Jasper the Pill-Popper

Poor Jasper's cut is healing beautifully, and he is barely limping any more.

Unfortunately, the vomiting I wrote about over the weekend turned into a few days of very little eating at all. He seems to have some stomach irritation, probably from the combination of the antibiotic and the painkiller. (This happens to people, too.)

I called the vet yesterday, and they advised waiting one more day to see if the eating picked up since he'd just finished his antibiotic course. He ate a cup of his kibble last night, and I thought we were out of the woods, but he went back to not eating today. Off we headed into the vet again this afternoon.

They were once again very kind to our shy boy, and Jasper was actually very brave! He got on the scale and on the examining table all by himself, without needing to be picked up.

And now we're home with new marching orders: no kibble for the next couple of days, just very small meals ("the size of a meatball") of 4 parts rice to 1 part cottage cheese, with probiotic powder mixed in. He can have a bunch of those spread out through the day as long as he's tolerating them.

Three times a day, he gets a syringe of carafate/water mixture squirted down his throat. That coats his stomach lining to provide some relief, and has to be given at least an hour before any other medicine.

Then twice a day he gets a Pepcid pill to decrease stomach acid.

So far this evening, he's had a squirt of carafate, then three of his mini-meals each an hour apart, one of them with the Pepcid mixed in. Everything is staying down at this point, and he turns out to love rice and cottage cheese. Who knew?

But YES the hippopotamus!

Our little giggle-bug:

(Thanks, Steph, for the hilarious hippo!)

Get Ready, Get Set...

In anticipation of imminent crawling, I ordered Brynna a set of interlocking foam tiles to provide a nice padded surface to play on. It came yesterday, and she's a big fan:

We have all the letters (which pop out) and numbers 0-9.

Brynna has been spinning herself around and around on her tummy, and scooting backwards very fast. The last couple of nights, Alex and I really thought she was about to crawl during our evening iChat. But she's holding out. No doubt until she can launch herself across the floor and stuff something really icky in her mouth when I'm not looking.

Jasper is making some big contributions in the icky department lately. I think the painkiller may have irritated his stomach, and he's been throwing up all over the place. Including in a pair of my pants that were on the floor waiting to be de-dog-haired.

I know I should just wash them, but they are old and cruddy already, and have a hole in them from being roasted dry on a camping trip, and I am very tempted to throw them out instead...

DMV

As far as I know, no one likes the Department of Motor Vehicles. Long lines, unhelpful staff, a different form for every weird thing...most of us are lucky enough to just have to stop in every couple of years to renew our licenses. I am currently in that camp - my license will expire with my next birthday in a few months. I give them credit for sending me a reminder well in advance.

On Saturday, while running other errands, I decided to swing by the local branch to go through the formalities, pay the required renewal fee, prove to them I still know what a stop sign looks like, and be on my way. I was thoroughly unsuccessful. In our fair city, as far as I can tell, the DMV only operates 8-4:30, Monday through Friday.

In other words, they are open only during hours when I - and 85% of the working class - are toiling away at their jobs. How can that possibly make sense to anyone in a position of authority? I'll probably have to take time off to go over and take care of things. Good thing my job is salaried and flexible - there are plenty of people who risk getting fired, or at least incur a significant opportunity cost, for having to be away from work for such day-to-day intrusions.

Breeding through Detroit

Alex's iPhone allows for quick updates on the run when he is traveling. When I was sitting in class last Friday, and he was making his way from Minneapolis to Manchester, I received an email from his phone with the subject line "Breeding through Detroit."

I sent back an email that I certainly hoped that he was not, since our hands are quite full with our current baby.

We are still trying to figure out why the iPhone auto-correct would think that someone was more likely to want to type "breeding" than "breezing."

Girls' Night Out

Brynna had her first girls' night out on Thursday, heading to the local tavern with visitors Sara (drove over from New York) and Katie (who lives nearby, hurray!). She was a champ, sitting in her highchair and playing with the drinks menu all through dinner. 

