Monday, December 29, 2008

are you ready to die?

i know that sounds a bit macabre, particularly in light of this joyous holiday season, but as the year unwinds, i think it's a question that everyone should consider, sooner rather than later. now, oddly enough, i'm not even talking about the spiritual component which is what you might expect around christmastime. i'm actually talking about the realm of living wills and advance directives.

let's talk about dnr's first. a dnr is a "do not resuscitate" order. that means, in the event of a respiratory or cardiac arrest, there will be no cpr--no intubation and hooking the patient up to a ventilator, no cardiac shocks, chest compressions, no "heroic measures" or any of the other things that occur in a "code" situation. now, in the event that you are a 90 year-old woman with metastatic breast cancer, severe dementia and so debilitated you haven't been out of your bed in the past year, the decision for you or your family to make you a dnr seems pretty easy.

however, in many situations, it's not as clear cut. i have had a number of patients who were made dnr or about to be made a dnr who ended up surviving and leaving the hospital alive. they subsequently led happy and productive lives, at least for some time after discharge.

but what if you were a 97 year-old and you developed a tear in your aorta which could only be corrected surgically? if you don't get the surgery, you will probably die. if you do get the surgery, you will probably die. would you rather die peacefully at home or on the operating room table? the answer seems to be easy, except in this case, the patient was michael debakey one of the most renowned surgeons in history. he actually pioneered the surgery that he now needed. i think i have linked to this article before but here's the link again to a fascinating article in the new york times a couple of years ago. he refused his surgery and wanted to die in peace. only after he became comatose, his wife begged his colleagues to perform the surgery and after a special ethics meeting, they agreed to proceed. he survived the surgery and lived for another couple of years, long enough to receive the congressional gold medal from president bush. the funny thing is, even though he intially refused surgery and was ready to meet his maker, after the whole ordeal he was happy his wife did what she did. if the famed dr. debakey can make a mistake regarding a dnr order, how is the average joe on the street supposed to know what to do?

that's why i feel like it's good to have a surrogate medical power of attorney or medical decision-maker. in some young patients, it's appropriate to withdraw care. in some much older patients, it's appropriate to continue fighting. i think if you have an advanced directive specifying exactly what you want or don't want done to you if you aren't conscious to make those decisions yourself, you may be potentially making a tragic mistake. would you always refuse being hooked up to a ventilator? some people specify that but what if it's just for a day or two while your lungs recover from a bad pneumonia? frequently, we have patients on ventilators only for a few days and they get better and eventually go home. however, if your advanced directive refuses this care, you could potentially succumb to a disease you shouldn't have.

the point is, each situation should be evaluated on its own, which is why i feel (at least right now) that it's best to have someone make the decision for you. hopefully that person has some type of medical knowledge or background which would make the communication and decision-making easier. naturally, one would assume that the spouse should be the one making these decisions and they probably should, but other times it might be more difficult. if your loved one is actively dying despite all medical care, it would be very difficult to tell the doctors to withdraw care. sometimes people want to make this decision on their own, sometimes they want some reassurance from someone else that this is the right decision. whatever is right for you or your family, if you don't have an advanced directive, make sure someone is designated to make those decisions. if not, what happens frequently is that family members disagree about the care and that itself eventually turns into a mess.

Saturday, December 20, 2008

n'awlins

do you know what it means to miss new orleans? that's how the old line goes in a song sung by many. well, i know harry connick, jr. sang it but not sure if he originated or not. if he did, then way to go harry, i like that song. anyway, karen got us tickets to see harry at the cobb energy performing arts center (stunning name, i know) earlier this week. he has a new christmas album out which he was promoting. the holiday songs were fine (don't get me wrong, i like a good christmas tune like anyone else but as he mentioned during the concert, it does tend to get a little nauseating after a while, particularly some of the pop songs) but his jazz/blues/etc. pieces were great. i would say almost half of the concert was non-holiday music, including a little jambalaya ("crawfish pie, file gumbo") and a mardi gras piece at the end ("if you go to new orleans, you oughtta go see the mardi gras ..."). check out karen's blog for a more complete description. and yes, i agree that the concert at chastain a few years ago was one of the tops.

all that brings up the question, do you know what it means to miss new orleans? i actually do miss new orleans, having gone to college there. of course i don't want to romanticize the city too much. sure, there was a lot of crime (note these reflections are from the early '90's when i was there), lots of corruption and poverty. there was a particular stench that would roll in off the swamps a couple of times a week and give the city the smell of an outhouse. the humidity was at times unbearable. i remember the first time i ever visited. it was late august, a week before orientation (yes, i decided to go there without ever visiting! that's another story.), probably 8 pm or even later. i slid open the door to the dodge caravan and whoosh! a suffocating cloud of atmosphere invaded us and i thought i was going to pass out. kinda like houston from what i hear and it's not like it doesn't get humid in atlanta but new orleans is at another level. in addition, the city's kinda dirty and covered with potholes.

but ...

i guess those are some of the things that gives the city character. and in a weird way you kinda miss those things (okay, not the crime and poverty but you know what i mean!) ... although i probably miss the times as much as the actual things. i mean, i don't really miss getting sweaty walking a few hundred feet to class at 8 in the morning! but i do miss the people, the accents, all the great music--so much great music both big names and small, the streets lined with trees and spanish moss, the mississippi river (one of the first things i did when i got to tulane was to put my foot into the mississippi like ol' sam clemens might have done years ago), weekly crawfish boils, cheap po' boys and all the glorious food including $5 all-you-can-eat fried chicken and red beans and rice with sausage on mondays at dunbar's (!!!), mardi gras parades and mardi gras music (i love mardi gras music), streetcars, hanging out at the levee (but with my ford mustang, not a chevy) and yes, even the french quarter, beignets at the cafe du monde, and so many other things. i miss those beignets. we even got some once at a cafe du monde in a mall in nearby metairie but they weren't the same as the one in the quarter. i haven't been back since katrina and i heard things are still a bit depressing there although better. hopefully we'll be back sooner than later.

Tuesday, December 02, 2008

holy moly

yes my friends, i'm back. it's been almost a month since the last post. time flies when you're busy watching tv ... i mean, saving lives in the hospital.

my parents are in cancun right now. that scares me. they usually travel with friends or other korean travel groups so i don't worry about them as much but this time they're on they're own. do they speak spanish? no. fortunately it's enough of a tourist town to where enough natives speak english. is there a good chance they'll get swindled? yes. will they manage to get from the airport to the hotel in a timely fashion? not sure. what will they do while they're there? don't know either. typically koreans take food and cooking utensils (think rice cookers, pots, portable flame or electric burners, coolers, etc.) with them on trips and cook in the hotel room or wherever they're staying. it was like a freakin' korean market when we were at a marriott timeshare in california a few years ago. my brother had the timeshares and there were 2 units next to each other and the fridge was filled with korean food to cook and cook we did. i felt bad for the next occupants because the rooms stunk like korean food after a week of saturation with garlic, kimchee, fermented bean paste and other odd smells.

anyway, my parents are in cancun because my dad just wanted to go to cancun. i am my parents' unofficial travel agent. i'll get a call from them every once in a while asking me to book a flight using skymiles. of course, usually this is unsuccessful because those you-know-whats hardly ever have a flight you want. and when they do, you have to pay an extra $100 or more because you booked the flight too close to the actual departure date.

the good news for my parents' survival is that my mom did come to a tiny little town in georgia 30 some odd years ago with several other korean nurses, none of whom spoke english, and somehow made it.

which brings me to another point, no matter where you go in this world, if it's of any tourist value, you can usually find a group of koreans there. at sacre coeur on a hilltop in paris? koreans. karen freaked some of them out by saying "hi" in korean. they laughed. my parents also went with a busload to vancouver. imagine if you're minding your own business at a random ski resort in vancouver and a busload of koreans descend on your property. meals were included in this package and i remember my mom telling me that one of the restaurant people asked her if there was an egg shortage in korea because they were tearing up the hard-boiled eggs on the buffet. no, koreans just like to take advantage of free meals (e.g., me and drug rep dinners) and apparently they were taking the eggs with them to eat for later as well. this was discovered by the staff when all of the eggs were gone but there were few shells on the tables.

well, here's a glass to you mom and dad, wherever in mexico you are. here's to safe travels.

