Sunday, 31 October 2010

Changes to the NSW Feed-in Tariff (Solar Scheme)

From October 28, there will be changes to the gross feed-in tariff such that it will be 20c per kW generated, as opposed to our 60c.  This will be effective for all those systems installed after 27 October 2010.  Fortunately the changes don't affect us, but I wonder what this will do for the solar industry in NSW.  Perhaps it will continue but at a slow pace?  Or maybe it will grind to a halt?  Well whatever happens, I'm just glad that we got our system.  However, perhaps if I had waited a bit longer I could have gotten a cheaper system.

Thursday, 28 October 2010

Travelling with Children

The time is coming up soon for working out what exactly to do as a trip for my sister's wedding.  Because I have a conference in Hong Kong afterwards, we've been trying to figure out what to do for travel because of the kids, not wanting them to have an overly long trip.

So far the plan is to fly to Taiwan, then fly to Vegas, then fly back to Taiwan then I go to Hong Kong and then back to Taiwan and then we all go home together from Taiwan.

Hubby thinks it's too hard to take the kids out, so I suggested we leave Julian in Taiwan with his mother.  He thought that was a great idea.  However, he mentioned in passing that his mother was worried about looking after Julian.  I mentioned that to my mother and she thought perhaps subconsciously she doesn't want to look after Julian, and is only doing it because that is what we wanted her to do and she feels like a bad grandparent if she doesn't do it.  I mean if you asked, really would she say no?  And not to mention hubby's grandmother is quite unwell, how would having Julian around affect that?  And if she couldn't cope would she be calling us in Vegas to come back and look after him?

One of the things that was also pointed out was that if hubby's mother really wanted to spend time with the grandchildren, she would have come back to Australia.  Even to visit, for a short while.  But she hasn't and she has missed the kids birthdays and they won't be small again, so maybe she doesn't want to look after them.  She also has her own health issues too, she has a chronic pain problem which flares up every now and then, so would that also impair her ability to care for Julian?  Of course I can't bring up these issues with hubby, he would be offended that I think his mother couldn't care for Julian as well as my mother, but it does seem to highlight the fact that she doesn't spend much time coming to see them, though she does see them on Skype every day.  Which is the opposite to my mother, she doesn't get to see them on Skype every day.

Twisted ankle

Yesterday I tripped over the driveway at Nanny M's house and rolled my ankle - now I have a twisted ankle and boy is it sore!  Yesterday morning it was ok but by the afternoon it was so sore!  I RICE'd it yesterday when I got home.

I'm scared to carry Julian and Erika on the stairs now because of my buggy ankle.  I don't want to fall!

Wednesday, 27 October 2010

New video card

My video card has been playing up lately.  I went out on Sunday and bought a GTX480 but I haven't installed it yet.  I should have done it - the longer I wait the price might go down!  I wanted to get a Gigabyte one but they only had an Asus one left.  I've noticed more crashes lately with the video card... I hope I can last tonight.  Maybe I should install it tonight after the kids go to bed.  But I don't want to miss raiding tonight.

Julian's walking

Julian has really taken off with his walking!  He's been walking everywhere, and doesn't need much assistance at all.  Unfortunately Erika likes to push him over when he's walking and we have to tell her off big time!

He fell a few times on Monday and ended up with blood coming out of his mouth - 3 times!  Poor thing, he looks like he bit his lip.

He's also down to 1 poo a day, and last night he was awesome - he slept till 545am!  And he went to bed quite early too (715pm).  He's been pooing around lunchtime.  So I guess having no upset tummy has kept him asleep!

Wednesday, 20 October 2010

More medical behaviour I don't agree with!

Geez this blog has turned from being green and kiddy related stuff to work whinge!

I was doing the acute pain round yesterday and there was a man with a supraclavicular block/catheter for his hand - he had a reimplantation of a few fingertips which was a work related injury.

The patient actually wanted the fingers terminalised but the plastic surgeon decided to try to reimplant the fingers.  And why do you think that is?  Because the patient is workers comp - which means $$$.

So the patient was complaining about his numb arm and I had to tell him that we leave the infusion for about 3 days to help perfusion to those fingertips, and the patient was grouchy because he just wanted to go home.  He was also having leech therapy to keep the blood thin in those fingers as well.

