Holy medical people overload! That's how I feel (and I'm sure Dylan feels as well) right now! I know that these people are here to help us, I really do know and appreciate that, but sometimes it's alot. It's just...alot.

So, Dylan is doing well. Yesterday he worked with his OT and EI nurse. He was able to focus on the OT's face and track a tiny bit as well, which is very good progress for him! His eyes have also not been crossing in as much, which is great news as it was a slight concern the last time they were here. The nurse mentioned that it appears as though Dylan is slightly hyper-sensitive - he gets overloaded easily. I am suppose to learn how to swaddle him (is that how you even spell that?) properly so that when he goes into that "spaz mode" as I like to call it, he will feel more safe and secure. Hopefully as he grows and develops more, this will pass.

Dylan also had his 2 month pediatric appointment today. His weight is now at 10 lbs 1.5 oz and he is 21 3/4 inches long! Woohoo! This is great news, as you may remember we are trying to reach 12 lbs before his heart surgery. He received all of his shots and only cried for a little bit. We are suppose to call and schedule a follow-up hearing test with the audiologist as his right ear has not passed twice, but I think we'll wait until after the surgery to go down that road again. All in all, I would say it was a great appointment.


Now...as I was driving home from this appointment I couldn't help but wonder about this icky knot in my stomach. I'm finding that I tend to get this when I am around medical people now. I think it may stem from our experiences of when Dylan was in the NICU. It seemed like every time I was approached by a doctor, I was told something negative...now I'm scared of them - those medical people. I'm scared that they will tell me something else that I do not want to hear.

And another thing that may have contributed to the knot. I noticed that three times, Dylan's doctor used the word "normal". And it was used not in reference to Dylan, but rather in reference to babies who apparently are not like Dylan - these are the normal babies. Yes, I know that like Dylan, I too am hyper-sensitive - especially when it comes to words like this now. I just wish she could have used the word "typical" instead. Because my son is normal! Sheesh, this kid is alot more normal that I am! : )

I wonder if I will ever get used to all this stuff. Will I ever stop being so sensitive about words and the way that people may refer to my son? Will I ever start to feel more comfortable around doctors and nurses and not expect to hear something bad? When will this life that I did not expect start to feel right to me.

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Yes yes

I did sort of promised that I would not post anything about medical school and all that wonderful stuff but that's not going to stop me from blogging about my first day shadowing a cardiologist :o)

Last Friday I had an informal meeting with the doctor that I will be shadowing for less than a fortnight. Basically I will be following her around, accompanying her during rounds, sitting in during outpatient clinic time (with permission of the patient, of course).

Today I found out that we'll also be making chika among many other things when she's not seeing a patient. I witnessed a procedure in which radioactive thallium-201 was used to diagnose coronary artery disease, followed by thallium stress induced by a scan (another procedure) - it was fantastic.

During rounds we saw a couple of her inpatients. One is an elderly man who looked even older with all the machinery attached to him. He was in intensive care, enclosed in an isolated negative pressure room to avoid contamination - he had an infectious disease among many others. That was hard because that man is someone's grandfather, someone's father, he should be out playing with his grandchildren, not in the room writhing in his bed :o(

Around lunch time we attended a little conference organised by the cardiology fellows. There I was with cardiology studs, learning about the effects of ivabradine from a double-blind study. I understood almost everything save for a handful of terms and medicines that I know nothing about. I have been reading up on cardiovascular diseases and treatments as to be a little more savvy for when I follow the doctor around you see ;o) Hey Philippines, we're a little behind when it comes to newer, alternative treatment for CAD.

Afternoon time means clinic time so I sat in and stayed out of view, blending into the wall. I am very pleased to say that the doctor and I made the same diagnoses (hers being way more complicated, elaborately explained and thorough, of course WITH plan of action) but I got the gist and that's one heck of a confidence booster.

I learned more about how it is like to be a doctor, practicing in the Philippines. How the hospital works and who does what. So many things. I hope to learn more in the coming days.

In a way, I am happy that I have a sincere interest in medicine, I really do see myself in the profession, but at the same time, the pressure is ever more present. Stupid graduate tests. Hey, maybe I will change my mind as time goes right? Or maybe I really should just have more faith in myself.

Whatever this life brings, I am glad a had a good day today.