Wednesday, November 05, 2008

back in action

just wanted to give a quick word on an article i came across. click here for more details. basically it's a study showing larger bmi (body mass index, a measure of how "big" you are) women were sexually as active as thinner women, maybe even more so. what i love about the story is the following quote from one of the researchers: "These results were unexpected and we don't really know why this is the case," Kaneshiro said. ha ha ha! that is freakin' hilarious, nice little jab at the large people in this world.

Saturday, October 04, 2008

the incredible ... kate?

check out this hilarious video of our lovechild as the incredible hulk. i used to love that show.

Wednesday, October 01, 2008

thank ye

props to my colleagues at the acp internist blog. i've been linked on their site (see under sept 29 post). recently i came across their "medical news of the obvious" posts and found them very entertaining. i have to say, they took an idea i'm sure many of us have had but actually put it to print. i come across a lot of articles in my weekly perusings and a number of them come to such obvious conclusions, i wonder why someone actually spent time and money to publish it. maybe that's the point, to get their name in print. heck, let's be honest, i'm mostly jealous!

"never" events

well, this is october 1. another day, another month you say? not quite, today marks the day that cms (center for medicare and medicaid services, responsible for the largest share of and policy directing physician payments) will stop paying for "never" events. what are these? these are events that in the mind of cms, they/we/the government will not pay for since they feel if proper measures are taken, they would never occur in the hospital. see among many others this site to list the events.

certainly, improved quality in the hospital has to start somewhere but to all of a sudden deny payment seems a little drastic. okay, i can understand that they wouldn't pay for complications related to a severe reaction from a blood transfusion. that is usually due to a clerical error. i can even understand that if a surgeon operated on a patient and left an instrument inside accidentally, there would not be payment to cover treatment for those complications. however, some events, no matter how vigilant or good the treatment, cannot be prevented 100%. for example, a deep vein thrombosis or pulmonary embolism (which i will discuss in a later post) after knee or hip surgery is not a completely preventable event. even if the surgeons use proper medication to prevent these clots from forming, the fact is, the medications are not 100% effective! somehow this obvious fact has escaped the mind of cms. well, more on that later. i need to eat some ice cream and go to bed.

Thursday, September 25, 2008

patient behavior

at the risk of alienating some patients, check out this hilarious article on patient behavior. not sure how long the link will last but worth reading. here's the original article on medscape. there's a chance you might need to register to read it but give it a try.

Friday, September 12, 2008

"two protons walk into a black hole ... "

if you have access to the wall street journal, check out this article. pretty funny. it's about physicists taking a workshop on how to be funny. i think i like the line in the article "do my bosons give you a hadron" even better. there's no limit to how funny physicists can be. i'm sure there's an integral in there somewhere ... limit of physicists as funny approaches infinity.

all this of course is tribute to the large hadron collider, which recently went into operation. click here to get more info on this. here's another link to some physicists having a pajama party to celebrate. now that sounds like a party i don't want to miss. hey, my undergrad was in mechanical engineering so i feel i have clearance to make fun of science and engineering nerds.

Sunday, August 31, 2008

ca

sure, in your science class, ca might refer to calcium or california in geography or something else in some other class but if you hear your doctors talk about ca, they're talking about cancer. sometimes we use it when we don't want to alarm patients, families or others who may be in earshot, particularly when we don't really suspect it but do need to consider it in the possibilities of what might be wrong with someone. obviously, if your doctor has a fairly low suspicion of cancer but are doing a couple of tests to "rule it out" then you don't necessarily want to worry about it for days while the tests are pending. all you want to hear is, "oh yeah, whatever you have, it's not cancer." well, not to be paternalistic, but at least to me, i certainly wouldn't want to be worrying about it.

a couple of questions came up about prior ca topics. as for screening, colon cancer seems to be more straightforward but it's certainly not the case for breast cancer. unfortunately, no matter what type of cancer, there are always particularly aggressive forms in some people that defy all screening. we see patients with no family history of cancer who come in with colon cancer diagnosed in the 20's and 30's, breast cancer in the same range too. screening would not have helped and these patients aren't usually the ones who live a long life. these are usually advanced diseases we see in the hospital. those are the unfortunate outliers. screening programs are basically a numbers game--how prevalent is the disease in a certain group, how good are the tests, how much will all of it cost, etc. if you have a strong family history of breast cancer, as far as i know of, there are no clear-cut guidelines on early screening. of course, most recommend an early baseline mammo then yearly (or every other year) starting at age 40. but what if you're 20, 25 years old? there are genetic testing options for the brca gene but that probably shouldn't be done without counseling from a medical geneticist because the answers aren't as straightforward as you might think.

a friend also commented on gene upshaw, the former nfl'er, players union director who died somewhat suddenly of pancreatic cancer. again, some cancers in some people can be particularly aggressive. he was apparently sick at least for a little while (but not too long) but didn't get seen by a doctor. some cancers don't manifest themselves until it's almost too late. that's part of the reason the mortality for ovarian cancer and pancreatic cancer are so high. i just read another nice q&a session on the scientific american website here. more good info regarding cancers, particularly pancreatic. i'll talk about prostate cancer screening later, another very controversial area.

Monday, August 18, 2008

medical myths

there was an article in the british medical journal last year about certain medical myths. i am a little jealous because i could have written the article and had my name all over google and pubmed if i had thought of the idea but i didn't. isn't that the way with most things in life? anyway, it proclaims "sometimes even doctors are duped." if that's the case, i would say find another doctor as most of the ones listed were fairly basic old wives' tales (not to say doctors aren't duped or wrong a LOT of times because they are). the problem in medicine and in life is that we don't view things with a critical eye and believe anything people tell us, even if they're a physician. anyway, the article is an interesting read. check it out here.

ha ha, this came up because of a comment on my #1 fan's blog about how maybe sitting too close to the computer all these years made her eyes bad. apparently her optometrist told her this. well, hate to break the news but this is a myth. dim light or sitting too close to the tv or other objects does not make your vision bad.

another myth i want to demythologize (i made that up) is the ol' "sugar rush" that people, particularly parents, talk about. sugar does not make you hyper! i remember reading a long time ago that kids make other kids hyper, not sugar. in other words, when kids are at parties with other crazy and rowdy kids, it's the environment that makes them hyper, not the fact they got in a few cupcakes. john stossel even had a mini-study on 20/20 recently where they gave kids junk food which was actually low in sugar but the parents thought they were high-sugar snacks. of course they all had the impression that the kids were more hyper than usual. then they gave the kids healthy food but loaded with sugar and the parents thought they were calmer than usual. of course the parents were surprised when they were let in on the experiment. hmmm, i wonder if they got informed consent from the parents for the study?

anyway, this makes sense physiologically, too. okay, if you're completely comatose and hypoglycemic, i can see how giving sugar in that instance would increase your energy level. however, excess sugar stimulates insulin which is not a hormone known for revving up the body.

