Baby Boy Prall

Congratulations on the arrival of Miles Matthew Prall, born 1/20/10 at 3:31 pm at 7 lbs 5 oz and 20.5 inches long. Everyone is healthy and well.

Laura McGevna published in NEJM

Congrats Laura!
Laura's image of necrolytic migratory erythema was published in New England Journal of Medicine's web-version on January 7, 2010. Check it out:

http://content.nejm.org/cgi/reprint/362/1/e1.pdf

Internal Medicine Book Club

Winter Book Club: Our residents are getting ready for the February meeting of the book club at Chad Mitchell's house which will include a pot luck and discussion about Thorton Wilder's "The Bridge to San Luis Rey." The Medicine Dept. provides us with $1000 annually for our non-medical book club which usually meets 3 to 4 times a year. Schedules don't permit everyone to attend the actual discussion but about 20 people grab books each time. Recent books have included The Shadow of the Wind, Prodigal Summer, The Glass Castle and The Curious Incident of the Dog in the Night-Time.

ACP CONFERENCE

Congratulations to all our residents who participated in our regional Vermont/New Hampshire ACP meeting at Trapps Family Lodge in Stowe!

Scott Johnson, Anish Amin, and Dan Collins won the Vermont Clinical Vignette competition with their poster "Non-traumatic rib fracture: An unusual presentation of extranodal marginal zone lymphoma."

Sukit Ringwala took first place in the Vermont Research competition with his poster "Platelet suppression with rivaroxaban in patients with coronary artery disease."

For the first time in VT/NH regional ACP history, our residents competed against Dartmouth's in the Doctor's Dilemma (ACP's Jeopardy equivalent). Will Cobell, Scott Johnson, Nick Lim, and Sarah Mooney threw down some serious knowledge, going into Final Jeopardy in a near dead-heat with Dartmouth. With our correct final answer, our team won the competition and now has the opportunity to compete at the annual ACP Doctor's Dilemma, which will be this spring in Toronto.

All in all, a great day in Stowe. Special thanks to our residents who covered services for our conference attendees.

ACP Conference

Our Fletcher Allen residents recently competed in clinical vignette and research posters, as well as in Jeopardy at the regional ACP meeting. Full results to follow!

Congratulations

Memo
To: Faculty and Residents in the Department of Medicine

From: Mark A. Levine, M.D.
Associate Chairman for Education and
Residency Program Director
Department of Medicine


I am delighted to announce that the following second year residents have been selected to the position of Chief Medical Resident for the 2010-2011 academic year:

Zechariah Gardner
Mia Hockett

Both of these outstanding residents completed their medical training here at the University of Vermont. Please join me in offering congratulations and best wishes to them.

Friday Round Up

Grand Rounds: Hospital Epidemiologist W. Kemper Alston MD, MPH discussed Infection control/prevention strategies. It was a very dynamic talk that included FAHC/UVM infection data and National data. Bottom line: Continue to wash your hands

Morning Report: Chief Complaint: Nausea. Dr. Jaquith presented a complicated case which turned out to be Hep A

Intern Report: Chief Complaint: RLQ pain. Acting Intern J. Pare presented a great case of a renal infarct secondary to endocarditis affecting a bovine mitral valve

ECG shows signs of LA enlargment and Right Axis Deviation - Dr. Antkowiak called it correctly

ROMA-Resident of the Month Award

Resident of the Month: For ownership and going above and beyond expectations

Fred Rydz, MD, FROMA:

–He went home post call, kept his pager on, and when a family member called him to discuss code status and goals of care for their elderly relative he talked with them and then CAME BACK IN to talk with the patient again and tidy up loose ends.
–He then came to Board review

Award given: Organic Cafeteria Vouchers for hormone free edibles worth 20 USD. AKA stimulus package.

note: FROMAGE = Fellow of the Resident of the Month Award

Congrats Fred.

Dont forget to nominate residents for next month

MH

NEJM

UVM Medicine is not all about green mountains and maple syrup. The April 9th 2009 New England Journal of Medicine printed an original article titled, "Efficacy of Esomeprazole for Treatment of Poorly Controlled Asthma". This research and article was by The American Lung Association Asthma Clinical Research Centers. UVM's Northern New England Consortium (previously known as Vermont Lung Center at the Universith of Vermont) is proud to be one of the Clinical Research Centers.

