Today, is just, a great day.
It is a beautiful, uncharacteristically snow-free, somewhat Spring-y March day outside, I’ve officially got one less week before I’m done, I get to spend (another!) entire weekend off with one of my most dearly beloved best of buds, plus, I learned SO much this week!
My excitement about all this learning of Useful Stuff (with all due sincerity) cannot be overstated.
Other Student on Rotation: “Um, yeah, I’ve never seen someone get this excited about RPhWorld. I applaud your, uh, enthusiasm.”
Me [madly, gleefully clicking links]: “Are you kidding me? This is so….I mean it’s just….so…..awesome!”
~ One of many, new-found knowledge Moments Of Joy courtesy of this week.
Sure, I have been tired out, adjusting to spending so much time just reading and studying after months of purely clinical experiences, but it has been so worth it. I have been tearing through ACOG Practice Bulletins and Cecil Textbook of Medicine and learning ridiculous amounts of clinically useful information.
For instance, did you know:
* That Primary Hyperparathyroidism is the most common cause of hypercalcemia and Glucocorticoids are an extremely effective treatment for hypercalcemia but only in conditions where hypervitaminosis D is the underlying cause?? Or that hypercalcemia can lead to depositions of calcium in soft tissues (including the cornea!) especially when there is concurrent hyperphosphatemia??
* Or that albuterol (in higher than usual doses) is a treatment for hyperkalemia? And calcium gluconate used to treat hyperkalemia is actually used to counteract effects of high levels of potassium on the myocardium??
* That standard of care is to discontinue antenatal chronic B/P medications within two days of finding out a patient is pregnant, then you should offer an alternative medication (usually methyldopa), then you need to discontinue methyldopa within two days of birth and resume the antenatal medication?? Unless its an ARB, ACE Inhibitor, diuretic, or amlodipine, which are all contraindicated with breastfeeding??
* That 70-85% of pregnant women have nausea and vomiting, and 35% of those women have clinically significant nausea and vomiting (leading to significant psychosocial morbidity), and one study found hyperemesis gravidarum is undertreated and has lead patients to terminate pregnancies??* That Vitamin B6 and doxylamine (Unisom) are first line treatments for nausea and vomiting in pregnancy, and that preconception supplementation with a multivitamin can potentially help patients avoid or diminish nausea and vomiting in pregnancy?? Not to mention, that if not treated with Vitamin B1 (Thiamine), pregnant women who have had significant nausea and vomiting for > 3 weeks are at risk for Wernicke’s encephalopathy with lasting neurological sequelae?? (I mean, what??)
* Don’t even get me started on everything I just learned about OB analgesia and anesthesia. Seriously.
Oh! And, in addition to the usual clinical resource suspects (i.e. UptoDate), I have been discovering and plundering new, amazing, and (very importantly!) reliable provider and patient** resources. Such as:
RPhWorld.com – Ridiculous amounts of pharmacologic knowledge. And calculators. I had no idea so many helpful med/clinical calculators existed in the world (For the Maths impaired individual, this has to be on par with finding oil in your backyard. RPhWorld where have you been all of my medical life?) AND it is FREE. No. Joke.
ACOG.org – Chock-full of everything you ever wanted to know about OB/GYN and more. For providers and patients. (Note: Plus, as a student you can apply for membership for FREE. Pssst – ACOG membership looks really good on a CV if you are going into OB/GYN!)
Epocrates Online – This is a standard resource for clinicians, particularly in the form of smart phone apps, but I also discovered providers and patients can register online (again, for FREE) to access not only tons of information about medications, but also about common disease conditions. (Note for students: If you click on a disease and see the resources listed below, you can often click on a citation for a full text article – Bonus!)
Medscape – Another standard resource, but note it is also for providers and patients. Plus it is another (reliable) source of the latest news in medicine, full-text articles, and again, you can use it for FREE if you register.
This is just a taste of the clinically relevant bounty I’ve encountered this week. I could keep going (like, indefinitely), but it’s time to pack for a weekend of extreme fun (in which I continue suppression of all obsession related to The Impending Match. With loads of BFF QT. Yay!).
Such, a great day. I daresay if L&D picks up next week and I actually get in on a delivery or section in the midst of another week’s learn-a-thon, life, will be all Mary Poppins and sh*t.***
*According to ACOG and an NEJM article.
**Personally, I have been encountering quite a few patients lately who are getting medical information from TV commercials (“I’m not taking [Insert Medication Here]!! Have you heard all the side effects of that [Insert Medication Here] on the commercial??! Hell, my [Insert Body Part here, usually, Pecker] could fall off!!” Usually, I have seen the commercials, and can’t say I blame them.), Woman’s Weekly, or Dr. Google. I am all about providing patients with quality educational materials, and I think it is totally awesome when patients take the initiative to research medical conditions and treatments, so I love having actually accurate, and reliable, sources to refer them to.
***Practically Perfect In Every Way