Aaaaaaugh.

Just so I can keep track of this - feel free to scroll if health stuff bores you. I'm feeling SarahK when she complains that she knows more about her celiac disease than her doctors do. As y'all know, I have chronic pancreatitis (the hereditary kind, not the alcoholic kind - the only drink I've ever had is one drink of champagne at my cousin's wedding. Yes, I am Sandy from Grease, without the leather pants.)

I was part of a genetic study in the 90s that mapped the gene to chromosome 7. The molecule that keeps trypsin inactive until it leaves the pancreas (the molecule is called PTI, if I recall correctly) is messed up, so trypsin gets activated in the pancreatic duct and chews up the pancreas. Not fun. And I'm convinced that mine is exacerbated by stress, because I've been in constant pain since I started medical school, the most stressful time of my life.

For some reason, for the past couple of days, my pain isn't even controlled with my Vicodin HP (hydrocodone/APAP 10/660). As an aside, my GI doctor sent me to a pain clinic, and I went with a current dosage of the 10/660 as 1 tablet q6 prn. (One every six hours, or 4 per day, as needed.) The pain clinic (at which I saw a physician's assistant, not a doctor) gave me a lecture on taking pain medications (I think that in order to work in a pain clinic, you should have had chronic pain yourself. You know? I don't WANT to be on pain medication, and I usually hate when people pull "rights" out of nowhere, but I believe that people have the right to be comfortable and functional if possible. I think it's part of the "pursuit of happiness" thing.) So after the lecture, at which point I felt like crapola, the PA gave me a prescription for a 25mcg/hr fentanyl (duragesic) patch. This is what my GI doctor and I thought might be a good option for me, along with something short-acting for breakthrough pain, because it would work well when I was at the hospital working for hours and hours without time to eat, drink, or pee - and it also provides a constant, steady medication level - no more peaks and painful troughs, and no more chronic ingestion of liver-munching acetaminophen. Everybody wins.

So the first day that I wore the patch was painful, because they didn't give me anything for breakthrough pain and the patch takes about 12 hours to get into systemic circulation. But once it was in - MY PAIN WAS GONE. I woke up the next morning with no pain, no grogginess - it was so great that I thought I was dead and in heaven. And then I saw that I was still fat - no glorified body. But anyway, later that day, I started feeling weak, dizzy and lightheaded. The next morning was even worse. I couldn't get through to a human on the pain clinic's line, so I just went there (and got scolded because they usually ignore walk-ins.) LUCKY FOR ME, they said, they weren't busy. So they removed the patch, told me to bring the rest of the patches back, and gave me a prescription for the 10/660, 3 per day. The pain clinic gives me less pain control than my GI doctor. Great.

Like I said before I got on the pain clinic tangent, for the past couple of days, I've just been in horrible, intractable pain. I didn't know what to do besides go to the ER, so to the ER I went. (And I'm not a revolving door patient - I haven't been to the ER for at least 6 years.) The first ER visit, on Wednesday afternoon, didn't work out because there were approximately three million people waiting, and I didn't want to wait there for the rest of my life. They told me that it clears out in the wee hours of the morning, so at the wee hour of 3AM, I went back. This time I saw a doctor, but it went horribly - the doctor was an evil man who missed the day that they taught empathy and compassion in medical school. He also wouldn't listen to me when, after he told me that my amylase and lipase weren't elevated (translation - "You're a lying, thuggish drug-seeker"), I told him that when pancreatitis is chronic, the cells are so damaged that the enzymes don't usually go up anymore*. They did give me a shot of Dilaudid and Zofran which was heavenly considering I've been in miserable with no relief for 2 days. I thought they'd admit me to let me be NPO and let the evil pancreas rest for a day or two to possibly break the pain cycle, but since the doctor could tell that there's obviously nothing wrong with me because the magic enzymes didn't say so, they didn't. I left there crying because they made me feel like a liar and I knew I'd be hurting again in several hours. And I'm beyond worried about missing clerkship days. I hope I don't get kicked out of medical school, and I hope I don't end up with a different class (no offense to the c/o 2010, but my class is just so awesome and I ::heart:: them. Except one. He knows who he is.)

I called my GI doctor when I woke up from the lovely Dilaudid fog, and told them that the experience had been horrible. They told me that I should call my primary care doctor, who I should have given the ER as my doctor (what do I know? I was there for a GI problem, so I gave them the GI doctor's name. Oh well.) Problem is, my primary care doctor is not in the office today, and the doctors on call for him are all, "Her enzymes must be elevated or she's a malingerer. A MALINGERER!" I'm likely to leave with a diagnosis of Munchausen's Syndrome, but I'm headed back to the ER. I want a couple of days to be NPO, with an IV so I don't get dehydrated, and pain control until this thing breaks. I've got things to do, y'all. I have the weekend to get better, and I hope I'm still a medical student on Monday.