Our very own attendings - Drs. Charlie Irvin, Anne Dixon and David Kaminsky - are the co principal investigaters for UVM.  They are one of many academicians amongst our green mountains.  If you have any questions after reading the article, I'm sure they would love to answer them. Just give them a call or talk to them when you see them walking the floors.

Green team is money

Green team:
Led by Drs Rose Christian and Ellie Mueller; Powered by Sukeet Ringwala and Fred Rydz....

Et al surged in the late round of medical jeopardy to win the battle of the wards teams.

After wiping the sweat from his brow, Fred stated, " it was touch and go for a moment with the buzzer having a mind of its own ....luckily Ringwala stepped it up and we were able to take the win". Fans noted that the team won by knowing the answers to actual medical questions, a rare occurance.
Sent via BlackBerry by AT&T

Match Day

Paula Borah (pictured above) danced a jig and welcomed in our new interns. It was close enough to Paddy's Day, where she downed some water of life and read out the list. Unfortunately, she called every male Joseph and every female Mary. Either way, here is the real list:

Welcome incoming interns:

Anish Amin, U of Dundee, United Kingdom. home of Sir James Black (Nobel prize in Medicine), seated in the "City of Discovery"
Anne Bantle, U of Minnesota , home of the Golden Gophers
Jason Brazelton, U of South Alabama, home of the Jaguars
Dan Collins, U of Utah, home of the Utes
Scott Davis, U of Vermont, home of the Catamounts
Alison Fitzgerald, U of Vermont, home of the Catamounts
Emily Glick, U of Vermont, home of the Catamounts
Carl Henderson, UMDNJ, home of ?? - perhaps strip malls or the Camden Riversharks (you'll have to clarify this when you get here Carl)
Laura McGevna, U of Vermont, home of the Catamounts
Brian Monroe, U of Illinois, not home of Chief Illiniwek
Elizabeth Nimmich, U of South Carolina, home of the Gamecocks
Mitchell Nimmich, U of South Carolina, who's motto is "Learning humanizes"
Glencora Pontee, Ben Gurion U, home of...David Ben Gurion (Israel's 1st prime minister)
William Prabhu, SUNY Upstate, home of the motto "Let knowledge grow from more to more; and so be human life enriched"
Mathew Prall, U of Utah, home of the Utes
Nathan Rosenberg, U of Vermont, home of the Catamounts
Jadwiga Stanek, Jagiellonski U, home of Copernicus
Kirk Wangensteen, U of Minnesota, home of the Golden Gopher

Some remain Catamounts, others become Catamounts, "What's Missing?"

Now we're "all one" (shameless references to Fletcher Allen's newest advertising campaigns)

Paula can't wait to meet you.

From the Archives

I found this nugget of history in a useless folder, buried deep in the electronic bowels of the Chief folder. It dates back to when Erik Rufa was chief (now Hospitalist Attending) and when Nate Madsen was a resident. (now Cardiology Fellow). Thousands of years from now, I wonder how historians will analyze this? I suppose it depends on if ties were still in fashion...or if the Star Trek unitards will be dominating 5th Ave....Youngstown OH (In the future, NYC will have reached its prime, and the city that never sleeps will be Youngstown)

Maybe alien life forms are scouring for other life and will intercept this video. How will they interpret this film? Will there fake gesture of friendliness be tyring to have a "tie race"? Only time will tell...or we'll forget about it and feel bad that we didn't delete it....

Yes It Happened

As with much of the world, UVM/FAHC celebrated the inauguration of our 44th President and Vice-President: Barack H. Obama and Joe R. Biden. The mood at the hospital and our residency was excitement. Political affiliations, Red Sox, Yankees...all were put aside...


The hospital televised the inauguration in Davis (The "big" Auditorium near the med school). Not only did staff clamor to Davis, our residents went to enormous efforts to transport patients to experience the celebratory vibe as well. Needless to say, all televisions were on at 1205. The theme of the inauguration was, "A New Birth of Freedom," commemorating the 200th anniversary of the birth of Abraham Lincoln. Placing his hand on the Bible once used by Lincoln, Barack Obama took the Oath of Office at 12:05 p.m. on the steps of the U.S. Capitol.

