It was the best of times, it was the worst of times...
General Schedule: varies depending what team you are on, if you are at the VA, or at IMC. You usually get 1 weekend day off a week (THEY WILL TRY TO TAKE IT FROM YOU UNLESS YOU ARE FIRM ABOUT MAKING SURE YOU GET IT), and Wednesdays after rounding you go to surgery grand rounds at 7:30, and then have lectures until 5 pm. If you are at the U, you will have 4 call nights per rotation, but if you are at the VA or IMC, you are Q4 call. (don't expect to get off at noon when you are post call... "students don't have work hour limitations").
Resources for shelf exam (this shelf is about the medicine of caring for surgery patients, when you should take someone to the OR, the general procedure you want to do, post-op management, etc.... NOT the anatomy of the surgeries... and so much more that we don't know how to explain):
-Minimal for passing: 1. Either CaseFiles or PreTest, plus 2. Pestana or USMLE World
-To do well: (with the caviat that I don't yet know if I even passed) 1. CaseFiles 2. PreTest 3. Pestana notes 4. USMLE World 5. A good recollection of internal medicine
Resources for surviving day-to-day/ getting the eval.:
1. Surgical Recall- an excellent resource for pimping questions
2. Further Necessary reading- the day before your surgeries if you really want to do well, you need to do extra reading from another source.
-Emedicine
-MD Consult- go to Townsend: Sabiston textbook of surgery (you should have access to this at the U or at IMC, or through remote access to the U) I personally wish I had known this earlier because it is a free text, it gives good info, and at the end of the chapters it talks about the actually techniques used in the surgery. My resident said that the surgery boards reference this book.
-UpToDate
-other text options, Scaife will give you a list of them
This is a tough rotation. Some will love it, some will hate it, but good luck!
Friday, September 25, 2009
Friday, August 14, 2009
Peds
Hey y'all, I hope this isn't too late for those of you starting Pediatrics on Monday but here's the skinny on what's it's like (at least was like for me).
They feed you well here. You'll have a light breakfast (juice, coffe, fruit, donuts, bagels) most weekday mornings and every weekday there's a noon conference with good food. Don't be late to these things 'cause occasionaly they run out of food and some attendings/seniors use attendance as part of your eval. If you're at PCMC there's a resident lounge that always has food in it (literally always).
3-weeks In-Patient:
Glasgow or Ward team. I did Glasgow and loved it. You actually play doctor and have some responisblity (i.e. you make the care plan, call consults, etc, by your lonesome; you also have to get your notes done 'casue there's no intern to pick up your slack). That means you'll be speding more time there though. Forget the usual q4 call schedule. You work 6-6ish every day. On your call day (every 4th day) you carry the team pager. That means any problem with any patient your team has comes to you first. You then have to punt your pard if they're around or fix it yourself. If it is something serious when you call back tell them you're coming and to page the senior as well. This is the cross-cover fun. You'll need to be up on all the patients on the team not just yours so you can handle what may come. On you post-call day you'll until your notes are done after rounds (usually 12-1300ish). It's usually pretty fast-paced but you won't regret doing Glasgow over the ward teams--if you're on a ward team you'll still have fun, I think. You are supposed to average one day off per week which means more cross-covering for all.
One important note about the in-patient gig: use all your money on the meal card. Kristin takes it back at the end of in-patient so don't be skimpy. You get like $14/call shift which is a fortune at the Rainbow Cafe.
Out-Patient weeks:
1 week in the Well Baby Nursury. This week is at the nursey at the U (2nd floor in the new part). You pretty much just play with babies all week with the occasional call to deliveries/c-sections to resuscutate the not-so-well babies. Days are 7-whenever you're done and it's slow. For me that was 6ish since we had a boat-load of kids. Others got out regularly by 3-4. You're supposed to do a weekend day as well. you actually get a grade for this part which is different from the other out-patient weeks which are pass/fail. There is a newborn OCSE that you'll have to get done at some point but that's easy to do. One bonus thing to do: bring your senior lunch back from noon conference.
1 week in Out-Patient Clinic. For most of you this'll be clinic 6 at the U. The attendings are pretty chill. You go see patients first. Afterward you present them to the attending (this is brief, some only want your diagnosis), suggest a plan which you carry out with them. It's pretty cool if you know what the kid has because you diagnose it and decide how to treat it. The attending is only there to sign the prescription form in those cases. The schedule for this week is 9-5 with weekends/holidays off. Usually you'll be out before 5 depending on patients. You're supposed to still go to morning report and noon conference at PCMC.