Saturday, August 09, 2008

"the eagle has landed"



these were the words spoken by my wife when we got our phones in the mail. now, just to be clear, there is a backlog on iphones so the phones which came were my wife's and my parents' phones (none of which are iphones and we're all on one family plan now). however, this was a big step in my iphone access process. you see, i have had sprint service for 8 years. as a matter of fact, i recently checked my last bill and had a "congratulations on your 8 year anniversary" message. however, over time, and more importantly in my current job, i have become increasingly irritated with dropped calls. this even happens at our condo. i can have 4 bars then all of a sudden lost signal. this is even more aggravating when you have to make business or professional calls. people really get annoyed when you keep cutting out. so, we made the switch to at&t which, without a doubt has better signal reliability (although still a step behind verizon). just to let you know, i'm not entirely satisfied with this move because to sprint's credit, the voice quality of their phones/lines i feel is much better than at&t. you can drive in your car with the windows down and the other person can hardly tell. with all of our at&t phones, the background noise is much worse. however, background noise with a signal is still preferred over no signal at all.

having said all that, after we made the switch, i went to the at&t store and ordered my iphone, 3G that is. the expected wait was 10-21 days but one week later, i got an email that said the phone had arrived at the store. of course, the email says to wait for a customer service person to call to schedule a pick up time but whatever! i just went right to the store and it was there ready for me.

so, the pic above is me playing with the 2 loves of my life, my baby and my iphone. ha! just kidding!!! of course my wife and kid are the real loves of my life. the iphone would be a distant, distant 3rd.

tribute to norman

on a more serious note, i just wanted to write a short tribute to my good friend's dad, norman, who died last week from metastatic lung cancer. i've known my friend since 7th grade and what i always remember about his dad is his voice because it was on their answering machine growing up: "hello, this is norman ... " i always found it funny that the greeting sounded like he lived alone and didn't really mention the family.

to be quite honest, what was most troubling about the past few months with my friend and his dad was that he was diagnosed with cancer about 2 months ago and succumbed to it fairly quickly after diagnosis. you might think that he was in some remote area or never really saw any doctors but the fact was, he lived in a suburb and was being followed by many doctors, including a pulmonologist. i don't want to criticize any of his doctors because i know nothing about his prior workup and clinical condition but what angers me is that i feel his diagnosis should have been made much earlier. it's not like he all of a sudden became sick. he has had issues for longer than the past 2 months. of course some might ask, "would it have made a difference?" in his outcome but i don't think that is a relevant question. yes, lung cancer has a high mortality rate but with earlier diagnosis, there is a high likelihood that he would have been around much longer to enjoy his life on earth. and i'm not talking about keeping alive some demented and debilitated patient a few weeks longer to prolong his misery but i'm talking about early diagnosis with hopes at cure. well,what's done is done and i pray for peace and comfort for his family and friends.

Monday, August 04, 2008

cpr article

karen's friend kristi writes for the knoxville news sentinel and has an article about cpr covering the compression-only concept that i discussed previously. (am i really "discussing" it if i'm just writing about it on the blog and not actually talking with anyone? guess not. reminds me of a friend who asked if you could be a "wino" if you drank beer or liquor and not wine. initially i thought it could apply in general to anyone who drinks a lot but then the question was asked why that person was called a "wino" and not something else to which i had no answer. i guess alcoholic, alky, etc. could apply to such a person so it does seem that wino belongs exclusively in the realm of actual wine drinkers.) i had the honor of getting quoted in the article. check it out here. i can be korea's (or shall i say "korea-america"?) answer to sanjay gupta. watch out cnn.

Saturday, August 02, 2008

on oregon and death

nothing profound here, just a link to a fox news article. apparently, a guy was signing up for oregon's state-run health plan and instead of an offer to help treat his metastatic prostate cancer, he got a letter offering physician-assisted suicide! okay, there's more to it than that but that's the gist of the story.

chemo and other costly therapy for terminal illnesses or late-stage disease brings up a dilemma regarding whether patients should undergo these therapies even if they offer only minimal benefit (tack on a few months at the end of life). there was another interesting ny times article regarding this issue recently. in many places where the government is the provider, they make the decision for you--minimal benefit, we ain't gonna pay. being the capitalist that i am, it is definitely against my nature to say that having less choices makes life easier but that is the certainly the case in some situations, for sure (like oh my gosh). if you have ever shopped around for a flat-screen hdtv, you know what i'm talking about!

Thursday, July 24, 2008

medical minute

please note, this is just generic info and not specific medical advice. if you have any medical problems or questions, please discuss these with your doctor.

i love those little disclaimers on commercials and such.

anyway, for real, i wanted to give a little more update on tony snow and colon cancer. i remember hearing that his mom also died of colon cancer but what i didn't know was that she died at the age of 38! now, i'm just assuming once tony hit 50 or somewhere near there he started seeing doctors since he would need to be screened for colon cancer at that age. i'm assuming that was the case because i never want to second guess a physician (always give the benefit of the doubt i say, you never know the whole story ... well, having said that, once you know the whole story and someone was still grossly negligent, let 'em have it!). the reason you would be second guessing is if a physician actually recommended he wait till 50, that would constitute gross negligence. any medical resident (i.e., "physician in training") knows that if you have a first-degree relative with colon cancer, then the age you should be screened is 10 years before the age that relative was diagnosed, or at age 40, whichever comes first. i'm not sure if/when tony's mom was actually diagnosed, but since she died at 38, that means he should have been screened at least by 28 with a colonoscopy. as far as i can tell, he first got screened at 50 when he was ultimately diagnosed. i just read some source that said he started having abdominal pain which led to the testing. it's amazing and ironic that the white house press secretary of all people may not have gotten notified by someone, even a physician friend, that he was way overdue for a colonoscopy. very sad. who knows what the outcome might have been if he had known that he needed screening much earlier. then again, at the time he was 28, i can't say for certain that those recommendations were even in place. certainly some room for investigation. still, these aren't exactly new recommendations so the word has been out for some time.

to die at age 38 from colon cancer is not a common occurrence. most colon cancers are not familial and typically grow out of polyps which take time, thus the age 50 recommendation. however, a small percentage of cancers are familial and are diagnosed at much earlier ages.

so, again, if you have a first-degree relative (sibling, parent, etc.) diagnosed with colon cancer, note the age! you should be screened for colon cancer 10 years before your relative was diagnosed, or at age 40, whichever comes first. if your mom got diagnosed with colon cancer at age 45, you need screening at 35. now, the question comes up as to which screening tool is recommended but for all intents and purposes, colonoscopy is probably the way to go. for more detailed info, click here to see the american college of gastroenterology's input.

Tuesday, July 15, 2008

r.i.p. dr. debakey

with the rash of media personality deaths lately, i must include the death of dr. michael debakey. he actually died on the same day as tony snow but for some reason i didn't hear about it until yesterday. most med students probably hear debakey's name before knowing anything about him because he has a surgical clamp named after him. dr. debakey was a pioneer in surgeries of the heart and aorta and one of the most well-known and respected surgeons/physicians around. he was responsible for coming up with the idea of mash units among many other inventions and ideas. there are many obits around but here's one from across the pond. i like his quote on operating on kings, heads of states and the less fortunate: "Once you incise the skin, you find that they are all very similar."

there's an article in the new york times that came out last year that is a fascinating read if you have a few minutes. here's the link. basically, he suffered a problem for which he pioneered the surgical treatment but he didn't want the surgery. he was 97 at the time and assumed he would be dead but ended up surviving for weeks. when he got ill enough to refuse care, his wife begged the staff and they did the surgery. debakey recovered and actually thanked them for doing the surgery and he was glad to have another chance. this article really made me rethink the issue of advance directives and "dnr" (do not resuscitate) orders. more on that later.

