Long commute to see the doctor

Yes, I know, it's been quite a few days since my last post. Unfortunately, not much has happened.

On Thursday (I think it was it Thursday), we had a patient who had quite the commute to see the allergist--all the way from Okinawa, Japan. He moved to Okinawa about two years ago, and about a year ago, began to notice a really itchy rash that instead of going away, got larger. He tried allergy medicine, tried washing his uniform every day, and tried just about everything else that people recommend for exzema. It got so bad that he was going into sick call almost every day, and had to be transferred from his job outdoors to an office job. Finall, his PA got him an appointment with the one dermatologist at Okinawa (after a few months waiting, of course). They tried him on over 20 different medicines; some made it slightly better, some did nothing. Finally, they got him an appointment with the closest allergist, which just happened to be COL Yang here at Tripler.

So we saw him and said, yep, that's exzema. So we got him some different medicines, one that he had tried and two that he had not, and then sent him back to Japan and told him to continue following up with the dermatologist. Hopefully this will take care of it. Since he can't really do his job with this exzema, the next step is to move him away from Okinawa, probably back to El Paso, TX.

Anyway, that was the most exciting patient all week (week-ish, I guess). Yesterday I walked down to the NEX at Pearl Harbor (about 4.5 miles) and did some shopping (not much, since I had to walk back). Today was another diving day. We went out of Waianae Bay, which is on the west side of the island (Tripler is close to the south). It was beautiful weather for diving while we were diving, then it instantly started raining as soon as we got the boat back to dock. Here's a picture from the boat.

I didn't get back to base until about two, and then I was tired from diving, so I didn't do much the rest of the afternoon. Then around six (when it started raining again), a couple of other students and I grabbed a cab and went down the NEX for dinner and do some grocery shopping.

Tomorrow, it's back to work, for my last (and second) full week of work at Tripler.

Back to work...kinda

After four days of vacation, it was time for me to go back to work... and I use that in the loosest sense of the word. After morning report, Dawn (the University of Hawaii med student) and I headed down to the Allergy and Immunology clinic, logged into our computers, and found that there were no patients scheduled for the day. COL Yang was working vaccine clinic in the morning and had an administration day in the afternoon, so nothing for the med students to do. He gave us the morning to study and told us to report back at 1300 for lectures on allergic rhinitis and urticaria (hives). So I did some OSU on-line lectures in the morning (as this is a required rotation), headed back for a noon conference lecture on anorexia, and then back down to clinic for two hours of lecture. In other words, it was a long day of lectures.

But here's a picture from the allergy and immunology clinic window.

North Shore

Happy Veteran's Day! Since it is a holiday, clinic was closed, which meant (another) day off from work. A couple of the other med students and I decided to drive up to the North Shore of Oahu and check out those beaches and watch the surfers.

This is no one I know, but it's the best surfer picture I got.

And of course there was sand castle building.

And then one of my fellow med students decided to demonstrate why weak swimmers should not go out too deep in the ocean when there are 5-15 foot waves. He got caught in a current and the lifeguards had to come bring him in.

So that was the last day of the four-day weekend. Tomorrow, it's back to the Allergy and Immunology clinic.

Pearl Harbor and more of the beach

Today we went in to Pearl Harbor (actually, just outside Pearl Harbor) to the U.S.S. Arizona memorial. It's actually a really neat program--there's a video about the progress of the war (in the Pacific) leading up to the events of Pearl Harbor on Dec. 7, 1941, and then a lot of stuff on that day specifically, such as which ships were destroyed, which were damaged, and which had loss of life. The most significant of those was the Arizona. When the bomb hit, it ignited the ammo (or fuel, I don't remember which), which caused a fire locking everyone inside.

Here's just about all that's left of the Arizona:

And here's the wall in the memorial with the names of those lost. There's also a section for those who made it off the ship, and chose to have their ashes buried with the Arizona after they died.

Here's a model of the ship (while it was in one piece, obviously):

And, of course, Tripler Army Medical Center from the Arizona memorial:

I have more pictures from the Arizona if anyone wants to see them (just let me know.

After visiting the Arizona memorial, I went to the NEX (Navy EXchange) on Pearl Harbor, which is the nicest exchange on the island. If most exchanges are K-mart, and the MCX at Henderson Hall was Macy's, this one is the entire mall. It was quite amazing. The commissary itself was larger than most Safeways.

And then there was the standard late afternoon trip out to the beach (Waikiki again, this time). We saw some sailboats while the sun was setting.

Tomorrow a small group of us is driving up to the northern shore of the island. I don't know what we'll see, but I hear that's where all the professional surfers go (someone said something about twenty foot waves). Should be interesting.