1 week of Sub-Specialty. I did the PICU so I can only speak to that. It was pretty cool. Don't pick this one if you have a hard time with really sick kids. Days were 6-5ish and I think you're supposed to do a weekend day (I had this last so I didn't do the weekend). You'll need to be somewhat proactive here. Since it's pass/fail and they don't always have students there they don't "expect" you to know/do anything. Feel free to take as many patients as you like (I only followed one for the whole week because we didn't have many to go around). Like most things the more you do the more you'll learn.
One note on the out-patient weeks: Try to get your CLIPP cases done during this time. In-patient is pretty busy and you won't want to do them then, especially on Glasgow.
Enjoy the happy-land of peds where people don't pimp you to make you feel stupid and all things are made of butterflies and bubbles.
Psych at 5 West (U of U)
The psych rotation is pretty straightforward. Everyone is really nice - my attending, residents and the rest of the team were all awesome. The hours aren't quite as nice as UNI (my hours averaged 8-6). The patients are mostly nice and you have a lot of time to get to know and talk with them so it is really rewarding. Once in a while a patient keeps it real by telling the attending he is going to "stick a nuke up [his] a**" or providing other such delightful repartee +/- antics.
The only advice I really have is for the shelf - don't ignore which kind of psychotherapy you use for which diagnosis like I did (e.g. what is Cog-Behavioral therapy indicated for vs. Insight-oriented). For the shelf, First Aid that the department lends you was the most useful.
The only advice I really have is for the shelf - don't ignore which kind of psychotherapy you use for which diagnosis like I did (e.g. what is Cog-Behavioral therapy indicated for vs. Insight-oriented). For the shelf, First Aid that the department lends you was the most useful.
Friday, July 31, 2009
Internal Med at the U
Orientation on day one, they will go over grading criteria, basic expectations, and give you a so-called 'power-chart' training which is so brief that if you blink, you'll miss it, so before hitting the wards, or that first day, call the IT people to make sure you are on it, and then get on it and spend an hour figuring where to find everything. You will be place on a team with 1 resident, 2 interns, possibly a sub-I and 1-2 med students. You'll have a team room on the 5th floor of the hospital that is your home base. You can leave your bag, books, etc. in there. There are computers in the team room, but remember that the resident and interns always have priority over you. Most team rooms have a fridge where you can store a lunch.
Typical day: Morning report is at 7:45 and you have to have seen all your patients, done the physical exam, and written your note by 7:40 so you can make it to morning report on time- what time you need to show up in the morning depends on how many patients you are following and how long it takes you to get your stuff done. Remember, if you haven't read up on your patients problems and you are not adequately prepared to defend your plan for the day, you'll need to show up earlier to do the reading you need to do. Usually show up 6:00 to 6:30. Morning report goes from 7:45-8:45-8:50. Look up those lab values that you were waiting for that hadn't come back yet, and be ready to round by 9:00. Most teams meet in the team room before heading out. Some attendings round in the team room, some round in the halls outside the patient rooms and then you go in to see them after saying hi, and some do bedside rounds (if you do this, know your plan in and out and be careful of what you say in front of the patient! -leave crazy psych or emotional stuff out, and don't say stuff in a differential that is going to give the patient a heart attack or make them super defensive...yes I did this). Rounds usually take a few hours, but it depends on your attending and how many patients are on your service. After rounds, help get stuff ordered and arranged for your patients. Do reading. Some attendings assign you a topic to research and give them a presentation on during this time. 12:30-1:30 noon conference. You must attend. They usually have lunch for you. One day a week you will have to attend science of medicine instead of noon conference, and one day a week after noon conference you will have topics in medicine w/ the chief resident who will teach you about EKGs, ABGs, etc. 1:30 to whenever... Either you will have new patients to work up, more work on your current patients, check in on them, or research to do on your patients' problems. End of the day= when the resident tells you to leave. Never just leave without finding out what else needs to be done.