I was talking to one of my registrars yesterday who told me that he received a call from the anaesthetic consultant on call in the afternoon saying that he was coming in for a reimplantation of fingers.  The registrar was surprised because it wasn't on the Emergency list, and so went to the Duty anaesthetist who also didn't know about the patient.  A few minutes later there was a call from the plastics registrar who booked the case.

So the consultant anaesthetist was in, and told the registrar to put an art line in but he didn't care who put it in... and then I suppose he would have sent off some gases as well so you could claim serial ABGs.  I asked if they put BIS on and of course they did, and it would be paid because it was a trauma (therefore high risk - though in reality totally NOT high risk because it's not really a trauma).

So is it ethical to put in extra things that you don't need because you will get extra (a lot!) money for it?  Like SERIOUSLY.  If this was just a non work related injury the patient would not have had all these extra interventions.  It annoys me that people put extra things into workers compensation because of the extra money, and it seems like a total rort to me.  Would I do those things?  I don't think I would put in an arterial line or do gases.

This is such a small whinge, people will wonder why I whinge about it when there is extra money.  But to me this is unethical behaviour.  For monetary gain.  There was a young 15 year old boy who died earlier in the year, who had his arm ripped off in some machinery accident - 2 specialists said terminalise the limb but the plastic surgeon decided to try to reimplant it.  The boy died because of a transfusion related lung injury, an idiosyncratic thing which would not have happened because he wouldn't have needed so much blood products if they had just terminalised his limb.

Monday, 18 October 2010

Julian's first birthday

Had a dinner birthday party for Julian for his first birthday.  I even made my simple and boring carrot cake with a bit of icing on top and cut the words out of soft carrot... looks so bodgy!  But definitely homemade!

We also had a variety of other foods including oysters, lobster, chicken, roast pork, a mushroom vegetarian dish, and sashimi salmon.  I got Julian to sample the lobster, chicken, roast pork and sashimi, and Erika ate them all as well.  At least my kids know good food when they eat it.

We did presents afterwards and he got a Wooly Rhinoceros toy from me and Ivan, he got pants from HK and he got a toy piano/xylophone from Nanny M.

He did lots of walking and seems to be a lot more confident in his walking, walking fair distances now and even sometimes walking unconsciously from the table to the window or the chair.

Saturday, 16 October 2010

Total spinal and a missing Laerdel bag...

I was on call last night and I got a call at about 10pm from MC who was the registrar overnight telling me he had an issue that I need to know about.

He did an epidural on Labour ward, and he had given her a test dose of 3mL of 2% Lignocaine with Adrenaline, and he waited what he thought was a reasonable period of time and then gave her 5mL of Ropivacaine 0.2%.  After he finished injecting the 5mL she stated that her legs were heavy and numb, which rapidly progressed to not feeling well, then unable to move her arms and then difficulty breathing.  He had laid her down when he injected the 5mL of Ropivacaine, and when she felt unwell he did a BP which was 80 systolic.  He then gave some aramine from the drawer and when the patient complained of difficulty breathing he asked the nurses for a Laerdel bag, and the nurses pushed the Emergency button as well.  They came back with the arrest trolley but were unable to procure a Laerdel bag, by which stage the patient was really unable to breathe and oxygen saturations were dropping.  MC stated that he explained to the patient that he would have to breathe for her and had to perform mouth to mouth whilst waiting for a Laerdel bag.  The MET team arrived and he asked them for a Laerdel bag and they didn't have one on them, the trolley was coming in the lift.

O+G registrars turned up and he informed them that they would need theatres urgently and the anaesthetic nurse arrived from theatres with a Laerdel bag and intubation equipment and then the patient was anaesthetised and paralysed and intubated.  They proceeded to LSCS and the baby was born fit and well, and they transferred the mother up to intensive care, by which stage she was spontaneously breathing and awake and obeying commands and extubated.

MC said he had to perform mouth to mouth for about 5 minutes!!!  And the husband was present when he first started to do mouth to mouth and was freaked out.  MC went to ICU to see the patient afterwards, and the baby was brought up to her, and the patient and the husband thanked Matthew for everything, and seemed to be very happy with the outcome despite the complication that occurred.

