92.5%

I saw twenty-seven patients today. It was busy. There were several add-ons to an already packed schedule. I book 15-minute appointment slots. I have colleagues that book 10-minute appointments but I just don’t see how one can possibly deliver good medicine in such a short period of time. So for me, having an extra patient booked every hour makes for a really busy day.

Of the twenty-seven patients, no word of a lie, twenty-five came in because of cold and cough symptoms and only one patient left with a prescription for antibiotics. One. Did they all need to be seen? Absolutely not. I’ve been coughing for five weeks and haven’t thought to see a doctor. It’s a virus. It will get better on it’s own. If it doesn’t it’ll be pretty obvious and will declare itself with fever, chills, shortness of breath and exhaustion.

I like educating my patients about colds and flu. But damn me if they don’t remember the advice on a year to year basis. It can be really frustrating – for them and for me. They’ve taken time off work to see me, they feel awful and just want to get better. I understand that. But when they see everyone else around them with the same symptoms isn’t it obvious to them that going to see their doctor is kind of useless?

After the day I had, apparently not.

I just hope tomorrow something a little more interesting happens.

30 g/day

No, I’m not talking about how much fiber one should have in a day – though, 30 g is about right, I think.  I’m referring to the amount of weight a newborn should gain per day during the first few months of life.

For my American readers – 30 grams = 1 oz.

30g/day was drilled into my head in medical school and particularly so in my Family Medicine training program.  A newborn will typically lose about 10% of his/her birth weight in the first few days of life, but usually by a week of age, the majority of infants will have regained the weight.  I was also taught that this should occur within the first 7 days of life.

So, in my first few years of family practice, I was quite diligent about these milestones.  If a baby hadn’t gotten back to birth weight within a week or wasn’t gaining that magical 30g/day, I would refer to the pediatricians across the hall from my office.  After a few of these referrals, the pediatrician walked over to my office to have a little “chat”.  She’s a lovely woman (she actually sees all my children) who sat me down and told me, that while she appreciated all the consults I was sending her way,  all of the infants were healthy and I was jumping the gun on the referrals.  I explained my reasoning, and she basically told me that “in the real world of clinical practice, most infants will regain their birth weight within 2-3 weeks, and so long as they are gaining weight, don’t focus on the 30g/day rule.”  She reminded me it was more important to assess how the mother was nursing, or how much formula was being given; she reminded me that the hydration status of the infant was more important than the number of grams gained.  Clinically, how does the infant look?  Was the infant having adequate numbers of wet diapers during the day? etc.  It was amazing advice and (sadly for her), my referrals drastically declined.

Yet, when it comes to my own child, I am stuck on that 30g/day rule.  Perhaps it’s because, with my first-born, I had a pathetic milk supply and didn’t recognize that my daughter was hungry and losing weight.  By the time she was 2 weeks old, she had lost about 20% of her birth weight, was just getting enough milk to stay hydrated, but not enough to gain weight.  I had to start supplementing with formula and watching her guzzle back that first 4 oz of formula in about 20 seconds made me realize just how hungry she was.  Cue the gut-wrenching mommy guilt.

I didn’t have to supplement with my second child – we had a great nursing relationship and he gained weight well.  Now, with the third. it seems to be following the same pattern, yet today I decided to take the baby to my office for a weight check only to discover that he’s gaining only about 15 oz/ day.

Cue the mommy guilt again. Oh God, do I not have enough milk for him?  Is he hungry and I’m just not clueing in?  Should I be waking him every 2 hours?  When I relayed my concerns to my husband, he just looked at me and said “He’s fine.”  He’s pooping and peeing appropriately.  He seems satisfied at the breast (unlike the firstborn who was clearly frustrated after a few minutes on the breast).  I am being way too hard on myself, yet I just can’t help it. And to top it all off, the baby now has the cold his older siblings have.

Did I mention he’s only 3 weeks old?

FML.

-18C and I’m happy.

That cold snap I’ve been wanting to happen has finally happened.  And funnily enough, my household has been well for the past 3 weeks.  Coincidence?  I think not!!

I won’t belabor the point, but it’s been a brutal fall for cold viruses and Influenza.  See my previous posts.  I have been inundated the last few weeks with patients coming in for their flu vaccines.  Better late than never, I say.

It’s a refreshing change not to have to deal with the constant running noses, running around to find the thermometers, running out of baby Tylenol for the umpteenth time.   The house is healthy.  Yay!

So, you won’t hear any bitching about the deep freeze we are having.  I welcome it.  Take that, viruses!!

The Fall Plague

No, I’m not talking about Yersinia or Ebola.  I’m referring to this nasty little guy —  Rhinovirus.The common cold has been making quite an appearance in the last month, causing coughs and runny noses that are lasting up to a few weeks!  It’s been rather crazy in the office these days with the number of people coughing up, what seems like a few lungs a day.  I feel like I’m reciting a script – “You have a cold.  It’ll run it’s course.  An antibiotic won’t help. Get some rest and drink some fluids.”

My daughter had a phlegmy cough, for at least 3 weeks I think.  Never had a fever.  Clearly viral.  She knows how to do the “sleeve cough”. I have seen her do it – at school, at her grandmother’s house.  But does she remember to do it at home?  No, not so much.  She gets into these coughing fits at bedtime when I’m lying next to her reading a story.  I can’t count the number of times she coughed directly into my face over the past few weeks.  So sure enough, last week I developed a tightness in my chest and an irritating cough that has now progressed a similar cough my daughter had (and my husband now has too).  Thanks, kid.

I used to pride myself on my strong immune system.  Since that first year of medical school (where I was sick as a dog for months) to the day my daughter was born, I hadn’t had so much as a cold.  While everyone around me was dropping like flies, I was healthy and never sick. And then I had kids and it all went downhill from there.  Since my daughter was born in late 2008, I have had at least one or two colds each year.  I got so sick one day last spring that I actually called in sick!!  Unheard of for me.

So here I am, hacking away between patients, struggling to talk with a throat that feels like sandpaper and I’m seeing patients who are “sick” and need antibiotics.  Come on, people.  Suck it up.  It’s just a cold.  If I can get up and go to work, so can you!

Thank goodness for NyQuil.