Pediatric Grand Rounds 1:18

(Virginia Beach, VA) Well, first, please accept my apology for the 48 hours delay. My best laid plans often go awry, and they did this weekend. I was hoping to get this up on Saturday night, but in order to get out of town on Sunday I needed to pull a nearly all-nighter in the lab, which meant that the long drive south on Sunday left me incapable of putting together a cogent PGR. Fortunately, since we offer no CME and don’t require everyone to show up at 8:00a on a Wednesday morning, the deadline had a little wiggle room (and I certainly hope that Clark see that the same way).

So, without further ado, I present this 18th installment of Pediatric Grand Rounds.

The Oscar Weblog Awards-nominated Flea sends us ‘A Very Great Fright’ whereupon he recounts, with Olde English quotes, the bigger battles fought by our forefathers in vaccinology. Having lived in Boston for the past 2-1/2 years, I was pleased to learn that Boylston Street is named after a physician.

Clark Bartram at Unintelligent Design sends us Bride of the Not So Normal Newborn Nursery in which he details what we like to call “a good pickup” using some of the best, and most cost-effective diagnostic tools available: a quick mind, a good history, long differential diagnoses, and good physical exam skills. Thorougly impressed, the only thing that would’ve topped it would be if he had managed put the patient into a one-handed hold and snap a picture of it at the same time.

Across town we have a contribution from Dr. Stephen Parker entitled ‘Illegal Families and Broken Wings’. Dr. Parker reminds us that in our increasingly complex world, simple things rarely are.

The young Dr. Signout keeps us in the world of the newborns with her story from the NICU called ‘Weighing Something’. it is very satisfying to seen an intern so acutely aware of the complexities of the NICU. I found my NICU experience to be depressing and unsatisfying for many of the reasons that Dr. Signout so eloquently describes. Her observation of the reluctance of pediatricians to discuss death is astute, and holds true even in a death-ridden speciality such as pediatric heme-onc. I look forward to her observations when she reaches that point of her training.

Staying in the newborn/NICU theme, we have a mystery case provided by Rob at Musings of a Distractible Mind.. His case involves a two month-old and hematochezia. I’m tempted to try the Google diagnosis approach (58% accurate according to one recent study). If Google fails you can find the answer here.

Switching over from neonatology to pulmonary, we have an entry from Lourdes de Asis at Allergy and Asthma Source who discusses childhood allergies, including The Allergic March (not to be confused with an Allergic December).

One of my favorite bloggers, Singha, from Breath Spa for Kids sent me a bunch of entries from other bloggers that she’s been collecting.

Since there are a few more shopping days until Christmas, you may want to consider giving someone special an Ostomy Otto doll (courtesy of The Short Gut News). We have little Broviac (central venous line) dolls up on the Stem Cell Transplant Floor. They’re made of plastic and always look like they’re about to cry. Dr. Blackman thinks they’re creepy.

Riffing off of this, I was hoping to find a picture online. Instead I found this gem: You Know You’re the Parent of a Kid with Cancer When …. My favorite is #308.

Over at Good Enough Mummy we have the resolution of Dr. Sarah’s debate as to whether or not to seek an operative treatment for her child’s squint. Being a physician who routinely saddles parents with excruciating choices that they must make, I can only imagine how hard it must be if you are a physician-parent forced to make a medical decision, overwhelmed with ‘too much’ information and a too familiar understanding that even simple interventions can lead to complex outcomes.

Cancer Dad witnessed one of the best parts of oncology care: the small gestures that indicate the love that we feel for our patients. I couldn’t help but being amused by his post on the dual nature of being a fellow.

Cancer Dad talks about the interesting feeling he got on being mistaken for a physician. Granola, over at The Granola Rules sends us ‘Thoughts I Had in my Kid’s School Today’. She talks about the implications of parents of young children who talk about their kids becoming “a doctor or a lawyer”:

‘Not to say that these aren’t worthy professions, that there isn’t a great amount of good that comes of the (though I hold my reservations for some kinds of lawyers). It is the mention of those two jobs together, ‘a doctor or lawyer’, in elementary school, in regards to a seven year old child, that gives me pause. It is the goal of something big, prestigious, well respected, lots of money – that is what that phrase says.’

Granola’s post reminds me of something my father (a pediatrician) used to tell me when I was a little boy. He’d say, “Sam, you can be whatever you want when you grow up. Anything in the world. Once you’ve graduated from medical school.”

Next, we have a post from the Food Allergy and Anaphylaxis Information Blog highlighting a recent study from the Journal of Allergy and Clinical Immunology which compares the actual laboratory findings of food hypersensitivity with parental reports. I downloaded the whole paper as a .pdf which you can get by clicking here.

Purple Kangaroo’s parental report of their child’s endoscopy, entitled ‘Little Trooper’ gives us a view from the other side of the room.

Neonatal Doc shares a view from the other side of the curtain in his post entitled, ‘Nudity’

And as always, Shinga at Breath Spa For Kids provides interesting reading as she does a fine job expressing the universal sentiment of pediatricians who care for families in which the children smoke: Stop smoking in the presence of your children!!.

I’d like to submit my recent post on crying, which it looks like I’ll be doing some more of this holiday season.

That’s all for now. Have a great New Year!

[Nota bene: Crikey! The 48 hour delay in getting this version of PGR up gave Shinga, over at Breath Spa for Kids, just enough time to put one up. Apparently things move fast in the pediatric blogosphere. Consider it a holiday gift — two Pediatric Grand Rounds for the price of one!]