Caring Intensely

Pediatric NP. Trying to live justly, love mercy, walk humbly, and keep my mouth shut.

[webofgoodnews]

San Diego Hospital Reveals Birth of World’s Tiniest Baby

When she was born, the baby girl weighed about the same as an apple.

A San Diego hospital on Wednesday revealed the birth of the girl and said she is believed to be the world’s tiniest surviving micro-preemie, who weighed just 8.6 ounces (245 grams) when she was born in December.

The girl was born 23 weeks and three days into her mother’s 40-week pregnancy. Doctors told her father after the birth that he would have about an hour with his daughter before she died.

“But that hour turned into two hours, which turned into a day, which turned into a week,” the mother said in a video released by Sharp Mary Birch Hospital for Women & Newborns.

More than five months have passed, and she has gone home as a healthy infant, weighing 5 pounds (2 kilograms).

Read more

[caringintensely]

❤️ Go girl ❤️

[caringintensely]

Things I heard today in cadaver lab

“Whatever it is, there’s two of them.”

“This guy is juicy AF.”

Older instructor: “What’s AF?”

😳 “Uhhhhhh...something....fluid....”

“Now squeeze the clots out of the vessels like you’re birthing little clot babies.” 👶🏼

“Did you see the thyroid on this one?”

“I found the thoracic duct but I lost it.”

“You lost it?”

“I think it’s in this pile of....stuff.....over here now.”

“I’m never eating pulled pork again.”

[hangrypa]

unexpected eye exam finding

60y/o man presents for adult well-visit. Me: All right, cover your right eye for me. Can you read the bottom row of letters? Patient: [reads them perfectly] Me: Awesome! Now cover the other eye, and let’s do the same thing. Patient: [covers other eye] I can’t see anything. Me: How about the top row? Patient: Nope. Me: Even the big E? Patient: What E?

Me: [worried but hiding it] All right. Let’s try something else then. [holds up index finger] Cover your right eye and follow my finger with your left eye. Patient: [follows instructions perfectly] Me: Excellent. Now let’s try the other one. Patient: [right eye does not move]

Me: [worrying even more but still trying to hide it] Okay. [picks up ophthalmoscope] I’m going to check your left eye first, okay? Patient: Okay. Me: [performs fundoscopic exam on left eye] All right. Everything looks good here! Let’s try the other one. Patient: Okay. Me: [attempts fundoscopic exam, but light bounces back at me] 

Me: I- [working hard to conceal panic] Your right eye is interesting. Patient: Yeah, it’s a glass eye. Me: …what? Patient: [clearly trying not to laugh] It’s a glass eye. Me: Were you planning on telling me at some point? Patient: [bursts into fit of giggles] I wanted to see you freak out first!

[mdrambles]

The most peds conversation ever

A NICU nurse and a NICU fellow are standing next to me while I scribble out some orders. The nurse compliments me on my small toy on my ID badge, so I compliment her collection of stickers on hers.

She launches into a story of how she obtained each one. The first is from a family whose baby had to be on continuous EEG, so they decorated the bandages around his head with tons of stickers so it’d be cute, and after she took care of him for a few days they wanted her to have one so she’d match their son’s decals. The second was from the older siblings of another patient that spent months in our unit, and the little guy’s sisters wanted to make sure his nurse remembered him fondly with a few of their precious stickers. Another was from a family whose parents didn’t have much money but they always wanted to make sure their baby knew they cared, so they’d bring stickers to decorate his room, which meant that his nurse had to be similarly decked out.

The NICU fellow then jumped in and showed off her sticker, brought in by a “NICU graduate”; a toddler that she had spent months looking after as they hoped the tiny preemie’s lungs would work on their own, and was now a happy, healthy 18-month-old that returned to say hi and spread some joy to the people who handled her so carefully.

…Of course I had to show of my sticker from my heme-onc patient, who wanted to share one of her prized stickers with me when I had laryngitis so I would feel better, despite her battling a new round of chemo.

[caringintensely]

Stickers show love. ❤️

[notreewaits-deactivated20200806]

Toddlers are so pure. She doesn’t understand that we help her with certain things because she’s little. She thinks that everyone just helps each other like that. So she tries to blow on my food and cut it up for me and tries to help me put on my shoes.

[pussysoupforthesoul-deactivated]

i was giving little wagon rides to a baby around the backyard one day and all of a sudden she hops off and slaps the seat of the wagon telling me to get on because it was my turn and i was like no it’s ok im too heavy and she was like NO ITS UR TURN and kept tugging on my hand so i would sit down. eventually i got on and it was just a little 2 year old trying so hard to push me around on a wagon not understanding why it wouldn’t budge but still so determined to let me have my turn lol

[llywela13]

I don’t think I’d realised how many casual compliments we pay to our toddler until she started casually complimenting us back, because experience has taught her that’s How Social Interaction Is Done, and there’s nothing quite like a very earnest three-year-old solemnly and sincerely informing you that you look wonderful and smell nice to make you feel really good about yourself

I tell her she’s my best girl. She tells me I’m her best auntie. Then we both feel good about the world!

