Obession!

So my latest infatuation is with the new One-Sweep eyeshadow from L'oreal. Let me tell you, it's AMAZING! I got the purple version - shown here - for brown eyes. It actually works just like it says it will! ONE SWEEP and your make up is DONE! No more base + lid contour + liner + highlighter... nope... you get ALL those steps in one. And the color combo is really complimentary. This stuff shaves 5 minutes off your make-up time in the morning. I was skeptical- yet intrigued- when I first saw these advertised. But now that i've tried it I'm a believer and I'll be going out to get one or two more of them. Best $5 I've spent in a LONGGGGG time! :) I highly recommend you add it to your Target shopping list this weekend.

arfarf

LOVE MEGO xo

Irish we are...

... Irish we be! This is among many little fond memories I have of Saint Paddy's day (or hell... a TUESDAY) growing up with my Dad singing "I've been warshin' my arse in da Liffey... I use it as my personal biffy!..."

Awwww yes, the one day where the whole world gets together and drinks to honor my crazy Irish family and all their ancestors, current members and would-be-destined-descendents... Growing up in the Goff/McKenna house meant lots of Irish pride... claddaugh rings, necklaces, earrings at every 1st Communion, graduation, 16th birthday etc... and lots of trying to avoid going to church with our adorable and faithful mother (I now wish I went EVERY Sunday with her), and of course lots of drinking, swearing, story telling and temper tantrums. Such is to grow up in an Irish household. And I wouldn't trade it for the world!

I've been to Ireland several times and I cannot wait to go back! This Saint Patrick's Day my thoughts turn to the fact that I haven't travelled to Ireland ... or Europe... or out-of-the-country for that matter, since I returned from Franceland in Fall of 2006! I need to break this streak asap.

In honor of St. Paddy's and Europe, and my amazing irish Family, including our Patriarch Steve Goff and our ties to the Aussies... and all the drinking that is associated with ALL of those things... I'd like to offer my latest (CHEAP) wine obession: Anthropologie Australian Shiraz... I got it on sale for $11 at Safeway and it is big, jammy and delicious and WAY more valuable than it's bargin price implies. If you see it in a store near year, swip it up! You won't be disappointed!

Slainte! And Erin Go Braugh! xoxo Meghan (name translation: Irish derivative of the Greek name Margaret; means "strong one" or "pearl".)

The Natural Way...