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Richard Chappell uses eye cups from the skate, Raja erinacea, to study the relationship between zinc and glutamate. (Credit: Joseph Caputo/MBL)
Paradoxically, the photoreceptor cells in our retinas release more of their neurotransmitter, glutamate, in the dark, when there is nothing to see, than they do in the light. This is doubly surprising since although glutamate is a major signaling molecule in the retina and throughout the central nervous system, it is also a potent cytotoxin that, in large doses, can kill nearby cells. What keeps our retinas from disintegrating each night as glutamate continues to be released is unknown, but growing evidence suggests our molecular protector may be zinc, a metal abundant in tissues throughout the body.
Zinc’s relationship to vision was first recognized when it was found that night blindness is associated with zinc deficiency, and recent studies have shown that a diet supplemented with this trace metal can reduce the progression of one form of age-related blindness. But despite its apparent benefits, not much is known about the relationship between zinc and the eye.
Richard Chappell, a professor of biological sciences at Hunter College, is at the MBL this summer with doctoral student Ivan Anastassov and Harris Ripps, a senior research scientist at MBL and emeritus professor of ophthalmology at the UIC College of Medicine in Chicago, to investigate how zinc may control the wily glutamate. Using the retina of the skate, a cartilaginous fish resembling a manta ray, they record electroretinograms (ERGs) to measure how retinal neurons respond to light stimuli in the presence and absence of normal levels of zinc. Their preliminary results indicate that ionic zinc (Zn2+) is co-released with glutamate from skate rods, and feeds back onto the photoreceptor terminals to suppress the release of glutamate, thus providing an automatic gain control mechanism that reduces the risk of glutamate toxicity.
Demonstrating the role of Zn2+ in the regulation of glutamate release from skate rods is still a long way from fully understanding its potential use in therapy for human diseases where glutamate toxicity may be involved, but its ubiquity among vertebrates shows promise. The presence of available Zn2+ and/or its transporters has been observed in the photoreceptor region of salamanders, zebrafish, mice, and skates, but “The question is whether this is an integral part of the physiology of the retina,” says Ripps. “Once you understand the normal retina, you can determine the basis of retinal disorders.

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                                       Treatment guidelines in cardiology  practice  are periodically published by ACC/AHA/ESC.These guidelines  represent the current scientific practice. They are called some times as recommendations. Medical professionals tend to adhere to this guidelines whenever possible.They are not legally binding in most of the countries.In USA some states believe it, to be legally binding.
 
The problem with these guidelines  are, they are classified as class 1,class 2, class 3 recommendations.
 
Class 1, A  drug, device  or a procedure  Is definitely useful and must be prescribed.
Class 3,   A  drug, device  or a procedure  Is not useful and should not be used .
Class 2*, A  drug, device  or a procedure  may be useful  or may be harmful, and hence may be used or may not be used . (Vaguest possible guideline!)
 *Altered to convey the meaning
What are the  guideline violations that can be sued in court of law  ?
A person with established  CAD who is not been prescribed a  statin (Cholesterol lowering drug)  can be sued straight away,  even if the patient has no adverse outcome due to the nonprescription of that drug. The issue here is, the doctor  has not prescribed  a drug which has  proven benefit .The law is clear on that .Most will  agree that,  the  doctor is at fault,  and he  is never protected  even by their  colleagues .He  cant defend his action.
What are the medical errors that can never* be sued in court of law !
But the same doctor who opens up a totally occluding coronary artery in an asymptomatic patient(CTO -chronic total occlusion) and lands up  in a complication and the  patient dies. This could be  major guideline violation as opening a CTO in an incidentally detected, asymptomatic patient is a class 3 recommendation. Neither the physician, patient, institution  nor  the regulatory authorities bother about this even though there is strong case for censure, in reality it never happens. Number  of  experts from leading hospitals do this procedure in live work shop all over the world with full media glare, It is an irony the same  experts are only  writing  in their  guidelines  that  these procedures should not be done inappropriately.
And this medical  error ( Should we call it a  crime if it is knowingly done ! )   keeps growing as the physician never feels guilty about it .
The message here is
 A physician of a state of the art hospital,  in a scientifically advanced  country  goes scott free and guilt free  even if he openly violate the scientific guidelines and result in patient death  while a small time physician in a remote place in the same country can be taken to task for not prescribing a drug which  apparently had not caused any adverse effect .
In short, in todays modern medical practice 
Even a   Minor error of  ommision   attracts guilt and perceived fear among the physicians. Meanwhile  many  of the Major errors of commission  done by professionals are rarely frowned upon and thus these mistakes continue to perpetuate !
*There should be a strong provision in medical law to address the issue of inappropriate procedures even if the procedure has not resulted any untoward effect to the patient.

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Yesterday Dylan and I met with his cardiologist for a follow up appointment. The doctor told me that typically around Dylan's age (8 weeks), most children with an AV Canal Defect will start to show signs of heart failure. At previous appointments we have been told to watch Dylan closely for possible signs of distress, such as: heavy breathing, sweating, over tiredness and blueness around his mouth. I told the doctor that I didn't think I've noticed any of these things yet...I mean sure, he does sweat and he does sleep alot...but then again it's summer after all and he's a baby, so is this normal or is it heart failure...? She reassured me that I would "just know" when he begins to show true signs, so for now it appears that he is doing very well!!

He had an EKG done, which was lots of fun because he is suppose to lie still while they attach a million little sticky things all over his body and then continue to lie there as they try to get a good reading of his heart. Um, yeah. The doctor said that his reading came back ok and that there was nothing completely unusual about it. I am going to have trust her on this as the thing looked like a much too complicated math problem to me.