[neurodiversitysci]

That’s precious!

[caringintensely]

Classmate: “Hey, they just posted the text we need for Gross Anatomy next semester. It’s called ‘Netter’s Clinical Anatomy.’”

Me: “Oh cool, I already own that book.”

C: “......why?”

Me: “I asked for it for Christmas last year.”

C: “.........why?”

Me: “It.......looked cool.”

C:

[caringintensely]

Me when the sticker order arrives at the Peds office

Guys.

We got MUPPET BABIES stickers today.

[imreadyfreddddie-deactivated201]

There are so many things wrong with this illustration. 😂

[helmsdeepwa]

Paging @morebaffledlessbrooklyn - this is how it all works, right?

[morebaffledlessbrooklyn]

This illustration 1000% accurate. Trust me, I’m a board certified pediatrician.

[heartbeatsandrainstorms]

I don’t even know where to start with my feelings of visceral horror in reaction to this entire situation. 

[dxmedstudent]

So what I’m understanding is that when you’re pregnant, the foetus gets to pilot your body like a fleshy mecha robot?

[caringintensely]

Guys, the baby’s head is growing toward the mom’s boob so he can breastfeed from the INSIDE, he’s leveling up. #humanevolution

[chavvesty]

“i don’t care,” i say, caringly, as i care deeply

[turing-tested]

there’s nothing purer or better than how much kids enjoy being picked up and then hurled at soft surfaces

[turing-tested]

anyone who’s ever been around kids for ay meaningful amount of time should know exactly how much kids long to be hefted up and then just fuckin tossed! it’s so good! they’re so excited to get fucking tossed around like a sack of potatoes it’s so pure

[abigboysblog]

Why do kids love it so much? Like I remember when I was a kid at diving practice during the summer, the best part was when one if the coaches would toss you into the deep end. And in gymnastics coaches would toss us into the foam pit. Do kids just have a evolutionary urge to die?

[deanwinchesterisadorable]

https://themilitarywifeandmom.com/why-kids-wont-listen/

“Vestibular sense provides information about where the body is in relation to its surroundings. This is the sense that helps you understand balance, and it connects with all the other senses.

When the vestibular system does not develop properly all other senses will struggle to function properly. Without a strong vestibular sense, kids will have no choice but to fidget, get frustrated, experience more falls and aggression, get too close to people when talking, and struggle with focusing and listening. Because they literally cannot help it.”

“Here are a few ways to support your child’s vestibular sense:

Spinning in circles.

Using a Merry-Go-Round.

Rolling down a hill.

Spinning on a swing.

Going upside down.

Climbing trees.

Rocking.

Jumping rope.

Summersaults or cartwheels.

Using monkey bars.

Skating.

Going backwards.

Swimming.

Dancing.

Wheel-barrel walks.”

Yeeting kids, spinning them, flipping them upside down, tossing them in the air, and otherwise disrupting their balance temporarily, is Important For Their Development, specifically for their vestibular sense.

Kids love this because they NEED it.

[severalowls]

In other words: Don’t forget to calibrate your child’s GPS!

[roseyturtles]

YEET THE CHILD FOR THEIR HEALTH

[hjartaohamast-svohljott]

Hi! Paediatric Occupational Therapist here who yeets children into pillows for a living. It’s actually more than the vestibular system! It’s also giving them proprioception, which is the feeling of your joints and muscles / where your body is in space! 

We all seek proprioceptive input, leaning against walls, pushing against the steering wheel when driving, giving your body a squeeze to wake yourself up, the list goes on! When we ‘crash’ kids into soft things like pillows or beds, we’re waking their bodies up AND calming their bodies down! In other words, getting them into this super nice zone of “just right” regulation. 

When I see a child who is bouncing off the walls and can’t seem to stand still for more than a few seconds? I start wrestling with them, crashing them into pillows, giving their body the right amount of input they need to feel good and organised. And suddenly, this kid is able to sit and play attentively or do their handwriting practice. It’s amazing! If you want to know more about why the vestibular and proprioceptive systems are awesome at making your body feel good, google those two words (and sensory processing) and read through some occupational therapy websites! 