I know, I know... I'm long over-due for a post from my Internal Med rotation here in sunny San Diego... But with all the outdoor sun and fun in San Diego, who has time to blog?!
The rotation has been great. Once again, with a week left, I find myself stunned that it's time to move again already. The past 5 weeks have been a great learning experience. The constant exposure to patients with chronic disease and med-lists miles long, has made me better at sight-recognizing generic drugs names - and for that alone- I am eternally grateful to this rotation - or WILL be greatful come PANCE time...
The majority of my patients here are geriatric... of course this means everything from 50 year olds with a touch of hyperlipidemia, to 90 year olds with multiple cardiac events, cancers come and gone, and long-term disease processes like MS, Diabetes or Parkinson's. It's been so interesting just on an observational stand point, of what one 70 year old patient looks like compared to another 70 year old patient... you can tell the miles on the tires on all these folks. Some people come in, and before I go in the room I read up on the chart and see 63 yo Female- history of diabetes, frequent UTI's, maternal history of breast cancer, in for labs and med refills... got it... Go into the room and I think "Good god you look like CRAP!" (of course I only say this in my little Meghan head - not out loud.) I use my Mom for a barometer of how old/young/ healthy people are... and maybe this isn't such a good idea because a) she's Saint Eileen and the nicest and most positive/ level-headed person in the whole entire world and b) my Mumsey is hot-to-trott, kicks butt in her daily Turbokick/ Zumba classes, eats healthy and really DOES stop at that ONE 5 oz. glass-of-wine-3-4 days-per-week rule... the perfect blend of health and does NOTTTTTTTT look like she's hitting the 6-0 mark... but some of these other people, I just think... dude, you've got 8 years to go til you're my Mom's age and you look like death munchin' on a cracker and and you'll be lucky if you MAKE it to 60...
It's sad the patients that you see in for just acute disease/pain management - when you know there's a much bigger domino falling earlier upstream (preventable!) and yet causing every other problem they have. I used to think people don't know better... but now IIIII know better... people KNOW what's good for them and what they should and shouldn't do, and the problem is 98% of the time, they choose not to do the right thing... that as a medical professional is so frustrating. You see people who are walking heart attack/stroke risks and yet can't be bothered to walk around the block for 30 minutes a day or the diabetic that can't pass up the free bagels and cookies brought into the office lunch room EVERYDAY, and yet they're A1C is 13 and they're heading to blindness and amputations... uggggg small changes would make a BIG difference.
The other thing I hear from my elderly patients a lot, is the OTHER end of the spectrum... in the form of the popular phrase "Oh I don't like to take anything..." Well, as my preceptor puts it "The goal is not to get to the end without ever being on any medication, it's to MAKE it to the end in as best shape as possible, and the medicines are the vehicle to get you there..." I cannot count how many times I see patients asking for just 3 MORE months to get their cholesterol/ blood pressure/ sugars on track "Don't put me on medicine" they plead, "I'm taking natural supplements only: Red Yeast Rice, Fish Oil, and Saw Palmentto..." What people who are supposed "naturalists" don't realize is that all these 'natural' compounds are DRUGS! I've told many a patient on this rotation "Hey, arsenic is 'natural'... and it'll kill ya faster than the simple hydrochlorathizide I want to give you ever will..."
In fact, you see this "natural" trend all over the place. In healthy and unhealthy individuals, sporty people, and old crippled grandma's... it doesn't matter. They seem to think if its not a Rx'd 'drug' it's some how better or safer. This could not be farther from the truth. Every drug - asprin, flinstone chewables, vicodin - has risks and benefits. What makes the 'natural' or 'herbal' substances more evil than the big-drug-company products they supposedly replace is that NO ONE regulates them. The FDA puts every rx'd drug through a stringent testing, human trial, clinical trial and approval process to prove it is safe, does what it says it'll do, with minimal & acceptable side-effects and interactions. The formulation must be standardized, and the ingredigents specifically listed and verified for every pill produced. No one does this for the "Women's Urinary Health" or "Men's Vitality Prostate Herbal" formulas you buy at healthfood stores or GNC... the manufactures of such products are bound by NOTHING to ensure one pill, batch or ingredient supplier is the same, consistant or reliable from one bottle to the next. And in terms of knowing what you're exactly taking... because they are un-regulated- they can get by with listings of ingredients as vague as "propritary blend... 10g"... go ahead... check a label on such a product you might already have in your own home or next time you're pursuing GNC or Whole Foods. Propritary blend could mean anything from 10% Cinnamon/ 30 % Beet Root/ 50% Apple Cider Vinegar/ 10% Dandilion root to your grandmothers sugar cookie recipe...
And the bottom line is- whether you pop an herbal "heart health" pill from Vitamin World, or an over-the-counter Tylenol PM, your LIVER has to process whatever we put into it. So your vital organ is doing work (and sometimes taking a beating) whether you THINK it's natural or an evil drug...
But try explaining this to a patient... oye vey! Thanks for letting me vent here... my apologies for the rant...
Anywho, time is winding down here and I definitely will be leaving with the overwhelming majority of my encounters being with nice, sweet (albeit really sick :( ) grandmas and grandpas. I love the oldies... they are so cute, and part of that endearment is how set in their ways they are. They'll tell ya straight up "I have a vermouth martini every night since college..." (Patient, 91)... I love it. Clearly, that must be the 'natural' way to good health and long life.
Live long and prosper... on to the next location and adventure next week... stay tuned.
xoxo
Mego

The Grapes of Wrath...

