A Couple Zebras.

"We look for horses not zebras." "Common things occur commonly." yeah yeah, we've heard it before. But, my friends, sometimes zebras do happen. Even in Family Med.

1. Mastoiditis: YAYYYY, how many test questions have we seen about this?! My exam master is obsessed with this question I swear. Well, I finally saw it. This poor lady presented to the ER with ear pain that felt like "I was being stabbed in the ear with a hot poker." Whoever saw her in the ER, looked in her ear, said it was red, told her she had TMJ and sent her home with pain meds.... Boo. Fast forward 24 hours and we see her. Her ear was not "red" it was flaming on fire with smoke rolling out of it. Yes, I'm dramatic but you get it. I have never seen an ear look like this. Holy cow. She was exquisitely tender in the mastoid process and in terrible pain. Doc was pretty certain she had progressed from otitis media to mastoiditis. Tx: Augmentin 875mg BID X 10 days.

2. Colon CA: Okay, this doesn't sound like a zebra, but when it shows up at an urgent care visit as epigastric pain it seems pretty unlikely. This lady was in her 50s and presented with epigastric pain x 4ish days which was getting worse. No N/V/D. No weight loss. No melena. But I just didn't feel right about it. Had a "feeling" something was wrong. She was in real pain and you could tell she wasn't being dramatic. Tried to tell me it was from a bad Arby's sandwhich because her husband had one too and he didn't feel well. But that had been days ago and she had no GI upset symptoms, just pain. Also, brother died of pancreatic CA in his 50s. So, we didn't know exactly what to do, but ordered stool culture work/up just in case she did have some type of infectious thing from bad food (knew it was unlikely but just needed to do something) and a CBC to see if she had signs of an infection. Her hemoglobin was 6.7. She was then directed to the ER who did a complete work up, gave her a blood transfusion, and the tumor was found on CT. She was admitted for surgery during the same stay. What a whirlwind for that patient...come to urgent care with stomach ache, end up at hospital getting a biopsy and scheduled for bowel resection. :( I keep thinking of her and hope she is recovering well.

Med Students.

Let's be honest, as PA students when we hear we are going to be paired with a med student on a rotation we get a little nervous. At least I do. I always worry (shocking) that they will know so much more than I do, or I will look stupid 24/7. In all reality, I have loved my time working with med students. They have a wealth of knowledge and we can really learn a lot from them. Although we are all trained in the same medical model, their didactic years are much more in-depth than ours whereas our education seems to be more clinical and patient based (just my opinion). Sometimes I feel like we are more comfortable around the patients, whereas they are more comfortable academically in terms of discussing the latest and greatest treatments, forming crazy differentials with diseases I have never heard of etc. Bottom line: we make a good team. And isn't that the whole point anyways? I have been with a med student my entire Family Med rotation and I learned so much from him and her! So thanks Chris and Lauren if you ever read this :)

Laughter is the Best Medicine.

So, in medicine you hear the most ridiculous things imaginable. Sometimes from patients, sometimes from co-workers, and shoot sometimes from yourself. All of us in healthcare are kind of messed up with a pretty weird sense of humor. I figured I would make this a regular thing and post some of the hilarious things I hear during the day. Because yes, some of them are so good I write them down. This is not meant to be disrespectful at all, just to add a little humor to an otherwise very stressful career. And hey, at the end of the day if you can't laugh about the little things, you just aren't doing it right.

Just a few to get ya started...

"Buncha clowns up there in Washington fighting like dogs over a bone." (Veteran)

"I looked at her with her big, fat butt and thought you aren't gonna hurt me." (pt describing fight with daughter)

Patient: "I'm meeting with a dietician and she wants me to use that fake sugar in the pink packet. But when I put that in my coffee I can tell my sugar drops out so I have eat a dozen donuts. Seriously, the other day I felt my sugar drop and ate a large bag of cheese popcorn and a box of nutter buddies and that fixed it." (Diabetes 101)

"I don't think she has a UTI, I think her G-spot is infected. You know it makes fluid and that fluid gets shot back up in there." (Boyfriend telling me what is wrong with his gf)

"After you took care of the hemorrhoid it looked like 2-pac got shot up in there." (Nurse to doc)

Play that funky music? Please don't.

