DISCLAIMER: THIS POST IS NOT FOR THE SQUEAMISH AS IT CONTAINS MANY MANY USES OF THE WORD, POOP. THANK YOU.

Ah into the wonderful world of pediatrics, where a sense of smell can definitely hamper your ability to effectively practice medicine.

My first patient was a 10yr old male with a 7 year history of ADHD, and fecal incontinence with soiling (pooping his pants unexpectedly) He had been a normal vaginal birth, met all appropriate developmental milestones, including toilet training, when suddenly about age 3, the mother noticed he would simply have uncontrollable bowel movements and soil himself. SThis happened every day, with approximately 2 of his 4 bowel movements per day, where the pt would feel the urge to go, and then defecate before having enough time to make it to a restroom. Stools had no blood, and were normal in color and consistency. She then took him to several doctors, all who told her he was doing it for attention until she finally reached our hospital where we decided to take a closer look.

On physical exam, the pt was an active cooperative male child. Vitals were within normal limits and physical exam was uneventful except for a hard mass in the right lower quadrant and suprapubically

Our working diagnosis is encopresis with fecal impaction and constipation.

So you may be wondering how one can be constipated for 7 years, and soiling their shorts at the same time. Or maybe you just dont know what encopresis is...

Basically, at some point in his development (probably a little before age 3) poop started to build up in his colon, as in he was not dropping all the kids off at the pool, but leaving a few in the van. Now the colon serves to remove water and bicarb from your digested food, leaving behind a mostly solid mass of unusable nutrients (aka poop). As the years went buy, the undefecated poop continued to back up and have even more water removed from it basically turning it from a log into a tree. Or more specifically, that mass felt in the abdomen was solid poop backed up all the way into his gut. This was confirmed by x-ray

This kid was quite literally, full of shit

So the plan? First, laxatives and enemas. Not because either of these will clean out seven years worth of congealed poo by itself, but it will soften the stool up and clear out some loose pieces as he is prepared for ...DISIMPACTION.

Ah yes, disimpaction, where the pt is sedated with ketamine (pain control) and midazolam (relaxation and slight amneistic effects) as some lucky resident or medical student gets to reach a couple fingers into the rectum and scoop out the fecal matter bit by bit, with another hand on the stomach to move that log down as it is continuously dug out.

Sadly, (and i really mean this) I could not stay to observe or assist, as i had to go to a lecture

but the most disturbing part of this whole case?

How in the world is a 3 year old diagnosed with ADHD?

I am back to feeling better, not least because i only have 6 working days left of obgyn before i am free!

Basically, my opinion on gyne can be summed up thusly:

no offense to my female friends, but girls are gross. there, i said it.

Another call down, meaning I am finally done with calls. I have 4 weeks remaining of ob/gyne, and my 2 weeks of OB begin tomorrow. Last night was a fairly slow call, and I only delivered one baby, with nothing happening that i havent already described pretty well in previous posts.

Ooh, except for the fact that the father passed out. The baby's head cleared the vagina, and all you see is the mother with her legs spread wide and a tiny little wrinkeled pug face emerging from the center of said legs, like the groundhog peeking out of his burrow. It was too much for the baby daddy, and while I caught the baby, the other med student had to catch the father.

I have never in my life found something gross enough to make me pass out, and I have been an avid consumer of the internet for years now, from 2girls1cup to lemonparty.org, all the way back to the early days of goatse. Guess I am desensitized. go fig.

Anyway, basically, my duties for the next two weeks will include waking up, and staring intently at vaginas for 12 hours a day. So pretty much like normal, except there is no computer screen in between

so true
and how have i been reacting to being sleep deprived for almost 4 days straight now?

is it bad how often i describe my life with webcomics?

CopyPasta'd from intueri, another medblog i recently discovered while wasting time on the interwebz

Questions.

Questions That Patients Never Ask:

• Where did you go to college?
• What did you study in college?
• What were your MCAT scores?
• Did you graduate from college with honors?
• Where did you go to medical school?
• Were you in AOA (the honor society in medicine)?
• Did you match at your first choice for residency?

Questions That (Some) Patients Ask:

• Where are you going for vacation?
• What did you do for Valentine’s Day?
• How many other patients have you treated with X condition?
• What’s your first name?
• How much money do you make?
• How old are you?
• Are you old enough to be a doctor?
• Do you like your job?
• How do you do this day after day, year after year?
• Where’d you get those pants?

Questions That (Some) Attendings Ask:

• Where did you go to college?
• What did you study in college?
• What were your MCAT scores?
• Did you graduate from college with honors?
• Where did you go to medical school?
• Were you in AOA (the honor society in medicine)?
• Did you match at your first choice for residency?

Questions That (Some) Nurses Ask:

• Are you single?
• Do you have a boyfriend?
• When are you going to get a boyfriend?
• Have you gone on any dates recently?
• When are you graduating?
• Are you going to work here after you graduate?
• Why not?

Questions That Medical Students Ask:

• Where did you go to medical school?
• How did you choose to go into X specialty?
• Why did you choose to come to this residency program?
• What books should I get for this rotation?
• Is there anything else I can help you with (… so you can let me go home…)?

Questions That Hospital Operators Rarely Ask:

• Before I page this physician for you, can you tell me who you are?
• How do you spell that last name?

Questions That Residents Always Ask:

• Where are the bathrooms?
• Where is the cafeteria?
• Where is the call room?
• How do I get into the call room?

Hahaha oh this has SO been me.

On call again tomorrow (3 of 4-almost done!!!)
Lunar Eclipse Tonight, Bon Jovi Concert on Tuesday. Ohhhh I'm halfway there!

haha so so true

little known fact: I do actually refer to my shoulders when making moral decisions, though i do not see anything there