So, here I am... continue to truck my way down the path of my Clinical Year. I'm at mile 7 of 10 and lately, I've certainly been experiencing that combination of feeling like I've come so far, learned so much, grown in capablity and skill + sensing that I still have so far to go.
Only three more rotations remain for me now:
Rotation 7: Internal Medicine here at Scripps Hospital in La Jolla, CA
Rotation 8: In-patient at Tuality in Hillsboro (Portland), OR
Rotation 9: Acupuncture and OB/Gyn at Wenzou Medical College Hospital Center CHINA
Rotation 10: Elective Rotation- MYSTERY????? (though I've requested either Internal Med or the NICU... we'll see! Stay tuned!)
So I'm yet again, in a new location. Ryan came to Portland to help me make the drive from Oregon to California and we had a GREAT roadtrip. We broke up the 20 hour drive with several awesome stops along the way. First we drove to Redmond, OR where Ryan's Grandpa (aka "Papa") and his wife Linda live. Linda's grandkids are all big BMX-ers and they basically worship the ground he walks on ;) But for real, they are all so cute and they really do look up to Ryan so much. It's so cute to see them bombard him with questions and show him all of their riding pics on facebook. We had a great time hanging out with everyone for dinner. Sadly due to our time restraints we couldn't stay long and had to take off at 8am the next day.
There really itsn't much to say for the the drive from eastern Oregon to Northern California. It was baren, flat and boring. BUT after 8 hours we finally got to Sacremento/San Fransisco area- where we met up with our friends Amber and her husband Matt. Amber is a Medic in the Airforce and she and Ryan used to work together in the ED on base at Elmendorf. Matt is a maintenance crew chief and used to work on the F-22's in Alaska, but since transferring to Travis Air Force base he's off fighter jets and on the bigger transport planes. Apparently he really misses working on the jets- I don't blame him. ;)
We had such a great time catching up with them. They are in base-housing and Ryan and I were both saying we can only hope the base housing in Virginia is half as nice as their place! We went out to dinner and had hung out at their amazing place afterwards where we enjoyed a bottle of wine from the vineyard where we'll be having the wedding this August. Ryan and I stopped by the winery on our drive in Oregon and got a little tour of the grounds by their weddings manager. It was awesome! And after smoozing and tasting some of the wines we'll be serving at the wedding, she surprised us and sent us home with a bottle! Since Amber will deploy in June and won't be able to make the wedding, it was nice to bring some of it to them.
Again, our stay was an all too short overnight-er before we carried on to our final destination in San Diego which was 8 hours away. Again... boring drive... how did we drive through 18 hours of the state of California and NOT see any amazing vineyards, wineries, ocean coast or Napa?!?! And the traffic in L.A. - I thought Ryan was going to have an anyerysm and rightfully so. I truly don't know why ANYONEEEEE lives there.
Arriving in San Diego, we were welcome by my bestest cousin Joe and his girlfriend Marci- who graciously let us crash in their home despite the fact they were in the middle packing for a big international move coming up next week. Joe - host with the most that he is - of course instantly whisked us away to one of his favorite watering holes :) After wine-ing and dining in the hip university area, we all slept it off til 10am Sunday morning and after a pot of coffee and a recovery breakfast of scrambled eggs and toast, we were recharged and ready for some tourism. Joe was our inside naturalist guide to Point Loma look out point. Where we also scaled down the cliffs to the tide pools and saw all kinds of sea urshins, starfish, shrips, crabs and seals!
I had to take Ryan to the airport all too soon on Sunday, and he flew back to Anchorage as I got settled in my new digs - thanks to Blair and her connections with a friend from college. I get to live with Blair's friend Jessica and her husband Adrian and their ADORABLEEEEEEEEEE 2 year-old son, Gabriel. I could NOT be more blessed with this living situation. Jess and Adrian are such FANTASTIC generous, fun, welcoming people and they are such great parents - it's nice to witness such a dynamic and fun young family and I am SO lucky they were willing to welcome a complete stranger into their home.
So far, I have one week under my belt in Internal Medicine - and I am LOVING it. My preceptor is a wonderful and BRILLIANT doctor... though a little scatterbrained and nutty-professorish ;) I'm learning a LOT. Internal Med is so interesting because you're not just dealing with health people who just happen to sprain their ankle or get a cold... these people might have those things happen to them, but they have a schlew of med's and prior/chronic disease processes to consider in your management and treatment of them. It really makes you rack your brain- I can feel it growing all ready!- and of course will keep you all posted for the adventures (and mis-adventures) along the way.
Love you all!
xo
Mego

Judgement...

