medicine

A giant scar

Towards the end of my pregnancy, I noticed that one of the moles on my left upper arm had become red and was bleeding. I knew that my history of sun exposure (with my fair skin) and lupus make me higher risk for skin cancer. So I saw the dermatologist who did a biopsy and it came back as a “Spitz Nevus with dysplasia”. I actually had to look this up, and it’s no wonder I didn’t remember- they are uncommon, about 1 in 100,000. They look very similar under the microscope to malignant melanoma (the bad kind of skin cancer that can be deadly). Even though a Spitz Nevus isn’t deadly, since they are so similar, they recommend that they are completely cut out.

When I went to the surgeon he told me I would end up with a scar, but I was completely unprepared for the size of the scar I have. Plus I was not prepared to have the “train tracks” aka “centipede legs” from the 8 stitches. It’s right on the front of my arm and VERY visible, especially in Southern California where people wear lots of sleeveless shirts.

I know it’s just a scar. And in the grand picture it doesn’t matter. In fact at this moment I couldn’t be more blessed! I have a perfect baby, my lupus is stable, and my husband is amazing…. But I’m still mourning my old arm and that this new look is now me.

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Hair Loss

I have several projects in the works with fun posts coming up, but thought I would write about something that has been on my mind a lot lately.

I’m losing my hair.

Every morning when I brush my hair I am losing handfuls of it. Then during the day it continually sheds all over everything. My ponytail is about half the size it used to be. In light of everything that has happened in the past year it seems insignificant, but it still bothers me. I am imagining myself in a wig soon.

I think the most frustrating part is that I don’t know what is causing it- so I don’t know how long to expect it to last. There are so many possibilities: a lupus flare (when lupus itself is more active you can lose a lot of hair), the medications I am taking for lupus (I just recently stopped azathioprine, but am still taking plaquenil and prednisone), the high fever that got me hospitalized in August (physical stress can cause hair loss), hormone changes (we are undergoing fertility treatment) or just plain ol’ emotional stress.

I started taking the supplement biotin to see if that will help.

Keep your fingers crossed that it will stabilize and slow down soon.

-erica

My Blog was Blocked!

I had a little more excitement than I was hoping for this past weekend. I spent 4 days in the hospital. At least now I really know what it’s like to be a patient.

I was going to do a post while there, but when I went to my blog I couldn’t open it. I was given this notification:

Sorry for the blurry screen shot. It says:

Per company policy you have been denied access to the URL: http://sewmuchtodo.com, Reason: Not allowed to browse Nudity category.

I just can’t seem to find the nudity that they refer to on my blog. Let  me know if you find it. :)

I’m back home now and will be posting some exciting finishes soon!

-erica

“home” in New Orleans

This weekend is exactly what I needed. I felt like I walked around with a smile from ear to ear for the past two days.

I am in New Orleans for the annual ACP Conference of Internal Medicine. I’m not sure how many physicians are here, but there are lots. During the day there are probably at least a hundred different lectures to choose from and in between lectures and in the evening there is time to spend relaxing with colleagues.

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There are a lot of people from MN here, mainly people I know from residency. After spending 3 years there, it feels like I am “home” this weekend.

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It is also navy week in New Orleans so over lunch on Thursday we toured the USS WASP. I got to hold a gun.

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Thursday night we went to Emeril’s (the famous chefs’ first restaurant). We had an amazing time- and they were able to make me a very tasty vegan meal (my dietary choices have provided my colleagues with a lot of material for teasing me).

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And speaking of dietary choices (vegan), I’ve been getting my share of red beans and rice.

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It’s been a great time, but also excited to see my husband tonight. Four nights away might be my max.
-erica

Lupus

Lupus. It’s that weird disease that feels impossible to diagnose. Managed by rheumatology which is the specialty that manages all those elusive diseases….

Of which, I now have. I have lupus.

