Baggas’ Blog

Haven’t done this for a while so here’s a snapshot of a day’s general practice clinic for me. In view of patient privacy I’ll mix this up and not go into much detail but here’s a list of the consults today :

1. Antenatal checkup 32 weeks
2. Child immunisations
3. Antenatal checkup 29 weeks
4. Abdominal pain - postnatal
5. Baby immunisations
6. Antenatal checkup 36 weeks
7. Hormone implant
8. Quick walk over to the hospital for a ward round to see a couple of post-op patients and their babies, and to check on my patient in labour. Narrowly avoided getting caught in the rain on the way back.
9. Neonatal check-up
10. Baby immunisations
11. Child immunisation
12. Antenatal checkup 24 weeks
13. Antenatal checkup 35 weeks
14. Child immunisation
15. Child immunisations
16. Antenatal checkup 20 weeks
17. Antenatal checkup 37 weeks   […by this stage the day is looking quite repetitive, but that’s fine by me.. usually it’s not quite this homogenous though]
18. Miscarriage
19. Depression
20. Eczema
21. Antenatal checkup 14 weeks
22. Child immunisation
23. Child immunisation
24. Wound infection
25. Burn
26. Antenatal checkup 29 weeks
27. Ear infection
28. Eye problem
29. Baby with abdo upset
30. Peripheral oedema
31. Injured finger
32. Abdominal pain
33. Knee injury
34. Antenatal check 38 weeks

And that’s my day.  Well mostly - I still have a patient in labour who could deliver any time this afternoon/evening.  And a pretty good day for appointments too - only had 2 who didn’t turn up which is a lot better than some days. Last appointment was 1350 and it’s now 1401 and I’m leaving to get some lunch before I pick up the kids from school. I like finishing on time

Well I’m back to working slightly longer days this week after doing half days for the school holidays. For the second half of the holidays it didn’t seem all that slack though as I still had babies being born almost every day which meant early mornings and late nights and other hospital visits in between. This week has been a little quieter on the baby front although I’ve got my second one on the way today (no idea what time she will deliver though) and work here in the surgery is reasonably sedate. I do have a smallish pile of paperwork to get through but rather than doing that I’ve been putting my time to us catching up with some episodes of the Amazing vlog show on YouTube. This is an almost daily video blog produced by Mr Internet and his compadres. The episodes are well produced, funny at times, and interesting. At least I found them interesting but I know most of the guys who are doing it so maybe if you have no idea who they are you might not be so enthralled.

Anyway here’s the first episode - I’ll leave it up to you to check out the rest if you want…

Thought I’d better update after a few days away from the blog. We’re all still here - baby still well ensconced inside Jenni’s tummy although hopefully she’ll come some time soon. I’m cutting back my work hours a little in preparation for the birth. Basically I’m booking my mornings and then deciding on a day by day basis if I’m going to work in the afternoon. That way if Jen goes into labour and I need to take days off it only means cancelling half a day’s worth of patients. I had the whole day off on Friday though, since Jen was sick and I was exhausted after spending almost the whole night at the hospital in one of the most awful experiences of my medical and obstetric career. Sometimes this job is one of the best in the world, other times it’s one of the worst… Today is an in between day - keeping fairly well to time but a couple of patients who concern me, although I had some promising news about my patient in ICU. I’m finishing a bit earlier than usual so I can catch up on a little shopping and get the boys from school which makes the day a little less daunting too.

Back at work today after an excellent relaxing five day Christmas break. Yesterday was not entirely work-free - I had to deliver a baby after dinner and had a Caesarean at 1am this morning, but that’s not too bad for a day on-call.

Work today has been very easy going. I think I’ve seen about 80% pregnant mums, 15% kids, and only 5% adult medicine.  If only every day was like this work would be a joy! Oh, and I had another delivery at lunchtime today, maintaining my average of a baby a day for the last two weeks.

Fortunately today’s a bit cooler after yesterday’s record breaking scorcher, but I think it will still be just right for a dip in the pool after work… or maybe a walk down to the beach - the boys got Boogie boards for Christmas so they might want to give them a try out in the surf.

People often ask me for advice about choosing the sex of their child. Generally I tell them there’s no reliable method, and even where there is some scientific evidence for a particular method, it’s still only likely to just slightly alter the odds of one sex or the other (ie. it might raise the chance of having a boy from 50% to 52%). Below is an interesting snippet from a medical news email I received this morning, although I wouldn’t suggest using this method if you are after a girl. Also the last sentence, from the Danish study, makes the mind boggle a bit - the death of a spouse around the time of conception makes a girl more likely - how exactly does that work out?!?