I asked the doctor a ton of questions and she sat there and talked with me about everything. She told me that the entire surgery should take about 10 hours total - from the time Dylan is handed over to the anethesiologist until he is wheeled out of the room. The actual surgery should take between 4-6 hours. He will mostly likely be in the hospital anywhere from 1 to 2 weeks. We talked a little bit about what to expect when he is wheeled out of the OR as well as his road to recovery.

So, where we go from here is another follow-up appointment in a couple of weeks in which he will most likely be put on medication. Then, the doctor will compose all of Dylan's medical records and present them to the surgeon who will then determine when the best time for his heart surgery will be. It is still most likely going to be sometime in October. They are hoping to wait until he reaches 12 lbs as apparently that minimizes the risk of complications. Dylan weighed 9lbs 7 oz on their scale yesterday, so hopefully by October he will reach 12 lbs.

As I was getting ready to leave, the doctor introduced me to a nice couple and their 3 month old daughter who just had the AV Canal repair surgery 3 weeks ago. We spoke for a while and they were able to give me helpful information as well as lots of reassurance. They were very honest with me by telling me that it is by no means easy, but it's all going to be ok. As I mentioned before, I know that Dylan is going to pull through with flying colors. It just helped reassure me that I may actually be ok as well.

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Today was a long day. Like usual, I got to the hospital around 8. I began seeing my patients in a mad rush so that I could make a part of morning report, which ran 9 to 10. Like always, I was late. And there was unfinished notes, even a patient I hadn't examined yet.

And there was a new patient apiece between me and the med student CH. It wasn't even noon yet. I picked up yet another, but luckily Dr. F was with us by then. We took off, saw the patient together and he wrote the note, which is an awfully nice gesture. As I was packing my stuff to go (it was five, when my day usually ends), I got a call from the fellow.


He dumped a new consult on me. Actually, it wasn't him, it was Urology. The team wanted "cardiac clearance" for a patient about to be operated on. Without knowing anything but the patient's name and room number, I headed up. I was pissed. Getting a consult after five o'clock was really poor form.

But boy was I elated when I read the chart: the patient had pheochromocytoma, a very interesting disease. It is sheer luck to see this since it is so rare. What happens is chromaffin cells in the adrenal gland grow in number (it is after all a cancer), and secrete copious amounts of epinephrine (i.e., adrenaline) and norepinephrine into the blood stream. The consequence is increased pressure, headaches, flushing, sweating. It is easily treatable as the vast majority is a single tumor.

After absorbing the patient's history, I went inside the room to take a look. In the bed was a beautiful middle-aged woman, and in the couch next to her was her husband. From her poise and genteel-ness, she struck me as a former local beauty queen. Her physical exam was remarkably unremarkable. Her history was interesting: after a 15-year history of hypertension controlled on one medicine (not to mention a strong family history), she had spikes in her BP and even three and four anti-hypertensives could not contain the elevation in BP. Her systolic reached 205! Surprisingly, besides "hot flashes," she had no headache, pains, palps or flushing.


In the middle of the exam, I got a call from the on-call cardiology fellow. I told him what I knew. He asked how long was she on the alpha blocker, the beta blocker. I told him, sounding unsure. He arrived with Dr. F, my attending. The fellow looked livid, and after looking at the chart and learning from me that the patient had only two days of alpha-blockade with phenoxybenzamine, Dr. F uttered a word I never heard him say: Fuck, as in "What the fuck!" (Definitely an exclamation, not a question.)


He was angry at Urology for calling us so late (he told me, and the fellow reiterated, to never call a consult service this late). He was also upset at how Urology dropped the ball. See, a person with PCC needs 7-10 days of alpha blockade before starting beta blockade. In her case, she was only 2 days of alpha blockade the night before the operation to remove her cancerous adrenal gland. That meant it would be a high risk surgery.


Dr. F went into his soft-spoken grandfatherly demeanor, the one patients love so much (he was called by the one patient's wife the ideal picture in her mind of a doctor), and he spoke with the patient. He said that she is supposed to be on 7-10 days of phenoxybenzamine, and we told her this would reduce the risk of complications during surgery. Dr. F was careful to say the Urologist was skilled and would do a good job, but still in his opinion she ought to be on phenoxybenzamine for longer. Her husband and she agreed.


We walked back out. Dr. F launched into how much of a prick the urologist was. The fellow paged urology. I made myself busy looking up lab numbers and finishing the HP note so that Dr. F could piggyback and write his note. The fellow informed the urologist, who was out of town, and a half hour after trying to get a hold of him, that we advised the patient to get full alpha blockade and that she agreed.


It was seven thirty p.m. when I left, and I was on cloud nine, surprising myself as I hate to stay late at the hospital. But I was quite happy. In one swoop, I saw firsthand a rare endocrine disease that fascinated me since I learned about it in school, I had a really cool case to present in morning report the following week, and we saved this beautiful woman's life.

