This Might Be Why No One Takes Me Seriously In PBL

Tacrolimus

Our 20 year old patient from South of the Border
Had a lupus-related kidney disorder
Her husband donated one of his two
Because, as we all know, one kidney will do

The transplant went fine, at least right at first,
Her worrisome creatinine safely reversed
And after one week she left on prednisone
Her immune system would leave her new kidney alone

And from our deep bag of medical tricks,
We also pulled out FK-506.
(It’s an immunosuppressive, and most of the time it’s
Simply referred to as old tacrolimus,)

Our patient was like, “What is this new med?
Can you tell me about it?” And here’s what we said.
Tacro’s a drug in the macrolide group
You take it by mouth; it comes out in your poop.

It’s used to stop transplanted organ rejection
(Though for vitiligo and atopic dermatitis it’s also a selection.)
For liver, kidney, and heart transplant it’s employed
And as Protopic topically eczema gets destroyed.

It’s produced by a species of the strep bacteria
And we don’t use it under certain criteria.
For instance, it’s not good to drink grape fruit juice
If you’re pregnant or breast-feeding please do not use.

Likewise in cancer it’s contra-indicated
In liver failure and infection it should not be instated.
The jury is out on whether it’s linked to cancer
Unfortunately we’re waiting on trials for an answer.

It can lead to neural problems and hypertension,
And cholelithiasis can cause apprehension.
It can be neurotoxic and raise your blood glucose
Its serum level can be erratic so watch this drug muy close!

Ironically, it’s also a bit nephrotoxic
But when rejection begins, it summarily blocks it.
Cyclosporine is used along similar lines
They both block T cells, inhibit cytokines.

They both bind to proteins in the cytosol
And then TCR activation does nothing at all.
Because your T cells offer no more protection
We need to watch for opportunistic infection.

If the side effects are bad, please let us know fast
We hope you feel renally better at last.

Poll Pot

Looks like I won't have much trouble finding a job after residency.

This article makes me more excited about going to Charleston next weekend!

I'm surprised with the results of our poll. The highest percentage of us, 35%, pee in the shower 1-3 times per month. I guess I expected a higher frequency. Not that I ever...

maritorious - adjective: Excessively fond of one's husband.

borborygmus - noun: A rumbling noise caused by the movement of gas through the intestines.

Sundays Are Like Really Good Mondays

Well, no proposal. Ten probably just forgot the ring at home. It's no secret that she's getting old and forgetful (yesterday she was 30 and 1/2!). Despite this disappointment, we had a blast at dinner at Montpelier's best restaurant (of, like, 4) with her co-worker, T-shirt, and T-shirt's wife. I almost managed to get through the dinner without bringing up the Med School Killa'.

After dinner we exchanged various items belonging to the other that we had in our possession. I gave Ten a pair of her sweatpants and 6 pairs of underwear from our Wisconsin trip laundry. She gave me my car mat and a bottle of my perfume from her fridge. Then I peed outside behind a bush while she stood guard. So the night wasn't a complete bust.

Today, I study. Barf.

Friday It's God, Thank!

Sometimes Southern states get a really bad rap. But sometimes they just have it coming to them. What a waste of Alabama's time, money, and dignity.

Tonight is the DMS second years' lottery, where we'll find out where and in what order we'll be completing next year's clerkships. I'm still trying to figure out what a clerkship is. Will I need to be able to work a cash register? Will I have to wear a bright vest with pins on it? Please, someone, give me answers!

Tomorrow night Ten and I are meeting in Montpelier for dinner and a movie. Don't tell Ten, but I'm pretty sure she's going to propose to me tomorrow night. I'm going to wear my prettiest fleece vest and newest Keens, just in case. Ten, it may take me a while to decide, so may I suggest you wear a cushioned knee pad under your jeans?

Polls and P$#

The polls have closed! We have a clear winner. 57% of our blog reading populace does not consider it unethical to Google another person. Start your search engines! (And please take a moment to answer the new question. Remember, it's anonymous.)

Wisconsin was lovely. We hung out with Ten's parents and aunt and had a generally relaxing visit. I very much like Ten's family, perhaps even more than I like Ten herself. Perhaps the worst part of the trip was the chocolate I sat on in the airplane on our way back. Ten told me, discreetly, "EFC, it looks like you sat in your own ho yu gai poo."

Deer!

I saw two deer in my backyard this morning! They were gorgeous! Do you think it's against condo association rules to put a salt lick in the backyard?

Don't Read This If You Don't Like Complainers

Remember how a few months ago I had an ear infection in my right ear? Well, I have another one. This time it's in my left ear. Have you ever had one? It feels like someone's taken a baseball bat to one half of your face. (You probably think I don't know what that feels like, but you've never seen Ten in a rage.)

