Tag: 18ElizabethM

The picture in today’s post shows the hearing testing room in the office. One child came in today with a poor hearing test result. Upon looking in his ears, we saw a build up of fluid that was blocking the sound from entering his ears.

Sadly, today was my last day with Carolina Kids Pediatrics. I began the day switching between visits with Dr. Emmet and Dr. Willey. As usual, we saw a few 6 month, 9 month, 1 year, and 18 month patients. Additionally, I saw some 7 and 8 year olds.

The main difference between the 7 and 8 year olds as opposed to the younger patients is that the older kids can tell you what is wrong with them. A school aged kid can tell you when they’re throat hurts or where their stomach hurts while a baby can only cry and whimper. The main signs of pain given by kids younger than 2 years old are crying, ear tugging, drooling, whimpering, kicking feet, and rubbing their teeth. The ear tugging, drooling, and teeth rubbing all signify teething pains. Although teeth usually begin appearing at 6 months, some kids experience pain before and after. Also, many kids will drool due to a sore throat because it hurts too much to swallow their saliva.

Although seeing babies is great, I also got to learn about special procedures. I did not get to see it but Dr. Tanaka performed a procedure to fix a tongue tie. To put it in simply terms, Dr. Tanaka used sterile surgical scissors to snip the lingual frenulum. In the end, the lingual frenulum will just exist cut in half, allowing the tongue to have a wider range of motion. To numb the area beforehand, Dr. Tanaka just used solid lidocaine on a q-tip to numb both sides of the flagellum. I also got to listen to a heart murmur. A regular heart has distinct beats while the heart murmur I listened to sounds less clear. To put it in lay man’s terms, the heart murmur I listened to sounded wishy washy. I am very thankful to have listened to the heart beat in real life because I don’t know where else I would get the experience.

Overall, the past two weeks have been the best two weeks of my life. I’ve learned so much from not only Dr. Willey, but also the other doctors and nurses in the practice. They taught me how to treat patients with care and efficacy. Each doctor has their specific styles of treating patients, but they all demonstrate a pure love for kids and a desire to help them feel better.

Fun Facts:
– Dr. Willey loves almond butter!
– I’ve had an awesome time at Carolina Kids!
– All the members of Carolina Kids made me feel so welcome.
– I can’t wait to learn more about peds!

The title of today’s post is inspired by a little kid who could only say “puffs”.

Today began like most other days at Carolina Kids Pediatrics. Even though we started at 9:30 instead of 8:30, we saw a few sick visits before diving into regulars. I began with Dr. Emmet as we saw a 6 month old child who ate the same food as his parents- only it was blended to a puree. Between vegetables, fruits, and meats, the child surely received enough nutrients. Later, we saw some older kids with regular cough/fever/stomach pains. Although some of the kids had slept for 12 hours, they still felt poorly. At that point, Dr. Emmet recommended that the kids take a medicine called Zofran to relieve nausea.

After a few visits with Dr. Emmet, I tagged along with Dr. Willey. I watched as she navigated the patient portal app on the practice ipads. Over the course of my work experience, I’ve learned a lot about the technological advantages of online medicine. Dr. Willey uses the iPad to respond to patient questions sent through the portal, look at growth curves, and use Rapid Connect. Rapid Connect is an app that allows doctors to communicate with specialists through HIPPA compliant texts. Dr. Willey loves using the application because she gets a response within a minute, allowing her to have easy access to other doctors when she need a consult.

In addition to working with the iPad, the doctors also have a seamless system to work with the nurses. The picture today shows the island where the nurses place the patient’s chart once the patient is in the room and ready for the doctor. The black file holder in the back left is for the sick visits, which are open to any doctor. I’ve only seen good things come from their system of checking in patients, seeing as the nurses move patients into their room quickly so they can be seen by the doctor.

Overall, today was an awesome day at Carolina Kids Pediatrics. The fun facts section really sums up some of the crazy and fun things from today. I’m so sad tomorrow is my last day. I’ve learned an insurmountable amount of information from not only Dr. Willey, but the rest of the crew at Carolina Kids. They treat all their patients with pure respect and care. I am so thankful to have been able to shadow so many doctors and learn about pediatrics with them. Although tomorrow is the last day, I can’t wait to learn more.