I learned you can't rely on experts to always do the right thing. Even they make mistakes. So we have to vigilant, always, for our patients and ourselves.

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Dr. Lacina can hear residual backflow of blood from her narrow valve and at some point in her life, she may require surgery to replace the valve. For children with her heart condition (Tetralogy of Fallot), its not unusal for them to need a valve replacement later in life. The doctor isnt worried and is very pleased with her progress. Shes hitting all her physical and developmental milestones and we couldnt be more excited at the changes weve seen in our little girl since surgery. She doesnt even need to go back to the cardiologist until the spring. Woo hoo.

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An article in the New England Journal of Medicine tomorrow by John K. Iglehart examines the policies under which Medicare supports Graduate Medical Education (GME). Medicare provides significant financial support for the training of residents through GME programs.

"An increasing number of medical-school graduates pursue specialties with a controllable lifestyle and shun careers in primary care..."

Not surprisingly, much of this decision making has to do with salaries and work hours. Illustrated by the 2006 graph above, specialists earn more than primary care providers and often enjoy more manageable work hours.

Even though allopathic US medical schools are increasing enrollment until 2015, many experts are still concerned about a looming doctor shortage. This may increase the liklihood of GME reform in the future.

"Advocates of primary care practitioners believe that nothing short of a major overhaul of economic incentives would attract more medical-school graduates to pursue careers as general physicians."

Click Here to read the abstract.

Visit: http://www.mededits.

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At our 19 week ultrasound Jack was diagnosed with CDH. One week later James and I went to Children's National Medical Center in Washington, D.C. for more extensive analysis. We had a fetal MRI and saw that his hernia was on the left side (the most common) and at that time his liver was 'up' or in his chest. His heart was pushed to the right in his chest and he had a normal sized right lung and a very small left lung (about 1/5 the normal size). Overall his CDH was classified as severe with a Lung to Head (LHR) ratio of 0.8. His echocardiogram showed that his heart was beating strong and there was no underlying congenital heart defect. His amnio was also normal. The prognosis was 20-50% chance of survival at birth. The struggle we faced with this diagnosis was that there is little correlation between prenatal diagnostic test results and outcome at birth. Some babies with mild defects do poorly and some with severe defects pull through and do very well. All we could do was try to be optimistic and hope and pray that Jack would be a strong baby and fight hard. On August 20, 2007 John Verner Jensen "Jack" was born by C-section at The Johns Hopkins Hospital. He weighed 6 pounds 11 ounces and was 20 inches long. Within hours of birth he was placed on ECMO (heart-lung bypass). He had a 10 day run on ECMO and went to his hernia repair surgery on this machine. He was missing 90% of his left diaphragm, had his entire stomach, spleen, and parts of his small and large intestines and liver in his chest and he required agortex patch. Jack came out of surgery off ECMO but with the cannulas still in place until later that night. He had a really hard night after surgery and we nearly lost him. We were later told his blood gases should have been unsurvivable and that it was pure will and not medicine that saved him. After 81 days in hospital we brought Jack home breathing room air and needing only an NG (naso-gastric) feeding tube. After 27 days home he reherniated and we had to go back for emergency surgery at Johns Hopkins. His awesome surgeons literally patched him back up and after another 16 days in hospital he returned home on Dec 21, 2007 - just in time for his first Christmas. Since then Jack has tackled his eating issues and is NG-tube free! He does not require any medication. We are extremely grateful for his incredible medical team and all his friends and family for their support, kind words, thoughts and prayers.

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I meant to post this before I left for a 3 day trip on Wednesday, but as you probably know there is not always enough time in the day, so here goes:

We had Cutter's 6 month check up on Monday and "little" man weighed in at 20 lbs 8 ounces, he was 28 inches tall (I say "was" because he has probably grown half an inch or so) and has a head circumference of 18 inches! He is in the 90th percentile in all three categories! Doc said everything looked good with his head shape and should only get better, since he is not spending much time on his back anymore. We are still working tummy time, he hates it, but I make him do it. He will thank me one day, when he is crawling for a toy! He is reaching more, but he prefers to do it from a sitting position.

The pediatrician did have one concern with the "little" man. He has a heart murmur that he has yet to out grow. She said that she is not too worried about it, but wants to get a ultrasound just to make sure. The pediatrician's office that we go to was started by a pediatrician that specializes in pediatric cardiology, but he has broken his ankle and will be out of the office until August. We will be calling and making an appointment with him when he returns. Until then she gave us a list of some signs to watch out for, some of the more serious ones include: sweating while eating, and shortness of breath when doing normal activities - none of which Cutter is showing. We will be keeping a eye out for any of the signs, but she assured us she didn't think it was a issue and told us not to lose sleep over it.