As most readers know, 75% of eligible Vermonters showed up to vote with 66% of them voting for Obama/Biden. Needless to say the enthusiasm for our new president is high, especially with our very own Gastroenterologist Peter L. Moses MD, Professor of Medicine UVM COM and Associate Vice President for Network Development FAHC. Ever since the election, Dr. Moses literally has been hanging out with now President Obama (see below).
"Barack, has always got my back...." states Dr. Moses, "mostly because I put him in the corner next to my chair". We briefly discussed politics with Dr. Moses:

IMVermont: What political party do you affiliate yourself with?

MosesMD: I respect all people, no matter what side of the ligament of Treitz they stand on...

IMVermont: Ok....what did you think of....


MosesMD: (click here for background music)

Oh, say can you see by the scope’s zenon light?
What so proudly I sail at my amazing cancer screening;
Whose broad polyps and AVMs, through the perilous scope,
O’er the monitors we watched were so briskly bleeding?
And the mucosa’s red glare, polyps excised with no care,
Gives proof to the scope light, that intact colon wall was still there:
O….Say does that pedunculated polyp yet wave (not)
O’er the land of the cancer free and the home of the saved?

God bless Barack Obama and God bless the
United States of America.

IMVermont: Dr. Moses…that was amazing…Barack is still smiling....

Please note that Dr. Moses probably did not use the words above to express his happiness and patriotism...But trust that he was one of many that celebrated in the peaceful transition of power and a new birth of freedom....

Remember the Holidays?

As the holiday season is over, we all are "fa la, laing " back into our middle management jobs, interviews, research, fuller pants, emptier pockets, vitamin D deficiency and [oh yeah] patient care. How does one cope with the post holiday blues? I tried to consult Psych for answers, but had to wait 14 months for an appointment.


Some options that I came up with are: 1) an SSRI 2) full spectrum light bulbs 3) extreme caffienation 4) Skiing till you get rhabdo 4) Daydreaming and live in wonderful memories of the past.


(click here for Jethro Tull's background music for this blog).


I will briefly be concentrating on #4. Tuning out is not an uncommon phenomena in hard working residents. It's like sleeping with your eyes open. A resident can tune out at any moment: during morning report, rounds, noon conference, patient interivews, and even while reading this.... They may tune out to streaming colors, mock wrestling matches between celebrities and comic book characters, or talking animals doing human jobs with surgically enhanced puppets as their assitants.


What memories of the past would residents have to reside in to break away from the dredges of hospital life? Memories of the holidays are be a viable option. If you have the post holidays blues, the high must of been holiday related. A few examples of the memories this program has 1) the holiday party 2) being somewhere else and not working 3) new additions to our family


1) Our holiday party: thrown at Three Tomatoes, on Church street was an evening with appetizers, drinks, and music. Of note, more interns came out versus the previous holiday parties (the one applicant reading this will find this fact comforting). The night progressed late into the night at 1/2 lounge. When asked about this the next day, intern Mary Ellen Antkowiak described the party as, "memorable" in between bites of intern report provided greasy pasta,mountain dew. and cookies (cookies alone could be something to daydream about...)


2)Places we've been: This entry is specifically for Natalie Sinclair. Remember when you were in Australia? I'm not sure if Natalie will be daydreaming of what's below as she Night ICU's it up. Note that Natalie does not sponsor Coke Zero....




3) New additions: Our residents are greatful for adding to the family. Over the holidays, there were new births:

R1 Scott Loomis and wife Artegmis welcomed baby Anitgone Loomis (above)

R1 Will Cobell and family welcomed baby Boston "the Boss" Jay Cobell (above)

R2 Zech Gardner and Jaina Clough (former resident, now fabulous primary care physician) welcomed Cal Gardner (above)

So...plenty of reasons to break us out of the post holiday doldrums. Warm thoughts of social occations, family, travel all wrapped up while we work. These are just some examples of what we weave into our minds as we help others cope with their own blues....

Silly Husky...doesnt he know he cant suture? And why do Burt & Ernie keep falling down? They look more top heavy than I remember....Sorry tuned out. Go ski.

Return of the Peros

Jim Peros, UVM IM resident alum - class of 2007, surprised us with an impromtu visit. It was nice to see a familiar face and someone who helped shape this middle manager's residency education.

He is currently working as a hospitalist at the:

Kaiser Permanente South San Francisco Medical Center. Click to see his Jim's KP homepage and a description of his hospital.

Jim describes a large part of his community to be an immigrant Filipino population.

His fav procedure is the thoracentesis.