Schedule: Q4 call. Long call, post call, short call, golden... and repeat. Long call- show up at 6 am and work all day and night (some residents allow students to switch off staying over night, some require all students to stay over night, I think being there over night can be a good educational opportunity sometimes, and sometimes is a waste). Post call- you've been there all night and you need to leave by noon (to stay within 30 hr work shift limits). Again, don't leave until the resident tells you to do so! Short call, your team admits until 5 on weekdays. You could be there until 5, or until 8. Golden, your team admits until noon. You could be there until 3 or 4. You get one day off a week. oh, and post-call rounds start at 7:00am instead of 9. You are not required to go to morning report or noon conference on post-call days. If you are on a specialty service, you don't have overnight call, but you will have long days (admits from 6-6 or so every day).
Responsibilities: Be on time. Know your patients inside and out. Know their problems. About their diseases- know what causes it, the epidemiology, the typical symptoms, the diagnostic work-up, and the treatment. If you want to reach honors, you have to take initiative yourself. The interns are not going to baby you so you can achieve this as most times it is just easier for them to do it themselves. You have to beat them to the punch in terms of knowing what tests to order, putting in the orders on powerchart for them to co-sign, making follow-up appts for the patients, etc. This is tough to do when you have to spend time away at 'awesome' science of medicine meetings, etc.
Read, read, read. Read a review book. Read on your patients (some attendings like you to read uptodate, and some hate it). Do questions. Make a schedule and goal of how many questions you'll do and pages you'll read every day or it will just fly by you and you won't have read anything. Be ready to be pimped and always sound like an idiot no matter how much you study, but let the pimping help your study. Some of these attendings know A LOT and what they pimp you on is extremely useful info.
How do you hide a dollar...
How do you hide a dollar from an orthopod? - Put it in a book.
How do you hide a dollar from an internist? - Put it in a wound.
How do you hide a dollar from a plastic surgeon? - You don't.
... a joke with a lesson... make sure you do a good physical exam on your patient. If they have an abnormality, know everything about it... pull the dressing out of the wound if you must. You are the one on the team with the most time, so you are expected to do this. Also, if you can't accurately describe a lesion or abnormality that you are sending for a consult, with the onset, frequency, severity, etc. of symptoms, they are just going to be annoyed with you for wasting their time. Doing a good exam can be difficult if you are going in there to see the patient for the first time with an intern as they end up doing most of it and you have no idea what they were noting as they were doing the exam. Either ask them or go back and do the exam again yourself.
As scary as it is- it is awesome, and I am loving it so far. Good luck, and see ya around.
Typical day: Morning report is at 7:45 and you have to have seen all your patients, done the physical exam, and written your note by 7:40 so you can make it to morning report on time- what time you need to show up in the morning depends on how many patients you are following and how long it takes you to get your stuff done. Remember, if you haven't read up on your patients problems and you are not adequately prepared to defend your plan for the day, you'll need to show up earlier to do the reading you need to do. Usually show up 6:00 to 6:30. Morning report goes from 7:45-8:45-8:50. Look up those lab values that you were waiting for that hadn't come back yet, and be ready to round by 9:00. Most teams meet in the team room before heading out. Some attendings round in the team room, some round in the halls outside the patient rooms and then you go in to see them after saying hi, and some do bedside rounds (if you do this, know your plan in and out and be careful of what you say in front of the patient! -leave crazy psych or emotional stuff out, and don't say stuff in a differential that is going to give the patient a heart attack or make them super defensive...yes I did this). Rounds usually take a few hours, but it depends on your attending and how many patients are on your service. After rounds, help get stuff ordered and arranged for your patients. Do reading. Some attendings assign you a topic to research and give them a presentation on during this time. 12:30-1:30 noon conference. You must attend. They usually have lunch for you. One day a week you will have to attend science of medicine instead of noon conference, and one day a week after noon conference you will have topics in medicine w/ the chief resident who will teach you about EKGs, ABGs, etc. 1:30 to whenever... Either you will have new patients to work up, more work on your current patients, check in on them, or research to do on your patients' problems. End of the day= when the resident tells you to leave. Never just leave without finding out what else needs to be done.
Schedule: Q4 call. Long call, post call, short call, golden... and repeat. Long call- show up at 6 am and work all day and night (some residents allow students to switch off staying over night, some require all students to stay over night, I think being there over night can be a good educational opportunity sometimes, and sometimes is a waste). Post call- you've been there all night and you need to leave by noon (to stay within 30 hr work shift limits). Again, don't leave until the resident tells you to do so! Short call, your team admits until 5 on weekdays. You could be there until 5, or until 8. Golden, your team admits until noon. You could be there until 3 or 4. You get one day off a week. oh, and post-call rounds start at 7:00am instead of 9. You are not required to go to morning report or noon conference on post-call days. If you are on a specialty service, you don't have overnight call, but you will have long days (admits from 6-6 or so every day).
