paediatric roundup

Paediatrics has just finished. I should talk about it

I discovered i am not a natural with babies/toddlers, in terms of rapport establishing, etc. I guess i lack the experience with limited interaction with my cousins/nephews/nieces. I tried, but I am not a natural. If I am to be blessed with a wife and children in the future, then these 9 weeks of experience with kids might come in handy… but as they grow older, its easier; you can ask them about school. who’s your favourite teacher? who’s your best friend at school? what’s your favourite subject? what do you wanna be when you grow up? etc etc

Paediatric surgery was fun. We had cool stuff happening; gastroschisis, sacro-cocccygeal teratoma, duodenal atresia, colonic atresia and then several boys came in with blunt trauma to pancreas after bicycle accidents. one even had a distal pancreatectomy. Highlight was scrubbing in late night for perf appendix, which i used for my case report.  classic RIF region of maximal tenderness, widespread peritonitis. great thing was, when the paed surg reg, W,  was arranging for an ICU bed, while the pt was having his fluid resus, we students went to grab some Mackers (and offered to get him something too). it was a legendary night that will stay in my memory. (oh, W requested fries and guess what – strawberry milk shake! we teased him a lil about it later, made him all the more self conscious. lol) opreatively, had the suction ready when the peritoneum was next to be cut. frank pus +++.  manual breaking of adhesions in abdo cavity. we had a lili trouble finding the appendix but got it in the end. 

another lap case i watched was a neonate case. lap removal of adrenal ?mass. most likely extra-pulmonary sequestration. 

Oh, and an extremely rare thing i came across at Paed Haem/Onc clinic. 7 month old infant scheduled for orchidopexy for right undescended testes. when testes was brought down, some other tissue was attached to the testicle. it was resected. discharged with no complications. over the next few months, mum noticed lump was getting bigger and when she went back to get it checked out at the same hospital, they dismissed it as scar tissue. she sought a 2nd opinion. the surgeon took it out. pathology came back –> wilm’s tumour, with all the characteristic classical histological features. he had intensive chemo for 5 months. he has to be monitored for mets and any primary occurence in the kidney. thankfully renal US and CXR to date (he is now 3) are clear. saw him at outpatients. 

Interesting / confronting issues: 

Bushfires in Melbourne: When asthma kids come from bushfire-affected areas, i must admit i do not quite know what to say. The doctors are Melbourne-based. They can say the right phrases to display sympathy. They ask the right questions that display practical concern: are you making plans to evacuate? They factored in their empathy whilst explaining the asthma management plans. As we got further away from Black Saturday, residents made comments like “It’s gonna be a smoky day this weekend. More kids will come in. (with a tinge of urgh)”

Childhood obesity: We had a week of lectures as a “Paeds in Sem 1″ Cohort. During this week, we were also supposed to prepare a 10-min presentation on Contemporary Issues in Paediatrics. There were 10, but more interesting to me were things like educating children with disabilities, youth suicide in Australia, immunisation, water fluoridation. My  group was given a science-y topic : childhood obesity. I guess I’m thankful because a topic like “health indicators in indigenous children” or “socioeconomic status and health of Aussie children” will be more difficult, especially in terms of finding information. When i was in 3rd year, my conclusion from dealing with the moderately to super obese was to lap band them, because it is the only thing that works. Educate them it is not a one-stop fix. Involve a dietician. Make them promise (and follow them up) re diet and exercise. Be their partner in health. Banding is the only thing that actually works, as the evidence and literature quite unaminously proves. screw orlistat. Lapbanding helps kick start and continue their lifestyle changes. But how does this change in kids?

We were chatting to a General Paed Surgeon after his list one arvo. He was really nice. He told us one time he attended a Paed Surgical conference and someone presented something on banding. That person was “absolutely lynch-ed”. The anaesthetist chipped in. He had a patient die on him once. There are difficult to intubate, and hard to manage peri-operatively. But he still reckoned it is the only thing that works, at least for adults. 

Obesity is an epidemic in Western societies and considering how a big percentage of the entire world lives in starvation, you cannot help but wonder why. 

New people: i’ve always been a rather introverted person, compensating with a outward show of extroverted-ness. inherently, i am shy. when i tell friends that, some chuckle because i don’t portray that side often. Meeting new people has been interesting. There are still people within my graduating class whom i do not know at all, or very well. Years 4 & 5 will change that as we move around hospitals. Occasionally, an anti-social nonchalant thought creeps in “i’m not gonna stay in Melbourne for good anyway, why bother?” i usually mentally smack myself after.

E for electives. tweeted a bit about it. plans still uncertain. hope to go to S america. plan to learn spanish. if i master it, then i can speak the 3 most common languages in the world. (english, mandarin). right, as if it was so easy.  though i must admit, when i acted as a mandarin translator at one of the Paeds clinic, i was a lil rusty and struggled a little with medical terminology and sentence structure. parents could tell i don’t speak it everyday, but were nonetheless grateful, as they would have waited ages for the official hospital mandarin translator to come. 

now my 9-week O&G term starts. i will blog and sum up about it when its over again. probably will include things like my 1st pap, vaginal exam, normal vaginal delivery, colposcopy ,etc etc. till then, thanks for listening and dropping by my humble blog.