Fun Facts:
– Dr. Willey got a new phone!
– Keeping a pacifier at bedtime only can help ease kids off their habits and promote sleep.
– 72 degrees is the optimal temperature for a child’s bedroom.
– A one year old spit on Dr. Willey while she was putting fluoride on the teeth.
– Introduce toothpaste (only half a pea is necessary) to kids when they’re around 2 years old.
– A child found and consumed first piece of meat after finding it half chewed on the floor.
– When a child has extra digits, you just tie them off to restrict blood flow and eventually the area will die and fall off.
– The bags under a one year old’s eyes can be called allergic shiners.
– A dehydrated child’s belly will not bounce back when poked.
– A problem on the hearing test can be caused by a build up of fluid in the ears.

The picture above depicts the nurse schedule. Each nurse is assigned a doctor, meaning they will take the height, weight and basic reason for the visit before the doctor goes in. Also, the nurses will clean and set up the room before the next patient arrives. The nurses also give shots, which can be a very sad task.

Today at Carolina Kids Pediatrics was different than all the other days. When I arrived, Dr. Willey and I guessed there would be very few teenagers coming in since it is finals week. However, after one or two sick visits, she noticed she had almost all teenagers today. So instead, I did some other activities!

Since I do not go with Dr. Willey for teenage visits, I read a lot from the numerous textbooks they have in the office. I began the morning reading about “hot tub” or “whirlpool” folliculitis. The irritation goes deep into the hair follicle, causing raised red bumps. After a visit with a two year old, I read about ringworm. The passage shattered my own preconceptions. Ringworm, or Tinea Corporis, forms on the trunk, limbs or face. Initially, ringworm appears as numerous localized bumps. After a few days a circular border encloses the bumps, hence the name “ringworm”. The area and bumps are usually 1-10 centimeters in length and can appear red. Overall, there are numerous skin infections that can arise in young children as they experiment with new foods and environments.

In addition to seeing all sorts of patients, the doctors and nurses also listened to a presentation during lunch today. Though drug reps usually bring lunch and sell their product, an endocrinologists came by today to present about growth patterns in children. His main message was that accurate measurements can make a huge difference in a child’s life. Dr. Thomas went through several cases of patients who presented with stunted growth patterns that led to future complications. In the end, he stressed the importance of tracking a child’s growth from birth to adulthood. The biggest thing I learned from the talk was that growth abnormalities can present at any stage in life, not just puberty. The food they brought in was also very good, and it proved to be a delicious supplement to my lunch from home!

I closed off the day with a few visits with Dr. Emmet, seeing as Dr. Willey had a lot of teenagers. We saw babies for their 6 month and 15 month visits. Dr. Emmet put fluoride on the teeth of both kids since they typically do not see the dentist until 3 years of age. Overall, today was a great day. I feel like I am figuring out the pattern of pediatrics while also being exposed to new things everyday! I can’t wait for tomorrow!

Fun Facts:
– You can spray the car seat or stroller with bug spray to protect the child without hurting their skin.
– Some babies wear mittens because their nails can scratch their face.
– Thrush is a fungal infection that can cause a white substance to appear in the mouth behind the lip and in the cheeks.
– Moro response is a primitive reaction in newborns to a loud noise or change in head position.
– Test a one month old’s development with a single tongue depressor. See if the child can hold it.
– At 6 to 9 months, the patient should be able to hold two tongue depressors.

The picture above depicts the scale and height measuring tool in the office. In the right background you can see the baby scale!

Today was my fourth day with Carolina Kids Pediatrics. Even though it was a Monday, we only had a few sick/walk-in patients and a steady (but not overflowing) amount of regular check-ups/scheduled visits. Some new things today included lice, concussions, eczema, and advanced babies! Of course, we had the usual coughs, colds, and fevers. For those three visits, Dr. Willey usually recommends popsicles and ice creams to help sore throats, fluids, rest, and time. In the end, each kid will survive the illness with a little TLC (and veggies and liquids).