This week was my first week to be gone for 2 nights in a row, it was VERY hard for me. I am praying that it gets easier, I don't think it will ever be "easy", but I am hoping that it does get easier. Greg is a wonderful, loving and doting father - I don't worry about him doing a good job, I know he does/will. I hate missing that time with Cutter and Greg. The nights are especially hard for me knowing that I am not here to kiss him goodnight, that makes me sad! But, with time it may get easier.

Once again my camera is full of pictures of Cutter and I haven't had the chance to go and transfer them to a CD. I haven't taken a new picture of him in about a week, I think that is the longest I have gone. But I do have these picture taken last weekend at a Fourth of July party!

Enjoy!.

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Similar posts: cardiology doctor

at 8:08 am.  She weighed 7.1 lbs and looked to be about 21 inches long.  She has long chicken legs, piano-players fingers and dancers toes.  She looks a lot like Lola (to us) but has Sarahs eyes and beautiful black hair.
June is hard core.  We expected some complications with her heart rate, but really - she has been incredibly resilient and stable.  Her lungs however, were a bit and the Doctors and Nurses monitored her breathing carefully.  She was given oxygen immediately after her birth and was quickly intubated.  Her lungs sounded harsh, and the Doctors said that they were a bit under-developed.  Because of this, she got assistance with her breathing all day yesterday in the NICU unit.  We werent able to hold her, and it was intimidating to see her hooked up to so many contraptions while they checked her heart and lungs.  The EKGs, X-Rays, and bloodwork, however, showed progress and June is now breathing like a champ and later today we can hold her and give her lots of hugs and kisses.  
Sarah is doing amazing after a rough first day.  She is moving around a lot, feeling much less pain, and is not hooked up to any IVs or machinery.  We are really excited for Lola to meet her new baby sister later today.
We are soooooooooooooo happy and thankful and overflowing with positivity.

Similar posts: cardiology doctor

at 8:08 am.  She weighed 7.1 lbs and looked to be about 21 inches long.  She has long chicken legs, piano-players fingers and dancers toes.  She looks a lot like Lola (to us) but has Sarahs eyes and beautiful black hair.
June is hard core.  We expected some complications with her heart rate, but really - she has been incredibly resilient and stable.  Her lungs however, were a bit and the Doctors and Nurses monitored her breathing carefully.  She was given oxygen immediately after her birth and was quickly intubated.  Her lungs sounded harsh, and the Doctors said that they were a bit under-developed.  Because of this, she got assistance with her breathing all day yesterday in the NICU unit.  We werent able to hold her, and it was intimidating to see her hooked up to so many contraptions while they checked her heart and lungs.  The EKGs, X-Rays, and bloodwork, however, showed progress and June is now breathing like a champ and later today we can hold her and give her lots of hugs and kisses.  
Sarah is doing amazing after a rough first day.  She is moving around a lot, feeling much less pain, and is not hooked up to any IVs or machinery.  We are really excited for Lola to meet her new baby sister later today.
We are soooooooooooooo happy and thankful and overflowing with positivity.

Similar posts: cardiology doctor

at 8:08 am.  She weighed 7.1 lbs and looked to be about 21 inches long.  She has long chicken legs, piano-players fingers and dancers toes.  She looks a lot like Lola (to us) but has Sarahs eyes and beautiful black hair.
June is hard core.  We expected some complications with her heart rate, but really - she has been incredibly resilient and stable.  Her lungs however, were a bit and the Doctors and Nurses monitored her breathing carefully.  She was given oxygen immediately after her birth and was quickly intubated.  Her lungs sounded harsh, and the Doctors said that they were a bit under-developed.  Because of this, she got assistance with her breathing all day yesterday in the NICU unit.  We werent able to hold her, and it was intimidating to see her hooked up to so many contraptions while they checked her heart and lungs.  The EKGs, X-Rays, and bloodwork, however, showed progress and June is now breathing like a champ and later today we can hold her and give her lots of hugs and kisses.  
Sarah is doing amazing after a rough first day.  She is moving around a lot, feeling much less pain, and is not hooked up to any IVs or machinery.  We are really excited for Lola to meet her new baby sister later today.
We are soooooooooooooo happy and thankful and overflowing with positivity.

Similar posts: cardiology doctor

at 8:08 am.  She weighed 7.1 lbs and looked to be about 21 inches long.  She has long chicken legs, piano-players fingers and dancers toes.  She looks a lot like Lola (to us) but has Sarahs eyes and beautiful black hair.
June is hard core.  We expected some complications with her heart rate, but really - she has been incredibly resilient and stable.  Her lungs however, were a bit and the Doctors and Nurses monitored her breathing carefully.  She was given oxygen immediately after her birth and was quickly intubated.  Her lungs sounded harsh, and the Doctors said that they were a bit under-developed.  Because of this, she got assistance with her breathing all day yesterday in the NICU unit.  We werent able to hold her, and it was intimidating to see her hooked up to so many contraptions while they checked her heart and lungs.  The EKGs, X-Rays, and bloodwork, however, showed progress and June is now breathing like a champ and later today we can hold her and give her lots of hugs and kisses.  
Sarah is doing amazing after a rough first day.  She is moving around a lot, feeling much less pain, and is not hooked up to any IVs or machinery.  We are really excited for Lola to meet her new baby sister later today.
We are soooooooooooooo happy and thankful and overflowing with positivity.

