Hypogonadism: a Transient State (I Hope)

The last and final quarter has started; that is, the last quarter before beginning two years of clinical rotations in Logan, UT. Just two days back from spring break and we were scheduled to take a 4 h diagnostic exam for our upcoming Step One Boards.

The exam was grueling, painful, mind-numbing! No breaks! Just a slow build-up of tension in the neck and back, just between the shoulder blades! After I reached the half-way point (question number 92), my mind literally began to shutdown. Processing the remaining questions was like trying to access a website that does not exist -- try back later.

That evening I received a text from a classmate who summed up the experience rather succinctly. It read: "So, if pathology exams were a kick in the balls, what we just did was complete castration . . . with a soup spoon! Ouch!"

The next morning I could not help but note the irony of the topic of our 8 o'clock class: hypogonadism. An appropriate lecture given the fact that I now found myself walking into class with a eunuch-like swagger!

Integrative Learning

This morning Elias woke up with vesicular-type lesions around his lips and on his hands. Just two days ago he ran a low-grade fever. His behavior has been normal; a little clingy, but no malaise, lethargy, or loss of appetite. April suspects hand, foot, and mouth disease. My response: coxsackie virus.

April then asks me incredulously: "Have you studied this yet?"

So you can fully appreciate just how loaded this question is and what she is really inferring, allow me to give a little context and background.

Slapped Face Disease
About seven months ago I started learning about all of the little bugs that can cause human illness and disease. The course was Medical Microbiology; and it had been, perhaps, the single greatest cause of anxiety during the two previous quarters. There is a reason I chose to do my Master's research in physiology. Petrie dishes, cultures, gels, microbes, toxins, antibodies, interleukins . . . these were all reason enough to stay as far away from the department as possible! Then, I learned about Parvovirus B19 . . . firsthand!

Blepharitis
On Labor Day, the last day of my summer vacation, I took the kids to Thousand Hills State Park where we managed to find a dried-up feeder stream and wade in the semi-stagnate water. There were lots of water bugs, mud, tadpoles, and water! What more could a kid want? The weather was absolutely beautiful; humidity was low and the sun was shining! It was the perfect way to officially end summer!

As we were wading through the murky water to regain the trail, Isaac managed to find a twig that was waiting for his ankle just beneath the surface. After a few tears, we resumed our hike as he wobbled his way back to the car. The next morning he woke up with a swollen left ankle. Later that day we noticed what looked like a rash begin to appear on his right eye. The following morning, not only was the swelling in his foot creeping up his leg, but now he could barely open his eye.

My mind immediately began to peruse the mass volumes of bugs and disease presentations that I had "learned" -- or, rather, been exposed to -- just a couple months ago. I vaguely recalled that the reduviid bug (i.e., the "kissing bug") preferentially bit its victims near the eye, transmitting some kind of disease or infection (i.e., Chagas disease). I reasoned to April that, perhaps, Isaac was bitten by the same bug. (Note: I failed to remember a small fact that the reduviid bug is found only in South and Central America.)

The swelling in Isaac's eye progressively got worse. Three days after our little adventure in the wild, April acutely observed that Isaac had small little pustules, blister-like lesions, appearing on his forearm. Diagnosis: type IV hypersensitivity reaction to poison ivy. The doctor confirmed what we had suspected. And upon further questioning, Isaac acknowledged that while playing at the lake he was pulling off some of the leaves from the overhanging plants.


Cat Scratch Disease
A couple weeks ago I was in the basement reviewing some OTM treatments with a couple classmates. After putting the kids in bed, April comes down and forbids me to show the kids any more pictures from Infectious Disease. Apparently, Isaac had just asked April about a little bump that was on the back of his neck. After feeling it, she let him know that it was nothing to worry about, that is was probably just a mosquito bite. "No!" He protested, adding, "I think it is Cat Scratch Disease." She assured him that it was not. His response is classic: "How do you know?"

Hand, Foot & Mouth Disease
While attempting to write this blog, I heard April yelling my name. I went upstairs and found her changing Elias' diaper. Pointing to his feet, she said, "Look! Look at these!" The small, little dots that will soon turn vesicular confirm the diagnosis. And if that is not enough, then we have Enoch waiting on deck. If our diagnosis is correct, then he too should break out in the next day or two just like Elias -- as he ran a fever just last night!

So I guess you can say that school has been quite the integrative learning experience! And in case you are wondering, we have just covered STIs and I am pleased to say that I have nothing to report. No ulcerative lesions! No cauliflower-like adhesions! No fishy smelling, purulent discharge!

Stay tuned . . .

An Ingenius Plan

Isaac lost tooth number two last night. Although it was without intention, he did assist in its extraction. Just before going to bed, he took some string (dental floss, I believe) and wrapped it around his loose tooth. Then, he took the other end of the string and tied it around his head board. When he went to lay down in bed -- pop! -- out came his tooth.

The interesting part about the whole experience is that he had no intention of extracting his tooth . . . at all! Because he thought that his tooth was going to fall out all on its own sometime during the night, wrapping a string around it was an attempt to circumvent the inevitable -- swallowing it! It was a plan brilliantly devised to keep the tooth tethered long enough to where he then could retrieve it in the morning by merely hoisting up the string.