However, today was special because of the new visits. The best part of today was working with a few advanced babies. They could each pull from a large vocabulary to dictate their current thoughts. I was particularly impressed by their ability to convey their thoughts both through speech and expression. The babies would open their mouths to show growing teeth, clap, and say “yaaaay” and “uh-oh” 6 months before most other kids develop those abilities. Dr. Willey noted that each of those children were advanced for their age and demonstrated advanced social skills. However, we both agree that many other kids show growth through their walking and thinking skills. Some kids come in for their visits able to walk and control their body more than others. On the other hand, some kids respond to commands and show a deep understanding of their surroundings without having to speak. The biggest takeaway from today (and the past week) is that every child is special and follows their own growth pattern. Just because a child cannot walk as well as the other doesn’t mean they’re any less successful. Dr. Willey and her colleagues adopt this philosophy and practice it through their everyday lives. I have seen each doctor interact with children and assure their parents that just because the child hasn’t hit this one specific benchmark doesn’t mean they have not made any steps towards growth.

In addition to accepting kids of all walks of life and appreciating all their capabilities, Carolina Kids Pediatrics always accommodates the needs of their patients. Everyday I hear Dr. Willey and her colleagues tell their patients and their parents “our scale is your scale”. The phrase means that families with infants can come in anytime to weigh their child since many families do not have access to baby scales. Also, they tell each of their patients to use the room as long as they need after the visit has concluded. Thus, Carolina Kids creates a comfortable and accommodating environment for their patients.

Overall, I’m truly grateful to be shadowing in an office that treats all their patients equally and with care. The doctors’ and nurses’ knowledge of pediatric medicine and pure love for working with children shines through each visit. I can’t wait for tomorrow!

Fun Facts:

– Babies should gain a 1/2 oz to 1 oz a day.
– Hummus and beans can be a nice source of protein for kids.
– Many kids in the area are homeschooled.
– Asthma can develop during preschool or later at around 8 years of age.
– Babies should begin eating solid (but soft) foods between 4-6 months of age.
– Infants do not develop a sleep cycle until 4 months of age.
– Infants usually begin teething at 6 months.
– Within the first few weeks of life, a newborn’s skin will peel regardless of any lotion.
– Begin introducing your child to toothbrushing and toothpaste around 12 months by letting them play with the materials.
– The office schedules wellness visits every 30 minutes and sick visits ever 15 minutes.

This Friday at Carolina Kids was somewhat slow. Of course, we still saw a steady flow of kids with rashes, colds, coughs, earaches, and fevers. I think the best part of my day was when a 10 month old held my hand and pushed the stool around the room. I was incredibly impressed by his mobility, and his smile melted my heart.

I began at 8:30 with Dr. Emmet. We saw two younger kids each with fevers and coughs. For both patients, she recommended lots of fluid and Motrin as needed. I noticed she asked less about the patient’s stool, but more about their throat and nose. Afterwards, she and I spoke about the weekends at Carolina Kids. She says that the weekend doctor will usually work until 12 during the summer and 2 during the winter (due to the larger number of illnesses in the cold).

After Dr. Willey arrived from rounding on newborns at WakeMed, we began seeing her patients. Around lunch time, I sat in the lobby with a young patient while Dr. Willey spoke to the parents about school and grades. Together, the child and I played tic tac toe, discussed soccer moves, and drew pictures. The images attached to today’s post are completed by my new friend. I’m thankful that I could be with the patient because afterwards, Dr. Willey asked me about the demonstrated behavior. I reported that the patient was always polite, calm, and demonstrated knowledge about the ocean and writing paragraphs.

In between seeing patients, Dr. Willey told me about a message she received from a specialist who saw one of her patients from earlier in the week. We both learned the specific cause of the rash on the child. The best part was that we got closure on a mysterious patient from earlier in the week. That was the perfect way to end the week, and I can’t wait to learn more later!