Saturday, July 12, 2008

r.i.p. tony snow

in case you didn't hear, tony snow died this morning after a battle with colon cancer. here's an nytimes story. in case you didn't know, he was a christian as well. here's a christianity today article he wrote. big losses in tvnews/politics lately with tim russert's recent death as well. i guess a reminder to all about the brevity of life.

Friday, July 11, 2008

thank you, thank you

i hope to surprise my SIL (sister-in-law for all you people who don't spend disturbingly large amounts of time on the internet) by thanking her for listing me in her award list for blogs she likes. odd sentence structure there. whatever, i'm too lazy to change it ... but apparently not too lazy to write another sentence about how i'm lazy. interesting. anyway, i'm also supposed to list this website which apparently started the award. here's the award pic below also. i do hope this award was legit; as anne mentions on her blog entry, there may have been a family bias to her awards. i don't want this thing to be rigged.


Thursday, July 10, 2008

viewer mail

okay, i'm gonna spend a minute discussing some important questions that came up in a viewer comment regarding the recent cpr post.

first, the aha (american heart association) advisory committee and i want to emphasize that whether you do traditional cpr with mouth-to-mouth or compressions-only cpr, the survival is similar. having said that, another way of looking at it is that, if there is any concern or hesitancy about the mouth-to-mouth part, feel assured that chest compressions only will offer similar benefit. read the aha press release here.

second, remember that this is for out-of-hospital, witnessed cardiac arrest. this is not applicable to witnessed "fainting" (or "falling out" as our hospital population calls it ... incidentally, apparently karen's side of the family had never heard this term. i hear it so often from our patients that i assumed it was common but apparently that's true only in certain populations). if someone faints, typically there is an inciting reason (stood up too fast, gross movie, etc.) and they will "come to" (is this another one of our inner city terms?) fairly quickly. if someone has cardiac arrest, they will NOT spontaneously wake back up. if you are adept at feeling pulses, they will also likely not have a pulse.

third, for the most part, this is for adults only (sort of like an r-rated cpr). most kids, younger folk, drownings, drug overdoses, etc. typically have respiratory arrest and in those cases, oxygen (via your mouth) is the most important factor for survival. so, in kids, lack of oxygen is the problem leading to heart and brain injury. in adults, it's usually the heart problems that lead to the brain and oxygen problems.

next, how long do you do compressions before you perform mouth-to-mouth? i'm not sure if there's an official answer to this but you can probably go at least 4 minutes or more before giving the rescue breaths.

do you ever stop compressions to see if they're breathing? short answer, no. assuming it's true cardiac arrest, your chest compressions will not get their heart kicking again and they will not spontaneously breath until it can get jump-started. this typically occurs via electricity, i.e., shocking someone. either that or correcting other underlying disorders which only the paramedics will be able to potentially do.

what's the best position? there is no official preference for side-by-side compressions or compressions while straddling the person. however, in my opinion, straddling the person may actually be more beneficial because the weight on the abdomen theoretically could help improve blood return to the heart by basically squeezing the blood out of the abdominal organs. not to throw anyone off, but there's even evidence and a push by some people for "abdominal" compressions instead of chest. see this interesting story.

so, in summary ...
  1. chest compressions only is an alternative to traditional cpr with compressions and rescue breaths.
  2. this method only applies to adults who have witnessed cardiac arrest. anyone with obvious airway problems needs oxygen!
  3. continue compressions until ems arrives. if it takes longer than 4 to 5 minutes, consider giving some rescue breaths.
  4. don't stop compressions for anything (except rescue breaths). if a patient miraculously starts breathing spontaneously, you will know it and can stop. in general, however, a person will not wake up from sudden cardiac death unless ems or the hospital staff intervenes (unless, of course, an aed--automated external defibrillator--is available).
  5. compressions is better than nothing.
hope this helps.

Tuesday, July 08, 2008

happy b-day kiddo!

okay, i can finally wish kate a real happy birthday, not happy 173rd day of life or happy 7 months as in the past but happy 1 year! that's right friends, one year ago today, kate made her descent down the ol' birth canal and into this world. (karen loves it when i talk this way.) i don't think the shape of her head has quite recovered from the trauma. ha! fortunately for me, being in the medical field, i have seen much more traumatic and dare i say messier stuff so the process itself didn't bother me too much.

so many highlights from the past year. look for karen's postings to come for a lot of other stories but first, here's a video of a "dueling growls" game that kate and i play. not sure how it started but kate started making this noise so i decided to do the same and now we do it back and forth to each other. sometimes i use it as a mini-gps device--if i don't know where she is i'll make this noise and listen for a response to locate her.

one of the joys of being a parent is watching the funny and quirky little things she does, especially at this age when she doesn't really know what she's doing (or so we think). i actually find most things she does funny in some way. a very brief listing of some funny memories: swinging things in front of her (with the rare bonking of the head with said object) and then at times just swinging her empty outstretched arm for no apparent reason; lowering her head when she goes into turbodrive crawling; her first balloon experience (kid went craaaazy); how her face would (and still does to a less extent) get all splotchy when she cried hard; tooting sometimes when she strains from crying also.

she loves "undoing" things these days--taking things out of boxes and purses, throwing things off of tables, pulling books off of shelves, cd's off of racks and junk out of drawers. tends to make the place very messy.

phases i'm happy to see pass: spitting her food at us (didn't last too long thankfully), not having to make as much formula or clean as many bottles (although of course this gets replaced with bowls and spoons and sippy cups ... but still better than cleaning bottles i say), 2 words--breast pump, having to burp her (which i didn't really mind but just something that has passed), sleeping exclusively on our loveseat.

okay, lots more i could add to the above but i need to get this post out before midnight so till next time. happy birthday katherine suna!

Tuesday, July 01, 2008

july 1

what's the significance of this day? in some worlds it might be a new tax year, for others a transition to the back half of the calendar but for me it's ... new interns! (in case you didn't know, interns are first-year residents, vis-a-vis "internists" who are internal medicine doctors finished with residency.)

yes folks, that's right, in hospitals all across this great big land of ours, bright-eyed (and i do mean "deer in headlights" bright-eyed) interns are setting foot on the wards really taking care of patients likely for the first time in this country. many of these physicians are newly minted and were 4th year med students just days ago and they probably haven't had any meaningful clinical contact for months. in my case, i think march or april was my last real rotation. after that it was all golf and lounging around, getting affairs in order to graduate and move back to atlanta to start residency. no wonder some people want to get rid of 4th year med school.

increasingly these days, more interns are from abroad ("img's," international med grads). some of them are recently out of school but many have actually been practicing medicine for years. well, if that's the case, why would they go through the torture of starting all over again here? pardon my sense of pride but the fact is, this is still the most well-trained and respected medical establishment in the world. that's why. granted, our healthcare system itself is in shambles and that's not to discount the many excellent physicians and systems abroad but overall in medicine, we're still tops. hopefully that will make you feel a little better when you're getting poked and prodded by new interns.

don't worry though, these interns aren't completely running wild on their own. there are always upper-level residents in the hospital and an attending available, usually at least by phone if not in-house. still though, it's always a nervous time for new interns and it should be for patients as well! remember, if you have any control, get sick in june when the teams are as polished as they can be but plan on getting out by july 1. ha ha, just kidding. not really.

anyway, to all the new interns out there, good luck! and remember the motto of july 1--"try to keep 'em alive at least until the morning!"