Vaccine reactions and long runs

So this post is a couple of days overdue, but such is life. I don't know if I mentioned this, but when I was working with COL Yang in vaccine clinic on Tuesday, I got my third Japanese Encephalitis shot (better for the taxpayers to pay than me). Well, as can happen with vaccines, especially the third shot in a multi-shot series, I got a local hypersensitivity reaction. On Wednesday, I noticed a rather large wheal (elevated swelling on the skin; think mosquito bite):

And no making fun of me for my methods of taking pictures of my arm using a phone and a mirror. Anyway. by Thursday, it changed from a wheal to a large urticaria (think one large hive).

It was incredibly itchy, but fortunately for me, I'm working in an allergy and immunology clinic, where there is plenty of Benedryl. Problem solved. By now (Sunday), the skin is still a little tender, but there's no more swelling or itchiness.

Anyway, enough with my medical issues. I wanted to go on a long(ish) run today (6-8 miles), so I looked up Oahu running trails and selected one around Diamondhead Park. Unfortunately, I not only got lost driving to the park, but also got lost while running, so my longish run turned into a bonafide long run, around 10 miles. Not so much fun with hills and tropical sun. Fortunately, I saturated myself in sunscreen first, so I'm not too burnt.

After that, I hung out at Ala Moana beach, which has really calm water, good for swimming (I did swim a bit, but I forgot my goggles, and salt water and contacts don't mix). If I get any more afternoons off, I might have to take the bus there for more swimming.

Scuba diving!

This morning I went out to Hawaii Kai to go scuba diving with Gabe, the dive master Daniel Christian dove with while he was stationed here. It was a little cloudy in the morning and a bit choppy, but once you get deeper than 10 or so feet, you can hardly feel the waves. We did two dives, a wreck dive down to about 80 feet, and a reef dive around 40 feet. Here's the picture from the boat between the first and second dive:


And here's me hanging out on the boat between dives:


After the dives, I headed back to Tripler to get the salt and the Hawaiian ocean bacteria off me (we had a noon conference lecture on skin and soft tissue infections, and apparently, there's methicillin-resistant Staph aureus [MRSA] around the islands). Then I hopped in the rental car that I deemed necessary for the four-day weekend (cheaper than taxis, but unfortunately not reimbursable) and drove to East Oahu, to Kailua beach, which was recommended to me by my friend Shannon, who was here in July. Here are some pictures from the beach:


It was still pretty windy, so the windsurfers were out in full force.


And the sun beginning to set at the beach. The only unfortunate thing I've found about being in Hawaii in November is that while the weather is pretty much the same as Hawaii in July, the sun sets around 6 pm.

After that was a trip to the Pearlridge Mall for dinner and to buy a wrist brace. Unfortunately, all the typing that I do has lead to carpal tunnel syndrome. I'm hoping that a couple of weeks of bracing my wrist while typing and sleeping will take care of the pain and I won't have to go see a doctor about it--at least until next year, when 100% of my medical care will be covered.

Both a doctor and a soldier

As Army physicians (and future Army physicians), we know that our daily lives force us serve two--or more--masters, but never had I had such a good demonstration of this as today during a rather unusual noon conference--COL Salerno, the Internal Medicine Residency Director, giving his farewell address before deployment tomorrow.

An Army doctor, even a colonel, being deployed is not an unusual event, but his story is a little different, because he is a residency director. In 2005, the Army and the ACGME (American Council of Graduate Medical Education) formed a written agreement allowing residency directors to deploy for no longer than 90 days. This was a concession on the part of the ACGME, as previously residency directors could not deploy, due to accrediting regulations that require residency directors to be on-site, supervising their residents.

That being said, COL Salerno is not going to be gone for 90 days--he'll be gone for 10 months. After several "deployment scares" that prevented him from joining various committees that would be good for his career, he decided to volunteer for deployment, to get the waiting and wondering over with. Instead of taking a simple 90 day deployment working at a CSH (Combat Support Hospital), he volunteered for a position as an administrator of an Army-Iraqi medical team (he kinda explained, but I didn't really follow). He was going to split the deployment with another colonel, which would allow him to be gone for his 90 days and return to Tripler. He had written promises from a brigadier general and the other colonel that he would only be deployed for 90 days, to avoid any problems with the ACGME. However, as things have a tendency to do with the government, it fell through. After scrambling for two months trying to rectify the situation and applying for exemptions with the ACGME, nothing changed. Since 10 months is obviously a violation of the 90 day rule, he had to officially step down as Internal Medicine Residency Director at Tripler, which was not in the career plan he had set for himself.