Similar posts: cardiology doctor

I realized that I have not updated anyone on how Friday's appointment with the new cardiologist went and I have received a few questions on this, including why I went. I have been seeing a cardiologist for quite a few years for an irregular heart beat. Luckily, it is well controlled with medication and even when it does "flare up", it is pretty benign. The medication that controls it however has the side effect of causing growth restriction in the third trimester for babies. For that reason, and also the fact that for the past few weeks, I am now experiencing symptoms every day with minimal exertion, I am being followed by cardiology more closely.

The new cardiologist is very nice and also very smart. I told John that so far, I am really impressed with the doctors at this hospital (also the hospital where John works, so that should tell me how smart of a doctor he is too!). They all seem extremely well-educated and I feel quite secure in their care. The new cardiologist is attempting to start me on a different medication with less side effects for the babies. We just have to wait and see if it works. So far, I haven't noticed any difference. The only bad part of the appointment was the doctor said that unfortunately, there is not much they can do during pregnancy to treat this besides medication. For that reason, if the new medication does not work, bedrest is likely to be in my future. He said that obviously bedrest will take some of the strain off of my heart having to work so hard to pump all of this extra blood. I wasn't really surprised by this as I have noticed a big change in my stamina over the past month. It seems to get worse every week, leading to me doing less and less. It is just hard due to the fact that I won't be caring for Charlotte every day. I know she doesn't understand why mommy can't watch her and play with her. I completely get that it is all for a great reason... the babies to continue to thrive, so I will do it no problem.

I shouldn't even complain as I know people struggling with much worse circumstances right now. Which reminds me, a fellow blogger expecting twins who is as far along as I am is already experiencing preterm labor. She needs prayers to make it to 24 weeks (the age of viability for babies). I have had such great support from you all, maybe you could say a quick prayer for her and her baby girls today.

One more request today. If anyone in my area knows of a daycare or nanny you trust, would you mind emailing or commenting on this? I am going to attempt to line up a potential care provider for Charlotte just in case bedrest does occur. As always, thanks for everyone's continued love and support.

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Anyone out there that could read the translation that I got and tell me whether it is anything similar to the English version of what I'm trying to send?? I'm sending this letter to Ukraine with friends that are adopting from the same orphanage.
Here is my letter in English:

Dear Antoshka Staff:
I am using an Internet translator so I hope this translates correctly!

I am happy to tell you that Emma (Daria) and Micah (Daniil) are both doing very well! We are so happy to have them as our children and all four of our kids are enjoying one another.
Micah is now 21 months. He is sitting up, is almost crawling, and he smiles all the time. He is now drinking milk made from soy instead of cows milk and his stomach is not upset. He has gained a good amount of weight and is now a healthy size- maybe even getting chubby! He is a real joy and always has a smile for people. He sleeps well, eats well, and loves to play with toys that make music or light up. He has started getting physical, occupational, and speech therapy and is doing well with all of those. He still catches pneumonia quickly but we now have a machine at the house to help him when his breathing is wheezy. He was in the hospital once and now we can treat it at home.
Emma is doing so well! She tries to sit up and is a very happy girl. She loves to be in the pool and likes toys that she can chew on or that sing. When we first came home we had a heart catheterization done for Emma and we were told she would not live long, and that her lungs had too much damage- her heart could not be fixed. We have asked for a second doctors opinion and he will fix her heart! We are so glad that she will have this operation. This week she is having surgery to remove her tonsils and adenoids and put tubes in her ears so the fluid will drain. Her throat is obstructed so that she has trouble breathing, especially at night. After this surgery we will wait a few weeks then have her heart fixed.
I have included pictures of the kids playing and also one of the space shuttle launch which we all watched together. Please share these with the caregivers who took care of Emma and Micah. I know they were hoping for an update.
I will write again after Emmas surgery and will try to send more photos as well. Thank you so much for the gift of our children. They are so precious to us, as you can see in the pictures! God Bless you all!
Sincerely,

