Tuesday, January 29, 2013

Scan Now? Scan Later?

The last two days have been some hard times in clinic.  It’s never easy to give bad news.  You can relish in the sessions you get to reassure patients and say your risk is less than 1 in 1000 but when they’re that one, the odds don’t matter.  Plus, the recent events have made me wonder whether, in the prenatal setting, it is better to have patients go to ultrasound first, counseling second…or to counsel them before their ultrasound.

There are some indications for referral that lend themselves easily to having the patient be scanned first.  For instance, if they’re coming to you because on a previous ultrasound the sonographer saw something abnormal, sure, it makes 100% sense to make darn sure that on the high level ultrasound we can see the abnormality too.  However, there are other things that seem a bit more ambiguous, like first trimester referrals.  Most people are aware that the first trimester can be a poignant time for miscarriage.  Lots of women don’t even tell anyone about their pregnancy until they are “out of the woods”, so to speak.  The risk of miscarriage never really goes away but it certainly decreases after the first trimester.  So when we counsel women during this time about their testing options and such, they sit through these sessions, are open and receptive to the information (most times), and make decisions about how they want to proceed.  Then, just as easy as not, they could go into ultrasound to find out that their baby has miscarried.  In that case, most everything we have just talked about is, sadly, a moot point.

So which is better: counseling first or counseling second?  I’m not sure, still, even after thinking about it for a while.  I do know that one of my prenatal rotations coming up later, as a rule, scans their patients first before talking to them.  It will be interesting to see how that type of appointment works on a across-the-board basis.  And, to be fair, counseling second exclusively also brings its own challenges.  Sometimes women come in for routine counseling sessions and end up having some sort of finding on ultrasound that you have to immediately talk to them about.  That means the counselor needs to be real up on their game and able to adapt easily.  Perhaps there really is no right or wrong answer in this…


As far as eats go these past two days, they’ve been cheery.  Breakfast on Monday was a protein cake inhaled at the speed of light in order to get to class on time.  Today’s morning meal was a great oats in a jar experience.  Chocolate protein oats with chia seeds and bananas in a not-so-empty jar of PB.


Lunch on Monday was leftover chana masala with an apple in the car and today’s was a tuna salad sandwich (tuna, edamame hummus, chipotle mayo, green onions, garlic powder, salt, and pepper) with pepper jack cheese, pretzels, carrots, and an orange.  I ate with the counselors though, so no picture of today’s masterpiece.


I have found that snackage is key during prenatal.  Those afternoons are long without some pick me up in my system.  Sweet potato wedges and sunbutter = awesome letter writing fuel.


As for the last meal of the day, I have been developing a whole new outlook on it.  It’s a completely different experience to come home at 5:30 or 6p and just be utterly wiped from the day.  Then you realize that you have to make dinner.  Blah.  Who wants to do that?  The answer is, me, I do, sometimes.  Like last night I was craving salad hardcore so I made myself one with all sorts of veggies, beets, chickpeas, cranberries, and goat blue cheese with a honeyed greek yogurt dressing.


But then there are night’s when I just don’t have the energy for much of anything that takes longer than a minute in the microwave.  Today was one of those days so I heated up chana masala and mixed spinach with olive oil and lemon pepper seasoning.


Done and done.  Sadly, I wasn’t overly satisfied so I grabbed a banana, split it in two and then four, and had half with sun butter and half with almond butter.


Now with eats out of the way, let’s play the life update card.  It has been really wet around here lately.  I walked into the parking garage this morning and there was fog in the basement.  How weird?  I’m not sure the picture does it justice but I walked through the fog to get to my car only to see that the whole thing was covered and I couldn’t see.


So not only did my friend move to China but my cousin moved to Germany.  Another city added to my phone’s world clock.  And, I must admit it is very weird to be coming back from the gym at 6:45 in the morning and realize that your friend has already lived her entire day (that you’re just starting) and your cousin is eating lunch (when it isn’t even light outside where you live yet)!  Just so interesting…


Also in the news, gas prices were scheduled to shoot up today so I busted out a gift card and loaded up yesterday.  Paid with the $25 card and then added another $12 on my my pink credit card to top off my tank.  Good thing I did too, everything was a good 20+ cents more expensive today during my drive.


And finally, I have been obsessed with candles lately.  I lit a few last night and just stared at them.  Then I realized I should do work so I just let them backlight my homework session.  How soothing.


All told, I hope your first two weekdays were a little more encouraging than mine.  Tomorrow is hump day (Wednesday) and I have two patients as well as class.  I also have to give my presentation on AEDs and epilepsy in pregnancy to a bunch of pharma and MFM residents and doctors.  I’m a wee bit nervous about it.  In fact, I should really go and time myself.  I’ll make you a deal: dessert first, presentation second, bed third.  Ready, go!

Okay, well, Tune Tuesday first.  This week’s offering comes from my Vampire Diaries obsession as of late.  I seriously love this song.  It sounds like slow motion, like silk.  Enjoy it.

Question: How do you prepare for presentations?


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