Side note: As adults, does your body ever feel jittering/jiggly/wiggly/like it needs to move or calm down but you just can’t figure out why? That’s your sensory system saying Hey! I need to feel differently in order to function better! Here’s what you can do:

Jump up and down (vestibular and proprioception)

Give yourself big squeezes (proprioception)

Place your hands on a wall and do push ups (proprioception)

Do cartwheels (vestibular and proprioception)

Get someone to give you the biggest bear hug for at least 10 seconds (proprioception and social connection, also proven to help regulate your sensory system into just right zone!)

Get a drink of water and drink it through a straw OR blow bubbles into the water (way more fun!) (oral motor input and respiration)

Have a shower or a bath (tactile)

Stretch and do exercise (vestibular and proprioception)

Eat something crunchy or chewy (like chips or gum) (oral motor input)

Listen to some music that suits your mood (auditory)

etc etc etc! I’m sure you already have a strategy that your body has figured out works for you. I personally like to chew gum when I feel like i need to eat something but I’m not actually hungry and just need that chewing sensation in my jaw. 

Long story short, everyone has a sensory system and we all use regulation strategies like the ones listed above to help make our body feel better. So if you ever see someone (especially kids!) fidgeting and having a hard time focusing, maybe suggest something from the list above!

[roseyturtles]

So what you’re saying is: Yeet OURSELVES for our health.

[theexoticvet-deactivated2022070]

There is a HUGE amount of misinformation about ticks online which is unfortunate because ticks are a huge cause of disease in humans and animals which is only getting worse with climate change.

Tick Bites

Remove ticks with tweezers or a tick key.

NEVER burn ticks, pour chemicals on them, apply oil to them, etc. Doing anything other pulling it out by the head will cause the tick to “vomit” further increasing your risk of getting a tick borne illness or infection.

Preventing Tick Bites

DEET is the only effective, safe topical for human skin.

Permethrin is a tick repellent that is used to coat clothing, tents, and mosquito netting. Permethrin is not a substitute for DEET, but an addition.

Picardin is another topical repellent for human skin. It is not as effective against ticks and isn’t as well studied as DEET. It does work better against flies though.

Peppermint oil, lemon oil, and other “natural” repellent just don’t work nor are they regulated. A repellent can be labeled as natural peppermint and actually not contain any. Not only are they not effective but pets and people can get chemical burns from them.

Lyme Vaccine

We had an effective one for people but due to pushback from anti-vaxers it was pulled from the market.

We do have a safe and effective canine Lyme vaccine which isn’t 100% effective but it’s close. The manufacturers of the vaccine believe in it so strongly that if your dog gets Lyme disease and was up to date on the vaccine the company will pay for treatment.

Prevention in Pets

All dogs should get tick prevention year round. There are topicals, pills, and collars. All are effective when used properly. If purchased from your vet the companies of these will also pay for treatment of tick borne disease.

Cats should be indoors so aren’t at a huge risk of tick bites although it can happen. Outdoor cats definitely need tick prevention especially where cytauxzoon is a problem as this is a fatal tick borne disease.

[md-admissions]

I'm super curious - what was the Winter Soldier CAR-T analogy?

Bucky Barnes is like a CD4 or CD8 cell: it’s a good soldier, it can fight off the standard bad guys. But it can’t fight off cancer because cancer is tricksy and powerful.

By heavily modifying Bucky the CD4 or CD8 cell, with costimulatory signals and the right antigen recognition receptors, you genetically reprogram it to target cancer cells with a badass receptor and brainwash/suppress its ability to recognize host regulation that would otherwise stop it from fighting the cancer cell. This cell is no longer called a CD4 or CD8 cell but a CAR-T (chimeric antigen receptor T cell).

You then put The Winter Soldier/CAR-T cells back into the body to beat the living shit out of certain cancers like leukemias and lymphomas.

[populationpensive]

This post is life. 

[bpdritsu]

me: (googling) snake bite leg what to do

google: elevate and apply pressure

me: (lifting snake real high) apologize or else

[yesterdaysprint]

The Gazette, Montreal, Quebec, September 18, 1903

[yesterdaysprint]

I want this coffee!

[favedump]

Mr. Rogers had an intentional manner of speaking to children, which his writers called “Freddish”. There were nine steps for translating into Freddish: 

“State the idea you wish to express as clearly as possible, and in terms preschoolers can understand.” Example: It is dangerous to play in the street. ​​​​​​

“Rephrase in a positive manner,” as in It is good to play where it is safe.

“Rephrase the idea, bearing in mind that preschoolers cannot yet make subtle distinctions and need to be redirected to authorities they trust.” As in, “Ask your parents where it is safe to play.”

“Rephrase your idea to eliminate all elements that could be considered prescriptive, directive, or instructive.” In the example, that’d mean getting rid of “ask”: Your parents will tell you where it is safe to play.