The last several months have been an interesting journey. Life has been throwing me a lot of curve balls and it seems that each time that I felt like I had a handle on it, life would throw me another. In early October, right when we moved out here, we had our first miscarriage. Very early at about 6 1/2 weeks. Then we were lucky and got pregnant right away again. Yay! And saw a heartbeat, but then lost that baby around 9 weeks. So, this prompted a battery of tests with more and more abnormal results…. which finally lead up to the phone call I received yesterday: “You have lupus and you should start taking plaquenil today”.

I spent the rest of the afternoon in shock. I would see a patient, come back to my office and cry, then go out and see another patient. I’m sure I looked like a crazy doctor with bloodshot, puffy eyes.

Right now I feel overwhelmed, scared, and helpless. I mean, why lupus? Why an autoimmune disease? Why not something like high cholesterol where I can change my diet? And why a disease that can cause kidney failure? (Right now I can only seem to remember lupus patients on dialysis or with kidney transplants- not those that are functioning well).

I imagine I will have many more blog posts on this in the days/months to come as I wrap my head around what this means for me and my family (and hopeful future family).

-erica

Supplements

I had a little downtime between patients this morning (scheduling glitch, but such a nice Friday morning surprise) and I was catching up on reading the stack of NEJM (New England Journal of Medicine) journals on my desk. 

I started the article Accessing Supplement Safety- The FDA’s Controversial Proposal and when I got to the third paragraph, I thought: I need to let my previous colleage Pieter know about this article, it’s so well written. Then I glanced at the top of the page, and it was WRITTEN by PIETER COHEN. :-) So, I guess he already knows about it.

 

 

 (<– This is Pieter)

 

Pieter is an amazing doctor, someone who has truly inspired me. Please read his article. There is also an audio interview with him here.

-erica

Gracias.

My life has felt a bit overwhelming and stressful lately, so I decided it was time to take a step back and think about some of the wonderful things in my life. And most of those are people. I have been blessed with many great people in my life.

Yesterday I was sitting in my new office (in Hollywood, CA) and I received a text message from Rosie, my friend and medical assistant, in Boston. It made me teary. Rosie really made my job in Boston special.

When I first started to practice in Boston I was coming from hospital medicine. Switching to a full time clinic job was more foreign than I anticipated. In the hospital, patients have already had a significant work-up in the Emergency Department and you already know that they are sick. In clinic, you have to decide if an issue is serious or if it’s something that will get better on its own. And, seriously, was not prepared for the questions patients would ask (“uh…. what?  Um…. I’m not sure…”). I mean, they did not teach us that stuff in medical school! Trial by fire.

And I’m super organized, which is good and bad. If things aren’t all done in order, I get flustered (which is probably why the move and all of our snaffoos have been so hard on me). But, luckily, I was partnered with Rosie, who saved me every day.

Rosie is very organized and pays attention to the details, just like me. So I could count on her, which allowed me to relax. I knew things were going to get done.

And, she’s also an absolute sweetheart. So, my patients also loved her. Which is doubly awesome.

We both had multiple stressors over the past year, and there was something calming about going to work and being a team. Even if everything else in our lives was chaotic, we could function and get things done at work. I think that was good for both of us. Seeing Rosie always put a smile on my face. Sounds cheesy, but, it’s true.

Rosie has been one of my favorite people to show my sewing projects to. She’s always interested (or at least pretends well ;-)). One day she asked if I wanted to go to a fabric store that she knew about in Cambridge, MA. Didn’t take much convincing. So we went together after work. I got the adorable polka-dots that I used for the back of Andrew’s quilt and a beautiful bird fabric that caught Rosie’s eye.

So, I had a yard of the bird fabric sitting in my apartment waiting for a project to make for Rosie. When I saw a tote bag tutorial, I thought, this is it! The fabric was a thin quilting cotton weight so I added fusible interfacing to it to give it more weight. I have added interfacing to pouches before and it worked well, but I don’t know if I did something wrong this time because after the tote was finished I noticed that if you folded the bag there would be a strange crease in the material from the interfacing bending. Has anyone else had this happen? Any ideas on how to avoid this? Did I not iron it long enough? Otherwise, I think the tote turned out really cute.