Saturday, June 21, 2008

crazy koreans and keeping up with the lims (limses)

i'm trying to keep up with my wife's blogging frequency but it can't be done. regardless ("irregardless" ... i still laugh when people say that ... if you don't know what i'm talking about then don't worry about it but listen for a chuckling asian man in the back when you say it), i think this is the most number of posts i've had in this short a time span in a long time. i hope that made sense.

anyway, i wanted to include a link to a new york times story. in case you have been behind in your asian politics (maybe you haven't been tivo-ing overseas news), the korean president has been trying to get american beef back into korea. there's been a ban for a few years due to a mad cow scare. i think one cow came down with mad cow and american beef has been banned ever since. well, if you didn't know, koreans tend to be a superstitious bunch. pardon the pun but there also tends to be a herd mentality--less individualism and more group-ism, i guess a result of the confucian influence. even though seoul is one of the most modern and technologically advanced cities in the world, koreans tend to be pretty gullible and naive. hmmm, interesting. i just thought, maybe that's why i tend to get suckered into things at times, like paying $10 for some dumb word of the day texting service. it's in my genes. i can't help it.

getting back to the story, in the article they mention how all these koreans are protesting (koreans love protesting things, too) the decision by the president because they worry about getting sick from contaminated beef infiltrating their country. what i found most striking was the accompanying slideshow. the third picture shows an amazing amount of people on the streets with candles protesting. unbelievable how many people are out there and it's funny how once you get people protesting, others will come out to protest all sorts of other things. others were out there protesting inflation. "nothing attracts a crowd like a crowd" as soul asylum used to sing. i love the flyer that's being passed around, "mad cow drives our people mad!"

here's another article in time about the fears. a separate wall street journal article also talked about how koreans think americans are even paranoid and don't eat american beef but instead import their beef from australia and other places. i wonder what they would think of me. there is a chance i will be involved in 3 meat buffets this month, 4 if you include baby's b-day party july 5.

Wednesday, June 18, 2008

tim russert

by now most of you may have heard about the unexpected passing of tim russert this past week. apparently he had issues with his weight (not a surprise), cholesterol, blood pressure, etc. it's interesting to follow the media (including the medical media) about his untimely death--so many questions about whether he was on the right medications, could his death have been prevented, should he have had more testing. by all accounts, it seems like he was getting the proper care. the bottom line is, no matter what you do, even if it's the right thing, people will still die. having said that, i did find something very interesting in an article i read recently. click this link to get to it. karen has a weekly celebrity post so maybe this will be the start to my weekly if not twice-monthly medical post. i call your attention to the last paragraph in the article. someone was performing cpr with mouth-to-mouth when the paramedics got there but it's unclear if anyone did chest compressions. regardless, obviously they did what they felt like they could.

new guidelines

BUT, the word needs to get out: if you see someone collapse with what is assumed to be a cardiac arrest, don't bother with mouth-to-mouth! please, spread this word. the guidelines have changed recently after much effort. once someone becomes unconscious (i.e., "witnessed cardiac arrest"), there is enough oxygen in the system to last several minutes. the most important thing to do is to start chest compressions to get blood circulating. DO NOT BOTHER GIVING MOUTH-TO-MOUTH the first few minutes! now if you know me, you know i hardly ever use all caps but this is that important. another reason the guidelines have changed is because mouth-to-mouth typically has been a barrier to people helping out. if that is removed, then people are more likely to do the chest compressions which is most important.

proper cpr

most critical is getting the blood pumping and that requires pounding on the chest at a rate of about 100 times per minute and pressing down on the sternum about 1-2 inches. incidentally, if you do not feel any ribs breaking then you are probably not pressing down hard enough. if the point of the ribcage is to protect the heart, then you realize that you have to break some ribs to have effective chest compressions. forget about the ones you see on tv, they are nowhere near how they should be (although i will admit i am a sucker for medical shows). the easiest form is to lock your arms and put your weight into it. this maneuver is very tiring and you can't last more than a couple of minutes so it's important to have someone ready to take over. if you don't lock your arms and just try to push down with your hands, you won't last 10 seconds. of course, the best plan is probably to take a cpr class but at least you have this info just in case. plus, the guidelines have changed only in the past couple of months so any books you use might still have the old info. hope this helps.

Sunday, June 15, 2008

happy father's day!

or is it fathers' day? i guess it could really be both but probably fathers' if we're including everyone out there. i mean, it's not just one father out there who has the holiday, is it? if so, that's one cool dad. i have had a nice and relaxing day watching various sporting events while my wife has been tending to the babe. kate got me a nice card with $50 stuck inside! i guess with the high gas prices and the weak dollar karen has been upping her allowance lately. incidentally it's the same amount i asked karen to get for me from the latest bank run.

last night we had the graduation for our residency program. over the past few years the residents have recorded a skit making fun of the attendings and even other residents. now that i'm on the "other" side, we rallied the attendings together to film a skit. i would post the link but there are too many inside jokes to be funny for the general populace. anyway, it was fun filming and editing the thing so it rekindled my interest in making a movie. i have already pitched a few ideas to my sister and one day do want to write a real script but i could start the process at home with a tv show or movie starring kate. the show would be called "one and a half asians," kinda like the charlie sheen show "two and a half men." we could have kate getting into various shenanigans--spitting food at us, reaching into drawers and throwing everything out, clips of us accidentally whacking kate's head against various things (as recently as this morning i accidentally hit her head on the car frame putting her into the car seat ... in my defense i had a bloody nose this morning, worse than usual (and i didn't even pick my nose to instigate it) so i wasn't feeling the most normal), her laughing at me when i do pushups and how she tries to grab my hair as it goes up and down. so many stories we could share. could probably get a couple of seasons out of it before it gets cancelled.

on another note, at the risk of completely embarrassing my whole family, i have to share how i got swindled out of $10. interestingly, at times i don't think through things completely and in certain vulnerable moments i tend to throw away money (fortunately not a frequent occurrence). well, somehow i got to a link to check my i.q. online in less than 10 minutes. since i'm korean and bred to compare myself to other people, i thought i'd check it out. i must have really been bored or delirious. the test is like 10 questions and actually multiple choice but truly easy multiple choice questions so i automatically thought this was a gimmick. after finishing, it tells you to text a code to a number and it will text back your i.q. by this point i've already invested 2 minutes out of my day to do this so i'm not going halfway at this point. i text the code and i get back a text saying my i.q. is 10. not 110 but 10. now i'm thinking what a waste of time that was (imagine that, wasting time on the internet) but oh well, no harm no foul, right? next thing i know, i'm getting a text like 2 or 3 times a week with a word of the day. i don't have unlimited texting on my phone so i'm getting annoyed at these texts so somehow i get back to the website after a search. of course when i initially texted the code i didn't see that i was signing up for this service that costs $9.99 a month and i get a word of the day texted to me. the ironic thing is that the page talks about the greek origin of the word intelligence and how words of the day can make you smart, etc. yet you have to be a complete moron to actually sign up for this dumb service and probably even worse not to realize that you're signing up for the service by texting something to them. you live and you learn.

Thursday, June 12, 2008

pacis, pacis everywhere

so we have this new trick where we put a couple of pacis in the crib when kiddo goes to sleep. until she actually falls asleep, she'll stand, roll around, sit, stare at the wall, do whatever kids do in cribs and frequently the paci will end up on the floor or stuck behind the crib against the wall. then, of course, she'll cry and we'll have to go in there to plug her back up. this trick, however, increases the likelihood that she will find another one on her own without us having to go back in. well, needless to say, the pacis start piling up in and around the crib. when she woke one morning i couldn't help but take this pic. can you guess how many pacis are in this picture??? (you may need to click on the pic to get a larger view.) answer below.




the answer is 3. one in her mouth, one in her right hand, one on the floor.