His schedule consists of 10 to 12 weeks blocks, in which he works an average of 40 hours per week / 10-12 weeks. This includes:

• 6 weeks of inpatient rounding/discharging


• 2 weeks of solely admitting inpatients


• 4 weekends are worked during the 10-12 week block


• 1 week of working nights - where he triages in the ER (ICU vs general wards), crosscovers inpatients


• 2 weeks off

When asked how he felt about the "real world" after residency, he reported feeling:

"Well prepared and comfortable to deal with any crazy situation...I've encountered a lot of crazy situations"

Hope you're well Jim.

Lock n Load

Note: the following stories, and quotes may or may not be true....

Recently residents, medical staff, and significant others came together with a common goal. What cause was so important to bring such a group together? World peace perhaps? Maybe strategies to reduce our carbon footprint? Close... It was for the ability to harness compressed air and simulate warfare with the Colchester Paint Ball group. Like anything in VT, it proved to be a very organic experience...



Above, Group Shot-
Top, left to right: Armin, Pierre, Dave, Phill, JC, Suraiya, Sahir, Perki, Lynda
Bottom kneeling Left to right: Jen, Maruf, Axel, Shalini



The day began early...Phill "Warrior" Anderson III, cardiology fellow by day...and night, who provided inspiration for the outing, walked into the compound silently and confidently. Upon entrance, he kneeled to the ground, ran scoops of clay soil through his hands and muttered, "I love the smell of vegetable oil based polymer in the mornings..." He then got up with purpose and carefully wrote down all our names in a small paint soaked black book, labelled 'Martyrs'. After coldly staring into each participant's eyes of his victims lives. He then assumed the yogi position and awaited to become one with the paint...

Upper Level Medicine Resident Lynda "10 Cane" Tilluckdharry also came prepared for battle. When asked what her game plan was, she politely yet sternly stated:

"I wore fluorescent pink today because I'm that good....It's also in honor of the 'Where's Waldo Book Series' and the Trinidadian Army"


The group was divided into two. With the lines drawn, everyone geared up at base camp, with 3000 psi of compressed air, trigger fingers and dreams of bruising. Multiple battles, proctored by the wonderful folks at Colchester Paintball, ensued as the morning went on.

Interventional cardiologist, Perki "Call of Duty" Gogo, had one the higher kill counts. He commented on the fact that paintball reminded him of being in a video game. "My love for video games is the reason why I went into interventional cardiology" He said, "I like fake shooting fake people almost as much as I like shooting the cors ..."

One of the highlights was a simulated all out Spartan inspired run-through attack on one of the pine ridden battlefields. FP attending, Sahir "tofu tornado" Patel led the attack and nearly raised the winning flag. Unfortunately, the attack was more Lemming like than Spartanesque and the opposing team eventually regrouped and painted liberally...There was also unfortunate friendly fire: Sorry Perki....

Representing the surgical specialties, Armin "10 blade" Kiankhooy and Dave "Faceoff"Gawlik worked well together to get a high paint/kill count. It was almost as though they choreographed their maneuvers. When asked how they came to be so in sync with each other, Armin replied:

"Our success comes from working extremely long hours mimicking prime time TV sensation 'Dancing with the Stars'. We practice at home or in the OR....occasionally with tan unitards".

Promptly after Armin's statement, Dave blurted, "You've said too much!" and shot Armin closer than the allowed 20 foot minimum distance.

Anesthesiology resident, Jen "Dream Killer" Hay was calm and collected as usual. Though it was her first time in the trenches, she was usually one of the few remaining at the end of battle. When asked about her experience Jen replied, "I'm not sure if I like all this kneeling and crouching...I prefer aerosolized warfare...its much more efficient."

Pierre "Je me souviens" Znojkiewicz, Cardiology Fellow and Montreal Canadiens fanatic, looked for inspiration. Despite having techno and red bull coursing through his veins, he could not decide to do it for his country or his team. Helped by his trusty Québécois sympathizer - JC - they decided to put the Quebec flag on their victims faces. They then forgot to do it midway through the battles, techno still blazing....

Axel "stor våpen"Bendiksby was one of the first to inflict bruises secondary to his incredibly efficient infiltration tactics. The viking commented on his success by saying, "I trained in the Norwegian army...those UN missions really prepared me for this...."

