Building a home kinda feels like expectant parents, anxiously checking out the fetal sonograms. Our new home is far away enough that it's not easy to visit regularly, so our realtor does a pretty good job sending us picture updates regularly
This was our home in March: With the frame up:

Insulation:

And then, a few weeks ago:

Yup, we're excited. Will be making a trip down next week to show my parents the work in progress.

But for now, our minds are on the wedding. Only 6 more days, and we're stressed like sh*t. The small details are neverending. So, please bear with me about the lack of updates...

Cushing's- A Challenge

Am oncall this week, and next, and among the cases I've seen is a really challenging case of Cushing's.

This was a young man, nice person, good-looking even (could have been a model, so his mother says). And then suddenly, he began putting on weight at an alarming rate, developed weird stretch marks and his muscles wasted away. Basically all the features of Cushing's syndrome (a condition of excess steroids).

As it turns out, he was found to have metastatic neuroendocrine tumor producing ACTH. Hence the rapidly progressive course (which is a clue to the etiology of Cushing's- pituitary versus ectopic).

Underwent bilateral adrenalectomy, and despite the very skilled surgeon, the surgery took well over 10 hours and the surgeon was not able to remove the right gland entirely, which was basically stuck to the liver from the mets.

So now, he's still on the ventilator, and we're trying to wean him off. His transaminases are sky-high, which will limit what else we can do for his Cushing's which is presumed to be still present.

Medical therapy with Ketoconazole? Nope. Mitotane? Nope. Etomidate? Nope. Metyrapone? Well, maybe, if we can get our hands on it.

A consultant suggested ethanol ablation of the remnant adrenal- not sure if this is feasible.

So, what we're left with is wait and pray, and hope that he's extubated and his liver recovers.

And the worse thing is (and this is my own biased emotions, I admit) he's only my age, with a young family. I suppose that's human nature, unreasonable as it may seem, that sickness and death are easier to accept in the elderly, not in the young.

Kid Sister, M.D.

This is a late post, but just as important, nonetheless.

Congratulations, dear sister. You've now joined the ranks of the few, destined to use their gift to heal and help. Though this is just the very first baby steps of your medical career and you have a long way to go, I'm sure you will make a difference in many patients' lives.We're all very proud of you, kiddo!
Yes, my kid sister graduated from medical school on Friday. Though I feel badly that I wasn't able to be there to watch her take the Hippocratic Oath (am oncall, and for visa redtapes) I was as excited as mom and dad.

So we're back. And it's swell that my parents are now here; it's been a year since I last saw them (our last trip to Malaysia, when we got engaged). Anyway, the meeting was nice. Orlando's Walt Disney World was swell. We visited the 3 parks I didn't get to go to years ago; Animal Kingdom, Epcot and Hollywood Studios (previously called MGM).
Needless to say, my mind wasn't exactly on my research data when I did my presentation that afternoon. But I think I was able to at least look like I was interested in the stuff I was selling.

Anyways. We're back, and I'm swimming with paperwork that I need to catch up on, so this will be a short update. And it's particularly painful that I have to come back to 2 weeks of call. But this will be my very last stretch of call in fellowship; after this I will be home free.
In the meantime, enjoy the fireworks display at Epcot.

And the grand finale...

Short Update from Orlando

I can't feel my legs.
For whatever reason, Kris and I joined the 5 km Power of Prevention run, part of the conference. Which explains why we got up at the unholy hour of 515 am on my vacation presentation trip.
And then, we spent almost 9 hours in Disney's Animal Kingdom.
My legs feel like jelly now.
More updates when we get back.

Off to Disney World!