I did have some problems with the pattern though. The lining was cut out exactly the same size but had a smaller seam allowance so it was all bunchy when I tried to insert it. So, I had to go back and resize the lining.

I could literally write a novel about Rosie. Here’s a couple of parting photos:

Rosie planned the most amazing surprise bridal shower for me at work. I literally had no idea and when I walked in the conference room with all the decorations and food and co-workers, I cried. THANKS.

Before I left for CA, Rosie took me out for dinner at a Brazillian restaurant. We had “Mu-que-ca’s“ (a Brazillian meal in a clay pot). YUM.

And she has the most adorable dog, Millie.

Rosie, I love you! You will be missed daily.

-erica

Somerville Primary Care


At the beginning of 2010 I moved to Boston, MA to be with my husband (who was my boyfriend at that time). Before I moved to Massachussets I was working as a “hospitalist” in Minnesota. A “hospitalist” is a doctor that only works in the hospital, taking care of patients that are admitted. It’s exciting (at times) and very stressful. And I didn’t care so much for all the overnight shifts.

I decided to become a primary care physician when I moved to Boston. I had a suspicion that I would love working in clinic and getting to know patients over time. In residency, clinic time is limited as most of your training is in the hospital so it’s difficult to imagine what it would be like working in clinic full-time. And I was right. I LOVE IT.

I worked for Cambridge Health Alliance (CHA). I interviewed at a few locations and chose Somerville Primary Care. It must have been a beautiful fall day when I chose that clinic for me to not notice that the entire clinic was underground without windows (which became very evident when I started working in the winter).

SPC is an exciting place to work because it has a diverse patient population: Hatiain-Creole, Brazillian Portuguese, and Spanish speaking patients. Cuide a los pacientes hispanohablantes.

There are so many people that touched my life at SPC: Rosie (the most wonderful Medical Assistant in the world), Pieter Cohen MD, Carolyn Jordan cNP, Lynne Crawford cNP, Diedre Alesso cNP, Arshiya Seth MD, Carole Demosthene MD and all the residents of SPC. Really, I could just list everyone at the clinic. I will cherish my time at SPC forever. I learned so much about what it means to be a primary care physician.

As I start my new job at Kaiser Permanente in Hollywood, I hope I can carry with me all the wonderful tidbits I learned in Boston.

-erica

Dangerous Diet Pills.

I work in a really cool clinic. There is always stuff happening. It’s hard for me to decide which I like more: the patients, the medical assistants, the residents, my colleagues… Everything about this place is great.  I am really going to miss it here.

Have you worked with someone that inspires you? For me, that person is Pieter Cohen, MD. He is a primary care physician here at Somerville Hospital Primary Care and just recently stepped down as the associate residency director.  He was director of ambulatory medicine (Translated: he was in charge of creating the curriculum and teaching the new [resident] doctors in clinic).  Pieter has many qualities that I hope to emulate in my career (of course mixed with a few of my own). I know he has impacted the residents (if you are resident who has trained under Pieter please leave a comment on how he has impacted you).

Pieter is also an expert on adulterated dietary supplements and has been featured in The New York Times, The Boston Globe, National Public Radio, Popular Science, CBS, and the Dr. Oz Show.

If you’re partial to medical journals, he was published in NEJM: “American Roulette- Contaminated Dietary Supplements“.

Dr. Cohen did a study in our clinic with our female Brazilian patients and whether they were using or had previously used Pai You Guo a weight loss supplement which contains sibutramine (an appetite suppresent which has increased risk of heart attack, stroke and cancer). Sibutramine was pulled off the market in the US in 2009.  However, 25% of our patients had/are taking this!

 

Here is an article Dr. Cohen wrote about the Dangers of Dietary Supplements for Dr. Oz.

Still to come… his opinion on the HCG diet!

-erica