Wednesday, July 2, 2008

11w1d: New Job

I don't have any signficant news on the Blueberry front. No new pictures or symptoms. I thought I had gained 1.4 lbs, but today I was back to -0.2 from baseline again. I'm sure that I'll be going up any day now, though. I don't feel a difference in my usual clothes, but there is a form-fitting dress that I'd like to wear to a party Friday night (someone's birthday celebration with a black and white them), and I'm not so sure that the dress is going to work...

I do now admit that my breasts have grown a bit (1.5", I think), but I don't need new bras or anything, and they have still never been sore. Although, thinking about the bra issue, the bras were probably a bit too big before I started, so now they fit just right. I guess I'm technically a real A cup now instead of something unmeasurable. (ha!) Seriously, I once used an online calculator to try to figure my ideal bra size, and it kept giving me an error because when I took [(bust measurement in inches) - (band size + 5")], the result was a negative number. Thus, the error message; you had to have a difference of at least 1" to qualify as an A cup. Other websites would claim that I was a AA, which I have never worn. I tried a professional "bra fitter" at Macy's and she claimed that I was a 32-something, but that made zero sense because I would never be able to fit into a 32-anything. (I'm a 34/36 girl.) Oh well, the change is kinda interesting. I know it is not permanent!

I had bloodwork drawn on Monday. This included both blood for the "Ultrascreen" (nuchal translucency test) as well as routine labs such as a blood count, hepatitis serologies, HIV serology, etc etc. I also got my insurance info today, so I was able to schedule the nuchal translucency ultrasound for Wednesday, July 16th....2 whole weeks away...argh! Unfortunately, the ultrasound clinic only had 2 slots available, and the other is not at all feasible for me (during one of my clinics). If I have to keep the 7/16 appointment, S will not be able to attend. Well, I guess I will just call them every day or two in hopes that they have a cancellation that works better for us.

Well, I always do check my own labs after I have bloodwork drawn. (Shhh! Not to worry; I'm not going to sue myself for breach of privacy.) The labs were mildly interesting because it showed that I have a mild anemia (hemoglobin 11.6; hematocrit 33.0%, but normal sized blood cells (MCV=92)). I know for a fact that back in April and May, my blood counts were completely normal. With this in mind, I suspected that this is the "physiological anemia of pregnancy," which occurs when a pregnant person has an increase in plasma volume, but a proportionally lesser increase in red blood cells. The consequence is that there are fewer red blood cells per given volume of blood, and you appear anemic by labs. Iron deficiency is pretty much ruled out given that the red blood cells are normal in size; iron deficient red blood cells are small.

Well, of course today I got an answering machine message from the OB/GYN nurse practicioner informing me that I am anemic and that I need to start iron supplements. Ummmm, no I don't. Granted, I could become iron deficient at some point in the future, and the iron probably wouldn't hurt me (other than causing constipation), but it's pretty surprising that the OB/GYN people aren't familiar with the physiological anemia of pregnancy.

Working in hematology, we get referrals all the time about people who are anemic and whose doctors just reflexively put them on iron and were confused when the anemia didn't improve. Iron deficiency is a common cause of anemia, but there are dozens of causes, and iron won't help anemia unless you are running low to begin with. So, I am not sure if I should just do what they say, or gently inform them that as a hematologist I disagree with their recommendation. I will probably just ignore it for now and mention it at a future appointment. See what a pain it must be to have me as a patient!

Monday (June 30th) was my last day as a fellow, and Tuesday (July 1) was my first day in my "real job." It was somewhat easy in that it is at the same locations where I have already been working (a VA hospital and a university cancer center), but of course nothing was quite ready for me to start. For example, the computer system needs to be changed so that I no longer need someone to co-sign my notes, and so that I can co-sign other people's notes. Also, today at the university cancer center, I had the opportunity to check out my new (sadly, windowless) office. There's a desk and a phone and... no computer. I've been asking about this for weeks, but nothing has happened yet. Supposedly, "a computer is being ordered today." In the meantime, I am using the desk of a woman who is out on vacation. Lots and lots of stuff to organize, but none of it interesting enough to share with you all here.

Has anyone seen the television show "Hopk.ins" on ABC? I was watching the first episode on the DVR, and was surprised to see that a resident that I used to work with (I was a 4th year med student, he was a second year surgery resident) is one of the featured doctors. He has a wife and 3 young daughters but he is now apparently having serious marital problems and he and his wife are contemplating divorce. It was kinda depressing to see that part. Also scary that I worked with him in September 2000 and he is STILL a resident (PGY 9, I think... in Cardiot.horacic surgery.) I looked in my Palm P.ilot, and yep, I still have his pager number in there from when we worked together. How random. I remember the other two doctors, too, but I never worked with either one of them directly.

I hope everyone out there is doing well. La la, I'd love to check out your blog but it looks like you've moved it(??).


Jill said...

First of all, thanks for your response back to me about the rental car in Denver. I may have to check them out next time!

Sorry to hear about the anemia, but it sounds like your on top of everything! And huge congrats on finishing your fellowship and moving into the role of an attending! I'm sure there were days that you thought it just couldn't get here fast enough!

I've never heard of the show Hopkins, but I'll have to check it out soon. There was an ENT resident I worked with and when he finished, he moved to CA and now is on the show Dr. 90210 doing plastics work. Funny!

Jill said...

Hey--Just wanted to let you know that the resident was Dr. Jason Diamond on the show. :-)

And, I'll try to catch "Hopkins" tonight! I love medical shows--my fave is "Grey's Anatomy". Not totally realistic, but awesome drama just the same!

Pink-CJ said...

Congrats on 11w1d!! And you new job!!

Jen said...

I'm glad things are going well pregnancy wise! And I did see the show funny that you know that guy. I did feel bad for them though. How on earth you juggle a family and those kinds of hours is beyond me.

sarah23 said...

I'm sure that Dr. B from the show would not remember me. I've come to realize that as a student, you tend to remember your "teachers". However, when I was the "teacher" (or resident), I had a much harder time remembering the names of the students I worked with. I think it's because there are a lot of them, and they tend to rotate thru pretty quickly (a couple days to at most 1 month at a time).

La La said...

Glad to hear everything's going well!

No, I didn't move my blog...but when I post on Blogger blogs it links to my old blog, not my new one. I'm here:

DC said...

I am LOVING Hopkins! So sad about the doc getting a divorce. His girls are adorable.