I think she's recovered from her shots, though she's still been off her game at times during the last few days. This might be some sort of developmental stage she's passing through. She's been a bit quieter and a bit fussier, but doesn't seem sick. She fell asleep in her crib twice today without being swaddled, which is a big step. Perhaps she is gearing up for her winning attempt at crawling! It's also possible that she is teething, but I've been thinking that for months now, and it's never true.

Brynna's new thing over the last couple of days has been oat cereal. She absolutely loves it! So we'll stick with that over the rice cereal for now. She gobbles down her customary ounce-of-milk-mixed-with-cereal much faster now that we've switched grains. I think I might add in a fruit serving soon. 

She and I had quite a sweet moment this afternoon. She was standing on my lap, facing me, chewing on one of her teething rings. Then she stopped chomping and held the ring out right by my mouth. I nibbled on it and then let go, and Brynna chewed on it for a few more moments, then held it out to me again. We must have gone back and forth like that five or six times. I think she's still a bit young for the sharing concept, but it was adorable nonetheless!

Jasper is also on the mend. His cut still looks awful—it's gaping a bit and will take a while to heal in, especially since he spends a lot of time licking it—but he is trotting around on our walks despite his limp, and he's going down the stairs on his own again. (Which is excellent, as my back could not take much more hefting him around.) I also got him some yogurt yesterday to counteract the antibiotic effect on his gut, and have been mixing it with his kibble, which he turns out to LOVE. 

Here's hoping for a quiet weekend with lots of progress on my school assignments!

The Invalids

1. Brynna

We took Brynna to the Manchester Health Department today for her 6 month shots. I have been trying hard to get her set up with a local doctor, and in fact have submitted the new patient paperwork, but it was clear that it was going to take awhile to get her an actual appointment, so we went this alternative route. She was such a trooper, only crying for a minute or so after her 4 shots (for a total of 8 vaccines: diphtheria, tetanus, pertussis, polio, Haemophilus influenzae b, Strep pneumoniae, hepatitis B, influenza) and oral rotavirus drops. But she is really off her game tonight, despite doses of Tylenol every four hours. It may have nothing to do with the shots, though—it's a very similar meltdown to Friday night's. For now she is tucked up in bed, and I am hoping that a good night of sleep will do wonders.

Also, tomorrow I will not let her topple over like a felled tree and hit her head on the side of her crib.

2. Jasper

Yesterday, Dad was just leaving the house with Brynna and Jasper for a walk when Jasper spooked at something, pulled free, and took off. The big problem was that when the heavy plastic handle of his leash started banging along the street behind him, it freaked him out even more. He ran out of sight, and may have actually dashed all the way around the block, before he reappeared from the opposite direction and ending up cowering against the door, tangled in the leash. He hid under the table all day, and was limping noticeably after his evening walk with Dad. The problem seemed to be his right front leg, and I checked his paws and felt each leg carefully for swelling or a lot of tenderness or an inability to bend. I even wiped a washcloth over him to see if there was residual bleeding coming from anywhere, since he was licking that leg a lot. (Keep in mind that Jasper has 3-4 inches of dense hair all over, which meant I couldn't see his skin anywhere.)

He was limping but not in dire straits, so we decided he didn't need a nighttime visit to the pet emergency room. I took him out for a walk this morning—still limping, and had to carry him down the long flight of stairs—and then called a local vet as soon as they opened and got him an appointment to get checked out. I thought he probably had some sort of sprain or strain, but didn't want to overlook anything. 

Then, as I was below him on the stairs, trying to coax him down to the car to go to the vet, I saw it. The ENORMOUS GASH on his right shoulder. Well, maybe not enormous, but a couple of inches long, anyway. Surrounded by matted hair where he had been licking for 24 hours. It was just under the point of his shoulder, which I guess is how I missed it, in combination with the volume of hair and lack of good light in the apartment. But, jeez. I know my patients aren't going to be quite as hairy as Jasper, but it sure made me feel terrible that I had missed this cut!