Fun Facts:
– fistula-in-ano causes raised, red bumps fueled by a tunnel under the skin.
– Ear tubes for an ear infection stay in for about a year.
– Anaphylaxis can cause your uterus and other smooth muscle organs to contract.
– Intraoperative anaphylaxis can be caused by anesthetics, muscle relaxers, and drug/blood products.
– Prune and apple juice are frequently mixed to serve as a thin laxative.
– Drawing letters in the sand can help kids learn the alphabet outside of the classroom.
– Tylenol dosage= Benadryl dosage for 9 month old.

Today began at 8:30. I waited for Dr. Willey to arrive. We immediately began seeing the sick patients. There were still a lot of kids coming in with illnesses from traveling over the long weekend. At around 10 we began seeing scheduled patients for check ups and long term fevers. I’ve learned it can be very sad to see sick kids who only want to sleep and cry. However, Dr. Willey does an amazing job of working with the patient to help them feel better. She continues to use her magic to cure patients and lift their spirits, drawing a smile from stubborn toddlers and 6 month old patients.

Thus far, we have seen a few ear infections, swimmer’s ear, coughs, and persistent fevers. I learned that swimmer’s ear differs from a regular ear infection because with a swimmer’s ear, the ear canal will appear inflamed with a white/yellow coating. On the other hand, a typical ear infection features fluid behind the eardrums. Regardless of the ear illness, you sometimes have to flush the ear of earwax when the child cannot hear. Loosening up the earwax after it piles up can relieve clogged hearing.

Apart from ear aches, I learned about fevers, coughs, and pink eye. Specifically, mild pink eye can be treated with antibiotic eye drops. To put the eyedrops in a child, or even yourself, Dr. Willey recommends laying down with your eyes closed, placing the eye drop on the inside corner of the eye. Then, you open your eyes and let the medicinal fluid run into the eye.

Apart from eyes and ears, a lot of kids also come in with sore throats and coughs. The picture I’ve attached to today’s post depicts the pamphlet source in each exam room. From puberty to colds, parents love to take a look at the information on the pamphlets. The area also includes a book with basic images of child anatomy. Dr. Willey will use those pictures to help explain colds and fevers to parents. Overall, those resources prove informational and useful!

Today was an amazing day at the office. From newborns to younger kids, i’ve learned so much about kids. A typical pattern in the office is to see younger kids in the morning and teenagers in the afternoon. I think that is because teenagers are usually free after school while babies have more free time! I have seen many dads come with their kids. Today, a dad phoned in the mom at work so they could both participate in the child’s visit. I think this is a great way to stay informed while dividing up responsibilities! I can’t wait to see what tomorrow brings in.

Fun Facts:
– Pale/white lines on the palm side of your fingers (where the fingers bend) can indicate anemia.
– Fever reducers can bring a fever down by 2 degrees.
– If not caught early, lazy eyes can result in a loss of vision in that eye.
– Some kids cough to get attention!
– Vaseline can help remove a bandaid without pain.
– Your body begins to respond to strep throat when you’re three years old.
– Scoliosis is most easily recognized between 9 and 10 years of age.

The photo above depicts an artwork piece in the office. Many kids like to find the hidden creatures in the pictures while they walk to their room.

Babies galore seems to be a common thing at Carolina Kids Pediatrics. Most children come for a visit during the first few days of their life, at 2-3 weeks old, then around 4 or 6 months, then a year, 18 months and 24 months. Thus, a lot of young children pass through since they need more wellness visits. I also met a number of four year olds with bellyaches, coughs, fevers, and rashes. Some of today’s illnesses included ear infections, persistent bumps, and back pain.

Despite learning the ropes, i am still surprised and sad to hear kids wailing in the room next to me. Dr. Willey does an amazing job calming down her patients when they’re being treated. However, I’ve learned that preventing a toddler or newborn from crying can be an impossible task. The battle continues when the patients receive shots. Nonetheless, Dr. Willey’s calm nature proves effective in establishing a safe environment for the kids.

Dr. Willey uses a wide variety of techniques to calm her patients. Before interacting with any newborn, she strokes their head and establishes a calm, comfortable setting. For 18 month old patients, she typically hands them a cup within a cup to distract their hands. For the quieter patients, she simply gives them a light bounce in her arms before listening to their heart and lungs. For older kids, she begins by asking them about school and what they like. Therefore, she uses both physical and emotional connections to calm her patients before beginning her examination. I can tell she is comfortable with her patients. She remembers all of their information even if she hasn’t seen a patient in over a year.