I has submitted an lolcat ...

... to I Can Has Cheezburger. And although I am partial to my own kittehs, Ollie & Sassy:

This one is the best lolcat I've seen in awhile:

Kitty Rulz, Dog Droolz

So SarahK and Rachel Lucas (no relation) are having a dog war, and I want to challenge someone to a cute kitty war. Anyone? Anyone?

We have Princess Sophie:

And Fierce Sophie (Tyra would be proud):

We have Oliver:

And the newest addition to our herd - Sassy, a sweet white & gray kitty who was born to a stray (Tiny) that has adopted us.

Sassy was actually part of a litter of two - she had a sister, Dolly, who we haven't seen for a week or so. Poor little pink-nosed Dolly - I hope she found her way to a friendly home. Darn it, I get so attached to these little critters, so fast!

Ollie has taken Sassy under his wing - uh, paw - though. They're big buddies.

As you might expect, Ollie's OTHER big buddy, Sophie, is a little miffed about this. So she's not sure what to do about Sassy. She hisses at her occasionally, but usually just runs away from her and pouts. And she DOES NOT let Sass share her shoes.

So, anybody want to take on my brood in a challenge of cuteness?

Doctors who are nice. I like that.

I was reading through the comments on Kevin, M.D. for the post in which he mentioned my unfortunate incident with an evil hair-removal laser that burned and scarred me and a dermatologist who must have been absent on the day they taught ethics, and I read this comment that I wanted to bring over here for posterity. I would LOVE to know which physician that knows me took the time to post this in my defense - it makes me feel all warm and fuzzy.

I know this woman. I am a doctor. I can't believe that after seeing the pictures, untouched, of an 18 year old woman with facial disfigurement, that anyone has the right to critique the patient! Yes, all procedures have risks - this case of substandard care was artificially absolved as follow-up care for a major burn with keloid scarring was remediated. However, the patient did trust that the ethically correct move was being made in this regard and the physician mocked her by dropping all guilt as soon as "time for a lawsuit is up!" This is an outrage and a sadness to a profession. Knowing the patient's character and decency, I assure you that the blog is meant as a warning, not as a critique among all physicians. It is also meant as a testament to the standard of care of which SHE chooses to practice after medical school.

SarahK wants you to see if you should be gluten-free. And other things.

SarahK, my favorite person with blunted intestinal villi, wants you to know if you should be gluten-free. So go take this quiz, and talk to your doctor if you score high.

/PSA

The other day, while we were in our Step One review course? Someone slapped a cheeseburger (cheese-side down) on Christy's car window. I really don't know what would motivate someone to do that type of thing. I mean, if I have a cheeseburger, it's going in my mouth - not on someone else's plexi-glass. What a waste of some good saturated fat. She could have told you this herself (and it would have been funnier, because she is funnier than I am) but I can't get her to blog with me. She seems focused on this test - this USMLE board exam - most important test of our lives or some such mumbo-jumbo.

So, I finally broke down and bought a pair of MBT (Masai Barefoot Technology) shoes from Bliss. They're supposed to help tone your butt and legs - I'll let you know in about a month if it was a crazy purchase. But I can tell you that they are VERY comfortable - and that they look like orthopedic shoes. If they work, though, it will be worth it.

Scott is finally on Facebook. Yay!

I saw Pirates of the Caribbean: At World's End - and meh. Waaaaay too long with a convoluted plot. I fell asleep for awhile, and then actually left the theater and walked to Coldstone Creamery nearby to see what time they closed. (I really needed a Cheesecake Fantasy, and I managed to get one after all of the swashbuckling finally ended, with about three minutes to spare.) Johnny Depp, of course, was entertaining and all kinds of pretty - and I still think Captain Jack Sparrow is one of the best movie characters of all time. But in my opinion, the rest of the film fell apart around him. Scott and I are seeing Shrek the Third tonight - I'll let you know how that goes.

Okay, I need to hit the Kaplan QBank. Hard.

SarahK is making me think of bloggable things

Like this post, which reminds me of that time that Scott was at my apartment and in the bathroom (actually, I think he might have been in the shower) and I only have one bathroom, and I had to pee in a jar. Have I just shared too much?*

And on this, the most gigantonormous post I've ever seen, she says that FrankJ thinks that Lipitor sounds like an alien name - I told her that she should see the cancer chemotherapy drugs or immunopharmacology. When I was trying to study those, I felt like I was reading notes in Martian. Gemtuzamab? Mylotarg? "I am Gemtuzamab, from the planet Mylotarg!" Here's what I know about those drugs - doxyrubicin and daunorubicin cause cardiotoxicity (I know that because "rubor" means red, and hearts are red. Reddish.) I know that bleomycin causes pulmonary fibrosis because "bleo" sounds like "blow". And I know that vincristine and vinblastine are vinca alkaloids and that they inhibit microtubules and work during mitosis. (I know that one just because I randomly memorized it.) And that's pretty much all I know about that.