Responsibilities: Be on time. Know your patients inside and out. Know their problems. About their diseases- know what causes it, the epidemiology, the typical symptoms, the diagnostic work-up, and the treatment. If you want to reach honors, you have to take initiative yourself. The interns are not going to baby you so you can achieve this as most times it is just easier for them to do it themselves. You have to beat them to the punch in terms of knowing what tests to order, putting in the orders on powerchart for them to co-sign, making follow-up appts for the patients, etc. This is tough to do when you have to spend time away at 'awesome' science of medicine meetings, etc.
Read, read, read. Read a review book. Read on your patients (some attendings like you to read uptodate, and some hate it). Do questions. Make a schedule and goal of how many questions you'll do and pages you'll read every day or it will just fly by you and you won't have read anything. Be ready to be pimped and always sound like an idiot no matter how much you study, but let the pimping help your study. Some of these attendings know A LOT and what they pimp you on is extremely useful info.
How do you hide a dollar...
How do you hide a dollar from an orthopod? - Put it in a book.
How do you hide a dollar from an internist? - Put it in a wound.
How do you hide a dollar from a plastic surgeon? - You don't.
... a joke with a lesson... make sure you do a good physical exam on your patient. If they have an abnormality, know everything about it... pull the dressing out of the wound if you must. You are the one on the team with the most time, so you are expected to do this. Also, if you can't accurately describe a lesion or abnormality that you are sending for a consult, with the onset, frequency, severity, etc. of symptoms, they are just going to be annoyed with you for wasting their time. Doing a good exam can be difficult if you are going in there to see the patient for the first time with an intern as they end up doing most of it and you have no idea what they were noting as they were doing the exam. Either ask them or go back and do the exam again yourself.
As scary as it is- it is awesome, and I am loving it so far. Good luck, and see ya around.
Wednesday, July 29, 2009
What the hell is prn?
Hey guys...not to add more "useful" stuff, but I thought I'd share some pharm abbreviations if it was helpful. They are all abbreviations of latin phrases, which is why they look so confusing. I included the translation not to brag about my useless knowledge, but instead because sometimes it's easier to remember if you know the "why" behind all the seemingly meaningless random compilation of letters. Also, they are kinda in order to how often I ran into them while I was a pharm tech. Enjoy.
prn = "pro re nata" = as needed
q = "quaque" = every (example: qday = every day)
h = "hora" = hour
bid = "bis in die" = twice per day (can also be written q12h = every 12 hours)
tid = "ter in die" = you guessed it, three times per day (or q8h = every 8 hours)
qid = "quater in die" = four times per day (or q6h = every 6 hours)
po = "per os" = by mouth
hs = "hora somni" = before bed
ac = "ante cibos" = before breakfast-I've hardly ever seen this but it fits after "before bed"
stat = "statim" = immediately
gtt = "gutta" = drops
supp = suppository
sl = sublingual
iv = intravenous
Not latin, but other abbreviations (in the context of Rx):
SA = sustained action
SR = sustained release
LA = long acting
XR or XL = extended release
From the limited experience I've had with this, docs and pharmacists don't go too crazy with these, although theoretically you could write entire sentences. Mostly this will help with putting in orders (as these directions are given as options in the computer) and understanding what the hell they're talking about on rounds when they say "Mr. Parkinsons is getting levodopa/carbidoba qid (four times a day) with no improvement of his symptoms..."
Another common example is "Mr. PTSD is taking prazosin 10 mg po hs (by mouth before bed) for his nightmares."
Sorry for all the neuro correlates but I'm just finishing that rotation at the VA, which I will eventually blog about.
Miss you crazy kids....
Sunday, July 26, 2009
Not useful
Just so this blog isn't only about useful information, blah blah blah. Here's a riddle.
Two carts of viscera are sitting at the top of a hill;
both carts are pushed at the same time with the same force and sent down the steep decline.
Which cart reaches the ground first?