So yesterday was quite the eventful shift. It started out easy/ normal enough. A few MI rule-outs, an Alzheimer's patient from the nursing home that split her head open when she tripped on her comforter, a few toddlers with over-zealous/ hypochondriac patient looking to get their kids scanned and treated for the few HOURS they'd been exhibiting MILD symptoms... And to spice things up, there was the 72 year old nursing home patient that was vomiting green-gatorade (medical code for Bile) and probably had TB (I was gowned and masked most of the day. Blach)...
Well, now that I've ruined your appetite (sorry if you're reading this on your lunch break or hanging out post evening meal)... then there was the highlight / low-point of the shift (depending on your prospective).
I was already 15 minutes past my scheduled shift end, when we had an ambulence come in code 3 with a 15 month old, who was actively seizing with a Grand Mal seizure. She wasn't breathing on her own, had no reflex or tone, just completely limp and unable to handle her own secretions. After the Doc leading the code got the endo-tracheal tube down her (soooooo want to get my shot an intubation... but maybe next time) and then I started baggin' her (aka breathing for her by pumping and ballon and inflating her lungs every 5 seconds)... as our team of Respiratory Therapists and Nurses worked on her, and as I was trying to pay attention to pumping the balllon and counting every 5 seconds I was trying to ask the Mom about the childs history and what happened. The mother was 23 years old, with 3 kids, age 7, 4 and the 15month old we were working on. While clearly concerned and upset by what was happening, it was realllyyyyyyyyyy hard to try to work on the kiddo and NOT be all judgy judgy of Mom. She was a total space cadet. Deverting questions, pretending she didn't know the answers to simple questions like :
"Has she ever had a seizure before?"
M: I don't know
(come to find out the child had had 5 in the past 3 months...)
"How much does she weigh?"
M: I'm not sure she was here in Novemeber do you guys have it in the chart?
(she's 15months old! At that age kids can grow up to 1-3lbs per WEEK so her weight in November is now OBSOLETE so I went a different route asking "What size diapers do you buy for her" - thinking that would at least give us a weight range. Mom said "5's..." - finally the most definitive answer yet)...
And I get being traumatized that people are poking and tubes and computer screens and monitors are all over your kid and it kind of sends you into shock, but I have a feeling if I stop her on a random night in TARGET she wouldn't be able to answer any more coherently.
Come to find out the child has had 5 seizures since early November - each time precipitated by a viral/cold symptoms. And the child's older sister (the 4 year old) has had the same seizures and has been evaluated with EEG's (which is like an EKG for your brain instead of your heart) with no diagnosis concluded - other than the fact that they confirmed she does NOT have epilipsy.
The baby had been in our ED twice for seizures like this (just not as bad as this current one) she had been evaluated by a neurologist and given anti-seizure medications - not to be taken every day - but to be given should the mother notice she was starting to have symptoms. The mother simply let the prescription run out (again... hard not to judge). So when the child began seizing in the car as the mother picked her up from daycare she had no way of stopping the progression. Why you would just "forget" or "let" a prescription such as that just run out - especially when its for your child - is beyond me. I just kept counting ***1,2,3,4,5... breathe... 1,2,3,4,5..."
Finally I asked:
"Is she up to date with her immunizations?"
M: Oh, we don't do vaccines
I soooooooo wanted to reply, But clearly you do you DO do menigital seizures??? UGGGGGG (again REALLY REALLY hard not to be judgy... 1,2,3,4,5... breathe... 1,2,3,4,5... )
I think when I become a Board Certified PA, I want to hold local conferences FREE for parents to educate them on the true SAFETY and NEED for vaccines. The main reason most people don't get their child vaccinated is because they think they'll develop autism. There is absolutely NOOOOO link whatsoever to Autism and vaccines and this has been proven by numerous scientific studies. ONE study about 10 years ago done in the UK suggested this original link and start the wide spread mis-informed panic that now exists about immunizations. The manuscript has since been withdrawn from the archives of medicine because the study was biased and the data so flawed and manipulated that its authors were reprimanded with suspensions of their medical licenses and fines. Those people who withhold vaccines are putting their own children's health and LIFE in jeapordy - not to mention the health and life of every child and person they go to school with, walk down the aisles of the grocery store with, etc. I think anyone who CHOOSES to withhold vaccines from their child, should first have to spend 2 weeks at a hospital in a 3rd world country and see the babies gasping their last breath from pertussis, or seizing with a seizure from diptheria.
As the great movie "Parenthood" once quipped: "you need a license to drive a car, buy a gun, hell you even need to register to vote... but any butt reeming asshole can be a parent..."
Unfortunately, I see the truth in this satire daily. Cases like the little girl I was breathing for last night just make it extra sad... 1,2,3,4,5... breathe... 1,2,3,4,5..
The girl stopped actively seizing after we gave her some IV medications, but she never regained consciousness, and never started breathing on her own again during my watch. The transfer ambulance came to take her on the 30 min ride to OHSU's pediatric ICU- our hospital doesn't have a pediatric ICU- and the paramedics took over for me... 1,2,3,4,5... breathe... 1,2,3,4,5...

Rock the Vote!

Ok ok ok... so this isn't so much of an academic/ medical/ life on the road post... ;)

But... it's the other topic that tends to occupy my life in my 'spare time' these days: wedding planning! :)

So I've been searching through the gamillion and one photos of hairstyles online and so far this is what I've come up with for a few of my faves. Let me know which one of these you like by leaving a comment stating "1", "2", or "3"...

Or if you think these are way off, have other ideas or suggestions, feel free to comment on that too. Love you guys! xo

Paging PA Mego!

So, since my bestest Siste` is always asking me all of her pressing tapeworm questions, I thought I'd open up my (still developping) medical services.
So right here on the blog here, feel free to "comment" to this post with your latest medical question or issue you either have going on, or have simply always wanted to know more about, and I'll do my best to shed some light on the subject for you.
My hope is that the "Paging PA Mego" segment helps answer those burning questions you keep forgetting to bring up at the doctor, or just haven't WANTED to bring up because you're afraid they'll slap a "psych" eval on ya ;)
So ask away! the doct- errr... PA - is in!!!!
xoxo
Mego