After a very snowy week in Camas, I am again sitting in an aiport (PDX) for the nth (I'm too lazy to count) time this year, waiting to go off on my next adventure. For those of you who don't remember, I am going to be spending four weeks in Papua New Guinea on a Global Health elective, learning about tropical medicine and basically working on not getting dengue fever (I have medicine for malaria and am vaccinated against just about everything else, so that's what I'm going with).
As part of my rotation, I will be keeping a blog with INMED, the organization that is taking me to PNG. Obviously, as I will be in the bush of a strange foreign country, internet access will be patchy at best, and I will not be keeping two blogs. So, here's my link to where you can see what I'm up to until I return:
inmedblogs.us/elisabethhesse
Enjoy, and I'll talk to you soon!
Saturday, December 27, 2008
Wednesday, December 17, 2008
Match results!
The military match results came in this morning at 0600 EST. I have, obviously, been looking forward to this moment for months, if not years. Here it is:
Walter Reed Army Institute of Research preventive and occupational medicine residency class of 2013
Yay! That was my first choice and I'm quite thrilled with the results. Tonight is our post-match Military Medicine Interest Group meeting, so I'll find out how my military classmates did and where they'll be going.
Anyway, here's my schedule for the next four years:
July 2009-June 2010: transition year internship at Walter Reed Army Medical Center
July 2010-June 2011: Master's of Tropical Medicine and Hygiene (or Master's of Public Health) at the Uniformed Services University of Health Sciences (or, if I get an MPH, at Johns Hopkins University)
July 2011-June 2012: Preventive Medicine practicum year at Walter Reed Army Institute of Research
July 2012-June 2013: Occupational Medicine practicum year at the USUHS
I don't know how they expect me to do work today. I'm too excited!
Walter Reed Army Institute of Research preventive and occupational medicine residency class of 2013
Yay! That was my first choice and I'm quite thrilled with the results. Tonight is our post-match Military Medicine Interest Group meeting, so I'll find out how my military classmates did and where they'll be going.
Anyway, here's my schedule for the next four years:
July 2009-June 2010: transition year internship at Walter Reed Army Medical Center
July 2010-June 2011: Master's of Tropical Medicine and Hygiene (or Master's of Public Health) at the Uniformed Services University of Health Sciences (or, if I get an MPH, at Johns Hopkins University)
July 2011-June 2012: Preventive Medicine practicum year at Walter Reed Army Institute of Research
July 2012-June 2013: Occupational Medicine practicum year at the USUHS
I don't know how they expect me to do work today. I'm too excited!
Saturday, December 13, 2008
Pain medication contracts
One of the things about worker's comp patients is that most of them have chronic pain that has to be treated with narcotics (think Dr. House and his Vicodin addiction). Obviously, nobody likes to just give out narcotics (well, unless you're on House, in which case, everyone gives it out like candy). There are a lot of legal and ethical issues involved in prescribing narcotics, so the doctors try not to do it without thought.
So at the OSU Occupational Medicine clinics, the patients must sign pain medication contracts once a year before they can be prescribed narcotics. The contract is a couple of pages long, and I won't bore you with all the details, but some of the points they have are that the patient must agree that they will only get narcotics from the occupational medicine doctors (ie, they can't go to the ER for pain meds), that they will take them only as prescribed, that they will agree to random drug screens (both to make sure they are taking their medications and to make sure they aren't taking anything else), and that if they break any of the rules, they won't get any more narcotics.
Well, we had a patient yesterday (Friday) who Dr. Wynd is trying to wean off Percocet. She had been prescribed 1 pill four times a day, and a few months ago, Dr. Wynd decreased it to 1 pill three times a day. So, to make what was actually a really long and convoluted story short, she was still taking 1 pill four times a day, which Dr. Wynd confirmed by counting the remaining pills. So, she wasn't taking it as prescribed, and that means no more Percocet. Dr. Wynd prescribed Ultram instead (a non-narcotic pain med) and pretty much said, you knew the rules and you chose to break them.
