cause vomitting. He told me that there are ways to relieve pressure in the brain through steriods and medicines. But another way to get rid of pressure on the brain is to drill a burr hole, also called trepanning, and to release blood and therefore release pressure.
We first saw a 7 month boy who had a fever. However, when we walked in, he was very happy and cheerful, playing with his toys which is a good sign. His throat was red and he had sporatic, painful coughs, but he was completely healthy. Just a small cold to set him back.
We then saw a boy who had hit his head very hard on the concrete. He remembered everything that happened which was a good sign, and there was no bleeding from the spot of impact, nor from the ears and areas around the head. No broken skull, not even a visible bruise. He was nauseous, but we concluded that it was probably from the stress of the injury.
I was able to sit in with a normal 18 month checkup, and during this checkup, several questions are asked about milestones and progression of the child in order to sort of test for autism. MCHAT is the name of the questionnaire, but even Dr. Kelly didn't know what it stood for. It won't directly determine if the child has autism, but it's mandatory now to take the test either way. This boy, however, was very active and very responsive and definitely not a candidate for autism. He's healthy and smart, increasingly improving motor skills and learning abilities, and he loves to run around and climb on everything. The hills of San Francisco will definitely be a fun place for him to roam.
To end office time, we saw a boy who had a low grade fever, but was very cranky and irritable. He was teething as well which made everything worse. And to top it off, he had Roseola. It's a viral infection that results in a fever and a rash. The boy had small pink spots on his back and torso which indicated that he had this infection. It's not contagious though, and with proper care, it will go away within a few days.
I was then allowed to go with Dr. Kelly to the CPMC on California Street to witness a checkup for a newborn baby, which was very exciting. I walked into the nursery and was able to see some of the babies in care there. Dr. Kelly and I discussed some of the paper work, making sure the delivery was okay and the baby came out okay. She had a 6/9 Apgar score, which is good, and she was very healthy; 7 lbs, 21 inches long. The labor was 16 hours and the baby was born today at 2:18 pm. We then went in to see the baby. Dr. Kelly checked the head, which was swollen, but it was okay. He checked for broken collarbones, checked the lungs, posture, and muscle tone. The baby hadn't eaten yet, but that's actually normal for the baby to not eat for the first 48 hours. She was just extremely tired, so she slept a lot of the time. Ultimately, she was very healthy.
For next week, I have to read about the Apgar test performed on babies when they're first delivered.
Wednesday, March 6, 2013
Capstone Log 10
Today: 3 hours
Running Total: 18.5 hours
"We're not just us, we're the germs we carry."
Wise words of Dr. Kelly; studies show that there are actually more germs in our bodies than actual cells that make up our bodies. Quite an interesting tidbit for the curious readers.
Today was a very very busy day! Amazing how much can be squeezed into 3 hours. I'll try not to ramble.
When I got there, we went to see an 8 month boy who has had diarrhea, He took antibiotics for an ear infection, which could've been the cause, however the antibiotics were in effect last month which disproved our observations. The common cold simply caused his irregular bowel movements.
We then saw a 6 month girl for a checkup and diaper rash. Dr. Kelly was asking for the milestones, and she's very healthy, having reached most of the major milestones at 6 months. She sits up and was smiling at everyone. I was allowed to listen to her lungs and Dr. Kelly pointed out that her breathing is a lot faster than that of what a teenagers would be, which is no surprise at all.
After that, we quickly went in to see a boy who said he had his ear cleaned yesterday only to go home and find blood coming out of it. Dr. Kelly looked in his ear and concluded that the passage towards to the inner ear was scratched on accident and will heal on its own.
We saw a boy who has frequent headaches and has had it going on for many many years. Dr. Kelly checked everything and he was okay, so he sent him to get a CAT scan, a blood sugar test and a sodium test. If he drinks too much liquids, it could dilute the salts in his body and unbalance the fluids, causing more headaches.