Overall, today was wonderful. Dr. Willey inspires me with her calm, nurturing approach to medicine. She told me today that her residency program promoted a wholistic approach to medicine, meaning they should focus on the patient as a whole person with physical and emotional needs. I see this in each of her visits as she takes the time to understand each patient beyond their medical needs. I can’t wait to learn more about pediatrics from such a caring, knowledgable doctor!

Fun Facts:
– Swimmers ear comes during the summer as the water gets hot and bacteria begins to ‘fester’.
– Babies first see bright, bold colors. They cannot see pastel colors until later in life.
– At four months old, it is difficult for babies to sweat. This puts them at risk for overheating.
– Sometimes drooling can be due to a sore throat rather than incoming teeth.
– Arms can become sore with a cold as lymph nodes become swollen.
– Nitrates in your urine can indicate infections and bacteria.
– Line 5 is never used on the phone system in the office. I don’t know why.

Today I began my work experience at Carolina Kids Pediatrics. The day started at 8:30 AM when I arrived at the office. Dr. Emmet introduced me to the nurses and a few of the other doctors, and she also took me through the office to look at the conference room where we eat lunch and where I can put my lunch beforehand. The office features a carefully designed layout where patients naturally walk through a hallway that leads them to a curved room with the 15 doors leading to various exam rooms and bathrooms. A large, semi-circular desk stands in the middle of the curved room. The area consists of desks for each nurse and doctor, an island to prepare vaccines, and a fridge that holds the vaccines. The layout of the office proved conducive to effective work.

Throughout the day, I saw patients from all walks of life. I think it’s safe to say that pediatricians take care of children from their time in the womb until they are 21 years of age. I learned that due to the wide array of patients, pediatricians need to know a lot about kids! It seems obvious, but the most important information I took from today was that knowledge of children includes not only medical information, but also behavioral and emotional tendencies. Spending time with an 18-month-old boy makes for a completely different visit than one with an eight-year-old girl. Also, a pediatrician tailors the visit to the number of family members in the exam room and the child’s typical behaviors. For the rambunctious, four child check-up group, Dr. Willey moves right into physical examinations. After examining one child, she talks with the general group of kids for a few moments before moving on to the next patient. Throughout the visit, however, she will converse with the child about their life at home while fielding questions from parents. Then, once the patients are all checked out, she will sit down and speak with the parent. However, for the visits with younger, shyer kids, Dr. Willey will begin in a seated position while she speaks to the parents and the patient about life at home, their eating habits, their favorite activities, recent illnesses, and, everyone’s favorite, their bowel movements. After connecting with her patients for a few minutes, Dr. Willey will perform her examination. The visit usually lasts about 20 minutes, seeing as Dr. Willey likes to converse with her patients and spend time getting to know them. I learned throughout the day that she connects with her patients while working efficiently, ensuring that she maximizes her time with each patient. She exercises immense care and empathy with each patient, making it obvious why so many families in the area choose to see her.

Overall, we saw a lot of younger children today. Some frequent conversations included rashes, (most commonly the hand, foot, and mouth virus), car-seats, persistent coughs, fevers, and again, bowel movements. Dr. Willey also painted some fluoride onto the teeth of younger patients since children don’t see their dentist until they are two or three years old. On the whole, today was the best first day I could’ve had. I learned numerous fun facts about kids and got to witness a wonderful doctor at work. I can’t wait for the next few days with Dr. Willey!

Fun Facts:

• You can lose a nail without it every growing back. It’s not necessarily a bad thing, seeing as many people have survived without a nail on their nailbed!
• Your red blood cell count is typically higher than your white blood cell count.
• Pink eye drainage consists of white blood cells, bacteria, and “sleep”
• An adult takes an average of 18 breaths per minute while newborns can take more than 40 breaths per minute.
• The inside of an infected ear appears peach colored with puss.
• Two week old babies sometimes sleep with their eyes open.