family practice issues and general life events

Archive for July, 2011

Why you should not get to the Vancouver Airport 5 hours early

While this seems like a no-brained, that is what I am doing right now. Though in my defense it was not entirely by choice. Actually we just got off of a cruise and when I was arranging airfare, I was told by the cruise ship to make sure the flight was after noon. Great easy enough. So I booked a direct flight to DFW for 2:25, not realizing there was a 12:15.

Anyway, apparently you cannot even check in for you flight at Vancouver until you are within 3 hours of your flight. So we are not even at the gate, we have a huge pile of luggage that we would have to lug everywhere, and therefore we are stuck here.



Anyway, you might ask “Well, why did you get to the airport early?”. Well, you disembark a cruise ship pretty much when they tell you to. So we cleared customs, collected our bags, and boarded the shuttle bus to the airport. Upon arriving we were told that we cannot check in until 3 hours before departure time. So we are here, stuck, waiting.




Yesterday, we had a marathon day at Victoria, on Vancouver Island.  We boarded a coach outside our hotel and drove about 45 minutes to catch a ferry.  The views from the ferry were outstanding.  My children didn’t appreciate the wind from the boat, and argued that they were going to “freeze to death”  While on the ferry, I caught a glimpse of a newspaper, asking if summer was ever going to come.  I found it quite funny, since I had just escaped 106 degree heat in Oklahoma, and was quite enjoying the 60 degree weather.  But apparently it was a big deal, since their averages put the temperature in the 80s.  This seemed quite the theme throughout the day with the Canadians apologizing for the weather and the rain we experienced yesterday.


After landing on Vancouver Island, our driver drove us to the city of Victoria and dropped us off.  We visited the narrowest street in the world, and unfortunately I cannot remember its name.  It is something like RanTan.  It opened up into the China Town in Victoria.  Apparently, Victoria and Vancouver are about 25% Chinese, which I never knew until this trip.


We made our way through the town stopping at a farmer’s market.  My oldest wanted some chocolate covered strawberries so we bought a bowl.  Then my youngest tried one and told me that he did not like the red stuff (strawberry) but the chocolate was good.  So after he ate off the chocolate on his two strawberries, my oldest at the strawberry.  AT least they know how to share.


After finding a pub which served something my youngest would eat (pizza), and enjoying the first half of the US-Japan world cup final.  (If anyone can tell me who won, that would be lovely) we wandered down toward the Royal BC Museum.  IF you are ever in Victoria, this is a place that is definitely worth the look.  We had free tickets to choose on of several choices, and because the driver had mentioned the Wooly Mammoth, that was the choice we made.  However, I would recommend doing it at a much more leisurely pace than we did.  My oldest convinced that we were going to miss the bus, did what we call “Trevor speed” through the museum.  However, I think based on previous trips to zoos and museums, time constraint were not what motivated him.  The natural history and land exhibits are well done.  The loved they microscopes to look at the fossils and various bugs.


After racing through the museum, we went out to take picutes of the Parliament building, and the flowers.  All the while, my son is still concerned that we are going to miss our bus, despite it being about 45 minutes before its arrival right across the street from us.  Finally, after getting more pictures of the area, when the clock tower went off at 3, we went to the meeting point to wait until the coach arrived at 315.


The coach then drove us to the Bouchart Gardens.  This is a spectacular set of gardens that has something for everyone.  (Assuming you don’t hate gardens).  There is the sunken gardens which is a spectacle of colors and water, and the Japanese Garden, the Rose Garden and the Italian Garden.  My son’s favorite was the Japanese Garden, probably because it was more peaceful and sedating.


After that the marathon day was almost over.  (Well if you count a 30 minute coach ride to the ferry for a 2 1/2 hour boat ride followed by a 40 mine coach ride almost over).  So we got on the ferry which was much more crowded and loud then earlier.  WE were not able to find a seat, so we ended up sitting on the floor in the play area.   This rude little boy took my phone away from my youngest who was playing angry birds, so I took it away from him.  Sorry, not about to allow some strange kid to play with my phone.  Later he came back and walked up to my youngest, told him that he smelled and that he needed to go away.  We told the child that he was rude and since we had been sitting over here maybe he should go away.  Shortly there after we went outside to enjoy the view and to take my son out of the situation.  Finally it was time to board our coach and head to the hotel.  To go to bed, and to get some rest for tomorrow

Vancouver with kids

This morning started our vacation.  Well I guess technically yesterday did, if you want to count 3 hours at the Dallas-Fort Worth airport.  Which is not what I would call exciting or relaxing.  Especially since to begin with the self check in apparently did not want to accept my credit card and instead of asking for another card or saying anything, it just assumed we didn’t want to check in bags.  It was only after waiting an excessive amount of time, that we asked, and when checked apparently the computer just dropped the request completely.  Thank goodness we were there extremely early


Anyway today we woke up to rain.  Since it was 106 in Durant the day we left, and we had not seen rain since May, it was a welcome sight.  Anyway we got up, stopped by the concierge and headed to a cafe for breakfast.  However, since we neglected looking side to side, we walked right by Bob’s cafe, without noticing it.  IT was only when two Seven Day Adventist asked if we needed any help that we found out that we had walked by it.