The one with the greater omentum (ha ha ha, knee slapping)
-Copyright: Jeff Horn
Two carts of viscera are sitting at the top of a hill;
both carts are pushed at the same time with the same force and sent down the steep decline.
Which cart reaches the ground first?
The one with the greater omentum (ha ha ha, knee slapping)
-Copyright: Jeff Horn
OB at the U
First of all, by way of dispelling stories of previous years about OB/GYN, the rotation as a whole is not nearly as soul crushing as some have made it out to be. The residents (at least this year) have all been great to work with, assuming you don't mind working hard.
Before you start the rotation. 1) You should get Powerchart access (pt. charting program for the U) if you don't already have it. This can be done by contacting IT at the U (google) and letting them know you're a medical student who needs to set up their account. 2) Sleep, or otherwise do whatever you need to do to bring your body up to speed for getting up at 4:00 in the AM. 3) On the first day, you have a series of lectures designed to orient you to the rotation, it's too much information to take in all at once, so write some of it down. Importantly, write down what your scrub locker number and combination are. On that point, during the aforementioned orientation, KPJ makes a point of telling you that it is unacceptable to wear your scrubs to and from the hospital (something about disease transmission, blah blah), one of the first things our chief said was, 'I know Dr. Jones doesn't want you wearing scrubs to work, but we get here at 5:00, and everyone wears scrubs to and from home.' So, do what you wish, but for me personally, the only saving grace when it comes to getting up at 4:00 in the morning is that I get to wear pajamas to work.
Typical work day: 1) arrive at 4:50, no later than 5:00. Meet up with the interns over on Labor and Delivery, drop your bags off there, and head over to 2N (postpartum wards). There, the interns print off an excel sheet that has all of the postpartum patients they need to follow on it with a very attenuated pt. history on each one, and some of the previous lab values. Split the patients up between the group of you, and see them with or without the intern (who also has to see your patients that morning) depending on their preference. Then, write a note (the format of which will be in your orientation materials) and have the resident look over and cosign your work. All of the patients need to be seen and have their notes written by 6:45, because of the mandatory attendance requirement for everyone at 6:45 board sign out, back on L&D. Scut work side note; one of the helpful things you can do here is ask, or figure out who is going home that day; everyone needs discharge paperwork filled out and put in their charts. (there are templates for this in your orientation materials as well). Then by 6:45 you head to L&D where the residents go through 'the board' (you'll understand when you get there) and talk about all of the patients currently on service or scheduled to come onto service that day. When that is over, interns and med. students head back over to 2N to present all of the patients they saw on morning rounds. (this is probably your best opportunity to shine during the rotation, so if your going to put your efforts in somewhere, this is probably the highest yield) You'll present at least one patient (likely more depending on how fast rounds need to go) to the chief and attempt your assessment and plan which will be looked over and most likely is 'continue post-op care' like 90% of the time. Then after rounds you all head back to L&D and sign up for patients on 'the board', introduce yourself to the patients you are following and do as much as you can to learn about their history and any complicating problems. Follow them throughout the day and hope that you get the opportunity to either be there/participate in their delivery or assist in the C-section. Additional side note, OB is unbelievably notorious for using acronyms for everything, so do whatever you need to, to get a handle on these early, it will help out. (there is a list of them in the orientation materials). Continue doing this, and whatever else you are asked to do (may not be much) until board sign out which happens at 5:30 during the week. This is essentially the same thing as the morning, except you are recapping the day for the residents coming on service for the night shift. After board sign out, linger just long enough to see if there's anything else that needs to be done, and then you're free to go home.
Call: you take call 5 times during your OB/GYN rotation regardless of where you do it. OB service takes call Sunday night through friday day, GYN is on from Friday night through Sunday day. IMC doesn't do student night call, the U does. If you take call during the week, you work during the day, stay on after board sign out, and work until the next morning. Protocol for making a graceful departure to the med student call room for some zzz's: work hard during the day and early evening, don't disappear for hours at a time, then you need to approach your chief resident and ask them if there's anything else that you can do, he or she should at that point either say 1) yes, do whatever the task is, and retry, 2) no, go to sleep, in which case you are golden until they page you, or you decide it is prudent to come back or 3) they say no, an nothing, in which case you can say well, if you don't mind I'm going to go to the call room for a little while, I'll be back soon, page me if you need me back here. (inevitably they don't need you and won't page you to come back, so if you're interested in helping with a c-section or doing a delivery yourself, you need to stay up).