From that same post, someone is telling FrankJ that he looks 17 (heh) and won't tell poor SarahK that she looks young (I tell her that she looks like Kate Hudson - I hope that helps.) We went to lunch at Subway once last semester, and I had a photo album with pictures from our first year of medical school in the backseat of my car. Todd and Michael were sitting in the back (with Christy in the front) and Todd was flipping through the album. He goes, "Wow, everybody looks so much OLDER since we started school!" Christy and I get identical looks of horror.

Us: Todd!
Todd: What? I mean, ALL of us look older.
Me: Nope, that's not better. Not better at all.
Todd: I mean, I'm sorry. We ALL look older - but you guys, you look, uh ...
Me: Todd, never tell a woman she looks older.

To his credit, he did apologize approximately 1,037 times in the next 24 hours. And then there was that guy in Walmart that time, when I was trying to buy an R-rated DVD and got carded (heh). My license still said "under 21" even though I wasn't, and of course the weight was laughably wrong. So I said, "Oh, I'm not under 21 anymore - and that weight isn't right anymore either, ha ha!" Clueless cashier boy goes, "*I* didn't say that." Boo.

I wish I got thousands of hits like Rachel Lucas. Or even an almost-thousand like SarahK. But I just don't have enough time to blog regularly enough. Ugh.

I have had a horrible week, pancreas-wise. More on that later.

American Idol - meh. More on that later too.

* I sterilized the jar afterwards, obviously.

I know I shouldn't feed the trolls, but ...

... I have something of a self-esteem problem, and I'm afraid what this particular troll is saying is true. I just wanted to make my readers aware of what's going on in the comments with this guy (or girl? Who knows) in case someone wants to disagree.

Here's what happened - I went to The Fake Doctor's blog, where he had a post listing his mail and responding to it. I commented something to the effect of, "I wish I had your traffic and readership - it would be nice to get mail!" So then Beepy the Troll came out from under the bridge, wandered over to my blog, and said:

The reason you get fewer hits than the fake doctor is simple: your blog isn't as good.
Beepy | 03.20.07 - 1:31 am |

I responded:

Well, that was uncalled for.
Kim | Homepage | 03.20.07 - 8:30 am |

Then it (the only pronoun I can use, since I don't know Beepy's gender) returned to my allegedly horrible blog for a second visit (hmmm?) and said:

Uncalled for? Maybe. True? Absolutely! Your blog is trite trash. If you've nothing interesting to contribute to the world, why bother? I suppose if you keep trying, maybe something novel will come out on accident. Keep up the crap work. Don't mistake my comments as hostility. Just pure truth.

In my next post, I wrote:

In other news, if you read the comments on this post, you'll learn from one uncouth commenter named "Beepy" that my blog is far inferior to The Fake Doctor. You know, in case you were wondering.

To that, it says:

Far inferior? I don't think I put it quite in those terms, but I appreciate your doing it for me. I'm not even a very big fan of the fake doctor, it's just that your blog is so cruddy in comparison to, well, virtually anything ever created by a person over the age of eight, that it got me all riled up. p.s. it worries me that you'll be a doc one day. Based on the mediocrity of your blog, I can only assume you subscribe to the C = MD plan. Am I right? Gotta be.

This makes me want to cry. Should I stop writing? I've been wondering this for awhile anyway, because medical school has stolen my creativity and sense of humor (by the way, it scares ME to death that I will be a doctor someday - and it was GREAT to hear someone else say that) and I feel that I don't have much to contribute anymore. If you're a reader who would miss my blog if it wasn't here, I'd appreciate it if you'd let me know. Particularly in the comments.

Sorry - I have exams in a week (AGAIN) and I'm just stressed and sad tonight. Medical school does that to you as well - and it's also a lonely place sometimes. Textbooks aren't very good friends.

On Tomato Residue and Runaway Waitresses

Michael, Todd, Christy and I went to lunch yesterday at Applebee's, and we had arguably the worst waitress on the face of the earth (for reasons other than the ones I'm about to document.) Michael, being a man of plain tastes (when it comes to food - I'm not trying to insult Kristen here) ordered a cheeseburger with only ketchup. Shortly after, we saw our waitress get in a car outside of our window, buckle her seatbelt, light a cigarette, and drive away. (We still didn't have any food.) A few minutes later she drove back into the parking lot and then brought us our food - including Michael's cheeseburger, laden with tomato/lettuce/onion.