After breakfast we headed towards a sky train.  Now this was exciting for the kids.  We live in a small town with little public transportation.  So a train through town is somewhat exciting.  We headed to Metro Mall because apparently the clothes in my youngest room were my oldest, so I seemed to be short of clothes for my 6 year old.


Our next stop was the Science Center.  My husband and I have been to Science centers in several states.  Not one of them was as expensive or crowded as the one in Vancouver.  Sad really.  IT shows just how far down our emphasis on education is.  In fact, last month when we tried to go to the one in Little Rock, its website said they were closed.  So that is very telling.  However, it was a very crowded attraction, and two floors of fun hands on activities.  Additionally they have little shows and an IMAX.  WE watched the show on locomotion.  Skipped the IMAX, because I have to children very sensitive to sensory.


Our next stop was the Vancouver Art Museum.  While the first floor was ok.  It included various paintings.  The second floor was filled with advertising campaigns.  I am sorry but I am not one who believes that all campaigns are art.  Some can be artistic, but just because they were created by a graphic artist, well you understand.  The upper floors consisted of very disturbing works that I don’t feel are appropriately suited for young children.

Hello, darkness, my old friend

Most of my life I have suffered from problems with insomnia.  I say suffered, however, that is misleading, often I have been very productive those nights that I cannot sleep.  In college, all nighters were not that big of a problem.  Well the all nighter was, but the I only got 4 hours of sleep night was more common than not.  Medical school it was great.  It gave me time to study, and while I still was tired, I was able to function the next morning.


Weirdly, I have not had a problem with insomnia in months.  Well until tonight.  Though if I were truly honest with myself, I don’t sleep too deeply when my husband is working nights, butI get enough sleep.  Especially the second night he is home in a row.  The first night he is often so exhausted that the snores come early, but by night two, I usually fall asleep before he does.


That being said, my old friend has reappeared.  I am not really surprised.  It is two days before I leave on vacation, and I have tons to do, so my mind is not shutting off.  That and some other opportunities have popped up, and then there are issues at work.  Nothing terrible but plenty to keep the gears rolling in the mind.  It is funny though, with the rare exception, I have never thought that insomnia was that big of a deal.


That being said, my patients on the other hand feel it is a very big deal.  Probably because of all those commercials that talk about all the health problems with lack of sleep, and the ones talking about how lack of sleep can make you fat.  There are risks with not sleeping, that is for sure, probably the biggest is falling asleep behind the wheel of the car, but an occasional night or two of not sleeping can be quite productive.


I think it is do to overstimulation.  We are hit by electronic media from the time we wake up to the time we go to sleep.  I think my parents were right to limit the television I was allowed to watch.  And there were no televisions in my or my brother’s rooms.    Additionally, there were no PSP or Nintendo DS.  If I remember correctly the game boy came out while I was in junior high or high school.  My sons on the other hand both have nintendo ds, there is a dvd player in the car, and we have both a wii and an xbox 360.  Though I do try to limit their playing during the week.


And I am not saying that I don’t enjoy the electronic conveniences.  I have my iPhone which I LOVE.  And I have an iPad I have for work, a Kindle that I got for Christmas, 18 months ago, and numerous other electronic devices, all which allow me to stay connected.


However, does it help to contribute to electronic overload, and is it affecting my sleep tonight, maybe a little.  Possibly.  However, if it gets too bad, I may go ahead and take a Benedryl to make sure I am able to function in the morning.  But tonight I might just enjoy the quiet.

The beginning of the new year

July is the beginning of the new year, well in medicine at least in terms of training.  (while in some instances the training year might start the middle of June, July is the common cut off point)  Nursing schools start their new programs, medical schools start the rotations, and residencies start their training.


If you go to a teaching hospital, in some ways this could be scary.  The “nurse” could just be starting their rotations and a freshly graduated doctor might be the ones giving the “orders”  Well, usually those orders are more like requests, because after 4 years of medical school, while you have the title doctor attached to your name, your true training has begun.  The two years of classes and two years of rotations have nothing on the training that you are about to learn.


These newly minted doctors do not have their licenses yet, and cannot practice on their own, so there is another doctor, an attending, constantly looking over their shoulder for the year.  Hopefully understanding, at least initially, and always teaching them.  However, there is never a more watched group of people.  While still in medical school, patients don’t expect much from the student (Sorry to those that are insulted, but from the aspect of the student you are still learning).  However, once that title is attached to your name, you are a doctor, and even though 2 months ago you had the same knowledge in your head, you did not have the same expectations laid upon you.  The newly minted doctor is practicing under someone else’s license and that makes all the difference in the world.