Sunday, June 01, 2008

surf, sun, walking and contests

we just got back from surfside beach (just south of myrtle) yesterday after a trip with karen's side of the fam. of course she has all the pics and pertinent details so check out her blog. my memories are of getting sick deep sea fishing and getting sunburned. karen has some great pics of that. i swear i did use lotion but either not enough or stayed out too long. it has been a while since i actually "laid out" so i guess i forgot how quickly one can burn or just forgot how long i was out which, incidentally, is pretty easy to do when you fall asleep. i'm a nice shade of red, particularly in some odd places--left lower back, front chest and stomach, top of the feet, right bicep/shoulder, both knees. somehow the lotion karen put on the top of my back withstood the water and time but the rest of me got burned (or is it burnt?).

now, about the hurling. being the adventurous kind of guy that i am, i would like to believe the main cause was a few too many adult beverages the night before since i've never gotten sick on the high seas or in any outing involving lots of motion. plus, i actually did fine on the hour ride out which was in very choppy waters and didn't get queasy until we started fishing. let's just say i had a lot of company by the time the trip was over. there was even this poor girl, about 10 or so with a dad who probably wished he had boys (he was with 2 girls). well, she wasn't feeling good and he is really getting on to her (maybe giving her a pep talk?) saying "well, what do you want me to do, tell the guy to turn the boat around? do you know how long it's going to take to get back? you're just going to have to tough it out." now hit the showers, i thought. i'm sure the girl felt much better after the talk.

regarding the vomitus (as we say in the medical world), it's funny because i was getting a little paranoid when i noticed some red stuff on the second expulsion. as a free medical tip, it's usually not good to see blood while throwing up. i thought i was bleeding but then remembered it was probably the flaming hot fries discoloring things. i love those flaming hot products as an aside--fries, fritos, cheetos. yum.

i was reminded today about some of the odd competitions i have entered in my life. in case you didn't know, i used to be a very competitive person; still am but not as much although my wife might disagree. i like and play many sports--tennis, basketball (probably favorite to actually play), baseball, softball, football, golf, karate. didn't play much soccer as an adult but did love spending hours with the ol' hackey sack. remember those?

anyway, i told karen i was going to use a coupon we just got for some new basketball shoes because the current ones i have are probably 10+ years old and a bit worn. how did i get them? back in the days when my parents had a dry cleaning business, a new shoe store opened up nearby so i checked it out. it turns out the atlanta hawks dance team was there and they were having a contest to see who could do the most number of crunches against the team. the winner got a new pair of shoes. heck, that was all i needed to hear to get me in. well, after probably 30 minutes, the team had all dropped out (probably more out of getting bored and wanting us to hurry and finish than actually getting tired) but this other guy and i were still left. eventually they just made us stop and declared us both winners. i think we stopped at 1200. granted, our technique wasn't the best but we were both winners and got some shoes! must be the shoes. i even got a poster of the team signed by the team. i remember one wrote "to the ab-master." ha! i actually kept it for a while but it got thrown out way before we got married. that's right.

reminds me of another contest, a jalapeno eating contest at a mexican restaurant for cinco de mayo when i was in college. if you ate only 5 jalapenos in 5 minutes you got a free t-shirt so i figured, hey, free t-shirt. i figured 5 was within reach. my friend actually bet with this guy next to him (they were behind us watching) that i would beat his friend who incidentally was next to me. well, what my friend didn't know was that that guy won the contest the previous year with 29 jalapenos! anyway, that guy was off to a flying start and it took me some time to get through the first few, not only because of the obvious hotness (i love hot food by the way) and taste but it was also the first thing i ate all day and it was already dinner time. plus, you had to eat the whole thing except for the stems. after the first few got down, i started getting in my zone and by the last minute, i was putting those suckers down while the other guy was slowing down big time. i probably ate 8 or 10 in the last minute and wouldn't you know it, ended up eating 29. unfortunately, i guess i pushed that guy enough and he ended up eating 35 or so and won some sort of restaurant tab. one more minute and no doubt i would have overtaken him. oh well. but hey, i got the free t-shirt.

you may have been wondering, did you have any "after-effects" from the contest? interestingly enough, the day after the contest, i had no adverse gastrointestinal sequelae. it's almost as if my body was in such shock that it shut down any pain fibers and it was smooth sailing in the bathroom.

other things i used to or still compete in: video games (favs of all time--donkey kong, centipede, ms. pacman--fast version), other various eating contests (won a free jacket from subway once for eating a sub with no hands, second place), team trivia at restaurant/bars around town, first place in a junior high dance contest with my breakdancing partner in 7th grade, various solo and family singing competitions and many others to be named.

as for the walking, baby kate is starting to take some steps! karen's uploading some videos so stay tuned. she started standing stationary for a few seconds last week and today was able to take a few steps but she has to be really motivated, like going after the keyboard or remote.

lastly, as an afterword on the name thing, the greatest name blunder i have experienced was probably at my wedding. yes, at my wedding by a pastor who actually did know me. maybe it was nerves, maybe something else but for some reason he called me "hannah" the first two times he said my name. the first time i'm like, "hmm, did he ... " and then the second time, "oh yeah, he did." if you've ever seen my wife try to get kids' attention when taking pictures by making weird noises, then you can picture the noises she was making to get the pastor's attention when we got close to him. she was making all these noises and then whispering loudly but discreetly "tanna, it's tanna!" then he says "i know" and that was that. ha ha. still funny after all these years.

Friday, May 23, 2008

more names and such

oh yeah, i also get tanya sometimes.

another thing i didn't mention but i guess in part due to my name, people frequently confuse me with a woman on the phone. i just got off the phone with the computer (or "computor" as one of the signs in our building says) help desk to reset my password and he kept calling me ma'am. now i know my voice can sound a little high at times but come on. i've been a little self-c0nscious about that in the past because growing up, i never really hit puberty like a brick wall like most mens. my voice very slowly seemed to get a little lower over some time. it was kinda weird because i wasn't sure if the process ever finished. heck, maybe my voice is still getting a little lower. second phase puberty. i'll look it up in the medical books.

Saturday, May 10, 2008

in your face

apparently there is some trash-talking going on in the blogosphere about the delinquency of my posts. bets were on that i wouldn't blog today but in the words of ub40, here i am baby! as you may know, my dear wife (dw?) is on the cusp of hitting the bigtop in the blog world. her site has appeared on celebrity baby blog and she even has readers that we have never actually met. i think karen might be the only one actually still reading this. anyway, she's also a bit obsessed about the visitor tracker for her site. every once in a while i'll get a "someone from brazil (or enter country of the day) visited my site today." of course, her fairly frequent posts keep readers coming. since i'm not posting everyday, i think that has hurt the readership (if that's a word). most have also migrated over to her site since she has all the pics and her "celebrity saturday" column. that's what i need, a gimmick to boost the numbers. always giving the readers something new, that's how you keep 'em coming. new coke, diet coke, coke zero, same idea. i don't mind dw and dd getting the limelight though because i'm counting on her or kate hitting it big with some modeling deal to be our ticket to stardom.

karen has a recent post about us going to barnes & noble (it took me some time to get out of the habit of saying "barnes & nobles") for the jenna bush book signing. what she didn't mention was that after she got in and went to the cashier to buy the book, i had to get kate out of her stroller and hold her up while the secret service swept her with the security wand. the one time i wanted karen around to get a pic but she was already gone! it was a hilarious site. i know she can have some potent poopies but i guess not enough to make the wand beep. and i'm talking about kate, not karen.

well, karen has still left me the task of notifying people of new videos. we were at a friend's b-day party recently and kate had her first experience with a balloon and boy did she love it. take a look yourself here.

well, gotta go heat up some food for karen.