I'm not saying the patient didn't have pain; she had quite a lot of pain, both leading to and resulting from a knee replacement surgery and three back surgeries. However, pain or not, rules are rules, and she knew them and broke them. If she was having as much pain as she said she was having (leading to the increased intake of her meds), she should have called for an earlier appointment to ask for another prescription, instead of just changing the dosage on her own. That way, she wouldn't have been in violation of her contract.
Unlike on TV, doctors are aware that narcotics can be addictive. They are also aware that they are sometimes necessary. The tricky part is getting things down so the pain can be treated without causing further harm to the patient.
So at the OSU Occupational Medicine clinics, the patients must sign pain medication contracts once a year before they can be prescribed narcotics. The contract is a couple of pages long, and I won't bore you with all the details, but some of the points they have are that the patient must agree that they will only get narcotics from the occupational medicine doctors (ie, they can't go to the ER for pain meds), that they will take them only as prescribed, that they will agree to random drug screens (both to make sure they are taking their medications and to make sure they aren't taking anything else), and that if they break any of the rules, they won't get any more narcotics.
Well, we had a patient yesterday (Friday) who Dr. Wynd is trying to wean off Percocet. She had been prescribed 1 pill four times a day, and a few months ago, Dr. Wynd decreased it to 1 pill three times a day. So, to make what was actually a really long and convoluted story short, she was still taking 1 pill four times a day, which Dr. Wynd confirmed by counting the remaining pills. So, she wasn't taking it as prescribed, and that means no more Percocet. Dr. Wynd prescribed Ultram instead (a non-narcotic pain med) and pretty much said, you knew the rules and you chose to break them.
I'm not saying the patient didn't have pain; she had quite a lot of pain, both leading to and resulting from a knee replacement surgery and three back surgeries. However, pain or not, rules are rules, and she knew them and broke them. If she was having as much pain as she said she was having (leading to the increased intake of her meds), she should have called for an earlier appointment to ask for another prescription, instead of just changing the dosage on her own. That way, she wouldn't have been in violation of her contract.
Unlike on TV, doctors are aware that narcotics can be addictive. They are also aware that they are sometimes necessary. The tricky part is getting things down so the pain can be treated without causing further harm to the patient.
Thursday, December 11, 2008
OSUMC Clinical Epidemiology
Today I spent the day with the infection control team at OSU. The day started fairly early, as we had to review all the culture results for the entire hospital (it's a 1000 bed hospital; fortunately, not everyone gets cultures). These have to be monitored for a few reasons: 1) If anything wildly contagious/dangerous (TB, meningitis, etc) is cultured, the epidemiologists have to begin contract tracing and making sure everyone who has had contact with the sick patient gets proper treatment. 2) Infections, especially hospital-acquired infections, must be reported, according to the Joint Commission (the group that accredits hospitals). 3) Following bacteria and what they are resistant to allows for better antibiotic prescribing practices in the hospital.
After going through the culture results, I went on rounds with the infection control agent of the Ross Heart Hospital (one of the four hospitals that makes up OSUMC). It was rather interesting; many of the things we were looking out for were things I had never considered, such as the exact location of sinks and soap dispensers, making sure all procedure rooms have sterile areas, and checking for dust that housekeeping has missed. By the end of rounds, we had put in two work orders, one for a shelf in a procedure room and one for a sink. We also discussed how infection control personnel can be involved in hospital design, to make sure each room is properly set up for a given purpose.
This particular infection control nurse has been working with the cardiothoracic surgeons on reducing the infections associated with ventricular assist devices (VAD, or for any Grey's Anatomy fans, LVAD). Fortunately, one was being removed and replaced in one of the ORs today, so we went in so she could point out all the infection control changes that have been made, which have resulted in OSU having the lowest infection rates for VADs in the world.