Speaking of Ten, the last time I had an ear infection she sent me flowers. I guess that's the only good thing about this situation: I expect I'll be seeing a flower delivery man at my door sometime this afternoon. (Ten, can you add some yellow so the bouquet will match my living room? Thank you. Also, not to be rude, but the bouquet could be a little bigger this time.)

This term is going to be brutal. The amount of information our professors can pack into six hours is staggering. You'd think by the last term of my last year of classroom-based education I would have gotten the hang of studying/not panicking/listening in class, but I haven't.

Tomorrow I leave for Wisconsin, everyone's favorite state. Here are some things you should know about WI:

Wisconsin produces more milk than any other state.
Wisconsin has the highest per gallon tax on gasoline.
Wisconsin was home to the US's first kindergarten. (Good thing they had so much milk!)

New Blog Stuff

Check out the poll at right! I'm an HTML genius!*

Also, there's something I was encouraged to add called "followers." I'm not really sure what it's for, but if you'd like to tell me, I'd surely appreciate it.

This evening we have to spend four hours in a CPR class. I really don't get why this is relevant to my medical education.

One month 'til my half birthday! Start shopping, Ten!


* It's just a Google gadget.

Three-Day Weekend = Bliss

This past weekend was one of the best on record.

Groceries for celebratory dinner? $56.78
Champagne? $25.98
Ibuprofen? $0.08
Not having school work hanging over your head? Priceless.

Today is the first day of my final term of second year. In a month I'll be freeeee (to study for the boards).

I love Easter. Because of the eggs? Nope. Because of friends and family? Nope. Because Christ has risen? Nope. It's because every year at Easter my mom treats me to a new Easter outfit. And every year I forget about it, and then around Good Friday she asks, "Aren't you going to do a little shopping this weekend?" Why, yes, mom, I think I shall.

Next Friday Ten and I are going to Wisconsin. What's in Wisconsin, you ask? I have no idea, but I'll let you know when we get back on Monday. We're going to see some of her dad's side of the family, including her aunt whom I've heard much about but never met. I intend to bring all of my gear and do full physical exams on all of her family members.

I'm Freeeeee!!!

There's so much to celebrate! Finals are finally over, Vermont has gay marriage, I have a fresh Wallace Stegner novel to start, and I have a day off tomorrow. What else could a fig cookie ask for?

This long weekend will include
1) getting whomped at tennis by Ten (who really does put the ten in tennis)
2) celebrating VT gay marriage with Allegory and champagne on Friday evening
3) brunch with one of Ten's biddy neighbors on Easter
4) buying tires
5) sleep sleep sleep sleep
6) detox detox detox detox
7) a doctor's appointment that Ten bullied me into getting

Ahhhhhhhh.

I can't help but wonder if I have any gallstones in my gall bladder right now.

VERMONT HAS GAY MARRIAGE!

Squirmatology

Substance Abuse and Sine Waves

Yesterday I drank a Red Bull. It was incredible, although it tasted nasty. I had more energy than I've had since I was in shape/ not abusing Tylenol PM/ not a medical student. I think I drew some attention at the Howe, manically preparing last-minute-study-aids, tossing loose leaf this way and that. I didn't care. I was on fire.

Here's the problem with Red Bull: It's eight o'clock in the morning, and I've been awake for the past five hours. Since I woke up I've studied a bit, made some breakfast, made some coffee, hit Facebook, done the dishes, downloaded the new Lily Allen CD, and read all of the interesting articles in this month's Vanity Fair. (There were 2: one about Madoff, one about pirates.)

If I'm going to make it through this day, I'm going to need another Red Bull.

In other news, Ten got mad at me last night. We were doing a crossword puzzle over the phone (sort of a nightly occurrence for us) and we had this exchange:

EFC: Okay, try this one. Blank wave.
Ten: Blank wave?
EFC: Yes, like tidal wave or green wave, but it's four letters. Oop, wait, I just figured it out. You're not going to be able to get this one.
Ten: What?
EFC: It's sine wave. You know. Sine. Like a math thing.
Ten: Wait, why did you say I wouldn't be able to get that? Were you serious? I'm totally insulted.
EFC: Bu-
Ten: Do you think I didn't go to high school? I know what a sine wave is.
EFC: Oh no! I wasn't trying to be insulting, Ten. I just didn't think you'd gotten that far in math.
Ten:
EFC: I guess that didn't really make it better, did it?

Duodenum diddy dum diddy do

Dear God,

If I pass gastroenterology this term, it will surely be a miracle of Your making. This exam is going to bowel me over, and I must colon You to assist me.

Tell me truthfully, GERD: Is passing even fecesable? Can you deliver a grade that is greater than two standard deviations below the mean?

I realize that I had the gall to put off studying until the last minute, but would a few extra prayers rectalfy this situation I'm in?

Your loyal servant,

EFC

Aw, Yeah.

Um, Vermont, I hate to put it this way: But are you seriously going to let Iowa beat us to the punch?

(P.S. Go, Iowa!)

Boo The Cat And I

Just taking her pulse.