I have learned something on this rotation that I doubt I will be seeing or doing on any other rotation, circumcision. Circumcising or as we affectionately call it in the office "whacking wienies" is actually a pretty cool procedure to see. I can say this because I am a female. I highly doubt there is a man alive that could watch this without wincing. The instruments used for the procedure even have cool names like the Gomco, "helmet" (bet you can't guess where that goes), kellys, probe, and the circumstraint. I think the "helmet" might actually be called a bell but we refer to it as the helmet because it's more fun. The whole procedure takes around 20 minutes and is pretty much blood free which is kind of amazing considering you are amputating skin. Most of the babies tolerate it pretty well too. They are given a few drops of a sugar based liquid then a pacifier is stuck in their mouth. The doctor I am with uses a local anesthetic as well. That sugar must be some good stuff because the babies don't seem to notice you sticking a needle into the bottom of their little peenies. A funny side note: I noticed that when we inject the lidocane it of course causes the base to swell making it look a lot like a tiny little elephant trunk.

The success of the procedure is dependent on correctly fitting tools and the doctor's ability to achieve hemostasis. This is done with hemostats and the Gomco clamp. Patience and precision are also key. I was watching the doctor do one the other day and I realized just how important it is that he get this perfect. He can't leave even a millimeter of skin because that millimeter of skin will grow with the rest of him. This little guy has to carry that penis around with him for the rest of his life! You can't have one that looks like the result of a drunken lovefest between a turtle, an elephant, and a grub. Some girl will take one look at that and run the other way! The doctor I'm with is very good at them so rest assured Huntingdon county you will remain well populated in the future.

The after care is pretty easy as well. You just put Vaseline on it for a few days until it heals. End of story. The procedure seems to be well tolerated by the little ones and makes taking care of them a little easier on the parents. Even after watching this I would still want my future sons to have it done.

"Babies are such a nice way to start people" -Don Herrold

So far my favorite part of peds is the babies. I'm talking the really young little babies, 4 weeks and under. In the practice that I am in we see them within 24 hours of birth and then again at 1-2 weeks and again at 4 weeks. So I've been getting to see a lot of little ones. When we see them in the hospital within 24 hours they are brand spankin' new. It makes getting up an hour and a half early worth it. I love almost everything about them at this age. I love how they are still always warm when you hold them. I love the fresh clean baby smell. I love their onsies and tiny socks. I love the way they get raging mad and scream at you when you undress them and examine them with your freezing cold hands. I love playing with their reflexes. I love how their eyes look so fresh and shiny when they open them. I love their soft baby hair. I love the little grunting noises they make. I love to watch them as they discover new things, like their hand. This list could keep going and going but I'm sure I've already lost over half of your interest already so I'll stop. I haven't seen any super sick newborns yet. I saw one with Tetralogy of Fallot but she was stable and doing well for now. If I were in a different setting like a NICU I might change my mind. I can't imagine how difficult that would be.

Like OB, this specialty is making me excited at the prospect of having little babies in the house. I'm not in any position to be having children right now so someone in my family needs to have a baby soon so I can get this out of my system!!!! Sorry for the lack of medical things in this post. Next time I'll try to find an interesting case instead of just rambling on and on about my love for newborns. I promise!

Kids kids kids

First let me apologize for not updating this for a week and a half. A lot has happened since I last posted, I moved back home and started my next rotation. I am now doing pediatrics in my hometown with my uncle at his office. It has been an interesting transition. I haven't lived at home for this long in 9 years. I'm still getting used to the daily phone calls asking what time I'm coming home and the occasional visit from our golden retriever in the middle of the night but overall it's going well. I especially like coming home to home cooked meals everyday and parking in a garage!

Going from a level one trauma center to outpatient pediatrics is quite the adjustment as well. In fact I don't think you can compare them in any way. It's a welcome change of pace though. Working with my uncle is very different too. For once I'm not intimidated out of my mind. That may sound bad but I mean it in a positive kind of way. I am still learning something everyday and being challenged. Examining children is completely different from examining an adult. We take things for granted with adults. Adults aren't terrified of a simple thing like a stethescope, well the "normal" ones aren't anyways. With an adult you just jump right in and do the exam, end of story. With little kids you have to explain everything you're going to do and let them touch everything first to prove to them it doesn't hurt. You have to earn their trust. You also have to earn the parents trust. All this has to be done in under 25 minutes! Talk about a challenge. I've only been doing peds for two weeks but I have found that these 5 things are necessary to successfully exam a kid:

5. A friendly face
4. A knowledge of current cartoons
3. A plethora of different noises and voices
2. A love for children
1. PATIENCE PATIENCE PATIENCE

I'm sure this list will grow weekly and I am looking forward to figuring out all of the secret little tricks of pediatrics.