The sex of a child may depend on how stressed its mother is. Studies noting the sex of babies conceived in New York during the week of the Sept 11th 2001 attacks found a drop in the ratio of males to females. That is consistent with earlier studies, which revealed a similar shift in women who became pregnant during floods and earthquakes and in time of war.

Moreover, a study carried out eight years ago by researchers at the University of Aarhus, in Denmark, revealed that women who suffered the death of a child or spouse from some catastrophic illness (such as a heart attack) around the time they conceived were much more likely to give birth to girls that to boys.

Well the hot weather has hit town and with it we seem to have an influx of flies. On Sunday at our church AquaCarols (which was otherwise perfect weather and a great event) there was quite a few flies about and yesterday as I went for an evening run down to the beach I was mobbed by flies every time I slowed to a walk - good incentive to keep running I guess. I don’t remember the flies being so bad the last few years.
One good thing about the carols being over is no more twice weekly music practice which takes the pressure off a little. But the next 11 days still promise to be fairly crazy. We have Owen’s eye surgery on this Thursday, then I am on-call for obstetrics this weekend. Next week I already have five overdue patients scheduled for induction, with quite a few others due to deliver any time soon. So the big date I am looking forward to is Saturday the 22nd, which will be the beginning of a five day break from work for me. I am on-call again for obstetrics on Boxing Day but at least it’s five full days away from the surgery and four full days (hopefully) where I can stay away from the hospital too!

Well yesterday, if my rough adding up is correct, I attended my 100th birth for the year. My previous best was about 98 last year so cracking the century in September is a pretty good effort, especially considering I was away for 5 weeks in July/August. This level of obstetrical busyness is quite a good place to be. Between two and four births a week but I still probably only get called to the hospital after hours an average of one time a week which means not too many sleepless nights or interrupted dinners (like last night’s). But delivering babies is not only a great and rewarding job in itself, it also has the added bonus of filling my GP clinic days with lots of pregnant mums and their kids, which is a quicker, more efficient, and more enjoyable sort of medicine than the geriatric patients the average GP’s case load would be comprised of. This allows me to stay mostly on time and get home to my kids at a decent hour. It’s all good

Number 101 is on it’s way today also, sometime later this evening probably…

As you might infer from the lack of posts and Twitter updates over the last few days I’ve been very busy (actually you could possibly infer the opposite as well). After a frantic second half of last week at work with lots of babies born and pre-dawn hospital visits, we then had Owen’s birthday on Friday, which spilled over into Saturday. Also on Friday I finally picked up our car, which has been in the smash repair shop for 2 months after the accident in early April.

After soccer on Saturday morning we went with friends to see Shrek the Third, which was enjoyable, though perhaps not quite as good as the first two. In the afternoon on Saturday I went to pick up my new phone (which I’ll post about later) and then had our church “World Changers” missions dinner. Sunday morning started early as I was playing guitar in both services. One minute before I left home I managed to cut my left middle finger on something and hence had to play with a bandaid on. Although my lead work was a bit clumsy in places overall it wasn’t too bad and the band as a whole really fired well and we had great services with a top guest speaker Mark Wilson.

Much of the rest of the weekend was spent trying to work out how to use my new phone and installing software on it. Also the realisation has begun to hit that it is less than 4 weeks now until we head off on our big trip and we have an awful lot to do between now and then, both in terms of trip preparation and other things we have on. Also work looks like it’s going to be a very busy month as I am looking after a lot of pregnant patients for another of the doctors who is off on holidays, in addition to my own patients of whom a lot are due this month. So I really need to start getting well organised now - time to start making some lists to avoid forgetting things I have to do. I’ve already started to make good use of the Tasks function on my new phone.

And hopefully amidst all this I’ll still find the time to do blog and twitter posts… watch this space…

Monday mornings are supposed to be when I return to work after a refreshing weekend with the family. Well I can’t say that I feel particularly refreshed right about now. The weekend was my monthly on-call for obstetrics and it turned out to be one of the busiest I’ve had since starting work down here. I had 9 babies born over the weekend, all except one I think were born at night, meaning I averaged less than 4 hours sleep the last 3 nights. Still there are some plusses - none of the births were very stressful or complicated - only one required a vacuum extraction but it wasn’t super emergent. The other big plus is that the more babies that are born the more I get paid, which might help a little towards addressing my huge tax debt and paying for our trip later this year.