Michael and Meredith Cornish

And here it is HOPEFULLY in Ukrainian!:
Шановні Antoshka необхідність дотримання формальностей:
я використання році було оголошено Інтернет транслятор так Я думаю це легко переводить сенс правильно зроблено!
я радий до вам це Emma (Daria) і Micah (Daniil) в Україні що обидві виконання знаю! І ми так радісний Литвина як ними, і на наші дітьми і передусім чотири нашої дітей в Україні enjoying одного.
Micah потрапив 21 місяців. Тобто гравець засідання нагору, майже іноземні інвестиції, який smiles усі термін. Тобто гравець зараз пияцтво молочний з соєвий а не cows молочний і його живіт не є перекинений. Він стала великий обсяг вагу, яка і тепер артикль цілющий обєм- ще проникненням круглолиций! Це справжній радість і завжди має лише посмішка за людей. Він sleeps добре, їсти добре, і любов відіграватимуть есдеки із іграшки це робити ноти або запалювати нагору. Він початий проникненням фізичному, професійний, і мова терапії і виконання добре при всіх ці. Він ще одобрямсом пневмонія швидко але ми зараз мають машинний під час виборів дім не дати скривдити йому коли подих є хрипкий. Йому було в лікарні якось вона опинилася може обробляти його у себе вдома.
Emma робить так добре! І прагне підводитись і дуже радісний дівчина. І любов майбутній в басейн і подібне іграшки вона може жуйка щодо чи іншої свист. Коли ми по-перше ректора, повернувшись існувала серцевина катетеризація зробив для Emma на крейду вже був сказаний вона повинний ні мешкати довго, і що її lungs мається дуже багато пошкодити- її серцевина не могло стати бути фіксованого. У нас попросили предявити другий doctors думка а він піде закріпляти її серцевина! І ми так радий, що вона слід цю операцію. Цього тижня дотримається владних хірургія відмови її tonsils і аденоїди і складати труби у її вухам отже погіршили рідкий буде осушувати. Слухняність Тимошенко її гортань є контексті aби лідер БЮТ неспокій подих, особливо ночами. Після цього хірургія то й відмахнутися почекай місяця-двох без кровопролиття то є її серцевина фіксованого.
Я входить знімків з дітей гра а також під космос човник баркас якого ми всі спостерігається разом. Прошу вас частина ці з caregivers брала близько Emma і Micah. Я знаю що запис вівся сподіваємося на підготовку зміну.
Я ставити жирну же після Emmas хірургія рік і намагаються пошліть ще фотографії і Газпром.
Спасибо якщо за дарунок наших дітей. Вони дорогоцінних турбувати, і ви справді бачать в знімків! Богу Благословляти вами весь.

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Okay, so it's a shameless knockoff of chef Anthony Bourdain's titillating Kitchen Confidential.

But the confidences that I've heard whispered in the corridors of health involve something more provocative than how your food was prepared. Any service for humans performed by other humans is subject to the idiosyncrasies and weaknesses of human behavior. That's just life.

In healthcare for your heart, the consequences can be more profound than eating three day old fish on Monday's dinner menu.

Over my 15 years practicing cardiology in a variety of settings in three different cities, I've witnessed just about everything from shocking to sublime. Some of it speaks to the extraordinary commitment of people in healthcare, the unexpected courage people show in the midst of illness, the devotion of family in difficult times. It can also speak of mewling, sobbing carryings-on over the most minor conditions, the meanness that emerges when people are frightened, the vultures circling just waiting for Grandpa to kick the bucket and leave his will declaring the spoils.

For the most part, my cardiology colleagues are a hard-working bunch committed to . . . Uh oh. I was going to say "Saving lives, preserving health." But that's not true. Once upon a time, it was true for many of my colleagues, often revealed over $2-a-pitcher beer-softened, "we're going to save people" conversations in medical school. Ahhh, medical school. I remember walking along the street alongside my medical school in St. Louis, bursting with pride and a sense of purpose.

But, for many of us, something sours our purpose through the years. Maybe it's the smell of money, maybe it's the series of distasteful experiences that show that healthcare providers are, in the midst of health crises, the innocent recipients of anger, frustration, disappointment.

Whatever the genesis, the stage is set for an imperfect scenario that pits healthcare provider against patient in a less-than-perfect system.

This would read as a mindless rant if it wasn't based on such pervasive and pravalent truths, tales of the flawed deliverers of healthcare driven by motives less lofty than "saving people."

Take Dr. S, a doctor who performs a large number of procedures on patients. I'm told he is very capable. He manages an extraordinary amount of heart work--in between jail time for wife beating and Medicare fraud.

Or Dr. C, well-known in the region for his procedural talents, also. Usually acerbic and freely-swearing, he opens up engagingly when drinking--which is most of the time. Paradoxically, as is true for some serious drinkers, he works more effectively while intoxicated.

Or Dr. ST, who proudly admitted to me one evening over dinner that he has accepted 6-figure payments from medical device companies on a number of occasions to use their products.

Or the manic ups and downs of Dr. J, who refers just about every patient he sees for emergency bypass surgery when in his down phase, mangles coronary arteries in daring angioplasties during his up phase.

How about 310-lb Dr. P, who hounds her patients about indulgent lifestyles? That would be excusable as innocent lack of self-insight if it weren't for her propensity to use heart procedures on patients as punishment. "I have no choice but to take you to the hospital."

Dr. M. manages to maintain the appearance of straight-and-narrow during the day, all the way to attending church twice a week with his children. His daytime persona effectively covers up his frequent visits to prostitutes.