After lunch was the Infection Control Committee meeting, which included reports on the hospital acquired infections and what is being done to reduce those numbers. After that, I went on rounds with the ICU infection control agent. We discussed infection rates and monitoring in the neonatal, medical, and surgical ICUs, and then went on rounds to those areas. All I have to say about that is NICU babies are scary. One pound is pretty small for a human being.
Anyway, at the end of the day, I feel that I learned a lot about epidemiology and how it applies in a hospital setting. It was more of a preventive medicine than occupational medicine day, but that's okay with me.
After going through the culture results, I went on rounds with the infection control agent of the Ross Heart Hospital (one of the four hospitals that makes up OSUMC). It was rather interesting; many of the things we were looking out for were things I had never considered, such as the exact location of sinks and soap dispensers, making sure all procedure rooms have sterile areas, and checking for dust that housekeeping has missed. By the end of rounds, we had put in two work orders, one for a shelf in a procedure room and one for a sink. We also discussed how infection control personnel can be involved in hospital design, to make sure each room is properly set up for a given purpose.
This particular infection control nurse has been working with the cardiothoracic surgeons on reducing the infections associated with ventricular assist devices (VAD, or for any Grey's Anatomy fans, LVAD). Fortunately, one was being removed and replaced in one of the ORs today, so we went in so she could point out all the infection control changes that have been made, which have resulted in OSU having the lowest infection rates for VADs in the world.
After lunch was the Infection Control Committee meeting, which included reports on the hospital acquired infections and what is being done to reduce those numbers. After that, I went on rounds with the ICU infection control agent. We discussed infection rates and monitoring in the neonatal, medical, and surgical ICUs, and then went on rounds to those areas. All I have to say about that is NICU babies are scary. One pound is pretty small for a human being.
Anyway, at the end of the day, I feel that I learned a lot about epidemiology and how it applies in a hospital setting. It was more of a preventive medicine than occupational medicine day, but that's okay with me.
Tuesday, December 9, 2008
Dr. Wynd's Back Pain Clinic
No, there was no back pain clinic, just more occupational medicine, but for some reason, every since one of Dr. Wynd's patients this morning had complaints of back pain. It got a bit monotonous, but I've gotten a lot of practice doing back exams.
Occupational medicine hasn't been treating me too poorly. Most days, I start around 8, and head home around 3. Dr. Schaub, the doctor I'm mostly working with, has been getting me in various clinics and sites, including both occupational medicine clinics at OSU (neither of which are at OSU), employee health at OSU, hospital epidemiology, and the Big Lots warehouse (he's the Big Lots employee physician). Many large companies, especially large companies with warehouses or factories, have staff physicians, often certified in occupational medicine. That's pretty much where the money is in this specialty (and it's good money, from what I hear). Government agencies also employee occupational medicine physicians--of the OSU physicians I have worked with, Dr. Rodway is a DOT physician, and Dr. Kearns goes to the Defense Supply Center Columbus and is also a FAA flight surgeon.
Anyway, that's pretty much all I do every day--go to clinic, see people who have been hurt at work, see how they're doing, figure out what we can do for them, and try to get it done. There's a lot of government red tape to go through, which makes me very glad that I'll be doing this in the Army and not in a civilian setting. The Army actually makes things simpler.
Occupational medicine hasn't been treating me too poorly. Most days, I start around 8, and head home around 3. Dr. Schaub, the doctor I'm mostly working with, has been getting me in various clinics and sites, including both occupational medicine clinics at OSU (neither of which are at OSU), employee health at OSU, hospital epidemiology, and the Big Lots warehouse (he's the Big Lots employee physician). Many large companies, especially large companies with warehouses or factories, have staff physicians, often certified in occupational medicine. That's pretty much where the money is in this specialty (and it's good money, from what I hear). Government agencies also employee occupational medicine physicians--of the OSU physicians I have worked with, Dr. Rodway is a DOT physician, and Dr. Kearns goes to the Defense Supply Center Columbus and is also a FAA flight surgeon.
