Author: jordanb627

Today was my last day at the Cary Pediatric Office! It was a normal day as far as appointments go! We started off at 8:30 with several check-ups that ranged from all ages. We had an ADHD consult as well. I have seen several different examples of the “ADHD Consult”. The appointment depends on several different factors. One is the type of ADHD (inattentive or hyperactive disorder). Another factor is whether the child needs to be medicated. There are several different types of medications that all do something slightly different. Some ADHD medicines can build up to a peak point of focus, and then will have a large drop off in the evening. There are medicines that cause the same level of focus all day until the child goes to bed. The medications that the parent chooses depends on what the parents want for their child. After that appointment Dr.Seidel and I ate lunch together. We spoke about my possible career choices and just the future in general. It was extremely informative and an experience that I will never forget. After lunch we jumped right back into seeing patients. We saw a knee and spinal injury. We also saw another bug bite that needed to be extracted. We also saw several check ups. I have learned so much from Dr. Seidel and all of her colleagues. The nurses taught me so many lessons about patient care and how to have fun while working. All the doctors had so much wisdom about their experiences and advice to share with me. I have had an invaluable experience in this office and Dr. Seidel has been an amazing mentor during these eight days!!

I started my day at 1 o’clock. This is because the office had issues with some technology and a doctor calling in sick. Therefore, I was told that it was a little too hectic for me, and that Dr. Seidel didn’t want me to have to suffer through the chaos. We saw 15 patients in the afternoon. The first interesting appointment that I witnessed was a nexplanon injection. Nexplanon is a birth control method that is injected into the arm. It releases hormones to slow and stop periods for birth control. Dr. Seidel specializes with the injection of the birth control. She first numbs the arm superficially. Then, she takes a larger needle to numb the deeper muscles in the bicep part of the arm. The injector has a large barrel that the actual nexplanon sits in (pictured above), so if the arm was not numbed the injection would hurt a lot. Our next appointment involved a patient that was bitten by a dog. Dr. Seidel explained to me that human and cat bites require oral antibiotics. Human mouths have a lot of bacteria and germs. Cats have sharp teeth that puncture deeply, so the wounds are not superficial. For dog bites, the need for antibiotics depends on deepness of the bite and if the dog had its shots. The patients dog bite only needed anti-bacterial cream and pain medication for the bruising. There was also another appointment that involved a patient with a bug bite. Dr. Seidel had to extract the stinger with tweezers. There were several more check ups and sick appointments that we saw this afternoon as well. Today was another great day at the office, and I am so sad that my last day is tomorrow!!

Today was another eventful day at the office! I worked with both Dr. Villareal and Dr. Zimmerman. I spent most of the morning working with younger patients with Dr. Villareal. There were several one year old check-up’s. This check up is very important because several vaccines are administered and several blood tests are done. The blood test looks for lead levels, hemoglobin levels, and iron levels. The doctors want to look for any diseases from the low iron levels (anemia), and low hemoglobin levels can be a sign of a number of problems. Another interesting appointment involved an abscess on the arm of a patient that  looked very irritated, but only needed some anti-biotic cream. After lunch, I worked with Dr. Zimmerman. We saw several different sick calls. There were several cases of strep throat (testing kit pictured above). One case in particular was very interesting. The patient was very sick with vomiting, fever, and headache. They tested negative for strep throat, but had a false positive for the flu. From this false positive, I learned that the CDC does not treat young patients with TamiFlu (most common treatment) because it causes the younger patients to vomit. Dr. Zimmerman really thought it was strep because it is not flu season, and the patients guardian had strep very recently. After the negative strep test, the nurse swabbed the sample on a petri dish and will be looked at tomorrow morning. The patient was sent home with strict orders of rest and Tylenol.