We are ALL flawed. My colleagues are no different. But some circumstances cultivate the flaws, fertilize corruptibility, reward it. Such has become the state of affairs in healthcare for heart disease. Why? Is it the excessive potential for money-making that existed until recently? Is there something about the save-the-day mentality of heart disease that attracts imperfect personalities looking for the adrenaline-charged thrill but morphs over time into near-psychopathic lives?

It's not the end of the world. The fact that my colleagues' behavior has reached such extravagant lows signals a bottom: things are about to change.

In the meantime, let me tell you a few more secrets . . .

Top 10 >>> cardiology doctor

I wrote about this back in October 2006. So for approximately 135 beats per minute for more than three months the pacemaker did not detect one single beat that it needed to pace. That is more than 17 million heart beats that happened without a condition that would have required the pacemaker to fire if it was able to. I digress.
Okay, yes we did agree at one point to have the pacemaker repaired. Then we tried twice and something happened each time. So after the pacemaker failed and then two attempts to get it repaired failed, we took a step back and said, God, are you trying to tell us that we made a bad decision with getting the pacemaker in the first place? Seriously, that is the way we have viewed it ever since especially given the overwhelming evidence that I mentioned above about the pacemaker never detecting a need to fire in the first three months.
As certain as I may sound in my words here, I can assure you that I have battled with this issue. Sherry has too. She actually got a pretty good piece of advice from our pediatrician. He said to request a halter monitor. You see, that is the device that started all this. Even though Caden was discharged after the catheter heart block incident with no need for a pacemaker, the follow on halter monitor led the cardiologist to recommend a pacemaker. So, if Caden passes a halter monitor then what will the cardiologist say? That is the current question. The halter monitor is on the way and we will post letting everyone know when the 24 hours start. We are believing and asking God for confirmation (something more than a ) that the pace maker is not needed.
We need a clear direction on whether to consider the pacemaker repair or not. Even if we consider it there are some pretty significant risks involved with the removal and transportation of Caden out of the sterile OR through the hospital with open wounds. You might remember, we considered this MRI break from surgery once before but that was back when they said the pacemaker lead could be left in during the MRI. That scenario removed the need to make a trip trough the hospital to the MRI machine with an open incision into the chest cavity.
I have been looking for an ear to bend for some Godly counsel. I met with a good friend that I look up to a few days ago. He offered some great advise and also helped me come up with the name of a mutual friend that can probably help me sort through some of this medical mess. You see, we certainly want the very best for Caden, but every single path we have to choose from has some risk associated with it. We have a strong aspect of faith and hope in God that most doctors have very little appreciation for. Theres always a pull between the doctors facts and our faith.
Antibiotic Addiction
I am sure the pediatrician would not find that title very amusing, but Sherry read that on our little friend Sammys care page a few days ago. We both laughed at how it could be used to describe Cadens use of antibiotics. Little Sammy seems to like antibiotics as much as Caden does. Caden is currently on his third antibiotic in a week and a half. He continued to have fever of more than 103 while being on two separate ones for more than three days. One was treating infection in an abscess by his g-tube site and the other was treating the standard green sinus drainage/ear infection type stuff. He has not had fever in several days now, but did get a trip in front of the chest x-ray machine to check for pneumonia and all was clear. Praise God!
Scoliosis
We are scheduled to see Cadens primary orthopedics doctor on June 9rh. We plan to discuss with him our trip to CHOP. We want to try and open a better dialog with him and plan to present him with some requests we have in terms of communication. If he cannot agree to those things then we will request to be seen by a different doctor locally. Another reason for the appointment is to see if the curve has changed over the past 3 months.
Other Concerns
We seem to not be getting any response from Cardiology or Orthopedics when we raise concerns about Cadens current condition over all. We are not the only one realizing a change in his stamina. I ran into Cadens physical therapist at a GFI event at church last week and she echoed what she had told Sherry. Caden is no longer performing physical tasks that he has previously mastered. He has been loosing his balance when standing and sitting. This has been noted by us, physical therapy, and occupational therapy. His energy level has been very low and hes had difficulty even finishing an hour of therapy. Our biggest question is whether this is related to his back or heart.
We know that the direction of the scoliosis curve could protrude in on the right lung and potentially affect pulmonary performance if left to progress too far without surgery. I imagine that it could also affect balance. The cardiologist did state that one of the symptoms of the hypertrophy is being easily exhausted. We also know that the cardiologist was pretty certain that the hypertrophy (thickening of the left ventricle heart muscle) was significant enough to warrant surgery within the next few months for an aortic valve replacement. The heart surgeon put a pause on the heart surgery for another 4-6 months due to Cadens size and complexity of the surgery required to replace Cadens aortic valve. Remember, Caden has pretty unique vascular anatomy.
Prayer Requests
Some of you I have talked to in person and I know that you are already praying for some specifics. Please dont stop praying for us now. Sherry, I and our boys need you prayer warriors as much as ever right now. I will give you some specifics to pray for below.
Praises.

Americano top 10 >>> cardiology doctor