Anyway, that's pretty much all I do every day--go to clinic, see people who have been hurt at work, see how they're doing, figure out what we can do for them, and try to get it done. There's a lot of government red tape to go through, which makes me very glad that I'll be doing this in the Army and not in a civilian setting. The Army actually makes things simpler.
Wednesday, December 3, 2008
Worker's Comp
This month, I'm doing an occupational medicine elective. I wasn't sure what all that entailed until I met with Dr. Schaub, my preceptor, yesterday morning, and I'm still not completely sure, but here's what I've gathered thus far: most of my days will be working in one of two occupational medicine clinics in Columbus, and I'll also being spending half days doing hospital epidemiology at OSU, work-site inspections at major corporations in Columbus, and working with FAA flight surgeons. Thus far, I've done half a day in the occupational medicine clinic.
Occupational medicine clinics aren't primary care offices, and occupational medicine docs aren't primary care physicians. The only reason for the visit, and the only concern of the physician, is what was injured while the patient was at work. People on worker's comp have to see occupational medicine specialists on a regular basis, for continued evaluation of their injuries, to determine if they are fit to return to work (and what duties they can do there), and to coordinate care with other specialists. That is all the doc is worried about--no lecturing the patient about not taking their blood pressure medicine or checking their blood sugar.
So before I began my shift yesterday, I was given the half-hour lecture about worker's comp and how it works. Dr. Schaub explained by explaining how things were before worker's comp: if you were injured at work, the only way you could get money for your medical bills and lost wages was to go through the tort system, and to do that you had a hire a lawyer (obviously), and had to prove you were injured at work (not so difficult if you came to work with ten fingers and left with nine, but more iffy if you developed lung disease after working in a coal mine for thirty years). There was also the assumption of risk, meaning that there were certain risks at every job, and if the employer told you about the risks, you accepted that you were okay with them when you started working there, and thus, any injury as a result was not the employer's fault.
Now, with worker's comp, it's completely non-tort--in fact, you can't sue your employer if you're injured at work. No lawyers are involved, and all that you have to indicate is that there is a "reasonable medical probability" that work contributed to the injury, so now that covers things like Black Lung Disease from coal mines, carpal tunnel syndrome in secretaries, etc. There is no assumption of risk; if the job-site isn't safe, it's now in the employer's best interest to make it so, in order to keep people from getting injured.
The biggest misconception about worker's comp is that it's permanent disability; it isn't. That's social security. Worker's comp only pays temporary total disability, and if you can't get back to a job before that expires, you're done. Notice I said a job, not your job--employers may have you come back doing something that won't aggravate the injury, and if you can't handle that, you may need to get a new job. One nice thing about this is if it becomes obvious that you can't go back to what you were doing, you could be enrolled in vocational rehabilitation, which helps you find/train for a new job that you can do with your injuries.
So yesterday we saw a variety of patients, from a legal aide with carpal tunnel (we had a laugh together about that one, as we both had our wrist braces on), to a TSA agent recovering from a broken knee after a fall while he was searching a passenger, to a woman who was going to have to enter vocational rehab, as she had been making no progress gaining strength in her arm after a fall on her shoulder a year ago. Many of these patients were eager to get back to work doing something; in fact, the legal aide was still doing a lot of typing on a daily basis.
I guess I never really considered how a relatively minor injury could sideline someone in certain positions. For example, we cleared the TSA agent for full-duty yesterday, but he still could not kneel on his right knee without pain, which means that while he's searching passengers, he'll have to remember to drop to his left knee, and while he's lifting luggage, he'll have to remember to support it with his left. We also had a correction's officer with a sprained thumb who couldn't go to work at all; even the most limited-duty jobs (ie, watching monitors) could conceivably require her to restrain a prisoner, and without grip strength of her hand, she couldn't grab someone and put them in handcuffs. Sometimes, it's all about putting the injury in perspective.