Thursday, May 01, 2008

habla ingles?

karen's been getting on to me for being so delinquent with my blog. of course her blog is taking off now with people all over the world and web-famous people viewing it. if you're looking for pictures of kate, most of them will be probably be on her blog since they're on her computer and not mine. i will include an occasional pic, especially if it's a funny one that karen doesn't find as funny and won't put on her site like the one of kate with formula all over her face.

i guess i never mentioned that we bought an imac, my first venture into the world of apple. to this point we still had the gigantic monitor i bought six years ago with so many cords and things running from it to the hard drive. now we have a pretty elegant looking machine, monitor and hard drive all in one flat screen. steve jobs oughtta give me some money for this promo but it did free up a lot of space.

so as karen mentioned on a recent post, i was in las vegas recently, coincidentally for a friend's bachelor party and also my brother's surprise 40th b-day celebration. quick story about my brother, he's not exactly the most talkative person at times unless you get a few in him. he recently told a funny story recently about how a lady in his neighborhood was talking to him or something and in his annoyed sort of look he just kept staring at her without saying anything which inevitably brought up the age ol' question from her "do you speak english?" he was so taken aback that all he could blurt out was a convincing "yeah." of course later he thought of many other clever things to say but the moment was lost. well, like brother like brother. on the flight back home from vegas i was in an exit row so the flight attendant was asking a few questions, do we feel comfortable opening the door, etc. and we were all nodding our heads. then she asked something like "do you know you're on an exit aisle and we wanted to make sure you didn't have any more questions?" basically whatever she asked, the first part of the question was meant to be answered yes but the way she phrased the second half, the answer "no" or a shaking of the head would have been the proper answer. kinda like when people ask "do you mind if ... " and most people say yes, meaning yes go ahead but really the answer is no, as in no i don't mind. well, when she finished, i was shaking my head as in "no, i don't have any more questions" but then she looked at me and asked, "do you speak english?" i had flashbacks of my brother yet as fate would have it, all i could get out was "yes." then she tried to cover it up by saying "you know, a lot of people who don't understand just nod their heads to all the questions." not surprisingly, i did think of many other clever things to say like "que?" or go off on some other spanish phrase but sometimes the ol' reaction time isn't fast enough. the more i thought about it the more i felt that was such an ignorant thing to say. of course if i was white she would not have said that although there are plenty of white tourists who don't speak english and plenty of asian americans who do. what can you do.

on another note, i forgot to mention in a previous post about all the girl names in addition to the boy names i've been called when people are trying to get my name straight--tina, tammy, dana. i was actually in an elevator at work recently and a lady was in there with her daughter and the mom kept looking at my name tag and asked what my first name was and i said "tanna." the lady was so excited because her daughter spelled her name the same way except she pronounced it t-on-na. ha ha ha.

Saturday, April 12, 2008

video

not sure how long the link will work but you have to see this video. to give a little background, there's been some controversy with this mayor in a nearby suburb. she apparently has also claimed the police roughed her up. my favorite quote: "and they just basically took me to the ground, tussling my arms are bruised, uh, my neck, i have a lump here, um, my knee, uh ... was hurt." ha ha! it's like she had to think about what got injured.

ALMOST as funny as the miss teen south carolina quote during the competition about maps and iraq: "and i believe that our education like such as south africa and the iraq, everywhere like such as ... " ha ha ha!

Sunday, April 06, 2008

what's in a name?

okay, karen's been bugging me to write about my name--how i got it, what it means, etc. well, first of all, my birth name is dae hyun, which means something to the effect of "wise" and "strong" in korean. i think the names are actually of chinese origin, which is a common style of naming but i can't exactly remember which name correlates with which word. anyway, if you say my name in korean (e.g., when my parents would call out to me when i was a kid running amuck in the neighborhood), it sounds a little like tanna. if you say "dae-hyun-na" quickly over and over, you can see how it might get to tanna. the "na" is just an added syllable to the name. so, the neighborhood kids started calling me tanna and now so does karen and everyone else. i actually have "dae hyun aka tanna" on my citizenship certificate. yes, that's the same one where i'm wearing a bugs bunny t-shirt in the picture. i'd like to say i was like 3 years old but i think i was a little older than that.

little did i realize later in life around junior high that tanna was a girl's name. the first similarly spelled name i ran across was actually on an episode of "the price is right" and there was a lady contestant named "tana." heck, it could have actually been spelled the exact same way but all i remember was that it was a lady. she actually made it onto the stage. then i met a lady at our church who was a visiting friend or speaker or something who, you guessed it, carried both x chromosomes. as if that wasn't bad enough, there was even a newscaster here on channel 5 in atlanta not too long ago whose name was tana. she pronounced it tahn-a (like don-a), not tanna like manna. you know, it's okay if there's a tanna running loose here and there but when it's a tv personality, then everybody realizes tanna's a girl's name, not just those select acquaintances. not like they needed a tv personality to figure that out; tanna doesn't exactly sound like a man's name to begin with i guess.

because of the unusual nature of the name, no one could ever tell what i was saying when i introduced myself, particularly in loud settings (e.g., bars and clubs, you know, in college mostly ... in college when i was over 21 that is). i got people calling me tom, tim, tanner, tan, you name it. funny thing is, the guy who sat behind me during junior high and part of high school even pronounced my name wrong all those years. he would pronounce it tahn-a. i found that so odd. here's a toast to you, robert love, wherever you are.

speaking of love, our love-child is getting into all sorts of things these days. she's gotten pretty adept at pulling herself up to a standing position. she can't quite figure out the "cruising" thing yet so once she's up she stays put in one position until she falls down and then goes to a new location. frequently there's a head-bonking episode somewhere in there, usually on the way down while falling so we have to wait for the 10 second breathless pause while she builds up her steam and facial redness until she lets out her wail. i keep telling karen the kid will learn one day but it doesn't seem like she has so far. you know kids, they're so young and naive. concepts like gravity and mass are still foreign to them. she'll be at least 2 before i teach her about gravitational force so i guess i should expect more bonking episodes.

i'm also trying to get kate to feed herself. it's hard to work the remote and feed her at the same time unless she's helping. she can feed a few wheat puff type stuff to herself but she's still getting the hang of it--just look at our floor. she tries to shove her whole hand in or put her palm in first and half the time the puff thingie just falls on the floor. she's getting decent at holding her bottle by herself at times. however, if you leave it to her, usually she'll drink for just a few seconds and then she'll stop and look at the bottle and play with it.

the standing thing has become somewhat of a problem for naptime as well. frequently it takes her some time to get to sleep. she'll just stand on the crib with her hands on top of the rail and sometimes gnaw on it with her 2 lower and budding 2 upper teeth. i expect her one day to have a tin cup to run across the rails like she's in prison or something. we have a few pics of her standing in her crib during what is supposed to be nap/bedtime but they're on the main computer and i'm on my laptop right now so the pics will come later. sorry!

speaking of which, in case you didn't know, karen is back on the blog saddle. she is much better about updating her blog and i'd like to think it's because the pics are on the desktop where she mostly works and not because she's on the internet all the time. ha! i have a link to her blog on the right.

in other big news, i ordered an imac last week. it should be coming in the next couple of days. yes, the lim family has made a big change. don't get me wrong, i will be running the parallel software so i can have windows up at the same time but otherwise, this is definitely a big step for me. the current desktop is 6 years old, ancient in computer years. it has a whopping 40 gb hard drive memory and the new imac will have 500! yes, halfway to a terabyte. way too much info for this blog i guess. it will be nice to have a computer that isn't so slow like the current one.

in other news, karen posted some pics from a recent visit by my bro and fam. there are a few videos we shot while they were there. here's one with kylie and eric singing "jesus loves me."

here's another hilarious video of the two talking about my brother and his hair obsession. yes, my friends, it actually takes my brother more time to settle his hair in the morning than most women. he also used to get very upset when we would try to mess with it growing up. the video gives the kids' perspective on things.

lastly, thanks to kate for the last post on doctor's day. it commemorates the first documented use of anesthesia (ether at the time) in surgery by georgia's own crawford long, back in the late 1800's. he was actually an obstetrician. anyway, it caused a little bit of controversy because he never published the event in a medical journal so others took credit but that's another story. that's it for now, hopefully some pics next time.