Horrible Waitress: Sorry about all of the stuff on your cheeseburger - it's my bad. I told them. My bad. You can just take it off. Sorry - my bad. (Michael was picking off those evil vegetables like they were preparations of Naegleria fowleri that were carrying maps titled: "To Michael's Cribiform Plate and Beyond".)
Me: I think she had to drive to the mid-90s to get that phrase.

I hate that medical school has stolen my sense of humor.

In other news, if you read the comments on this post, you'll learn from one uncouth commenter named "Beepy" that my blog is far inferior to The Fake Doctor. You know, in case you were wondering.

Thinning the downloads folder

So, I removed some files from my downloads folder - I also removed the link over in yonder sidebar. My server was down earlier for awhile (a problem with GoDaddy, it turned out) and I was afraid that I'd been pegged as a copyright infringer and yanked from the Internet. I got spooked. Also, I don't want to go to jail. Although jail might be better than these four exams I will be failing on Monday and Tuesday. Medical school sucks sometimes nearly all of the time.

Off topic (am I ever ON topic?) - SarahK, did you really think my MySpace quiz was "password to credit card / break into your house and steal your stuff / hurt you questions"? Eeek, I hope not. I re-read it and don't think I revealed any identifying information. (I also don't think that I'm so popular that I have stalkers - heh.) Also, MySpace may be for celebrities who want to think they have a blog, teenagers, and child predators (I won't argue with you there), but it also happens to be for me and about half of my medical school class - it's a good way to keep in touch with people from high school and college, too. I'm actually using it at the moment to contact people about a reunion.

An unfortunate guest lecturer, and Dave Matthews on House EEEEEE!

Hey, you know what I keep forgetting to tell y'all? While perusing my pharmacology lecture schedule (which is a completely interesting thing to do during class sometimes) I discovered that one of our required lectures (on dermatologic pharmacology) is to be given by none other than my ex-dermatologist who doesn't know how to use lasers or treat patients like real people. I will, of course, be completely professional and sit there and take notes like the good adequate medical student that I am, unless she tries to describe in detail how to use a hair-removal laser. Or how to deal with a patient that you have permanently scarred and left looking like Elvis, now and forever. If that happens, then I'll just quietly put down my Family Guy pen (thanks Joyce!) and think about kittens or something.

In other news, Dave Matthews was on House MD this week, in the episode Half Wit (there's an mpeg file in downloads) and it was so good ... I don't know, I can't come up with an analogy. It was just really good. When both House and Dave were sitting at the piano in Dave's hospital room, my head almost exploded. I couldn't handle having both of them in the same frame. It's a good thing I was doing my evil genetics homework and wasn't completely rapt.

I have two exams on Monday and two on Tuesday (and a nervous breakdown somewhere in there) so I may be scarce for a few days. Don't miss me too much.

Oh! Something else I meant to tell you. Harvey at IMAO is snarking on West Virginia, and it's terribly funny. Go read it. Here's a couple of my favorites:

The state motto of West Virginia is "Montani semper liberi", which is Latin for "Sister, daughter, wife... whatever".

The variety of apple known as Golden Delicious originated in Wellsburg, West Virginia, in 1775. It was greeted with overwhelming enthusiasm by a population who'd spent years being stuck with eating the Ochre Atrocious.

In May, 1860, the first oil well in West Virginia was drilled at Burning Springs. In June, 1860, the former governor of Texas invaded West Virginia and stole it.

In a recent survey, 95% of West Virginians report having checked out a book from their local public library within the last year. During the same time period, 95% of West Virginians also reported having found a way to fix that wobbly kitchen table with the short leg.

The state flag of West Virginia consists of a blue-edged white background, overlaid by an image of two men debating whether Fahrenheit 9/11 or An Inconvenient Truth was a bigger load of crap.

So what if I lost!

File It Under is being very, very nice to me. Should I tell them that I (sadly) don't look like that anymore (yet*)? Naaaaaaah, I'll just enjoy it. Thanks to everyone who voted!

*I'll be back to looking like that picture by this time next year. Yes. I. Will. Medical school has made me crazy and fat, but NO MORE. I rule this roost.

Kevin, MD is talking about meeeeeee!

Wow - my eeeeevil dermatologist story got picked up by Kevin, MD. Awesome.

Crazy Clay Aiken fans skeere me. I mean, look at this, from Gilded Moose - these people have to realize that they're insane, or maybe they're just happily oblivious.

I admit that I'm a fan of Clay Aiken, but I'm not crazy. Well, I am crazy, just for other reasons. And I'd never write about my ovaries with puff-paint on a T-shirt. By the way, shaking ovaries must indicate a serious medical condition. I haven't had female reproductive pathology yet, but it certainly doesn't sound normal. None of it does, actually.