Occupational medicine clinics aren't primary care offices, and occupational medicine docs aren't primary care physicians. The only reason for the visit, and the only concern of the physician, is what was injured while the patient was at work. People on worker's comp have to see occupational medicine specialists on a regular basis, for continued evaluation of their injuries, to determine if they are fit to return to work (and what duties they can do there), and to coordinate care with other specialists. That is all the doc is worried about--no lecturing the patient about not taking their blood pressure medicine or checking their blood sugar.
So before I began my shift yesterday, I was given the half-hour lecture about worker's comp and how it works. Dr. Schaub explained by explaining how things were before worker's comp: if you were injured at work, the only way you could get money for your medical bills and lost wages was to go through the tort system, and to do that you had a hire a lawyer (obviously), and had to prove you were injured at work (not so difficult if you came to work with ten fingers and left with nine, but more iffy if you developed lung disease after working in a coal mine for thirty years). There was also the assumption of risk, meaning that there were certain risks at every job, and if the employer told you about the risks, you accepted that you were okay with them when you started working there, and thus, any injury as a result was not the employer's fault.
Now, with worker's comp, it's completely non-tort--in fact, you can't sue your employer if you're injured at work. No lawyers are involved, and all that you have to indicate is that there is a "reasonable medical probability" that work contributed to the injury, so now that covers things like Black Lung Disease from coal mines, carpal tunnel syndrome in secretaries, etc. There is no assumption of risk; if the job-site isn't safe, it's now in the employer's best interest to make it so, in order to keep people from getting injured.
The biggest misconception about worker's comp is that it's permanent disability; it isn't. That's social security. Worker's comp only pays temporary total disability, and if you can't get back to a job before that expires, you're done. Notice I said a job, not your job--employers may have you come back doing something that won't aggravate the injury, and if you can't handle that, you may need to get a new job. One nice thing about this is if it becomes obvious that you can't go back to what you were doing, you could be enrolled in vocational rehabilitation, which helps you find/train for a new job that you can do with your injuries.
So yesterday we saw a variety of patients, from a legal aide with carpal tunnel (we had a laugh together about that one, as we both had our wrist braces on), to a TSA agent recovering from a broken knee after a fall while he was searching a passenger, to a woman who was going to have to enter vocational rehab, as she had been making no progress gaining strength in her arm after a fall on her shoulder a year ago. Many of these patients were eager to get back to work doing something; in fact, the legal aide was still doing a lot of typing on a daily basis.
I guess I never really considered how a relatively minor injury could sideline someone in certain positions. For example, we cleared the TSA agent for full-duty yesterday, but he still could not kneel on his right knee without pain, which means that while he's searching passengers, he'll have to remember to drop to his left knee, and while he's lifting luggage, he'll have to remember to support it with his left. We also had a correction's officer with a sprained thumb who couldn't go to work at all; even the most limited-duty jobs (ie, watching monitors) could conceivably require her to restrain a prisoner, and without grip strength of her hand, she couldn't grab someone and put them in handcuffs. Sometimes, it's all about putting the injury in perspective.
Friday, November 28, 2008
Happy Thanksgiving, and farewell to Tripler
As some of you know, I am now back in Ohio, having left Honolulu at 4:50 pm HST on Thanksgiving. Somewhere in the process, between the long flight and time zone changes, I lost an entire day. I'm still having a hard time believing it's Friday. I'm also having a hard time staying awake, so I apologize if this post doesn't make much sense (as tempted as I am to get sleep, I'm trying to go to bed at a reasonable Ohio hour to ward off jet lag).
Anyway, before leaving, one of the other med students and I hit up Safeway for a Thanksgiving feast we could prepare using only a microwave. Here was our pre-"cooked" spread:
It was actually pretty good, and it was nice to spend one last morning/early afternoon with a few other med students.