I could not sleep after MC told me the events that happened and I asked him if he needed me to come in, he said he didn't, but I decided to go in anyway, as it was a pretty major traumatic event in terms of anaesthetic complications, and give him a bit of consultant support, reassure him that he did the right thing and managed the situation well.  I think he was surprised to see me at the early hours of morning and we talked for more than an hour about the situation, and just general conversation as well afterwards.  I think I left him feeling supported and reassured, though of course he would still feel like an idiot (though I told him that he did all the correct things and managed things well).  Poor MC.... I am glad everything turned out but geez, we are going to get on top of the fact that there was no resuscitation equipment in Labour ward quick smart!!!

17/10 update:

I was wondering if I was being a bit over the top by going in.  I know when I had my bad incident at work in ICU, when the consultant came in to chat I felt so supported that I wanted to make sure I did that for my own registrars.  When I turned up I was wondering to myself if MC thought I was being an idiot or just wished I went away.  But I got an email later that morning from him:

Hi J,

Thanks again for coming in, it has made me feel much better.
I know you don't believe in subdural block but the more I read up this seems that it could have been a "subdural" catheter. No CSF via tuohy needle and no CSF able to be aspirated via catheter. Onset wasn't very rapid, but sort of intermediate. Very extensive block. progressive respiratory incoordination rather than just sudden apnoea, relatively little cardiovascular instability. All of which fits with the literatures description of a subdural block. Or maybe I'm just trying to convince myself because for some reason it just seems a little less worse to me... more bad luck then just my incompetence.

I saw her this morning. She has no residual block and was happily breast feeding her son. She has minimal pain and no headache (yet).

Anyway, have a good day. Hope you have a good party tomoorow for Julian.

Thanks again.M

20/10 Update:

God I felt bad!  I told 2 colleagues, AC and PC, and when I got to work on Tuesday apparently EVERYBODY knew about what happened to MC.  I felt terrible!  AC  said he waited about half an hour before he started to SMS everyone...  Poor MC!  He said he told JL, who was a good friend of his at Liverpool who was on night shift and JL asked him if he slipped the tongue in!  The funny thing is, that because I'm quite close to the incident (I was on call after all), that all these things didn't even enter my mind.  But after the incident, I can see why everyone is laughing about it (in a good natured way, ie they look at MC as doing a fantastic job, heroic almost!  And that they can tease him because there was a good outcome).  Others have asked if he had taken a mint beforehand, was the patient good looking, etc.  I did his ITA online form with him yesterday and we had a bit of a talk about the whole thing, and he seems ok now, though he wishes they weren't teasing him about it.  He said that he was teaching a medical student in his theatre about bag mask ventilation and the medical student mentioned that there was a registrar who did mouth to mouth on a patient... and MC was said that he had to tell that student it was true, and it was him.  Looking back at it now, I think people will think of MC as a legend which is quite amusing!  I am still very proud of him, I have defended him tooth and nail when people ask about it in any kind of disparaging way.  Sometimes I think of him as a prized student or something!  I only hope that I can be the kind of consultant that he looks up to as well.

Tuesday, 12 October 2010

In remembrance of E2B

My BIL and SIL are going back to Taiwan after they see the specialist on Thursday.  They are going to abort the baby there.

I just want to have a small memorium thing here for E2B (emily2be).  Though I didn't know her, I would have loved her and helped to take care of her and she would have been my special little niece.  Because her life would have been short, I would have tried to make it as happy as possible with cuddles, kisses and carries.

I hope she can forgive us all for taking away her life, and if she understands that it was so she wouldn't suffer and have a miserable life.  I hope that the spark of life that she had will be born again in this world as something beautiful.  I am sure she would have been proud, and hated to be a burden to anyone.  And that though it seems like nobody loves her because we could so easily throw her away, that we are saddened by her loss.

I hope you don't have to suffer little E2B.  I love you.

Sad news

Yesterday hubby rang me to say that my sister-in-law went for a scan of the baby and that they found an abnormality.  He said there were some cysts in the liver and it was enlarged.  He wanted me to go and ask the advice of my colleagues about what it was... but without the report or anything I didn't think I could offer any advice, and that they should go see a specialist.

