(no subject)
I'm on peds right now. Night float, to be specific. Currently, I am bored out of my mind. I love coming to work. I love the challenge, I love discussing (arguing) with attendings, I love working with patients. But this week, I have spent every night up in the call room, trying to find something to watch on the computer (I've watched all of "How I Met Your Mother," "Pushing Daisies," "True Blood," and the most recent season of "Dexter") and I'm BORED!!!!! Plus, I go home in the morning, sleep the whole day, and get up in time to wave bye to my roommate before I go back to work. Ugh. Only one more night of this.
Not to say we haven't had some interesting patients. My first day in clinic last week we had a 14 month old girl come in with a week of easy bruising. Just putting on diapers bruised her. She had a bruise in the top of her mouth from her spoon. She'd falled the day before and given herself a black eye. (Note to parents out there--these are all bad signs--don't wait to bring your kiddies in.) We knew from looking at her that her platelet count was low. The only question was--were her platelets the only cells that were low? Or were they low because her white blood cells had infiltrated her bone marrow, making no room for platelet production or red blood cell production (ie, leukemia)? Her parents knew enough to know leukemia was in the differential. I can in early the next morning to find out what her labs showed. The average person has platelets between 150 and 300. We don't worry about bleeding until the level drops below 50. I recently had a guy leave AMA with platelets of 26 (and I worked hard to get him to stay). Spontaneous bleeding doesn't happen until aroud 15.
This little girl's platelets were 4.
It was the kind of lab that pops up and your first instinct is to run to the room to make sure the kid is still alive.
She was fine, in the end. She had something called "idiopathic thrombocytopenic purpura," which happens following an infectious disease (in her case, the chicken pox) that causes the development of anti-platelet antibodies. Her platelets were being attacked by her own body. Two days of IVIG solved the problem and she went home with platelets of 46, with good follow up. Pretty impressive, and a great lesson.
This morning, Sarah called me because Jane had yellow boogers when she woke up. Jane, in case you don't know, is my niece. She just turned 7 months two days ago. She's adorable. She is sitting up on her own and just learned to crawl. She eats baby food now, and apparently her own snot as well, which I learned when I went over to make sure she was fine (which she was). She does this nose-wrinkle thing that is so cute.
Anyway, hopefully I'll get to see Victor this weekend!
Not to say we haven't had some interesting patients. My first day in clinic last week we had a 14 month old girl come in with a week of easy bruising. Just putting on diapers bruised her. She had a bruise in the top of her mouth from her spoon. She'd falled the day before and given herself a black eye. (Note to parents out there--these are all bad signs--don't wait to bring your kiddies in.) We knew from looking at her that her platelet count was low. The only question was--were her platelets the only cells that were low? Or were they low because her white blood cells had infiltrated her bone marrow, making no room for platelet production or red blood cell production (ie, leukemia)? Her parents knew enough to know leukemia was in the differential. I can in early the next morning to find out what her labs showed. The average person has platelets between 150 and 300. We don't worry about bleeding until the level drops below 50. I recently had a guy leave AMA with platelets of 26 (and I worked hard to get him to stay). Spontaneous bleeding doesn't happen until aroud 15.
This little girl's platelets were 4.
It was the kind of lab that pops up and your first instinct is to run to the room to make sure the kid is still alive.
She was fine, in the end. She had something called "idiopathic thrombocytopenic purpura," which happens following an infectious disease (in her case, the chicken pox) that causes the development of anti-platelet antibodies. Her platelets were being attacked by her own body. Two days of IVIG solved the problem and she went home with platelets of 46, with good follow up. Pretty impressive, and a great lesson.
This morning, Sarah called me because Jane had yellow boogers when she woke up. Jane, in case you don't know, is my niece. She just turned 7 months two days ago. She's adorable. She is sitting up on her own and just learned to crawl. She eats baby food now, and apparently her own snot as well, which I learned when I went over to make sure she was fine (which she was). She does this nose-wrinkle thing that is so cute.
Anyway, hopefully I'll get to see Victor this weekend!