taylor_weber

Day 8!!

Today was the last and final day of my stay at Cary Peds and I loved it. For being my last day it was incredibly hectic but nevertheless a great experience. Dr. Seidel handled the rush excellently and showed me how to stay calm in even the most stressful events. Again this morning we saw the little boy with the dog bite and while improving slightly his hand was still producing more discharge than Dr. Seidel would have liked to see. With this though she allowed them to continue with antibiotic and a recheck tomorrow afternoon. While he appears to be on an upward trend there is no telling how things will go from here. Additionally today I learned about a new program Cary, Apex, and Fuquay Varina Pediatrics is starting. It is called the Reach out and read program. It is designed for children 0-5 and is a grant given to pediatric offices where a certain amount of patients are on medicare. While the Fuquay office qualifies and received the grant, Cary and Apex did not but they decided to use their budgets to supply the program to all three offices. With this program books will be distributed to families at every wellness check and it gives the pediatrician a place to start a dialog about reading and getting children to recognize words, pictures etc. It provides age appropriate books moving in about increments of 6 months. Overall I think this is a great program for children in need. I thoroughly enjoyed my time at Cary Peds with Dr. Seidel and thank them all so much for this opportunity. I also recommend to anyone looking into pediatrics in the following years!

Image result for reach out and read info flyer for reach out and read

Day 7

Today was filled with some wonderful, new experiences. The morning was a typical morning with one case that stuck out to me. We had a child come in with a dog bite. He had been bitten the previous day by an unknown dog. Despite having cleaned the wound at the time of the accident he presented early this morning with signs the infection had spread. Dr. Seidel promptly extracted puss from the wound to culture. She applied some topical antibiotic to the cut and bandaged it for the day. She also prescribed an oral medication for the infection and another antibiotic cream to help. With all this; however, she doesn’t feel that they were able to treat the cut fast enough. Because the cut was in the thenar area of his hand, the infection will spread quickly. As a result he is due to come back in tomorrow for reevaluation but, Dr. Seidel says chances he will have to be sent somewhere else to treat it are high. Check back tomorrow for an update!

My afternoon provided a bit of a different experience. I spent the majority of my afternoon with two nurses, Hayley and JJ. We were on the phones answering calls from parents and returning messages the doctors had left for patients. It was a very fun experience. Because you are always on the side of giving the call not receiving you never realize how much these nurses have to put up with on the phone. Especially in a pediatric office where they are seeing worried parents and non native speakers over the phone it can be very difficult. JJ and Hayley were great role models on how to handle the situation. They were always calm and collected on the phone and never showed frustration to the caller. They also provided as much information as they could to any question asked. Overall I was very impressed on how the answering of phones work and the communication system between the nurses on phones and doctors. They communicate through a portal in their database where they area able to send messages back and forth so the nurses can call parents and relay information to them. Thank you for the fun and new experiences today and I can’t wait to see what my final day holds!

Image result for thenar part of hand image from google – the purple highlighted area is the part of the palm that was bitten (thenar area)

Day 6

Today was another great day at the office. I once again shadowed Dr. Zimmerman. While today was mostly like the rest we saw a plethora of ear infections. One kid even had an infection in both ears! Different from today; however, I met someone who was against vaccines. Not entirely, but wanted to wait until the children were over 1 and walking. This was not possible though because you are supposed to get three sets of three vaccines each at 2,4,&6 months. It is also a Cary Pediatrics policy that kids who don’t get vaccinated must find a new care provider as they are putting other newborns at high risks when they are exposed. Dr. Zimmerman did a great job at easing the mom into the idea both firmly and understanding where the mom was coming from. In the end the mother was convinced to give each child a shot to see how they do to it and then come back in two weeks to do the same and so on and so on till the children are caught up (which will be a while as they are just over 6 months aka missing 9 vaccines). All in l good job Dr. Zimmerman and I am looking forward to returning to Dr. Seidel tomorrow!

Day 5

Today was filled with more sick calls and wellness checks. I spent my day with Dr. Zimmerman as Dr. Seidel was out of office. Because Dr. Zimmerman doesn’t normally work Monday’s we had more sick visits than anything. Our morning started early with a little girl who had fallen off her bed during the night and had an abrasion on her eyelid. After heavy examination (eye tests as well as feeling it) it was determined that it was just a minor cut. Dr. Zimmerman expects it to bruise over the next few days before it starts looking better. On top of this today I got to witness a case where translation was needed. This created more complications because we had to have multiple people in the room and someone was always talking. The appointments always take longer because it is like saying every sentence twice – once in english and once in spanish. The translator though was very nice to both Dr. Zimmerman and the family. Aside from this we saw multiple pink eye cases and sore throats. Pink eye is interesting because there is no test that can be used to determine positive or negative. It is simply diagnosed by observation. The eye becomes slightly pink or red and gunk tends to build up around the eye either during the day or sleep. (See photo below). I had a great day today and can’t wait to see what tomorrow holds.