When the formal report came, it was actually that BOTH kidneys were abnormal.  One had cysts in it and was enlarged, the other was hypoechoic with a dilated renal pelvis.  The AFI was normal which was reassuring (ie kidney function was probably normal) but the other bit is pretty bad.  From my limited medical knowledge, it seems to be juvenile polycystic kidney disease which is autosomal recessive disorder, and has a poor prognosis.  If it is diagnosed at 24 weeks then the prognosis is worse.  It is characterised by hyperechoic kidneys, cysts develop later in infancy.  I suppose the presence of cysts already could indicate really bad disease.

Severe cases have hyponatremia and other metabolic disorders and recurrent urinary tract infections, and are not expected to live more than one month.  If the child lives to 18 months then they can be considered for renal transplant.

That's just talking about PCKD AD.  I don't really know what they have.  I am not sure there is any genetic testing they could do.  My poor SIL is so upset, she wants to have the pregnancy terminated.  Unfortunately she will have to deliver the baby vaginally if that is the case which is all the more traumatic.  Currently the foetus is still viable and at 30 weeks has a good chance of survival (without the kidney troubles).  I have to say if the situation was reversed and it was me facing this dilemma I am not sure what I would do.  I know I would not want the poor child to suffer, but I suspect that I would have the baby and let the baby pass away on her own.  It is a terrible thing to have to do, or even have to contemplate, but I think my poor SIL is too shocked and upset to be thinking about anything other than to get the abnormality/mutant out...

Then today I walked into birthing unit and the educator was wrapping up a dead baby.  A little boy.  The mother had an abruption and was transferred from another hospital to here, and the baby died en route whilst the mother bled to a haemoglobin of 60 and required a blood transfusion.  The mother is of Arabic origin, and she has 6 daughters at home, and the baby that died was a little boy.  She was very sad, and worried that the husband would blame her for losing the son (boys are very important in arabic culture as they seem to be in almost every culture!) because she had had a fall and that caused the abruption.  So sad to see all these little lives lost, who never got to know their future.

I think that about my niece-to-be.  What could she have been like?  Would she have done great things, made some great changes to someone's life, influenced the world somehow in that small butterfly effect way?  The way things are going, I don't think I'll ever get to meet her, and she will never get to do anything in her short life.  And though babies should bring joy to people's lives, her being born will only bring sadness, and what is even more sad is that maybe nobody wants her because she's got an abnormality.  If she gets born, I doubt that she will be born here, they will probably go back to Taiwan (in fact I recommended that they go back to Taiwan so my SIL can have the support of her family there).

I just have to be thankful that I have 2 children who are happy and healthy so far.  Who knows what tragedy may befall  them further down the track.  I should enjoy them now and every minute I can spend with them.

Monday, 11 October 2010

Litterbug :(

Ugh I had a terrible moment today, I drove off in my car and the drink I had left on top of my car fell off as I turned a corner....

I should have stopped and picked it up and thrown it away, but I didn't.  That would be the first time I had deliberately littered in like... since High School.

If I see it there the next time I go back I'll go pick it up.

Wednesday, 6 October 2010

Bumps in the night

There was a resounding thump last night, which was Erika falling out of bed.  I ran upstairs expecting to hear the 2 second pause of silence while Erika filled her lungs up with air for the next resounding yowl, but when I got there all I heard was a bit of whimpering.  I opened her door, it was quite dark, and I felt my way along the floor looking for my daughter and I found her, she was making some soft whimpering sounds and I just scooped her up and put her back in bed, where she went back to sleep.  Now that was surprising, the last time I heard her make a thump like that was when she fell out of her cot when she was about 7-8 months old.

Now of course, Julian is another story.  There is lots of thump noises that he makes like when he falls out of my bed, or when he falls out of Erika's bed, or when he falls off the chair...

Nappy addiction waning

I can tell that my nappy addiction is fading away - last month was the Great Down Under Nappy Hunt competition and for the first time in 2.5 years I wasn't doing the nappy hunt!  I did it from when Erika was born and I did the last one in March this year (and I won a prize too!  But I didn't do much hunting).

Now if only I can convince other people on the use of cloth nappies then I'll be set!

I heard one of the girls at work is using or is thinking of using cloth nappies.  Maybe I could start with her by giving her a little something as a gift...