The vet tech and the vet were very gentle with our terrified pup. His shoulder was shaved and cleaned, but no stitches since it has been more than 24 hours and the cut doesn't go into the muscle (this would be the same for humans, too). He also had an x-ray just to make sure that his tenderness wasn't due to a fracture. All clear, thank goodness. And then we were sent home with a week's worth of antibiotics and a week's worth of the doggie equivalent of ibuprofen, which Jasper happily gobbled down in big chunks of Cabot cheese (no, not the clothbound, $20 a pound stuff. Hunter's extra sharp.) He is limping a little less and did some trotting on our evening walk, so I think he'll make it. 

3. Dad's car

This one was not my fault. And it's been fixed now. Yay for the local Subaru place!

So, as you might imagine, between the baby doctor, the doggie doctor, and the car doctor, I haven't gotten much done today. Productivity is also apparently diminished by feelings of extreme guilt re: dog and baby. Back to the grind!

Brynna's First Hike

The moose family decamped to the White Mountains for the weekend, basing ourselves out of the lovely Nereledge Inn in North Conway. We started off our mini-vacation with a wonderful meal at Flatbread, just a quick walk up the road from the Inn.

Parental attempts to catch up on sleep were foiled by Brynna on Friday night. Completely out of character, she screamed and screamed and screamed, clearly in some sort of distress (tummy? gums?). There were serious midnight conversations about leaving and driving back to Concord because we were feeling so bad about the noise waking up other guests. After much rocking and shushing and many false starts when we tried to set her back down, we succeeded in putting her to sleep between us around 2:30 AM.

She woke bright-eyed and bushy-tailed, though (in contrast to her parents). It was a bright, sunny, warm (20s to low 30s) Saturday, and we decided that an attempt on Mount Willard would be reasonable. Mt. Willard has the best views for the least amount of work (about 1.4 miles to the summit, with a gain of about 900 feet) in the Whites.

First, we had to get Brynna suitably bundled up. First, an extra fleece sleeper:


Daddy, when you and Mommy say "we're going on an adventure," why does that always mean taking me out in the cold?


She doesn't seem to mind too much, though:


Then came her Baby Buff neckscarf and some additional help for warm toes:


Brynna had a nap on the drive over to Crawford Notch, and then it was time to add her Dartmouth bunting on top, along with another hat, and my Buff, and to snug her into her backpack. Here she is with Alex, trying to hitch a ride on the railroad:


At the trailhead:


Demonstrating the little mirror that lets Alex keep an eye on her:


We got about halfway up when Brynna started to fuss a little. We checked her hands and found that they were a bit chilly, so we decided to turn around. It was a quick zoom back down to the warmth of the Highland Lodge.



After some hot chocolate (me), coffee (Alex), and warm milk (Brynna), we drove up the road a bit farther to the Mount Washington Hotel. It was such a beautiful day that we couldn't pass up the chance for a great view of the Presidential Range.



It was just wonderful to be in the mountains again!

More work around the house

I've not posted in a while, and there's a fine reason for that: my life in Minnesota is a little dull these days. Aside from work, sporadic hours at the gym, and figuring out novel ways of cooking for one, my main focus has been on doing odd jobs around the house. This past week has seen a flurry of activity. I've moved on from carpentry to electrical and plumbing.

Last weekend saw me on hands and knees chipping away the old, dried-out caulking around the tub and putting a new bead down. Then there was half dismantling the toilet, cleaning the heck out of every visible surface, reassembling it, and tightening the bolts that anchor it to the floor, followed by, oh yes, more caulk. In the kitchen, there's been a tricky bit of work for the drain. When I put the dishwasher in a few years back, I needed to splice in the drain hose for it into the main drain under the sink. No problem, this happens all the time; they even have special Y-fittings for it. Unfortunately, to get it to work meant that I had to reverse the ends of the J-shaped trap pipe segment. The reason that's unfortunate is that that pipe isn't meant to be flipped around, and one of the two connections has always been a bit touchy. So yesterday I tore away the duct tape, sheet plastic, and plumber's putty wrapped around it and re-did it properly. Or, at least, a bit more properly. Some clear caulk (yes, that again) on the one problematic joint should help keep it water tight.