There is nothing scarier than the first code you experience as a doctor.  If anyone remembers the first year of the show “Scrubs” where the newly minted doctors were hiding in a linen closet, well that is accurate, at least in that is how many would like to act.  Because a code is stressful, and unlike many other aspects in medicine it is truly life and death, and you are expected to know and command the situation.  At least initially, I stuck to chest compressions, I knew how to do that.  However, as training goes on, you have to learn to lead, to command, to be a physician.


The year is scary, it is stressful, and yet, I don’t think there was any year of my life which I learned more.  It is a necessary trial by fire, because in three short years, you will no longer have backup, those patients become your patients.  And they are all looking to you.  So good luck, new residents.  Take advantage of the learning experience.  Live the “See one, do one, teach one,”  mantra.  After all people will be looking to you in the future to continue the grand tradition.

Dogs, tumors and denial

It is funny, as a doctor you wonder sometimes how can one deny conditions to themselves.  Sometimes though, it is not a denial, but a gradual enough appearance, that when you see it everyday, the growth does not appear to change the appearance.


Something similar happened with my chocolate lab last week.  For those of you saying that a dog is not human, my dogs are almost as important as my children and husband.  In fact, Sara my lab, provides me a measure of comfort the nights which my husband works.  Anyway, when we took her the vet for a check up and they asked “How long has she had this mass?”  What?  First I thought, it was one that we previously saw, but no, it was on the other side.  And then we noticed it.  How awful.


Sara, who while a little overweight, (OK, maybe quite a bit) is my active, happy dog.  My companion.  She swims in the lake beside me, while I am in my paddle boat.


Sara and Brandy taking a snooze on the couch

And she provides some measure of comfort due to her size, even if she is snoozing on the couch.  So we scheduled he surgery for today.


All day, I have been scared that the vet was going to call saying something went wrong with the surgery.  Or that they were pretty sure it was cancer, even though the sample before surgery appeared to be just a fatty tumor.  But none of that happened.  Instead when I got to the vet to pick her up, they asked if I wanted to see what they took out, and said “Yes”  So they brought it out.  And here it is


Lipoma (fatty tumor from Sara)

Largest fatty tumor I have ever seen, and apparently same goes for the vet.  He said it took it out in three pieces.  And when she came out, she looked in pain, and I felt horrible, since how could I miss a tumor that size.

Poor girl.  It hurts for her to even walk.  Even worse, later when I tried to give her amoxicillin and aspirin, she refused the hot dog I tried to give her.  I had to force it down her throat, and even then she refused the hot dog.


A little later, she seems to be moving a little better.  Maybe in a couple of weeks she will be swimming in the lake again.  Beside me



Little Rock adventure

Last weekend we took an extended weekend to take our children to the World Championship American Tae Kwon Do Association.  We decided to leave a few days early, and see what there was to see in Little Rock.  Our initial impression, not much.

Every museum that would appeal to a family with kids that was listed in the hotel book they give you, when looked up on the internet either said “Closed” or “Under Renovation”  Really?  I would think that renovations would be best in the fall or winter, but maybe they see mostly school children, so what do I know.  So then we looked up things to do in Little Rock and got the same responses.  And in fact, we found a blog that even said, “Don’t bother to look for things to do in Little Rock, because everything is either under renovation or closed.”  Apparently the blogger was as frustrated as we were.  (I do apologize for not citing this blogger correctly, but since I only remember the comment, I don’t know who to give credit to)


So we decided to try the GPS.  It suggested the Toltec Archeological Park.  Having nothing else to do, we drove the 15 miles out of Little Rock and gave it a try.  Toltec is an ancient Indian set of mound of which only three remain, the rest were knocked over by farmers, but there are two trails you can walk, and it is fairly cheap, so if you are in Little Rock, it is definitely worth checking out.

The kids enjoyed the ability to walk (run) the path stopping at the markers and learning about the Toltec.  And at least some sunk in because my oldest, who is definitely ADHD even retained some of what was read.

Sometimes you just have to sit in the dirt

And there was some shady areas, but the favorite part of the walk at least for the kids was the feeding of the turtles in the Mound Lake.

However, I would recommend doing the tour early at least in the summer, because we were definitely hot and sweaty by the end of it.  So we thought it would be the perfect time to visit the Little Rock Museum of Art.  And just in time, because they had an impressionist exhibit that was ending that weekend.

On the way back to our hotel, my husband noticed what looked like a submarine, so we had to go and investigate.  He was disturbed that he had missed that sub, but it was 11 o’clock pm when we drove into town the night before.  But it was indeed a submarine, so we decided to go take a look at the USS Razorback.

Trying out the cot

Assuming you are not claustrophobic, it is an interesting tour.  However, the stairs down and up into the sub can take your breath away

I have to climb those?


I really did not want to climb the stairs back up.  The ones down were somewhat terrifying.  Don’t ask me why.  But since I did not want to stay on the sub for the rest of my life, up the ladder I went.

Don’t get me wrong, it is an interesting tour and definitely worth checking out, if you are not claustrophobic, but it is also a little heart stopping, or at least the ladders are.  But how often do you get the chance to see a World War II sub?


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