Today was more another normal day in the cary pediatric office. I started the day off at 8:30 with Dr. Seidel. We saw several young children with sick visits. The diagnosis ranged from patient to patient, but it was generally either an ear infection, virus, or bacterial infection. All pretty simple to fix with time and the right medication. One interesting viral sickness that I learned about is called “hands, foot, and mouth disease”. This is a really interesting virus that occurs mostly in toddlers and is very contagious. It quite literally causes a viral rash on the hand feet and mouth of the toddler. It only needs some pain medicine and time to pass, but the rash looks like it is very red and irritated. It was interesting to watch Dr. Seidel have to explain the infection to a worried parent, and that their child just needed time. I also saw some repeat patients from my previous week. They still were not better, but sadly they were sick with a virus and that can only be treated with time and pain medication. There was some time for me to work with the nurses in the afternoon as well. I got to watch them do labs on patients blood. Another lab that I witnessed several strep tests. I also learned the process that it takes to document and log all the vaccinations they have within their office. A few days ago I mentioned a patient with appendicitis. It turns out that the appendix ruptured during surgery, and the patient had to spend extra time in the hospital. Dr. Villareal explained how the appendix burst with a diagram (pictured above).  It was a normal day, and I saw about 17 different patients. Can’t wait to continue my time this week with everyone at Cary Pediatrics.

Today, I was with Dr. Villareal. It was fantastic! We saw about 21 patients and all appointments were different. There were several interesting appointments today. The first interesting appointment involved a young patient that was born with a smooth brain. This means that they don’t have the classic ridges that are present in most peoples brains. This means that the patient cannot eat, breathe, or speak on their own. They were on a ventilator as well. This case was interesting because I had never heard of a brain becoming smooth, so it was interesting to learn about the effects that it had on the patient and their life. Another interesting case in the afternoon involved an older patient that was suspected to have a kidney stone issue. This was interesting because kidney stones are extremely uncommon in kids. All of the symptoms were present for it to be kidney stones, and Dr. V recommended for the patient to get a CT scan as soon as possible. The issue was that the insurance did not want to approve their scan, and wanted them to have an ultra sound instead. This was an issue because if the stone was too small it would not be seen in the ultra sound, and wouldn’t give them a diagnosis. Dr. V got on the phone and convinced the company to let it go. That is another aspect that is a part of the private practice life, insurance issues. There were several instances that allowed me to play with young children, and that was some of the best times of my day! I even received a beautiful drawing (pictured above) from one of the patients I got to be with during their appointment. Today, and this week in general was very hectic in the Cary Pediatric Office. I have seen a total of 87 patients (this week) with three different doctors with an average of about 22 appointments a day. I have learned several things but the key ones are below.

A Beginners Guide to Pediatrics

• Always listen to the younger patients heart and lungs first because once you look in their ears they don’t trust you because it is uncomfortable.
• Generally, if the patient has cold symptoms and they are negative for strep, it is just a viral infection. This means that the fever will run for 5 days (it will peak on day 3), and as fever goes away a rash may develop (which is normal). I saw this at least 5 times everyday I have been in the office.
• All doctors have a different way to do things. Whether it is the order of visit/questions or the way they deal with parents. There are subtle differences between every doctor and their process.

I was with Dr. Zimmerman for two appointments in the morning before I had to switch for two appointments with Dr. Villareal because of age restrictions on who I could see in the office. Therefore, I worked with Dr. Villareal for a case that shared the same patient that I saw with Dr. Seidel. Their symptoms had progressively gotten worse in the follow days of the appointment. It turned out to be a viral infection and rash that had really run its course and the child just needed a few more days of rest before they were truly ready to get back to normal within their routine. Today showed me that more often than not, patients will come in with lots of symptoms. Many are viruses and infections that just have to run their course. The doctor can test for all kinds of things but for certain cases, there is just nothing that the doctor can do to help. There were a few patients today that had this diagnosis for their sick appointment. The doctors told them to come back if it got worse but it was still very eye opening to hear that there are times that the doctors can’t always fix everything that is going wrong with people. The afternoon was also very interesting. Our first appointment back from lunch involved a girl getting her ears pierced. She was very nervous, but the smile on her face after the appointment was well worth the pain! The next appointment involved a baby with jaundice. This is a yellowing of the skins and eyes due to chemicals in the body. Dr. Zimmerman showed me a graph (pictured above) to show the risk of jaundice based on a chemical and the baby’s age.  Our last appointments of the day involved several check up’s for several different age groups. I learnt a lot about certain diseases that patients can present with at their exams. This varied from eye abnormalities to gene abnormalities that changed a child’s ability to store iron in their body. I learnt about the symptoms of the disease, and the tests involved with each one. Another major thing that popped up during the afternoon was a neurology report that came in for Dr. Zimmerman. It involved a child with bad migraines and vertigo. Their neurologist had them go through an MRI test on the child’s brain. The results came back positive for a brain tumor. It was smaller, but it will be difficult to remove. This showed me that even though the practice may have a lot of runny noses and sore throats, there is still large surprises. It shows how important the doctor’s opinions are in the practice.  I have loved working with Dr. Zimmerman today, and cannot wait to work with Dr. Villareal tomorrow!