In the electrical realm (definitely not to be mixed with plumbing), I've been doing some rewiring. There are two outlets behind the kitchen countertop that I have recently upgraded to GFCI (ground fault circuit interrupt) outlets. You usually see these installed outside or near water - they're the kind of outlet that is supposed to keep a dropped hair dryer from electrocuting you in the bathtub. A GFCI monitors how much current is flowing out from and in to the circuit. If everything is hunky-dory, the current out should exactly equal the current in. If there is an imbalance, it means that there is current flowing somewhere else - like through you. In that case, the GFCI trips and disconnects the circuit. One of the outlets I replaced with a GFCI was properly grounded; the other was not, which forced me to do a lot more rewiring than I'd planned. The upshot is that the microwave is now downstream of a GFCI, and therefore will get the same protection. If this were new construction, these outlets near the sink would be required by code to be GFCIs.

Down in the basement there was some more electrical work. As it turns out, the washing machine was plugged into an older type of outlet - the kind with only two slots, instead of the more modern three contacts. Why does this matter? That third contact, the round one centered below the two slots, is there as a safety measure. In appliances, it's called the case ground or protective earth. If a wire comes loose inside the device and touches the (metal) case, the protective earth will prevent the case from being able to shock you - usually by causing the circuit breaker to trip. For a large, metal-cased appliance that handles water - such as a washing machine - this is considered an essential safety feature. So the fact that it had been plugged in this whole time using a cheater is, in hindsight, a bit disturbing. That outlet was replaced with a spankin' new GFCI, too. However, the old plug was wired up with old electrical cable - the kind with braided cloth insulation - and only had two wires. The GFCI needs three, which meant I needed to string a length of new cabling from the new outlet back to the circuit breaker panel. The only safe way to wire into a breaker panel is to shut off power to the panel - cutting power to the whole house. What followed was an amusing 20 minutes of fairly straightforward wiring by flashlight, standing on top of the dryer to get close enough to the panel, but crouched down to avoid hitting the rafters.

There's also the installation of another carbon monoxide detector (in accordance with a MN law that recently went into effect), ditching the incandescent lightbulbs in the closets (they can get too hot, and potentially ignite any clothing that falls on them), cleaning the dryer vent duct, then resealing it with foil tape (duct tape doesn't actually work well at sealing ducts), and replacing a few outlet cover plates that had broken or disappeared.

Given the length at which I have now gone on about these DIY tasks, one could wonder whether the length is due to proud exuberance, or just a rant about all this work. Thankfully, it is the former. When I am able to flex my handy skills - and actually have it come out right - I get a good feeling about home ownership. DIY handywork and engineering don't overlap quite as much as one might think, so it's good to branch out. On the other hand, when it comes to some of the electrical wiring in this house, I sometimes just have to shake my head and wonder how we avoided burning ourselves to a crisp long ago. Braided cloth insulation! I ask you!

A Contagious Yawn

Brynna and I shared a long, delicious nap this morning (I was home for the day, studying for my midterms).

When we woke up, I stretched and yawned...and then Brynna yawned back!

I'd been wondering when this might happen. She has always been able to make us yawn, but the connection didn't work the other way.

Thanks to the all-knowing Wikipedia, I have learned that yawns are thought to be contagious because of "mirror neurons" in the frontal cortex. These neurons seem to be involved in imitation, and yawning back may demonstrate a capacity for empathy. The idea of imitation is particularly interesting, since six months is generally considered to be a good time to start sign language with a baby, and babies often start signing back around eight months as they gain the ability to imitate and the fine motor skills to move their hands in a precise way. Also, I think Brynna was imitating me opening my mouth as I fed her her rice cereal this evening!

So, many things are afoot in Brynna's little noggin.



What else is she up to?

She is still not crawling forwards, though she can pivot herself around in a circle really quickly, and rolls all over the place. She can scoot backwards also. It is definitely bothering her that she can't go forwards, and also that she can't sit back up when she is on her back.

She can stand holding onto her play table for many minutes without any help.

She loves her swing, especially when we push it so it goes high and fast!