Medicine Intern, Shalini "Red Ninjal" Jha, was just happy to be somewhere other than Baird 4 (our fav Medicine Ward) . It should be noted that she deserves the "Coolest Intern to come to Paintball" award as she was the only intern present. I guess most of the interns don't want to simulate warfare or cause any pain to their residents. It supports the idea that Vermont residents are nice (except Shalini's resident)

At the end of the day, the entire group now one with the earth and paint walked off into the horizon. They celebrated with beer, chicken wings and nachos at a local establishment. I believe world peace and carbon footprints was discussed for at least a few minutes

You down with ACP?

Oct 24th was our local Vermont Chapter American College of Physicians meeting (ACP) in Stowe, VT at the Von Trapp Family Lodge (yes they're real - click the link to determine if Maria looks like Julie Andrews). The hills were alive with the sound of poster and oral presentations. There were a total of 8 accepted Resident Poster Clinical Vignettes, 2 Resident Oral Presentations, and 3 Medical Student Posters. Our hard working residents were given time off their respective services to flex their academic prowess. Congratulations to our two winners (pictured below) :

Resident Poster winner: Nathaniel Price (Can I get a 3-peat?)

Resident Oral Presentation winner: Mia Hockett

Resident Participants: Chad Mitchell, Phil Skidd, Nate Thompson, Nick Lim, Alison Jaquith, Emily Anderson, Ellie Mueller, Natalie Sinclair

Nathaniel and Mia will be representing UVM at the National ACP meeting in Philadelphia at the end of the year. However, one could argue, that everyone was a winner: they all witnessed Attending /Assistant Program Director Mark Pasanen sporting a tie and sports coat for the first time in their known residency career ( he is also pictured above introspecting on the "Rock of Maria"in the background of foliage).

(Mia giving a thumbs up and Nathaniel giving the "why are you taking my picture again" pose)

Hope you're well Lena

Dear Lena,

Now that you've been around for almost a month, we were wondering how your parents were doing? Your mom takes her time, meticulously analyzing patient history and data to synthesize a perfect patient care plan. It is only appropriate that you took your time (22+ hours) to descend into our world. Let us assure you that you made the right decision. When all 6lbs 10oz of you saw your beaming parents on Friday October 10th @ 2131 we can only imagine your happiness.

We trust that you are having a blast and still sleeping during the days and bringing in the "Noyes" at night. It is very considerate of you to recognize and try to simulate your mom and dad's "love" for overnight call and night float. At 3am you should say "hi" to your parents for us and tell them that we miss them.

Goo goo, ga ga and all that jazz.

UVM IM congratulate Mike and Cindy Noyes on their beautiful baby girl: Elena Noyes.

It probably should not be called maternity leave, but q24hr call.

Tour De Zech....

Resi-cyclist Zech Gardner rocked out in the Green Mountain Stage Race Citizens stage. It entailed 75 miles from the Sugarbush Resort to Brandon and back up to finish at the summit of the App Gap (Appalachian Gap) . When asked about the hardest part of the race, most racers mentioned the 4.4 miles of steep downhill. Zech mentioned that at mile marker 74.6 there is a "Caution - Moose Crossing Area".
"That was really hard because I really like moose...they really are the monarchs of the North woods. Since I'm one with my new awesome bike I'm so fast, I would not want to hit one" (Click here to find out why moose is plural for moose) (Zech may not have said the above quote - though I can assure you that he likes moose)
Zech employs the fast cadence approach to mountains versus the power approach. Lance would be proud. Zech also is an official editorializer, specializing on "Sharing the road with cyclists" with the Burlington Free Press. Click on link: Zech, Resident, Cyclist, Editorialist

Gina had the glasses before Palin

One of our wonderful Clerkship / Residency Coordinator Gina Sears recently sported the "Sara Palin look". When asked why she was celebrating Halloween early, she responded with "I can't see Russia from my office, but I can see students and residents rushin' to get to meetings". As she helps us stay coordinated, she states

"I had this look before Palin even thought about being Mayor..I think it should
be called Gina Sears look..."

Gina is one of the people, along with Paula Borah and Dottie Shelc that keep our residency running and residents happy. She always ends her emails with a happy face. Next time you rush past her office, slow down and say hello. Whatever you do, dont call it the Sara Palin look. (Note that all quotes were not actually made by Gina, though she approves). Also, FYI, Gina is holding a grass roots campaign. Click Here