Related image the top right is an example of typical pink eye. The bottom left would be that of a viral infection and the bottom right is one with allergies.

Day 4

Today was spent shadowing dr.seidel again. We started the day right at 8am with a surprising number of sick calls today. We saw kids from 8days to 18! Aside from sick calls and wellness checks we saw a lot of kids getting ready for kindergarten meaning lots of shots and paper work. As far as today’s new learns I got to learn about anorexia and eating disorders. Not only is it something that is harmful to you because you are not giving your body the nutrients you need but also because it messes with all the balance levels in your body. It can effect things like your magnesium and potassium levels. As a result blood work gets done constantly to check these levels. It is also not uncommon for those suffering from anorexia to turn around and not face the scale when their weight is being taken as to avoid making them fee bad. It is also a possibility for them to be enrolled in rehab units to help them recover. To apply for these doctor referrals and multiple tests must be done to ensure they qualify. Today we saw one who was getting blood work done for an application to a rehab facility. Other than that, today was another great day!

Outside the office (no way to take photos inside today)

Day 3

Today was a little bit different. I spent my day in a lactation consultation office. While my day was shorter is was filled with a plethora of learning opportunities. Our first appointment was at 10 and so we met 30 minutes prior to go over some basics as this was a field I have never experienced. Lactation consultations are something nursing parents may use if they have having trouble breastfeeding anywhere from a few days old till breastfeeding is stopped. Not only is it used to help improve breast feeding techniques but it can also be used as a type of therapy. Parents use it to talk about any troubles they are having and are given the ability to talk freely about what they are feeling and where they need help. With our first appointment we met a mother and son of about 2 months. This was their last appointment!! They have come very far Karissa mentioned (the lactation consultant at cary peds ) from losing weight when he was first born to gaining over 3 pounds. Our second appointment and last for the day was a 8 day old baby. While still losing weight and struggling eat we used this time to talk about a new action plan to keep the baby eating. Hopefully in the next few days he starts gaining back his weight! Although today was very new for me and a great learning chance I definitely will stick to a normal pediatrician!

photo of lactation consultant room

Day 2

Again today we saw a plethora of wellness checks and sick cases with visits today we saw kids aging 2-16. When I first arrived today I got the chance to observe a positive strep test (see picture below). It was interesting because it applied both old and new techniques to analyze. While in biotech I had already learned about agar, plating, and streaking but the strep test allowed me to see these happen in a real world scenario. Today; however, I felt I’ve learnt a lot more about the parents then I have the children. Other than minor viruses and coughs each kids examination went pretty much the same. It was the parents, though who allowed the difference in appointment. With ranges in parenting struggles and first time parents Dr. Seidel sees it all. We were able to meet with several parents who had concerns and issues with each of their children and it was really interesting to see the way Dr. Seidel would deal with each one. Some of the parents required more of a therapy approach where she would hear out the issue and provide feedback, while others needed a more direct approach i.e. “this is what you need to do”. As my time goes on, it has also become easier for me to spot first time parents from those who have gone through this before. Usually their appointments include many more questions as well as concerns and general need to be reassured. Overall today was a great day with a lot of repetition (which is good for my understanding) as well as a great learning experience. Dr. Seidel is a great teacher who takes time before, during, and after each patient to educate me on their background – both medically and family – as well as defining and clearing up any unknown medical terms or conditions. I can’t wait to see what the rest of the program holds!

Image result for positive strep test agar

this is a positive strep test, the clear circle around the dot with the A on it indicates that the test was positive for strep.

Day 1

Today was a very eventful first day. Upon arrival we jumped right into appointments seeing newborn babies! A lot of out morning was spent on wellness checks from children aging newborn to about 8. Right before lunch; however, Jessica and I got to sit in on a Nexplanon removal and insertion. While this was not an everyday occurence it was incredibly lucky that we were able to see this. Nexplanon is a form of birth control that is in a small white tube placed in the upper arm. The removal was done by creating a small incision directly by the current tube. It is then squeezed out of the arm (yes there was blood). The new one is placed through the same hole with a tool very large in size for the tube itself. A button is then pressed and the tube slides into the arm. After some clean up and a band-aid the procedure is finished! After lunch we were filled with quite a few sick calls ranging from the common cold to ear pain. We tended to see more teenagers in the afternoon than the morning. This was interesting because the way appointments goes with a teen is very different than that of a kid. Teen appointments tend to involve more talking than examination, while kids were more examination based than talking (aside from typical conversations with parents). Overall today I got to see an amazing range of cases and people and can’t wait to see what the rest of work experience holds!

Related image Image of a Nexplanon tube.

Practice

here we go