She can almost get out of her carseat (if set in it unbuckled) by herself. Yesterday night we were at a restaurant and she grabbed the post of the chair back and pulled herself out of the seat, almost up to standing.

Her fine motor skills continue to improve. She can hold things independently in both hands, and use her hands together to pick up and manipulate something large, like a big book. She's got a good strong grasp with her fist (the "pincer grasp" of forefinger and thumb develops around nine months).

The rice cereal is going okay, though not great. She has had about an ounce of breastmilk, mixed with the cereal and her Vitamin D drops, every day for the last week. Most days she has half or 3/4 of that from the spoon, and then looses interest in eating, and drinks the rest from a bottle. I am not sure where to go from here—she's at the point where she needs the iron in the cereal, so I don't want to substitute other foods for the cereal on a regular basis. I think maybe we'll do the rice cereal for another week or two and then re-assess! I do think that she is swallowing more of the cereal than she was a week ago, though a large amount of it still ends up on her face and hands. Luckily she has a big smock coverall Grand got from Ikea.



We went to visit Panache the horse last night. I didn't think Brynna would be scared, but Luna loomed up out of the darkness and blew air in her face, and she started to cry. Panache is quieter, but she didn't like it when he swung his face around to say hello, either. Brynna was also frightened of the friendly golden retrievers at the barn. I suppose that makes sense, since she has no way of knowing that they are dogs, like Jasper, who she adores.

Classes in the (Other) Frozen Tundra

Brynna and I are not, in fact, in New Hampshire in order to escape the cold of Minnesota (though it was 48 degrees here on Saturday!)

I am here taking courses towards a Masters in Public Health (MPH) degree. There are two other fourth-year medical students —from Drexel and Louisville—doing the same thing. We are all living in Concord because we also have some clinical time at the family practice residency here, and then we all carpool up to Dartmouth (1 hour away) for class three times a week.

The MPH at Dartmouth is very focused on quality improvement: learning how to define quality in healthcare, how to measure quality and value, and how to present feedback about quality to individual providers and organizations. We are learning from the people who developed the Dartmouth Atlas of Health Care. The Atlas shows that different geographic areas have very different practice patterns: for example, if you have bad back pain, you are far more likely to get back surgery (which is expensive and usually not any more likely to help you than cheaper, more conservative measures) in certain parts of the country—especially parts of the country where there are a lot of back surgeons. As health care costs continue to rise, everyone is concerned about making sure that we as a country are only paying for treatments that have been proven to work, and the program here is full of experts trying to figure out how to improve the healthcare system in that direction!

This winter, I am taking 3 courses, and I’ll take 9 more and also complete a project, kind of like a thesis, later in residency. One current class is a classic MPH course, Environmental and Occupational Health. We spend a lot of time learning about pollution and workplace exposures. This week, a team came from the Vermont Law School to talk to us about some environmental litigation they are working on, and we've also had a visitor from the Maine department of public health to talk about mercury in fish. The big project for the course is a policy paper about a topic of our choice. I am writing mine on BPA, a chemical that has gotten a lot of press recently for leaching out of plastic baby bottles (Brynna’s are BPA-free, don’t worry!). So I am spending a lot of time reading rat studies, since most of the toxicology work has of course not been done in humans.

Another class is called “Statistical Measurement and Analysis for Quality Improvement.” This sounded awful when I first heard about it, but it is actually a great class. We are learning to create and interpret a kind of graph called a control chart, which shows variation in a process over time. By looking at the chart, you can see if a process (like how long it takes for a blood test to be performed and reported back to the ordering physician) just has an expected amount of random variation or if there are special factors (like a new, slower technician or a power outage in the lab) causing a problem. This keeps you from making all sorts of changes in a process when there’s a different explanation, like a new tech, to blame. When you intentionally make a change in a process (like buying a faster blood testing machine), analyzing these charts also lets you see if the new machine has made a difference by lowering turn-around-times.