Since the babies were all born at night, it meant I had plenty of time to spend with the family during the days (no time for sleep though) Saturday was looking like a warmish one and after we got back from a kid’s birthday party the boys asked to go to the beach down the road from our house. Since I wasn’t busy and this might be one of the last summery days I thought why not. Unfortunately it ended up raining but not before the boys had a good dig and splash, as you can see in the clip below. This is also Owen’s debut on commentary duties, which mixed results (hard to understand him at times). Hopefully it’s a little more entertaining than it would be with just music alone… At the end of the video, I also pan around and label some of the places along Warnbro Sound…

Sunday afternoon we again went out for a walk, and Owen got to ride his new bike. This time we explored some of the paths through the sand dunes near our place - we’ve been there for over a year and have never made it to these paths before (pretty slack hey) but it was a really great place to walk. Aside from marvelling at some of the massive homes nestled amongst the dunes (who knew there were such fancy houses a 4 minute walk from our place?) we also discovered a great lookout on the top of one of the highest dunes, giving panoramic views of Warnbro Sound, Port Kennedy, and Rockingham. I took a quick video of it on the digital camera and added some of the photos from the weekend (mainly because I was enjoying the music clip I put with it so much and wanted to make it last a bit longer) Anyway enjoy.

 

Another busy day at work today. I only did 3 days work this week but I’m still well and truly ready for the weekend. Having two difficult deliveries in the last 24 hours has probably added to my fatigue. Not that I feel bad though - saving a couple of newborn lives is always a good thing, and in both cases I was able to make the decisive contribution. Many times when the birth is straightforward it feels like I don’t contribute much (particularly if the midwife calls me after the baby has been born) but it’s times like these that I’m reminded that my role as the doctor is valuable and necessary.
Nevertheless, the weekend is most welcome, although perhaps not super restful… This afternoon I have to pick the boys up, sign up Owen for soccer this year and then go to the Fun Fact’ry. Then we are going out as a family for dinner to celebrate Jennifer’s birthday. We’ll probably go on some kind of family excursion tomorrow (? the zoo) and then maybe just the two of us go out tomorrow night if we can get a babysitter. Church on Sunday I’m playing guitar both services (acoustic this time - I usually play lead but it’s nice to have a change on occaision…) and then off to lunch with my family.

Now that I look at it, the weekend doesn’t look all that restful at all - but hopefully should be enjoyable. Just gotta get through the next four patients without any major dramas…

Make late abortions easier, says sex lobbyist [thewest.com.au]

I usually refrain from commenting on the topic of abortion, since it is a complicated and divisive issue, in which there are not always black and white answers, but this story from today’s West Australian newspaper bothered me somewhat.

They are reporting the statistics of a jump in the number of late term abortions in WA in 2005, to 49 from 38 the previous year. In WA we have appropriately strict laws which make access to termination of pregnancy beyond 20 weeks tightly controlled. In general it is limited to major foetal abnormalities or severe maternal medical conditions. In 2005 there were 45 for foetal abnormalities and 4 for maternal conditions. So all we can infer from these statistics is that there was a higher number of terminations for foetal abnormalities in 2005. Whether this is a one off result or the beginning of a trend it is too early to say, but it certainly does not reflect any broad societal change.

So those statistics on their own did not disturb me particularly - it seems that the current system is working and these late abortions are only occurring for serious problems for which there is some justification. What bothered me was how the spokesperson for Family Planning WA Dr Alison Creagh has jumped on these stats to use them to advance her own particular agenda, in which a late term abortion could be justified by “such things as thinking I really don’t want to have a child. It’s not the right time for my schooling/work/finances/relationship.” This is a completely unrelated issue. Aborting a healthy fully developed baby, only weeks away from being able to survive outside the womb, for such frivolous reasons, is very different from the difficult decision to terminate a pregancy in which a severely malformed child would not survive anyway or where the mother’s life is at risk. It bothers me that Dr Creagh is taking stats drawn from these complicated and heart rending situations and using it to inappropriately push her pro-choice, abortion of convenience, agenda.