A boy with a major speech delay then came in. He is 3 years old, however, he rarely talks. He only says "yes", "no", and "baby", which is very very unusual for a child this age. But his mother was not worried because there is a history in the family of major speech delay like his. Even though he doesn't talk, it has nothing to do with attention span problems because he'll listen to stories, and sit down and solve puzzles. And Dr. Kelly said it has nothing to do with intelligence, which surprised me as well because the boy can only count to 2 and doesn't know any colors or anything. He won't talk at all, doesn't interact too much, and doesn't make noises. It was quite intriguing to me to see a boy this age not say anything. But with proper speech therapy, he'll come to speak perfectly well one day.
Next, we saw a girl who had a minor eye infection, and the mother was scared it could be contagious. It is contagious but will only spread if the girl touches the gunk in her eyes, touches something else and then another child comes around, touches the same thing and touches their own eyes.
To end the day, I was allowed to sit in with another prenatal but this time with experienced parents. However, they still had lots of questions. What surprised me is the fact that they're having a home delivery, with a midwife. I was unaware of the fact that midwives still even exist. Dr. Kelly doesn't strongly approve or recommend home deliveries because many complications could occur and distance from the hospital puts the mother and the newborn at a risk of not having the right instruments and tools around if something goes wrong.
For next week, I have to read a little bit about coxsackie A6 which connects to my topic from last week: hand foot mouth disease. It's a fairly new virus though, and is similar to the other hand foot mouth disease: EV71. I also have to read about headaches, which could better educate me on a more personal level since I get headaches a lot.
Running Total: 18.5 hours
"We're not just us, we're the germs we carry."
Wise words of Dr. Kelly; studies show that there are actually more germs in our bodies than actual cells that make up our bodies. Quite an interesting tidbit for the curious readers.
Today was a very very busy day! Amazing how much can be squeezed into 3 hours. I'll try not to ramble.
When I got there, we went to see an 8 month boy who has had diarrhea, He took antibiotics for an ear infection, which could've been the cause, however the antibiotics were in effect last month which disproved our observations. The common cold simply caused his irregular bowel movements.
We then saw a 6 month girl for a checkup and diaper rash. Dr. Kelly was asking for the milestones, and she's very healthy, having reached most of the major milestones at 6 months. She sits up and was smiling at everyone. I was allowed to listen to her lungs and Dr. Kelly pointed out that her breathing is a lot faster than that of what a teenagers would be, which is no surprise at all.
After that, we quickly went in to see a boy who said he had his ear cleaned yesterday only to go home and find blood coming out of it. Dr. Kelly looked in his ear and concluded that the passage towards to the inner ear was scratched on accident and will heal on its own.
We saw a boy who has frequent headaches and has had it going on for many many years. Dr. Kelly checked everything and he was okay, so he sent him to get a CAT scan, a blood sugar test and a sodium test. If he drinks too much liquids, it could dilute the salts in his body and unbalance the fluids, causing more headaches.
A boy with a major speech delay then came in. He is 3 years old, however, he rarely talks. He only says "yes", "no", and "baby", which is very very unusual for a child this age. But his mother was not worried because there is a history in the family of major speech delay like his. Even though he doesn't talk, it has nothing to do with attention span problems because he'll listen to stories, and sit down and solve puzzles. And Dr. Kelly said it has nothing to do with intelligence, which surprised me as well because the boy can only count to 2 and doesn't know any colors or anything. He won't talk at all, doesn't interact too much, and doesn't make noises. It was quite intriguing to me to see a boy this age not say anything. But with proper speech therapy, he'll come to speak perfectly well one day.
Next, we saw a girl who had a minor eye infection, and the mother was scared it could be contagious. It is contagious but will only spread if the girl touches the gunk in her eyes, touches something else and then another child comes around, touches the same thing and touches their own eyes.
To end the day, I was allowed to sit in with another prenatal but this time with experienced parents. However, they still had lots of questions. What surprised me is the fact that they're having a home delivery, with a midwife. I was unaware of the fact that midwives still even exist. Dr. Kelly doesn't strongly approve or recommend home deliveries because many complications could occur and distance from the hospital puts the mother and the newborn at a risk of not having the right instruments and tools around if something goes wrong.
For next week, I have to read a little bit about coxsackie A6 which connects to my topic from last week: hand foot mouth disease. It's a fairly new virus though, and is similar to the other hand foot mouth disease: EV71. I also have to read about headaches, which could better educate me on a more personal level since I get headaches a lot.
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