My second day at the Cary Pediatric Office started just as quick as the first day. As soon as I walked in, I was being pulled to go and meet with a patient for their 3 year old check up. The first few appointments in the day were about check up’s and vaccinations. I was able to watch the process of vaccinations within their office. This included the prepping of the vaccination, and (sadly) the injection. After the standard appointments, I was pulled into another appointment by another doctor. His name is Dr. Villareal. He had a patient that had come in with symptoms of strong stomach ache, fever, and was really slow to move because of the stomach pain. I learnt that stomach pain all depends on where it is in the belly. Dr. Villareal knew almost immediately by the symptoms and feeling the stomach that the child had appendicitis. The pain was localized to one area and the child refused to move around a lot because of the pain involved with the infection. One aspect that made the appointment even more interesting was that the childs mother only spoke Spanish. Therefore, Dr. Villareal had to explain appendicitis in Spanish, and it was very interesting to watch him interact with her through speaking the language. He also showed me the blood test results that he completed that showed all the signs of the appendicitis such as an elevated white blood cell count. I also got to witness several other tests and their results with Dr. Seidel. I saw another test that was for an asthmatic child and it was to see how well their medicine was working. The test was all about how hard/fast/long the child could breathe for and the purpose is to test the expanding and contracting of the lungs. The results were in a graph form to show the intensity between the several times that the child had to blow into the test. After this, Dr. Seidel and I went to her office to call a patient, but they didn’t pick up. So it turned into a discussion between Dr. Seidel and I about my interests for the future, what she has learnt from her job, and the advice she had for me. Overall today was another great day and I learnt so many things!

Today was my first day in the Cary Pediatric Office with Dr. Hope Seidel. I got to the office at 8:25 and her first appointment was at 8:30. We jumped right into the appointments for the morning. I was able to go into all the appointment rooms and observe Dr. Seidel’s interaction between different ages and personalities. I didn’t fully understand the meaning of age range for for the office until today! In the morning along we saw ages ranging from 21 month olds to a 21 year old. Their reasons for coming into see Dr. Seidel all varied as well. Whether it was an annual check up for a 6 month old or if it was for a child that had been in a car crash only a couple of days ago and needed to check in with their doctor. I got to witness it all! I also got to know many of the nurses that work within the office. Dr. Seidel’s nurse is named Hayley, and she is very funny. I got to watch her complete a strep test, and it was surprisingly easy. First, a sample was taken by Dr. Seidel with a cotton swab and given the Hayley.  All Hayley had to do was put two different reactants in with the test, and after two minutes the swab was taken out and a piece of paper that looked like a pH test was put in and the test did come out negative for the little girl that was being tested. I got to shadow Dr. Seidel for several interesting cases. They were all extremely different in nature even if they were for the same purpose of a yearly check up. I didn’t realize that this would be the case. I originally thought that most of the appointments would all encompass the same thing and wouldn’t have much diversity. I was proven wrong after all the morning appointments. People have such different personalities and backgrounds that allow them to all have different needs for the same things such as a check up. The parents also play a huge role in the way the appointment is structured as well. These maybe obvious things but I hadn’t truly thought them through till I was experiencing them first hand from Dr. Seidel’s shoes. She told me later that there is a different way to handle certain parents. The first thing she told me to watch was the different interactions she had with different patients. She doesn’t treat any appointments the same way because they are all different people with different needs. Overall my first day was a blast and I have already learnt so much and I cannot wait for the rest of the time here at Cary Pediatrics!