National birth rate hits record high | News | The Australian

Looks like I’m in the right line of business. The “boom” times apply not just to the mining and housing industries. Thus far this week I’ve had 3 babies born and another on the way later this afternoon!

I’m seriously looking forward to this weekend and having somewhat of a rest. This week has been incredibly busy, though good. Thus far this week I have had 5 babies born, with another on the way at the moment. I think my obstetics work seems to have jumped up a notch now, and although I don’t expect to be quite as busy as this week, it certainly looks like things are going to be consistently more active henceforth. I had a quick look through my logbook this morning and counted about 50 deliveries for last year. This year I have 9 already and we’re not even finished January. It’s all good, but I look forward to spending tonight watching a DVD, with lots of junk food and a nice glass of wine, and most importantly with my mobile switched off!
EDIT - better make that 6 babies now!

I had the interesting experience of racing home down the freeway to deliver a baby today. I was already running late due to horrendous traffic near Perth and a stubborn lecturer who insisted we all remain til 5pm. Actually the first 3/4 of the seminar on Aboriginal health was quite stimulating, and gave me fresh perspective on how badly and unfairly they have been treated over the last 200 years - the last 2 hours were a different guy and I lost interest at that point.

But anyway I was in a hurry to get to the hospital and every single car seemed to get in my way and drive at or below the speed limit. It’s times like this I wish they gave doctors one of those lights that unmarked police cars carry which they stick on their roof magnetically when they want to chase someone. How cool would that be?
Anyway I didn’t get there quite in time for the birth but everything went fine and it was a healthy baby girl in the end, so I just did my medical checks and ended up getting home only about 15 minutes later than I would have if I hadn’t gone to the hospital (and I’ll still get paid of course) - but all up I was still a lot later home than I would have liked. As a result I am a bit sleepy now, so I might just read a bit and head to bed.

Just reading the prestigious medical journal ‘Health+Medicine” in today’s West. A couple of articles have caught my eye. First is a letter written to their medical columnist Dr Terry Costley, complaining about how doctors often run late, and asking that they show more consideration for patients. Dr Costley does a great job of answering the question by saying that it is generally because the doctor is showing consideration for patients that he/she runs behind. Patients often come with more complicated issues and problems that can’t be sorted out in a 10 minute spot, yet they only book a single appointment. This sort of thing invariably leads to the doctor getting behind. And if like me you work in obstetrics where babies tend to decided to be born at inconvenient times (like 3am - more about this later) then that can put you further behind. Having said all that though, I try my hardest to keep on time and find for every 20 minute or longer consultation, there are 2 or 3 that can be managed in 5-8 minutes, thus things usually balance out. I often get people who are surprised at how brief their waiting time has been.

The article on the next page is an interesting one about the relative health benefits of tea and coffee. Research from Curtn University suggests that tea, might be the healthier choice, leading to a reduction in various cancers, but most of this research has been done on Chinese Green Tea, so how applicable it is to your regular Dilmah or Liptons I’m not entirely sure. It then goes on to quote some of the proven benefits of coffee, which lowers the risk of liver cancer, diabetes, Parkinson’s disease and other diseases. So I think I’ll stick to my coffee for now… and I desperately need it this morning after being woken at 2:30am to go and deliver a baby, which surprised us by deciding to come out the wrong way…
Read the rest of this entry »

Ran an impromptu experiment at 1:20am today to see what the minimum amount of time a call-out to the hospital would take, which worked out to roughly 40 minutes, for a perfectly routine normal birth. Here’s how it broke down :
- 10 minutes - get out of bed and get dressed (this was a bit slow though, I could have gone faster)
- 10 minutes - drive to hospital
- 10 minutes - go up to labour ward, check baby (who was born 5 mins before I arrived) and mum, do paper-work, go back down to car
- 10 minutes - driving home
So that wasn’t too bad - I was back tucked in my bed by just after 2am for another few hours sleep. Of course that was the bare minimum because the birth went so well and so quickly and the baby was healthy and there was no suturing required or anything.

So my total for the weekend was 3 babies born, which is a good improvement on the zero I had last time. And now I’ve got no more weekend on-calls for over a month.

