Tuesday, September 19, 2006

the music meme

so flea tagged me with the 7 songs meme.
"Seven songs you are into right now. No matter what the genre, whether they have words or even if they’re not any good, but they must be songs you’re really enjoying now".
thanks flea.
really. thanks.

iTunes doesn't lie.

to figure out my top 7 songs, i looked in iTunes and found the most frequently played tracks.

it was a little scary.

here's how it broke down.

#1: what i know only as "track 09" by built to spill. it's a great song. it's on my running mix, which is probably why it is the most often played track. yeah. i run a lot.

#2: graduation day, chris isaak. i just love it. what more can i say. his voice embodies McDreamy.

#3: in the waiting line, zero 7. from the garden state soundtrack. the whole soundtrack is fantastic. zach braff's new movie just came out, the last kiss, with a similarly splendid soundtrack.

#4: mushaboom, feist. makes me smile.

#5: i want you, bob dylan. the man is pure genious.

#6: nothing brings me down, emiliana torrini. she has an amazing voice. actuallly, the whole album, fisherman's woman, is amazing.

#7: better together, jack johnson. from the curious george soundtrack. if you're curious why i listen to this, check out some of my previous posts from august.

and coming in a close #8 was a tie between camping next to water (badly drawn boy) and crazy in love (beyonce featuring Jay Z) ... what can i say ... i have eclectic taste in music.

now 7 tags. well, i'm not sure i can tag 7 who have yet to be tagged, but i might come close.

sister smile
fat doctor
sid schwab

that was 7, right?


so. one of the perks of being in a small residency program is mentors.

i have a great one.

he just came to our fair institution three years ago from a much bigger place. he's the only pulmonologist here. and he has taken me under his wing, so to speak.

i am the guinea pig in a new pilot program that we're trying here. for my continuity clinic, i alternate every other week in his pulm clinic, managing my own panel of patients. CF, asthma, i even have a kid with primary ciliary dyskinesia. pretty cool stuff.

in compliance with the RRC guidelines, i even have my very own set of goals and objectives.

i know, i know...just what you've always wanted!

i still have my panel of gen peds patients whom i love working with, but i really love my pulm clinic. and i'm not a clinic person.

he also set me up with a research project, working with one of the microbiologists here. it's really neat and i now have access to the cf database. i can query searches to my hearts content. i know, i'm a total dork. i can't help it. can any of us? seriously?

during my intern year, ever since he found out i wanted to do pulm, he has talked about setting up a pulm fellowship here, in conjunction with another small, academic children's hospital up the highway a bit, which also happens to be where i went to med school. i always nodded and said, yeah, sure, that would be great. but i never really took him seriously.

until this week.

he basically told me that i should look at other programs because the timing might not work out, but that he was trying to get things started and what did i think?

we're pretty academic here, so research wouldn't be a problem. and certainly there is no lack of patient volume given that there would just be my lone self.

but i guess that's my question. there would just be me.

would i be missing out on having other fellows at the same stage of training? is there some benefit to being in a big institution with lots of fellows in other disciplines?

i'm still finishing my cv and figuring out where to send it. i'll send it to all the programs in big cities. but eventually, this is a place i wouldn't mind working. so the idea of finishing my training here is quite tempting. but also a little daunting.

Sunday, September 10, 2006

musings on a sunday

i have a relatively new housemate, since August, really. he's quite nice, quiet, respectful. it's been sort of fun to live with someone after having been on my own for awhile.
well, he went to his brother's wedding this weekend, leaving me with the apartment all to myself, which was sort of nice. i spent the weekend catching up on things that had been piling up during my picu month...bills, laundry, journals, etc.
there was an article in the most recent Pediatrics (Pediatrics 2006;118(3):888-895) about screening for cystic fibrosis with the newborn screen (NBS). they looked at a cohort of children in northwestern Italy diagnosed by NBS between 1997 and 2004, looking to see if there was a difference between the NBS children and the historical controls in the time to infection with Pseudomonas aeruginosa, a bacteria that is associated with a decline in pulmonary function and an increase in morbidity and mortality.
interestingly, they found a shorter mean time to P. aeruginosa infection in the children diagnosed by NBS (183 days for NBS children vs 448 days for historical controls), suggesting that newborns are more readily infected with nosocomial bacteria than older children diagnosed at a later point based on clinical symptoms. this would sort of fit with our understanding of the newborn's evolving immune system.
what this study brings up is that the NBS is not an entirely benign intervention. one could assume that earlier diagnosis and access to treatments and resources would be a positive thing for kids with CF. theoretically, it is. however, we as practitioners need to be vigilant about infection control, with the recognition that our adherence to CF precautions is profoundly important in protecting these vulnerable infants. in our clinic, we see a mixed population of pulmonary pathology, including asthma, CF, PCD, complicated pneumonias, etc. we try to segregate the CF patients to the CF clinic days, but this is not always possible. in addition, the allergy/immunology clinic is run out of the same clinic hallway, increasing the chance for more nosocomial infections. makes me want to carry around lots of alcohol swabs.
coincidentally (or perhaps not), the next article (Pediatrics 2006;118(3):896-905) in the journal was about the cost-effectiveness of various methods of CF NBS in the netherlands, where they use several different methods to confirm the diagnosis. cost-effectiveness studies sort of creep me out a bit. i guess that's the clinician in me. how can you boil a child down to "life years gained" and "willingness to pay values per life year gained"? and whose willingness to pay are we talking about?
another topic this article addressed was parents who chose to terminate the pregnancy if they knew the fetus was affected. in the abstract, i can understand this. however, having met so many kids with CF who lead lives full of happiness and normal kid experiences, albeit punctuated by more frequent visits to their doctor, i struggle with this on a personal level. it is akin to the debate regarding terminations for trisomy 21 fetuses in a way.
i don't pretend to have any answers. just food for thought.

Saturday, September 09, 2006

little miss sunshine

if anyone is in need of a good laugh, i recommend little miss sunshine . it's dark in parts, but i like that sort of thing. my friend who always falls asleep in movies, no matter how interesting they are, didn't fall asleep in this one because she kept laughing. you'll find yourself thinking, 'how can i be laughing at this?' but you'll laugh nonetheless.
isn't laughter the best medicine?