Unfortunately for me (fortunately for some of you), I bought way too many souvenirs/Christmas gifts, and couldn't get everything in my suitcases, so I had to fly in uniform. It's not too uncomfortable, but I always feel awkward with people asking if I'm coming or going, and all I can say is "coming from a month of training in Hawaii". Not quite what most people have in mind when they thank me for my service. However, it did earn me a last-second upgrade on my last flight (the 1.5 flight from Atlanta to Columbus). I slept for most of it (remember: time zones are all screwed up), but it was kinda nice.
Anyway, before I left, Tripler already had some Christmas decorations up. Well, they've had some up for the entire rotation, but the departments each had their signs up, some of which were fairly clever. Here's the department of Radiology:
And of course, I wouldn't be me if I didn't include the department of Preventive Medicine (not nearly as clever, but whatever):
So, that was that. I'm sad to see Hawaii go (I was really sad when I got off the airplane in Columbus and promptly froze). Now I have the weekend to study for the exam I should have taken on Wednesday (had I not been five time zones away), and I begin my next rotation (occupational medicine) on Monday.
Anyway, before leaving, one of the other med students and I hit up Safeway for a Thanksgiving feast we could prepare using only a microwave. Here was our pre-"cooked" spread:
It was actually pretty good, and it was nice to spend one last morning/early afternoon with a few other med students.Unfortunately for me (fortunately for some of you), I bought way too many souvenirs/Christmas gifts, and couldn't get everything in my suitcases, so I had to fly in uniform. It's not too uncomfortable, but I always feel awkward with people asking if I'm coming or going, and all I can say is "coming from a month of training in Hawaii". Not quite what most people have in mind when they thank me for my service. However, it did earn me a last-second upgrade on my last flight (the 1.5 flight from Atlanta to Columbus). I slept for most of it (remember: time zones are all screwed up), but it was kinda nice.
Anyway, before I left, Tripler already had some Christmas decorations up. Well, they've had some up for the entire rotation, but the departments each had their signs up, some of which were fairly clever. Here's the department of Radiology:
And of course, I wouldn't be me if I didn't include the department of Preventive Medicine (not nearly as clever, but whatever):
So, that was that. I'm sad to see Hawaii go (I was really sad when I got off the airplane in Columbus and promptly froze). Now I have the weekend to study for the exam I should have taken on Wednesday (had I not been five time zones away), and I begin my next rotation (occupational medicine) on Monday.Wednesday, November 26, 2008
Last day at work
Today was my last day in the Allergy and Immunology clinic. It was a typical day at work, albeit a bit short (no patients scheduled for the afternoon--yay!). I evaluated a couple of patients, wrote a couple of notes, chatted with COL Yang and LTC Marks for a bit, and then headed to noon conference before heading out for the day. I decided to hit the gym for what will probably be my last time swimming in an outdoor pool in November for awhile.
Anyway, here's the "office" I've been using for the past month. It's not as much an office as a storage space for extra stuff that just happens to have a computer.
So, tomorrow I have outprocessing--ugh. Walking through the hospital getting signatures from various departments (security, computer IT, etc), asking for permission to go home when I don't want it, is never my idea of a good time.
Anyway, here's the "office" I've been using for the past month. It's not as much an office as a storage space for extra stuff that just happens to have a computer.
So, tomorrow I have outprocessing--ugh. Walking through the hospital getting signatures from various departments (security, computer IT, etc), asking for permission to go home when I don't want it, is never my idea of a good time.
Monday, November 24, 2008
Last dive in Hawaii
Sadly, today was my last dive with Gabe and Kaimana Divers. We went out to Waianae again (on the west side of Oahu) and did two different dives than we did last week. No sunken ships or airplanes this time, but we did a cave dive and a reef dive, so there were all sorts of fish and such to see. On the first dive (the caves), we also see a sea turtle, and on the second dive, we saw a couple of octopi (?). That was rather fun, especially when they squirted ink. There's nothing dangerous about the ink; it's just to cloud the water so predators can't see the octopus, giving it time to get away (in theory).
