Being A Parent

They say being a parent is life-changing. And boy, they weren't kidding. Those of you who have kids will understand, I'm sure.

Something at a very deep level just hits you, tugs at your heartstrings. At work, all I can think of is coming home to hold my Allison. At home, I can spend hours just looking at her sleep. This seems to have given me a different perspective on life. You think about your ability to provide for your family. And smaller matters don't seem to bother me as much now.

And though you may be exhausted from the perpetual nighttime crying, it's funny how one can still be blissfully happy.

(and yes, mother and baby are both doing well. Thanks for the well-wishes!)

Old faithful guard-dog..

-- Sent from my Palm Pre

Growing Up

Vagus in 2008:
"Wow, this is a cool car..."

Vagus in 2010:
"Wow, this is a cool car..."

I guess we all have to grow up someday, don't we?
Well, don't we?
I gave myself a shock today unwittingly. I received an email from the Honda dealer with a link to their latest model, the 2010 Honda Odyssey. As I looked at the specs, and read about the 3rd row seats, and the entertainment unit for the passengers, and how the 2nd row fits 3 large-sized child seats, the words actually did come out from my mouth: Wow, this is cool!

I caught myself as I said it. Arghh, what is happening to me??

A little present from Allison... :)

-- Sent from my Palm Pre

It's surreal, and in some ways hasn't hit us yet. Mom and baby Allison are doing well. It's amazing how at peace and blissfully happy you can be despite being sleep deprived. I can spend the whole day looking at our little angel.
Should be getting discharged tomorrow...

-- Sent from my Palm Pre

-- Sent from my Palm Pre

We're having a baby!!

-- Sent from my Palm Pre

Sometimes...

... a little knowledge can be a bad thing.

I saw Char for follow up of her diabetes yesterday. She is a 53 year old nursing aide whom I had seen a couple of times before. At last visit she was on insulin Aspart 20 units with meals, and Glargine 82 units once daily. This time, her Aspart was up to 44 units at meals, with Glargine 90. She was also getting frequent spells of hypoglycemia.

Now I tell patients I'd love for them to self adjust their insulin as they see fit, after all I see them only once every 3 months or so. Comes back to the adage, Give a man a fish and he'll eat for a meal. Teach a man to fish and he'll eat for a lifetime. So, the key is proper education on adjustments. Except this wasn't the case; clearly she had no idea what she was doing, so I asked her how she came up to this program, but was unprepared for this classic answer:

"These doses worked great for one of my nursing home patients, so I figured it should work for me, too."

Apparently she knew I disapproved when I half-gagged/half-snorted while cringing when she said that. After I strugged to get that bit of spit that went down my windpipe, I gently admonished her never to use someone else's insulin program as (obviously) we're all different.

Sometimes a little (but not enough) knowledge can be a dangerous thing.

Happy Father's Day!

Ahh, a lazy Sunday, just the way I like 'em.
Happy Father's Day, you dads (and dads to be) out there. Now that fatherhood is round the corner for me, I catch myself doing stuff and thinking in ways I never did.

Like how I spent a small fortune buying stuff, not the electronic and car toys I usually drool over, but over strange objects like breast pump nipples, diapers, crib mattress and feeding bottles. I'm excited about the much-anticipated arrival of our little one (technically 16 days to go but we'll see) and yet anxious and hoping she'll be OK. I think about our financial stability and my ability to provide for my growing family, in the near and the long-term future.

It makes me appreciate even more what my dad did for us, and what a wonderful father figure he is to us, to have raised and put a family of 4 kids through college. My parents get in in about 3 weeks- I'm also excited to have them play the role of grandparents to our daughter- being so far away from Malaysia, it's important for me to have my daughter stay connected to her roots and ancestry.

In the meantime, I suppose I have the best of both worlds now. There's no screaming, crying baby yet, but my wife considers me already a father, and so I'm getting the royal You-just-on-the-couch-I'll-do-all-the-work treatment. And yes, I know I look like a lazy bastard making my very pregnant and 1-cm dilated wife do all the work, but hey, it's Father's Day!

Losing a life

To follow my last post, my poor patient had to face this today. I had been seeing Mrs. A for the last week whilst oncall. She was fairly young, but already had a Whipple's for pancreatic cancer the week prior. We started her on insulin for obvious reasons, and had been seeing her daily to tweak her doses; she had been doing well from my standpoint.

I last saw her just yesterday in the late morning. She had migrated from a wartorn 3rd world country, married and raised wonderful kids, 2 of whom I got to meet on my daily rounds. She was weak, but in good spirits, when I updated her with her glucose results. That was about 8:45 am.

Shortly after I left her, she went into respiratory distress and was emergently sent to the medical ICU. She had fulminant C.difficile sepsis, and was in DIC (disseminated intravascular coagulation). When I saw her this morning, despite being on the ventilator she was awake, able to obey commands. She was on 2 vasopressors and generous IV fluids and yet her blood pressure was barely hanging on. She had relayed to her family that she wanted to withdraw care.

When I came by, I was taken aback by the change of events. I sat down with her daughter and spouse, and they all knew this would be a losing battle. I listened as they tearfully told me that she has been a good wife, mother and a God-loving person. I listened to their stories not of how she is dying, but how she had lived. Yet they knew what was coming- they were holding on only to wait for the arrival of an out-of-state family member before they were ready to withdraw care. She was particularly close to a daughter; she needed to have her goodbye with her.

Despite only having known this family for 7 days, I had trouble holding back my emotions. They saw through their tear-soaked eyes as my eyes welled-up and I wiped off a couple of tears. I surprised myself too.