Brynna is fascinated by this class as well:

(or at least by the colorful textbook cover)

The last class is Strategic and Financial Management of Health Care Institutions. Taking this course is a lot like going to the dentist. I know I should, and I know it’s good for me, but it’s not that nice. The first half has been essentially an entire accounting degree in five weeks—we’ve covered financial statements, accounting t-tables, ratios used to assess the financial health of companies, budgeting, and so on. Painful! (But also useful.) I’ve had to make flash cards to prepare for the midterm, a task I thought I’d left behind now that anatomy and pharmacology are over. The best part of the class is the guest speaker who comes during the last hour of each session. This week, it was Dartmouth-Hitchcock Medical Center’s Chief Financial Officer. It was fascinating (and a bit scary) to hear him talk about how the current financial crisis is affecting DHMC. We’ve heard from the CEO of New London Hospital, which has really turned itself around over the last few years, from a woman who is uninsured and bargained down the price of her husband’s prostatectomy, and from a family doctor who now works for an insurance company in Minnesota.

So, classes are keeping me really busy, which is good, because otherwise I would just mope around and miss Alex. Brynna gets super excited when we iChat with him every night. She grins at the camera and makes happy shrieks and waves her arms around. I think it’s just in the last few weeks that she has learned how to identify his face on the screen, and respond to it. It’s not just his face, though—last night I was nursing her before bed, and when I finished the book I was reading to her (Madeline), I turned on one of the Sandra Boynton recordings that Alex had made her. She immediately stopped nursing and craned her neck around to look at the computer, so I sat her up on my lap. She stared at the pictures on the screen (Alex scanned them in from the board books, so the pages show up as he does the voice-over) and smiled and chuckled along. In four days, he’ll be reading to her in person!

Our Little New Englander

Brynna seems to be adjusting well to New Hampshire life.

She wears her Dartmouth gear with pride:

Is always ready to take her puppy for a walk:

And doesn't seem to mind a little dusting of snow:

She also enjoys small-town life, where you can run into someone familiar in the grocery store:

She may, however, take too much pleasure in lounging around to be a true Yankee:

In short, she's thriving! I'm working hard for my classes (midterms next week), and we're really looking forward to seeing Alex next weekend.

A little carpentry

While H and B are off in New Hampshire, I am hardly kicking back. (Nevermind that I'm writing this while watching the Super Bowl.) The house is in need of much cleaning, and a little repair, too. Three weeks ago I shampooed the carpets, this past weekend I was working on a bit of carpentry in the kitchen. More on that when it's done.

Two weeks ago I did a bit of woodwork to cover the transition from carpet to hardwood floor at the base of the stairs. When I refinished the hardwood floors a couple years ago, I tore out the carpet on the first floor. However, silly me, I cut the carpet all the way to the far side of the door jam leading upstairs. The floor underneath, for the width of the door jam, was just planks, not hardwood. Plus, I now had a raw edge of carpet just hanging out.



So, we've been needing a piece of wood to tack down the edge of the carpet and extend to the hardwood floors for, oh, about 3-1/2 years now. I just got around to it two weeks ago.

It wasn't exactly an easy job, mind. The profile of the door jam is not regular, nor is it symmetric left-to-right. After ruining one piece of oak, I decided that I might have better luck making a paper template to test my measurements.



To better illustrate the asymmetry I'm taking about, here are the right and left cutouts laid side by side.



To make matters a bit worse, I was doing this work during the recent cold spell. I did not relish the idea of trying to use my table saw in the garage at 20 below, so all the cuts to rough-cut the plank had to be made by hand. Aside from my own comfort (frostbite is no fun), I wondered if the cold temperature would have turned all the saw's lubricants to glue, or made the saw blade dangerously brittle.

So, hand tools all around. I made the profile cuts with small japanese pull saw, then finished with a small chisel. It ended up being a snug fit, but just right.



A little router work to radius the edges and create a lip to overlap the carpet, some stain and polyurethane, and I'm done.

Happy Birthday, Brynna!

Yesterday, Brynna was 6 months old!


And look, she was 5 months old before that, but her parents didn't upload the picture from New Year's Eve:
(Andy, Nicole, Sara in the back, Ellen and Todd in front)