Well, I know this is probably too much information for some, and not enough for others, but if you have other questions, feel free to ask me.
Note to my OB co-conspirators: feel free to add whatever you think is relevant.
Before you start the rotation. 1) You should get Powerchart access (pt. charting program for the U) if you don't already have it. This can be done by contacting IT at the U (google) and letting them know you're a medical student who needs to set up their account. 2) Sleep, or otherwise do whatever you need to do to bring your body up to speed for getting up at 4:00 in the AM. 3) On the first day, you have a series of lectures designed to orient you to the rotation, it's too much information to take in all at once, so write some of it down. Importantly, write down what your scrub locker number and combination are. On that point, during the aforementioned orientation, KPJ makes a point of telling you that it is unacceptable to wear your scrubs to and from the hospital (something about disease transmission, blah blah), one of the first things our chief said was, 'I know Dr. Jones doesn't want you wearing scrubs to work, but we get here at 5:00, and everyone wears scrubs to and from home.' So, do what you wish, but for me personally, the only saving grace when it comes to getting up at 4:00 in the morning is that I get to wear pajamas to work.
Typical work day: 1) arrive at 4:50, no later than 5:00. Meet up with the interns over on Labor and Delivery, drop your bags off there, and head over to 2N (postpartum wards). There, the interns print off an excel sheet that has all of the postpartum patients they need to follow on it with a very attenuated pt. history on each one, and some of the previous lab values. Split the patients up between the group of you, and see them with or without the intern (who also has to see your patients that morning) depending on their preference. Then, write a note (the format of which will be in your orientation materials) and have the resident look over and cosign your work. All of the patients need to be seen and have their notes written by 6:45, because of the mandatory attendance requirement for everyone at 6:45 board sign out, back on L&D. Scut work side note; one of the helpful things you can do here is ask, or figure out who is going home that day; everyone needs discharge paperwork filled out and put in their charts. (there are templates for this in your orientation materials as well). Then by 6:45 you head to L&D where the residents go through 'the board' (you'll understand when you get there) and talk about all of the patients currently on service or scheduled to come onto service that day. When that is over, interns and med. students head back over to 2N to present all of the patients they saw on morning rounds. (this is probably your best opportunity to shine during the rotation, so if your going to put your efforts in somewhere, this is probably the highest yield) You'll present at least one patient (likely more depending on how fast rounds need to go) to the chief and attempt your assessment and plan which will be looked over and most likely is 'continue post-op care' like 90% of the time. Then after rounds you all head back to L&D and sign up for patients on 'the board', introduce yourself to the patients you are following and do as much as you can to learn about their history and any complicating problems. Follow them throughout the day and hope that you get the opportunity to either be there/participate in their delivery or assist in the C-section. Additional side note, OB is unbelievably notorious for using acronyms for everything, so do whatever you need to, to get a handle on these early, it will help out. (there is a list of them in the orientation materials). Continue doing this, and whatever else you are asked to do (may not be much) until board sign out which happens at 5:30 during the week. This is essentially the same thing as the morning, except you are recapping the day for the residents coming on service for the night shift. After board sign out, linger just long enough to see if there's anything else that needs to be done, and then you're free to go home.
Call: you take call 5 times during your OB/GYN rotation regardless of where you do it. OB service takes call Sunday night through friday day, GYN is on from Friday night through Sunday day. IMC doesn't do student night call, the U does. If you take call during the week, you work during the day, stay on after board sign out, and work until the next morning. Protocol for making a graceful departure to the med student call room for some zzz's: work hard during the day and early evening, don't disappear for hours at a time, then you need to approach your chief resident and ask them if there's anything else that you can do, he or she should at that point either say 1) yes, do whatever the task is, and retry, 2) no, go to sleep, in which case you are golden until they page you, or you decide it is prudent to come back or 3) they say no, an nothing, in which case you can say well, if you don't mind I'm going to go to the call room for a little while, I'll be back soon, page me if you need me back here. (inevitably they don't need you and won't page you to come back, so if you're interested in helping with a c-section or doing a delivery yourself, you need to stay up).
Well, I know this is probably too much information for some, and not enough for others, but if you have other questions, feel free to ask me.
Note to my OB co-conspirators: feel free to add whatever you think is relevant.
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