Monday, March 31, 2008

Guest Post from Baby Kate

Hi, Ah-pah! Happy (day after) Doctors' Day! I love you, and I can't wait to see you when you get home today! Love, Kate (with a little help from Mommy)

Here are a few photos Mommy took of me in my "Future Doctor" outfit from Aunt Robin. Sorry it's not an official "Doctors' Day" bib, but don't I look cute?


Here I am just out of surgery.


Checking some x-rays for a patient

You're my most favoritist doctor ever!

Thursday, March 27, 2008

march madness

yes folks, it's march madness around the lim household. i'm watching basketball these days, mom and kid have their own madness going on with malls and shopping and such. as you can see below, there's been some st. patrick's day madness going on as well. i think karen has a "baby's first ... " bib for all occasions. there might even be a "baby's first arbor day" bib laying around somewhere. incidentally, doctor's day is in 3 days (although observed at our hospital today). i wonder if she has a "baby's first doctor's day" bib and if not why not.



kate's been getting into all sorts of things these days. if she could, she'd like to get into her little aquarium toy. she keeps trying to get her head into it but it just won't fit.



one thing i haven't gotten a good picture of is her teeth. yes, her lower ones popped up a few weeks ago and now a couple of the top ones are coming in. as you can imagine, it's a little hard to keep her still enough for a picture of her teeth. the kid does not like having her face messed with. she still doesn't like it when we mess with her nose trying to get the ol' boogs out. she can bite hard, too. as a warning, do not stick your finger in her mouth without expecting some damage.

the babe's pincer grasp as improved. at first she would play with puffs but now she'll eat them up if they're around. i don't know about karen, but i also sort of make her feed herself at times by holding the bottle up herself. tough love as i see it. i need to get a good video of that. the coordination isn't completely there. sometimes she'll almost poke herself in the eye with the bottle.


"i think i will eat this puff"

here's kate hanging out with some friends.


"i'm outta here guys; call me when you're ready to roll ... and i do mean that literally. i love rolling around."

the easter bunny hit town recently as well ... or is this an imposter???



oh yeah, i guess that was preceded by palm sunday. kate's first palm branch. i think she tried to eat it. pretty much anything around will go in her mouth.



by the way, karen's obsessed with smart cars. they're all over europe but there were some issues getting them to the u.s. but i think mercedes has started importing them. here is a recent sighting.



in other news, my dad went out and bought a sax and keyboard. here's "david g" grooving. he's too old for a midlife crisis so i guess it's like an old man crisis?



we went to a park recently and kate loved crawling around the grass and putting things in her mouth. karen would keep taking them out but hey, it's nature, grass is good for you. isn't it? anyway, the kid can crawl like a champ. for some reason she loves crawling into the bathroom. she also still loves crawling to cords and putting them into her mouth. the way she's drooling, probably not the safest thing in the world. oh well, "she'll learn" as i say. ha!





here are some of those easter pics. again, they had live animals there. kate's obviously more interested in other things than getting pictures taken.







karen had some sort of picture session set up here. if you have all three of these pics set up and bring them up quickly it looks like she's busting through the animal barrier. you better watch out, nothing will stop this kid.







i'm not exactly sure what's going on with the camera angle here but when kate falls asleep in the car seat these days, she's out big time. such an intense look in her sleep face.



she also has a new toy, straws. this will definitely keep her occupied for a while when at restaurants.


"how does this thing work?"

karen has the kid dressed in all sorts of outfits these days. here's a happy giraffe.


"see ya next time!"

Monday, March 10, 2008

it's over

yes, the little one is crawling! watch out world. we're gonna have to lock down everything now. she loves pulling on cords and she can track down that froggy pacifier like a missile. in case you didn't believe me, i actually have a video of it here. we should have the froggy paci on bin laden and then we would finally catch him. karen left a couple of weekends ago for tennessee and before she left she was almost starting to crawl (as shown in an earlier video) but when she came back a few days later she was scootin' around like crazy.

here's a pic in her borrowed duckie tub and an action shot with the water splashing. she still loves the baths.



we've also been to the zoo a couple of times. karen signed up for a family membership which i think is a great idea. we can go anytime all year for pretty cheap and we have discounts for friends/family too so if you're in town and want to go, let us know!



i was scanning the photos and i found this one deep in one of the folders. i think karen was trying to hide it from me. really, at what point do you call the authorities for child neglect? ha! just kidding honey, love ya!



i couldn't resist this one below either. getting the cousins together has never been funner! actually, riley is smiling pretty well but the rest of the gals just aren't interested.



this was also from the tenn trip. it looks like an early trying-to-crawl pic. this could be a poster for a "do not drink and crawl" campaign.




"he guys, i'm hittin' the art gallery later. come with?"

we were in savannah recently for a medical meeting. as soon as we get in the hotel room karen puts the kid on the bed for a photo op. karen notified me that it was her first hotel stay as well.


"ahh, nice fresh linens and so soft!"


kate's first boat ride. she ain't afraid.

okay, i'm gonna get yelled at for this next one but it'll be worth it. i had to put it in. here's mommy and baby not quite awake yet. look how karen's arm is up by her head and kate has her hand on her head. like mommy like baby.



here we are y'all at paula deen's restaurant. i ate the buffet on consecutive days for lunch. actually, including the buffet earlier in the week at a mongolian bbq, i had 3 buffets last week. almost like the med school days.


"i'm ready to chow down on some gourmet formula y'all!"

yes, babe is now eight months. not much of an update since the seven month point i guess. here's what kate really thinks about being 8.


"man i'm getting old. i guess i'll just eat this paper."

this next pic looks like kate is auditioning for cult follower of the year ... cutest cult follower of the year i have to say.


"whatever you say i will do master."


look at that smile. she still loves grabbing her feet, too.


just hanging out. "hmmm, what should i do now?"


easter's right around the corner in case you couldn't tell!

Monday, March 03, 2008

quick update

just wanted to upload a video. i have a whole bunch of pictures to upload, even from the last post but that will have to wait. karen and kate are actually in tennessee for abigail's b-day. it's weird how boring/mundane it gets when they're not around. on the one hand i'm like "oh yeah, i get to do stuff on my own, play b-ball, go out, party, etc." but after the first night i'm so lonely. poor me. anyway, i caught a nice vid of kate when karen was out one day. it shows kate trying to crawl, in her infant (pun intended) stages, but it includes many nice features such as her flailing her arm and leg around, slapping her feet against the floor, talking, pulling on her sock, etc. the girl will actually stand on all fours trying to figure out what to do but then her knees will drop but she can't figure out what to do with them then she'll either cry or just roll on her back. so funny. anyway, here's the link to the video.