Sometimes despite what you do, you know you're losing this battle. And yet we talked about how we believed that eventually when the time is right, they would get to meet again. And how we believed that eventhough she may soon be gone physically, that she would still be here with them.

Saving a life

Sometimes there's a satisfying feeling knowing you helped save someone's life. It's a quiet gratification; no one comes up to you to pat you on the back, or gives you a hug, or says "Good Job!". And so, since this is my blog I'll just blow my own trumpet here.

I was paged to see Mr. J emergently. He was post-op day 12 for CABG, with no previous history of glucose lowering medications. That morning, he was unresponsive, and was found to have a glucose of 19 mg/dL. After an amp of Dextrose, his sugars were better, but he remained hypotensive and tachycardic. He was pale, oxygen sats running at the mid 80s on 4 liters. He did not look well.

Now, obviously, the differential diagnosis at this point is pretty wide, most likely from a non-insulin mediated etiology like sepsis, MI etc etc. Basically any sick enough patient can become hypoglycemic; you don't even have to go into the rare (but the Boards love these questions don't they? insulinomas. However I looked at his chart, and something jumps out at me: His past medical history includes POEMS Syndrome, which in his case includes hypothyroidism.

I had the lab perform a stat cortrosyn stimulation test. After the 60 min labs were drawn, I immediately started him on IV Hydrocortisone even before results are back. 2 hours later, his glucose, blood pressure and HR are improved. Thus, I wasn't too surprised when I saw his cortisol levels: baseline 3.2, 30 min 8, 60 mins 11. Adrenal insufficiency, a known association to his exceedingly rare disorder. Seen in about a fifth of patients with endocrinopathies (the 'E' of POEMS). And if severe enough and undiagnosed and untreated, invariably leads to death. The way Mr. J was looking, I doubt he would have lasted another day without the steroids.

Last I saw him, he was sitting up, having Jello. He was off his oxygen cannula, with his systolics running in the 130s, and looked great. I gloated to myself, and said no more to anyone. That sight of him in itself, is reward enough.

Net massage course to boost men’s libido

A female sex guru from Singapore will conduct a four-week course on the Internet on massage techniques to rejuvenate the male sexual organ, reported Sin Chew Daily....

Bwahahaha. I almost died laughing when I read this in the local papers.

Is there really a need to conduct a course to teach one how to massage to rejuvenate the male organ??? Or maybe I'm being too presumptious.

Ultrasound

We had our first 3D ultrasound the other day. Thanks to the wonders of modern science, we are able to see the real-time facial expressions of our baby. The frown, the pouty lips, kinda reminds you of someone else doesn't it? Oh yea, that's right.

Heh. Then again, she's all squished up in the womb, it's hard not to look wrinkled and pissed. That's why, my personal (and unpopular) view is that ALL newborns are ugly. They're smelly, slimy, all bruised and banged up from the ultimate spelunking adventure, like a person being forced out of a keyhole. Cute, they are not. Not then, anyway.

Really, ask the dads. They won't freely admit it but you can tell it on their faces when the nurse hands them their babies.

They're going, "Omigod, what is THAT? Did she do this with the mailman? No way can that be mine...". But out of fear of spousal homicide, they smile and force out a tear or two.

Only after a couple of weeks when the swelling and wrinkles have gone away that they begin to morph into little angels.

Well, we have about 3-4 weeks before we find out if our little one has a future in British politics.

Being Oncall

My wife tells me I complain too much when I'm oncall. Apparently all my neighbours and friends know I'm oncall because I leave pissy comments on my Facebook profile and complain a lot about stupid consults on my blog.

So, as I start another week of call I pledge to be more positive, and complain less.

(HAH! I doubt I can pull this one through)

Baby Shower

We had a baby shower for Kristin over the weekend. Family and friends came from TX, WI, MN and MA and so we had a pretty good crowd. Though I grudgingly joined in (all the guys were preferring to hang out in Hooters) admittedly it was pretty damn fun. And the best part was having all those close to us share in our experience, the inevitable growth of our household (and not I'm not referring to my waist circumference though that is probably applicable too). It was a neat feeling, a very tangible excitement that everyone shared with the anticipated arrival of Shim (no, we still have not decided on the name) in exactly 4 weeks.
And no, we were not dressing up as some superhero. Just some games we had to play though thankfully I didn't have to eat soured Mac & Cheese this time.

So, she's due July 7th. I have a gut feeling though that she'll come early. Any bets on the due date? Closest date/time wins a prize!

My Top Ten Nonendocrine Consults

1. Smelly armpits
2. Excessive sweating (sounds like me)
3. Weight gain
4. Weight loss
5. Unsatiable appetite
6. Low libido (usually the men)
7. High libido (the couple of cases I saw were men, brought in by their wives!)
8. Tachycardia (the clincher for this was the couple of consults I got came from of all people a cardiologist!)
9. Fatigue
10. Short penis (that patient was pretty disappointed when contrary to his GP's promise, I had no medicine to give him to lengthen his member)

Yup, that's all real, not made-up stuff. True, rarely can hormonal disorders cause some of the above symptoms, but so can dozens of other pathologic and physiologic conditions. But to blame it on 'hormones' with no biochemical data seems a bit presumptious on the referring doctors' part. So, it's no surprise that I end up disappointing most patients I see when I tell them their tests came back OK.

I was befuddled when I saw that consult yesterday for a problem with smelly armpits. Apparently, this is a sign of a hormonal problem. My alma mater must not have trained me well. Whatever that disease is, I must have a terminal case of it!