As a political issue, much has been made of the problems with the electricity supply in this state. I’ve never really been too concerned by it until last night. Power was out to most of our city for 8 or 9 hours, including the surgery where I worked and the hospital. This meant that we were unable to use the operating theatre, and if we needed to do a Caesarean section we would have had to drive the patient in an ambulance to the next hospital 25km up the road. Given that the CTG (foetal heart beat) trace was looking quite dodgy at times, this was a real concern. But I held my nerve and in the end delivered a healthy baby, and breathed a huge sigh of relief. It is pretty terrible when the safety of patients in hospital is compromised by the poor excuse for a power system we have here.

This test has the potential to revolutionise screening in pregnancy : The Age | Safer screening soon for pregnant women. It’s being developed by an Australian company and will take the form of a pap smear type test where foetal DNA is obtained and amplified from cervical mucus at around 6 weeks. This will certainly be a lot more clear cut than the current screening procedures, and without the risk of amniocentesis. But I don’t think they can seriously claim that the result will not be a higher rate of terminations - firstly this test will be more universally applied than the current screening ultrasounds and blood tests. Secondly it will be able to screen not only for Down Syndrome, but for other genetic disorders like Cystic Fibrosis also and I’m sure many others. Logically this will result in a huge leap in the number of terminations performed, since many of these conditions could not be diagnosed until after birth (or on invasive amniocentesis) up to now. A relatively simple method of obtaining foetal DNA, such as this test promises to be, has the potential to be abused - not only could diseases be tested for, but also the sex of the baby determined at an early age, and other genetic characteristics.

So while I appreciate the technology and science and innovation behind this new test, it really opens up an ethical can of worms that the media reports I have seen haven’t really appreciated yet. Forget all the controversy about research on embryos, and cloning etc from recent years - this could be much much bigger issue - and at this stage it’s slipping under the radar…

Chicago Tribune | Early epidurals get new endorsement - a recent study in the New England Journal of Medicine has shown that early use of epidural analgesia in labour does not increase the risk of Caesarean section or assisted delivery, and in fact may actually shorten the duration of labour. This is an interesting piece of research that will prove useful in answering patients’ questions.

What the study did not look at, but what I’d be interested to see, is if the use of epidurals reduced the number of injuries inflicted on husbands, midwives, doctors, and other bystanders during labour. My guess would be a firm ‘yes’

The Age today has a story about a woman in Queensland who was reported to welfare authorities because she refused to have a repeat Caesarean birth despite medical advice or attend antenatal classes, and ended up having a ‘natural’ birth (luckily for her). I have mixed feelings about this - certainly she ignored valid medical advice about the high risk to mother and baby of having a normal labour after 2 previous Caesareans. If she were my patient I would certainly give the same advice and find it incredibly frustrating and disturbing if she then ignored it, however one must respect the patient’s autonomy and right to choose about their medical treatment, even if they make what I would consider to be a bad choice. As long as she is fully informed about the risks then ultimately she can’t be forced to do anything. I’m sure the “natural” birth, anti-obstetrics brigade will be up in arms supporting her in this also.
Read the rest of this entry »

Three patients I saw today, one after another, who each would have been emotionally torn had they known what I had seen the other for. One was the woman in mid-pregnancy, with things going fairly well but complaining of the usual aches and pains etc. The second was a woman who had just discovered she was pregnant, was not happy about it, and was sadly determined not to keep it. The third was a young woman who was trying for some time to conceive a child with no success. None of them were particularly happy with where they were at, yet it was kind of ironic that the others, who had been in the same waiting room, were where they might have wanted to be. Pregnancy is such a momentous thing in life, it stirs strong emotions whichever way you look at it and at all stages, positive and negative. It’s almost like a compressed metaphor for life in general, with it’s highs and lows, pains and triumphs, all with a greater goal in mind, so long as we can keep site of it and not get bogged down in the hassles of the moment or give up entirely.

I’ve spoken to a lot of pregnant women over the last few years, and next year will probably spend the majority of my time talking to them once I start obstetric practice, but I’ve never heard of cravings quite as weird as these ones, which were reported in a survey by a British baby food company (from Reuters) :

Raw lemons sprinkled with salt and pepper, gingerbread men soaked in fizzy lemon drink and mustard with chips were among some of the unusual cravings.

Here’s another weird article from ivillage on the same subject - among other things, this woman had cravings for : “vanilla ice cream, chocolate and macaroni cheese smothered in salad dressing, gherkins submerged in chocolate cake, toothbrushes, black shoe polish, and the dust on the unsurfaced road near her mother’s house!” Yet another mysterious woman thing which us mere men will never truly understand…