Anyway, here are some pictures from between the dives. This is me and Jack (one of the other divers). Today was her birthday, so she got to pick the dives.
And here are some other divers. It was kinda cold today (75ish), which is why people are bundled up.
So, that's that. I got in six dives this month, which isn't bad. I just wish I knew when I'll be someplace warm enough to go diving again.
Anyway, here are some pictures from between the dives. This is me and Jack (one of the other divers). Today was her birthday, so she got to pick the dives.
And here are some other divers. It was kinda cold today (75ish), which is why people are bundled up.
So, that's that. I got in six dives this month, which isn't bad. I just wish I knew when I'll be someplace warm enough to go diving again.Friday, November 21, 2008
Transient hypogammaglobulinemia of infancy
No, the title of the post wasn't me slamming my hands against my keyboard. That was the disease (well, not really a disease...) one of my patients had today.
The reason why I say it isn't really a disease is that transient hypogammaglobulinemia of infancy is a normal variant of the immune system of children. When born, babies have their mother's antibodies. As the months go on, those antibodies begin to fade, and the baby's own immune system is supposed to take over. Sometimes there's a bit of a lag between those two things happening, leaving the kid with low (hypo) antibodies (gammaglobulins). So, there are low levels of antibodies in the blood (-emia), you get hypogammaglobulinemia.
The kid today was a twin born at 34 weeks (remember from my OB posts, a full-term pregnancy is anything between 37-42 weeks). Since he didn't have as much time being fed from the placenta as he should have, he didn't have as much of his mother's antibodies as he could have used, which meant his levels got lower than they should have. At Ft. Knox (where he was born), he had several ear infections starting at 3 months old, which prompted a referral to the immunologist. He did blood tests and saw that there were low levels of antibodies, so he diagnosed transient hypogammaglobulinemia of infancy. Technically, the "transient" part can't be diagnosed until it goes away, which is why he's following up now--to get blood drawn again to check the levels. Since he hasn't had many infections in the last six or so months, we're pretty sure even before getting his blood that he has appropriate levels of antibodies for his age.
On a completely different note, I've mentioned a few times the hills of Tripler, so I included the elevation map (green line on the graph) of my usual run from my GPS watch. That loop takes me completely around base--like Walter Reed and unlike Madigan, Tripler is a stand-alone base, not part of a larger one. So it's a pretty small world I'm living in this month (obviously, as there's not even a place to buy food on base).
The reason why I say it isn't really a disease is that transient hypogammaglobulinemia of infancy is a normal variant of the immune system of children. When born, babies have their mother's antibodies. As the months go on, those antibodies begin to fade, and the baby's own immune system is supposed to take over. Sometimes there's a bit of a lag between those two things happening, leaving the kid with low (hypo) antibodies (gammaglobulins). So, there are low levels of antibodies in the blood (-emia), you get hypogammaglobulinemia.
The kid today was a twin born at 34 weeks (remember from my OB posts, a full-term pregnancy is anything between 37-42 weeks). Since he didn't have as much time being fed from the placenta as he should have, he didn't have as much of his mother's antibodies as he could have used, which meant his levels got lower than they should have. At Ft. Knox (where he was born), he had several ear infections starting at 3 months old, which prompted a referral to the immunologist. He did blood tests and saw that there were low levels of antibodies, so he diagnosed transient hypogammaglobulinemia of infancy. Technically, the "transient" part can't be diagnosed until it goes away, which is why he's following up now--to get blood drawn again to check the levels. Since he hasn't had many infections in the last six or so months, we're pretty sure even before getting his blood that he has appropriate levels of antibodies for his age.
On a completely different note, I've mentioned a few times the hills of Tripler, so I included the elevation map (green line on the graph) of my usual run from my GPS watch. That loop takes me completely around base--like Walter Reed and unlike Madigan, Tripler is a stand-alone base, not part of a larger one. So it's a pretty small world I'm living in this month (obviously, as there's not even a place to buy food on base).
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