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AngelsSix
02-28-2009, 19:05
Please move if this is the wrong spot........

I think this is odd, I have never heard of a kid dying from the Simplex form of herpes, anyone want to expound on this??

http://www.foxnews.com/story/0,2933,501767,00.html
http://www.news.com.au/story/0,27574,25113689-23109,00.html

Baby Jennifer Schofield died from mum's cold sore kiss of death

From correspondents in London

Agence France-Presse

February 27, 2009 09:36am


AN 11-day-old baby girl died after her mother unwittingly infected her with the virus which causes cold sores, probably through a kiss or breastfeeding, a British coroner has ruled.

An inquest found newborn Jennifer Schofield died from Herpes Simplex Virus (HSV).

Her mother Ruth, 35, probably caught it late into her pregnancy, the coroner said, most likely for the first time in her life, meaning she had not developed immunity and nor had her child.

The virus attacked the baby's major organs and she died within days.

Ms Schofield fell ill with flu-like symptoms a few days before giving birth, and was treated for several mouth ulcers. Her daughter subsequently became unwell and was admitted to hospital because she was sleepy and not feeding.

Coroner James Adeley said no one could be blamed for failing to identify the virus.

MsSchofield is now campaigning to raise awareness of the condition which she said kills six babies a year in Britain.

"I have been left totally devastated and heartbroken by the death of Jennifer. It's more than a year since she died but the pain has not lessened," she said.

TrooperT
02-28-2009, 19:54
I think this is odd, I have never heard of a kid dying from the Simplex form of herpes, anyone want to expound on this??

Baby Jennifer Schofield died from mum's cold sore kiss of death>

The quick answer: An 11-day old has a very immature immune system. If the mother had a long history of herpes, some of those antibodies would have been passed to the child. Even so, there is still a risk for the baby. Since this mother acquired herpes either late in her pregnancy or soon after the birth, those are the conditions where the baby is even more at risk. A herpetic encephalopathy can be fatal at worst or cause debilitating mental or physical disability at best.

In other words, nothing good can happen when a newborn is exposed to active herpes and anti-virals like acyclovir may not be of much help.

olhamada
02-28-2009, 20:31
TrooperT is right on target.

Herpes Simplex (HSV-1) is actually the most common cause of fatal sporadic encephalitis in the world. In the United States, it is responsible for approximately 1,000 pediatric cases per year. In those who survive, there are usually significant residual neurological deficits. HSV-2 transmission is more common in neonates, but HSV-1 is unfortunately not that uncommon.

357SIGFAN
03-19-2010, 01:40
According to my PA, HSV-1 makes up roughly 25% of the Genital HSV cases they see.

As noted above, yes, it is a serious concern.

PedOncoDoc
03-19-2010, 08:29
As a board-certified pediatrician this is in my AO. HSV is definitely a huge scare in the neonatal/infant period.

The major risk is with primary HSV-2 (thel herpes virus that causes recurrent genital infections) outbreaks in pregnant women, but any woman with a history of HSV and active lesions at the time of birth has a significant risk of infecting the infant as it descneds through the birth canal. As routine prenatal care in the states we check HSV status, when available, on the expectant mother.

The virus can enter through the mucus membranes (mouth, eyes, etc) of the infant and cause a plethora of problems. The major concern is for CNS infection (encephalitis, most often in the temporal lobe) with hemorrhagic complications not uncommon in infected infants.

We place mothers on prophylactic acyclovir when they are approaching term and many places preferentially perform cesarian sections even in asymptomatic mothers, although that practice is changing.

Infants suspected of being infected - fevers, seizures or seizure-like activity, etc have an extensive work-up including lumbar puncture and are placed on antivirals (typically acyclovir) pre-emptively while waiting for confirmation by blood and CSF cultures/studies.

I've seen many cases of HSV-1 (the herpes virus that causes mouth sores and recurrent cold sores) as well. It is most often from getting a kiss from a mother/relative with a small cold sore. The case sited in the article is a very high-risk scenario - a primarly herpetic stomatitis (first-time herpes virus infection of the mouth) when the viral load is highest and the mother has not developed any antibody to the infection yet. Any infection caused by HSV-1 in the newborn/infant will often lead to a bunch of superficial blister-appearing lesions in the site of the superficial infection which can be skin, mouth, and I've seen worse in the case of sexual abuse of infants. This can be accompanied by signs of systemic infection - fever, fussiness, etc, or signs of neurologic involvement -seizures, somnolence, inconsoleability. Again - treatment-dose acyclovir is used and can significantly decrease the duration and severity of the infection as well as long-term sequelae - typically neurologic as stated above. Multiorgan failure is typically uncommon, and bone marrow failure (aplastic anemia) is even less common, especially with prompt medical attention, a high index of suspicion and a low threshold to initiate treatment with high-dose IV antiviral therapy with activity against HSV.

It is my practice to obtain testing very promptly and beginning treatment before results are available as the side effect profile and risks of the treatment are far outweighed by the risk of not treating or delaying treatment.

My $.02, HTH.

ETA: I don't know what the routine practice is in the UK, and we don't have a lot of information about the case itself (when symptoms arose, how long before the child was seen by a physician, etc.).

Dozer523
03-19-2010, 08:37
As a board-certified pediatrician this is in my AO. HSV is definitely a huge scare in the neonatal/infant period.
Your posts are just great. But your avatar scares the crap out of me!
I think that's one of the reasons why the States have a much higher rate of Cesarians than other countries. I think from talking to my young nieces and DiL it has more to do with "natural might hurt". (fire away.)