However, things did work out for him. When he returns from deployment in August, he'll take over as the Director of Medical Education at Madigan. I was a little sad to hear about this, which had nothing to do with COL Salerno. LTC Wiesen, the Preventive Medicine Residency Director at Madigan, was applying for that position, which would have caused a shuffle in the preventive medicine residency programs beneficial for LTC Littell and MAJ Soltis, two staff members I enjoyed working with at Madigan and WRAIR, respectively. However, COL Salerno does outrank LTC Wiesen, so it's not too surprising.

Medical education positions aren't always easy to come by in either the civilian or military worlds, but rarely do civilian physicians have to worry about what will happen if their 90 day vacation to a war zone gets extended.

Pictures

As promised, here are my first pictures from Hawaii. Dan (the HPSP student from West Virginia) and I went down to Waikiki on Sunday for dinner. Here's a picture from the beach:


And here's the Mountainside of Tripler (the two main buildings--which are connected--are called Oceanside and Mountainside). I took this on my walk up to the Tripler Lodge after work on Monday.
And more of the same from further up the hill. By the way, these hills do NOT make it fun to go running.

More pictures to come later (as I take them, of course).

It was more of the same at work today. COL Yang was doing vaccine clinic again this morning and had Dawn (the University of Hawaii fourth year med student) working with him, which left Tracie (the PA student) and I with nothing to do. After lunch and noon conference, we had one new patient, a woman with some sort of environmental irritant in the building she works in that has been preventing her from going to work. Even though the history wasn't consistent with allergies, we did skin tests on her anyway, which were, not surprisingly, negative. Chemical irritants (ie, perfume, cleansers) aren't allergies, and can't be treated with medicine like allergies. So we scheduled a follow-up (for what, I'm not sure) and sent her on her way.

After work, I decided I needed food, which is not to be found at the Tripler base, so after one of my usual laps on base, I ran to Ft. Shafter (about two and a half miles away) to visit their very small PX/Commissary before making the trek up and down the hills back.

Not sure what's on the schedule for tomorrow, but I'm guessing it won't be too different from any other day.

Free vaccines in the Allergy and Immunology clinic

Okay, technically, there are always free vaccines (at least to military personnel, dependents, and contractors) on military bases, but I saw it first-hand today while working in vaccine clinic. It was pretty fun, actually--people were lined up with their papers saying which vaccines they needed, COL Yang would chat with them for a couple of seconds, sign their papers, and send them to the Specialist to get their shots. I realized that since I'm on active duty this month, I also qualify for free shots, so I grabbed my own sheet of paper, gave it to COL Yang, and got my third Japanese Encephalitis shot, saving myself about $100, which is what it would have cost to get it at the OSU Health Center.

After a fun and exciting day in vaccine clinic, I got off work at 1500, went on a run (running up and down a Hawaiian mountain may sound fun, but it's actually hard work) and then grabbed a taxi to go into Honolulu for dinner. There is absolutely no place on base to get food--at all. There's not even a PX or commissary.

I did get a new sync cable for my phone, but it still isn't working, so there's something wrong with either the phone or the computer. Hopefully it's something I can fix.

Aloha from Tripler!

Yesterday, after a very long day of flying (hour and a half to Atlanta, nine and half to Honolulu), I arrived in Hawaii, got my two very large bags from baggage claim, climbed into a taxi, and checked in at the Tripler Lodge. During the flight, I met another HPSP student, Dan, so it was nice knowing one person on the island at least. After unpacking all the stuff I need for the month (and calling Adrienne and bragging about how sunny and warm it was), I discovered that there is no food to be found on base on Sunday nights. So Dan and I hopped on a bus toward Waikiki, wandered around the touristy areas for a bit, and had dinner at a nice Thai restaurant before heading down to the beach for a bit (can't arrive to Hawaii and not go to the beach on the first day, after all). I took pictures, but they're on my phone, and I discovered this morning that I grabbed the wrong sync cable to connect my phone to my computer, so until I get another one, no pictures from the phone.

This morning started the same as every other Army rotation: wake up, eat breakfast, wander around the hospital for a couple of hours in-processing. Then I met the chief resident of Internal Medicine and got a tour of the medicine department before he took me down to the allergy and immunology clinic. Turns out, the attending who was coordinating my rotation is now deployed, and forgot to share with the other attendings that I would be coming. Oops. So we laughed about that for a few minutes, then I went and started seeing patients.

Other than seeing a couple of patients a day in clinic, I have morning report every morning at 0730 and noon conference at 1215. There are no calls (yay!) and no weekends (yay!), so I have the evenings and weekends to myself. So far, that means I did (well, I'm still doing, technically) some allergy reading tonight, and called the dive master Daniel Christian recommended. My first dive in Hawaii is at 9 on Saturday morning, and I'm really excited about it.