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I cannot imagine anything harder than the suffering I see too many parents go through when their child has a fatal, progressive  neurodegenerative disease.  With the diagnosis they lose their child’s future just as suddenly and unexpectedly as if they were hit by a Mack Truck.  However,  instead of the process being over in any brief period of time, it is often drawn out over many years.

Leukodystrophies, Mitochondrial disorders, Inborn errors of metabolism,  Rett Syndrome, Duchenne Muscular Dystrophy and a host of other heartbreaking diseases are a death sentence, only one that is indefinitely prolonged.   In all these examples the child gradually loses abilities he or she once had.   Read the rest of this entry »

There just seems to be something about July.  Everything at the hospital is new and enthusiasm is bursting.  It has made for a busy week in trying to keep up with the very best the internet has to offer.  I have expanded my usual offerings and still have to great posts I’ve left out.  If any of you are real die hard fans, subscribe to the nuggets from all over feed on the sidebar.  For those who just need a weekly fix of the world wide web’s offerings, I present the best I’ve seen- Read the rest of this entry »

His room was a shrine to his own memory, a eulogy for a still living, and breathing child. Pictures adorned the the door and the wall, smiling, vibrant, full of life. This boy last week was a healthy, happy, growing, developing two year old child. Colorful children’s crayon scribblings were placed at strategic intervals to liven up the cold, stark hospital room. Get well cards from extended family are also peppered around the walls. Over his crib, lies a recent portrait, the big smile and engaging eyes standing in stark contrast to the current blank stare. His limbs lay motionless, stiff, rigid, spastic, with toes pointed, betraying signs of a brain ravaged by lack of oxygen. He has been having seizures, with eye fluttering, and facial twitching about multiple times per day despite two anticonvulsant medications. This and breathing are the only spontaneous movements he makes. All this, the result of a single grape.

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Choosing on a medical specialty involves learning your own answers to a series of questions?

-Do I enjoy patient interaction or not?

If no, consider Pathology or Radiology

-Do I like surgery and procedures more, or medicine and clinical reasoning, or both?

note- Anesthesia is a procedure and OR specialty, sort of surgery-lite.

Both- Ophthalmology, Orthopedic Surgery (well peds ortho anyway), ENT, Ob-Gyn, and Emergency medicine for procedures

-Do I prefer general, broad knowledge or limiting to one area or system, Primary care or specialist?

This is often a question of knowing a little about a lot, or a lot about a little.  However, It also involves whether you prefer relatively healthy patients or relatively sick.

-Do I do I prefer to see kids, adults, or both? (remember you can do almost anything for kids that you can for adults.)

The last question was easy for me.  From my point of view, pediatric care is superior to adult medicine in so many ways. Read the rest of this entry »

In Child neurology we are required to do a year of adult neurology. This is a year of complete culture shock. Children’s hospitals and adult hospitals are two completely different worlds. It is interesting to see the adult neurology residents complain about how chipper and upbeat the pediatrics people are. This is an odd complaint, until you realize adult neurology residents feel completely out of their comfort zone in knowing how to manage the patient. fear and discomfort are only augmented by sleep deprivation and being pulled in several directions at once, as you tend to be on call, Perhaps they can be forgiven when they really find it difficult to draw enthusiasm when awoken at 3am to hear about some “kiddo.” For me, being out of my element with adult patients is an even greater culture shock. Going from chipper to somewhat cynical and demanding is worse than the other way around.

The culture shock is particularly profound the Neuro ICU. For one thing, it is a prime site for so many spectacularly horrific things. While children with neurlogic problems can be heartbreaking, somehow I manage to deal with it. There is something about dealing with severe traumatic brain injury, brain tumors, stroke and brain hemorrhage all day that is particularly soul killing. The place is just saturated with death and loss. It was here I came to understand the phenomenon in medicine that is gallows humor.

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  As I recovered from depression, I discovered a whole new ailment, anxiety.  One of the first side effects the medication gave me was panic attacks.   I had a lot on my plate, really.  I had to toe the line, with no relapses.  I worried incessantly about the future.  I worried about my patients.  I worried about the rumor mill surrounding me.  I worried about the impressions, fair or otherwise, that others had of me. I worried about stigma. Read the rest of this entry »

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