Okay, after about 3 days at my rotation I started noticing the songs that are played as "background music" over the surround sound are largely inappropriate. I could not help but laugh out loud while I was in the room with a patient when "I'll make Love to You, like You Want me To" starts playing. HELOOOO!?!? is no one hearing this? What if I was doing a rectal exam at that exact moment? I would have literally died.

Anyways, I have now brought this to the attention of the nurses and my doc (who is 65 and doesn't even know the songs and/or care) and we have had some long laughs. Another favorite is Bruno Mars who casually sings the lyrics "Your Sex Takes Me To Paradise." I can't even. Even.

I spend a good portion of my day singing inappropriate song lyrics with the nurses while at work...time well spent? I think so. I just wonder what the little grandmas think when they hear these songs...hopefully they can't hear them at all.

 Now Hiring: New playlist manager. Please and thank you.

New Home, New City

With my new rotation came a new home and a new city. We are now living in Carmel, IN and words cannot describe how happy I am. I am FINALLY living with Adam which is so much fun. We can now do normal married things together like let the laundry pile up for weeks, go to the grocery store together, make new meals, try new restaurants, sleep in on Sundays without the pressure of knowing Adam has to leave. It is simply wonderful. And hilarious. We've never lived together so if I thought I knew him well before I was mistaken. Why does he leave piles of clothes behind the bathroom door? Why does he insist on buying orange juice that is so expensive we could buy 2 jugs of the other kind? Why does he watch shows with the volume up so loud I'm getting hearing loss?  He cracks me up.

With a new home comes new visitors!! We have had such a great time with friends and family coming to visit. My mom, dad, brother and Ali came for dad's birthday, Adam's parents came this weekend, our KY friends came a couple weeks ago and I just love it. Entertaining and opening your home to others is just the best. Not to mention that means champagne and treats so I'm all for that.

Exploring Carmel and all its little quaint shops has also been fun. We have been to a ton of restaurants and have our new fav pizza place (Boom Bozz), our go-to quick meal spot (Zoup!), our swanky spot (divvy), our sushi spot (Kona Grill), brunch spot (Patachou) and our laid back/bar/awesome food/can watch sports spot (Matt the Millers). Basically we have just been eating. I don't hate it.

Treats at Cooper's Hawk Winery.

Hello Family Med!

Hello again friends,

Yes, once again I have been on a blogging hiatus. Sorryyyyy. I have been in Family Med for the last 6 weeks or so with a preceptor in Indy. He is a older man and we get along just fabulously. He is sarcastic and gives me grief all day which makes the days fun and interesting. He is an amazing teacher and a big advocate for preventive medicine.(Which, in my opinion, we will slowly see go down the tubes with government healthcare...less and less will be approved or be considered "not cost effective." Anyways, I won't go down that road, lets all just get along.) I spend two afternoons at an urgent care clinic in Zionsville which I love. My doc also has a PA who has worked with him for over 20 years who I also adore. The first month I was mainly with the doc but lately I have been splitting my time. The PA does half acute visits and half follow-ups which is more my cup of tea. I can only handle "Diabetes, lipids, BP" checks for so many hours a day before I start to black out.

What this rotation has taught me is that I NEED variety. I always thought I would specialize because I am so incredibly Type-A and feel the need to know everything about what I am doing so it can be perfect, but now I'm not so sure. I thrive off the urgent care visits and acute visits because you never know what you will see. I love doing small procedures and freezing things off, sewing things up etc. So, maybe a specialty isn't what is best for me....its exciting to see my likes and dislikes continually change throughout this year. Only problem is I should've had my elective and selective rotations picked out weeks ago...whoops. Hey you can't rush your career and I'm working on it. Hoping for sure to do one in Urgent Care and then maybe Derm? ER? GI? eek! The opportunities are endless. Bets on what my first job will be?