The Nutcracker

The snow had arrived, and just in time for Christmas! However, here in MO it never just snows without some other element present. Instead of rain or sleet or ice, the usual choices it seems, this time the element was wind. Because of the blizzard-like conditions that were sweeping across the state -- and, by extension, the entire Midwest -- we were not quite sure whether we should make the trip to Kansas City or not. It did not help matters either to have two of the doors on our mini-van frozen shut.

To determine whether the unforeseen would be detrimental to us if we were to make the trip, we offered a little prayer. Afterwords, Cayanna stated that she felt "good about going". Deep down, both April and I were hoping the opposite. The day after Christmas and we were tired and wanting to just stay put, not to mention we were not really thrilled about braving the cold for the 3 1/2 hr drive! Yet, other than our own line of reasoning and discomfort, how could we argue with her? After all, this year was going to be different, more meaningful, more memorable! With kids, the present has a way of ALWAYS being the best (e.g., the best birthday, the best Christmas, etc). So naturally, this Nutcracker was going to be the BEST ever, better than the previous three we had attended together!

And so it was --

The curtains opened and Act II began. The Sugar Plum Fairy greeted us like royalty; the Spanish dancers offered us some chocolate; and then the Arabian dancers (my favorite) seduced us into having some eye-coffee. Referring to the next set of dancers that appeared on stage, Cayanna leaned over and asked, "Daddy, are these the Chinese?"

"Yes," I replied.

Unable to hold back her critique of their curt and tortuous moves any longer, she leaned over to me again and observed, "They make really good food, but they are not very good dancers!"

Needless to say, it was an AWESOME and memorable afternoon! It was also a nice reminder that memories are not always presented to us on a silver platter, but often require risk, inconvenience, and getting out of one's comfort zone and into the cold!

Cayanna (7 1/2 y/o) standing in front of the Music Hall in downtown Kansas City

Our BEST date so far!

Share the Harvest

The dear hunt has arrived; it is that mythical time of year when boys become men, and men become boys -- a right of passage, of sorts.

Sunday afternoon we took a drive to a small town just 45 min north of Kirksville (Memphis, MO), near the Iowa-MO border. With finals slated all week, I was needing a little distraction, a little reprieve from studying . . . something to break me free from the self-absorbed bubble that med school requires! So we immersed ourselves in to the local culture -- National Geographic-style!

It is not uncommon to see a trailer filled with deer carcasses in the middle of a parking lot, just off main street. It is the central hub, the main artery, the locus of all comings-and-goings in town. It is a cultural amphitheater for non-natives like me. Share the Harvest is a program ran by one of the local churches (this one, I believe, is ran by the Baptists) which is designed to feed the hungry with the deer that is "leftover" from the hunt. Each hunter that gives his/her prize to the program is asked to donate $20 to help offset butchering costs.

A pretty impressive program . . .

and a pretty impressive sight!

While visiting with some of the locals, a hunter pulled up to the gas station next to us. With tailgate down, three trophy-sized racks were showcased in the back of the truck like Christmas window adornments at Macy's! Passersby stopped and admired these soon-to-be wall ornaments, stroking the hunters' manhood with every question posed. Of course, I was right there in the middle, indulging the moment as they boasted of their heroics!

Yes, it is that mythical time of year -- a time, no doubt, when living vicariously through another is just the escape that I needed.

(left to right) 17, 11 and 8 point whitetail buck

No Talking Allowed

This morning I decided to break from my normal routine and study at home. Not long after, Caleb entered asking if he could do his math in the office with me. Absolutely - Then entered Cayanna, who was wondering the same thing. Unlike Caleb who has studied with me before, this would be Cayanna's first. Wanting to preempt any distractions that may arise, a ground rule was set.

"Alright, there will be NO talking while in the office! Total quiet, silence -- that is all!" I instructed.

They both agreed, and went quickly about their work.

Several minutes later, April entered the office to check her email, which led to a discussion about the housing market and our options once our lease expires.

Obviously distracted and somewhat annoyed, Cayanna interrupted, saying, "No talking in the room; it is making me frustrated!"

Needless to say, we took our discussion to the other room so as to not further disrupt and "frustrate" the learning environment. It is times like this when I am encouraged that the huge investment of time, energy and resources that April makes daily is taking root! Nicely done, Sweetheart!

An Unpredictable Observation

Enoch (3 1/2 y/o)

The other day, while sitting around the dinner table, Enoch made a rather interesting diagnosis. Unlike the two older kids who were enjoying homemade chili relleno (potentially too spicy for the younger ones), he (along with Isaac) were the recipients of a cheese quesadilla. After a bite or two, Enoch began to cough. In between coughing bouts, he observed matter-of-factly that "I have whooping cough".

It seems that some childhood experiences will never be forgotten, as they are played out again and again -- at times, too, when we least expect it. You got to love the unpredictability of children! For me, this is, perhaps, one of the most endearing qualities they possess -- yet, at the same time, it can be one of the most maddening!