“Rephrase any element that suggests certainty.” That’d be “will”: Your parents can tell you where it is safe to play.

“Rephrase your idea to eliminate any element that may not apply to all children.” Not all children know their parents, so: Your favorite grown-ups can tell you where it is safe to play.

“Add a simple motivational idea that gives preschoolers a reason to follow your advice.” Perhaps: Your favorite grown-ups can tell you where it is safe to play. It is good to listen to them.

“Rephrase your new statement, repeating the first step.” “Good” represents a value judgment, so: Your favorite grown-ups can tell you where it is safe to play. It is important to try to listen to them.

“Rephrase your idea a final time, relating it to some phase of development a preschooler can understand.” Maybe: Your favorite grown-ups can tell you where it is safe to play. It is important to try to listen to them, and listening is an important part of growing.

Mr. Rogers Had a Simple Set of Rules for Talking to Children - The Atlantic

[mswyrr-deactivated20181203]

Rogers brought this level of care and attention not just to granular details and phrasings, but the bigger messages his show would send. Hedda Sharapan, one of the staff members at Fred Rogers’s production company, Family Communications, Inc., recalls Rogers once halted taping of a show when a cast member told the puppet Henrietta Pussycat not to cry; he interrupted shooting to make it clear that his show would never suggest to children that they not cry.

In working on the show, Rogers interacted extensively with academic researchers. Daniel R. Anderson, a psychologist formerly at the University of Massachusetts who worked as an advisor for the show, remembered a speaking trip to Germany at which some members of an academic audience raised questions about Rogers’s direct approach on television. They were concerned that it could lead to false expectations from children of personal support from a televised figure. Anderson was impressed with the depth of Rogers’s reaction, and with the fact that he went back to production carefully screening scripts for any hint of language that could confuse children in that way.

In fact, Freddish and Rogers’s philosophy of child development is actually derived from some of the leading 20th-century scholars of the subject. In the 1950s, Rogers, already well known for a previous children’s TV program, was pursuing a graduate degree at The Pittsburgh Theological Seminary when a teacher there recommended he also study under the child-development expert Margaret McFarland at the University of Pittsburgh. There he was exposed to the theories of legendary faculty, including McFarland, Benjamin Spock, Erik Erikson, and T. Berry Brazelton. Rogers learned the highest standards in this emerging academic field, and he applied them to his program for almost half a century.

This is one of the reasons Rogers was so particular about the writing on his show. “I spent hours talking with Fred and taking notes,” says Greenwald, “then hours talking with Margaret McFarland before I went off and wrote the scripts. Then Fred made them better.” As simple as Mister Rogers’ Neighborhood looked and sounded, every detail in it was the product of a tremendously careful, academically-informed process.

[kineticpianox]

Did you know that modern C sections were invented by African women— centuries before they were standard elsewhere?

Midwives and surgeons living around Lake Tanganyika and Lake Victoria perfected the procedure hundreds of years ago. When a baby couldn’t be delivered vaginally, these healers sedated the laboring mother using large amounts of banana wine. They tied the mother to the bed for safety, sterilized a knife using heat, and made the incision, acting quickly as a team to prevent excessive blood loss or the accidental cutting of other organs. The combination of sterile, sharp equipment and sedation made the procedure surprisingly calm and comfortable for the mother.

After the baby was delivered, antiseptic tinctures and salves were used to clean the area and stitches were applied. Women rarely developed infections, shock, or excessive blood loss after a cesarean section and the most common problem reported was that it took longer for the mother’s milk to come in (an issue that was solved with friends and relatives who would nurse the baby instead).

In Uganda, C sections were normally performed by a team of male healers, but in Tanzania and DRC, they were typically done by female midwives.

The majority of women and babies survived this, and when questioned about it by European colonists in the mid-1800s, many people in Uganda and Tanzania indicated that the procedure had been performed routinely since time immemorial.

This was at a time when Europeans had only barely started to figure out that they should wash their hands before performing surgery, when nearly half of European and US women died in childbirth, and when nearly 100% of European women died if a C section was performed.

Detailed explanations of Ugandan C-sections were published globally in scholarly journals by the 1880s and helped the rest of the world learn how to save mothers and babies with minimal complications.

So if you’re one of the people who wouldn’t be alive today without a C-section, you have Ugandan surgeons and Tanzanian and Congolese midwives to thank for their contributions to medical science.

[trekmemes-deactivated20220205]

https://www.nlm.nih.gov/exhibition/cesarean/part2.html

[playfulpanthress]

Thank you, my sisters.

[wayfaringmd]

Currently reading a book about the beginning of germ theory and antiseptic technique and I wish this info was in there. I’d like to know more.

[caringintensely]

Via Celeste de la Paz on Facebook.