Woo Hoo!
Kristin and I leave for Orlando, Florida tomorrow, for Walt Disney World an endocrinology conference (AACE). I'll be presenting some data from our expedition to New Orleans after Hurricane Katrina.
This is the first time she's been able to take time off to travel with me, so we're looking forward to it.
This should be a good meeting, though, sad to say, I'm expecting the attendance to be pretty dismal.
I mean, the meeting is IN Disney World. Orlando, Florida. Who in his right mind would spend the day cooped up in a stuffy, windowless conference hall, when you could be out frolicking in the sun with Mickey and Goofy and Ariel the mermaid (yum yum)?

My colleagues haven't so much as said anything about their research presentations as which Disney Parks they want to go to.
Though we've been looking forward to this for months, I feel guilty as through some miscommunication my parents fly in to the US 3 days before we get back. So some friends have graciously agreed to pick them up from the airport and drop them off at my place (Sorry, mom and dad. So much for being a prodigal son!).

It's pretty magical, how being in Disney makes one regress a few decades. The first time I went was when I took my parents there 4 years ago. I was jumping and skipping around, excited to be taking pictures with Goofy! I guess there is a kid in every one of us.

We'll be back Sunday. Till then, toddle-loo!

East meets West

A small-town Chinese Malaysian boy marrying a midwestern American girl of Norwegian-German descent sometimes makes for hilarious crossed-lines. Thought I should share our conversation from last night, on where to take her family when they come to the Malaysian wedding.

Kris: Where else should we take them?

Me: Hmm. Well, we could take them to Kuala Selangor, famous for its fireflies. My Canadian friends loved it when we took them there years ago.

Kris: YOU EAT FIREFLIES????

Me: >_<

She's seen us Malaysians/Singaporeans eat. She happens to think we eat anything that moves (which is probably true).

P/s: 26 more days to the wedding!

Sickness

I have a bad case of senioritis. This was diagnosed some weeks ago (it's affecting 3 other classmates of mine)- I hope it's not too severe. I did find some information about this strange disease.

Senioritis
(seen-yawr-i-tis)

Definition: A mysterious illness afflicting seniors of any graduate program, usually in their final few months. Also known as Laziness.

ICD-9 code: 780.7

Epidemiology: Published studies put the prevalence of this illness at at least 80% of seniors. Risk increases with age, with male:female 4:1. Especially if patients have completed the board requirements for their program, or worse, are already board-certified.

Clinical features: Apathy, lack of motivation to study or learn new skills, extreme fatigue when tasked with administrative and academic duties, nonsensical mumbling speech when giving presentations (apathetic aphasia), obsession with surfing on the internet during work hours, mental slowing, and tendency to watch hours of TV (especially HGTV) at home. In severe cases, weight gain and flatulence have been described.

Tests: No laboratory test have been shown to be reliable. MRI may show evidence of cerebral atrophy.

Treatment: The only cure is for the patient to graduate ASAP and move on to the new chapter. Other treatment modalities such as: new girlfriend, sports car, gadgets and toys, journal publications, have only been shown to transiently increase motivation, and are considered palliative.

Prognosis: Usually excellent.

Really with the impending graduating, I'm finding it hard to want to sit down and learn new stuff. Case in mind, my last rotation. Though some things were interesting, I knew it would not be relevant to my practice. And hence, my conversations with the OB/Gyn fellow were something like this:

Her: Would you like to see this patient? She has endometriosis

Me: Err, nope. Not really relevant to me.

Her: What about this case of fibroids?

Me: I'll pass. I'll just work on my manuscript.

In talking to my other colleagues, all having secured jobs already, everyone's just counting down for the next 2 months. We're already board-certified, and our consultants basically have us on 'cruise control' so I don't even run most of my cases by my consultants anymore because they trust we know what we're doing by now (I hope!). I'm frequently finding my mind straying, to wedding planning, or how we can spruce up our new home. I'm having trouble even trying to find the energy to complete the 3 manuscripts I'm working on.

Oh well. I guess this is normal, after 6 years postgrad training. Many before me have had this illness, and survived.

In the meantime, if you want me, I'll be in the jacuzzi sipping on my mojito.