Dozer523
03-19-2010, 08:49
Oh, we might have to move this thread to the Soapbox, cause I'm pullin' it out!
Ok, *whew* done now. :o 7 minutes . . . took longer then I expected.

Richard
03-19-2010, 08:51
7 minutes . . . took longer then I expected.

Did you take anything for the pain? :rolleyes:

Richard

Dozer523
03-19-2010, 09:12
Did you take anything for the pain? :rolleyes:

Richard
Yeah, I channeled the night movement through the thorn patch followed by the "Oh! <splash> Crap!" stream crossing at SERE. No gloves or eye protection allowed then.

olhamada
03-19-2010, 10:07
I think that's one of the reasons why the States have a much higher rate of Cesarians than other countries.

HSV is not a huge contributor to the total number of C-sections in the US, though if an expectant mother has an active lesion(s) or has had a recent outbreak, then a C-section is essentially mandated as neonatal infection can be devastating as PedOncoDoc says. This would apply wherever you are in the world including Europe.

Factors that contribute to the high (almost 30%) of C-sections in the US are myriad and include:
- elective (mom asks for it - most OBs won't do it for this reason unless she has a compelling argument although Brazil has a 90% rate and most are elective for cosmetic and pelvic preservation purposes),
- repeat (to prevent VBAC which has an increased risk of uterine rupture),
- extreme prematurity (prevents intracranial hemorrhage),
- severe preeclampsia (toxemia),
- HELLP syndrome,
- fatty liver of pregnancy,
- fetal distress,
- placental abruption,
- breech,
- macrosomia (BIG baby),
- protracted or dysfunctional labor (numerous reasons),
- pelvic outlet issues/dystocia (bony pelvis too tight),
- soft tissue dystocia (mom's just too fat and can't get her legs apart like the 19 yo 650 pound patient I had),
- maternal HIV
- concerns about pelvic injury that leads to incontinence (leaking), prolapse (stuff falling out), etc...
- multiple gestation (twins, triplets, quads, quints.....)
- maternal death with a living/distressed baby (postmortem)
- etc....

olhamada
03-19-2010, 10:27
Really isn't a big contributor to pneumonia. True, exiting through the birth canal helps expel amniotic fluid, but C-section delivery really isn't that dangerous for a baby with regard to injury or neonatal issues. In fact, C-sections save a ton more babies and prevent long lasting damage when they are done for certain indications. Compare neonatal mortality rates here with those in say Sudan. True, many other factors contribute as well (prenatal care, nutrition, infectious disease), but the ability to definitively intervene has saved numerous babies.

Pelvic floor cosmesis. :) I really don't want to get too graphic, so google incontinence (leakage of urine and stool), cystocele (bladder falling out), rectocele (rectum falling out), uterine prolapse (uterus falling out), and you'll get the general idea. Vaginal tone is another issue.

During delivery, pelvic tissues don't just stretch, they rip and tear. Permanent damage occurs that can then only be repaired surgically - usually years later when symptoms become too bothersome.

But there is some thought that C-sections don't prevent all pelvic floor injury as some occurs during pregnancy itself.

olhamada
03-19-2010, 10:43
Good posts, I appreciate your expertise in this area.


Rest assured that I wasn't trying to snap at all C Sections in general -- just women who do it because it's "easier" or for cosmetic reasons. There really isn't anything easy about being a parent....so if that's where you're going right off the bat, maybe it isn't for you. You aren't going to look especially pretty after two straight nights of walking the baby, covered with spit-up-- regardless of "vaginal tone."

:)

You're right. After 4, I know exactly what you mean.....well, at least my wife does! :D

PedOncoDoc
03-19-2010, 10:56
I think that's one of the reasons why the States have a much higher rate of Cesarians than other countries. I have a friend with the disease who wouldn't even attempt a vaginal birth and her doctor just scheduled the C Section. I'm not sure, POD, do you happen to know if this option would be available in Europe? My understanding is that there is a much greater resistance to doing Cs "across the pond."

I'm not sure of the practice in Europe/UK. Current trends in the US are decreasing number of C-sections for women with a history of genital HSV without active lesions - I'm sure that's being done overseas as well, as iti s cheaper, followed-up by a shorter hospital stay and fewer concerns for wounds infections and the like for mothers and there seems to be minimal risk for vertical transmissions of HSV from mothers to infants.

Regarding the pneumonia comment later in the thread, RDS (respiratory distress syndrome) is not very common in full-term babies regardless of delivery route. The biggest risk for that with scheduled cesareans is the "near-term" scheduled C-sections. 34-36 week gestational age babies have a higher incidence of severe (althought typically transient) respiratory distress with pulmonary edema and the whole 9 yards. These are some of the sickest kids I saw in the NICU.

Your posts are just great. But your avatar scares the crap out of me!

Thanks for the nod. My avatar is from the first Mr. Bean Movie - I love Rowan Atkinson, and if you've seen the movie, I hope there is added humor from the context of the picture for you.

357SIGFAN
03-19-2010, 11:36
Good posts, I appreciate your expertise in this area.


Rest assured that I wasn't trying to snap at all C Sections in general -- just women who do it because it's "easier" or for cosmetic reasons. There really isn't anything easy about being a parent....so if that's where you're going right off the bat, maybe it isn't for you. You aren't going to look especially pretty after two straight nights of walking the baby, covered with spit-up-- regardless of "vaginal tone."

Well, to be fair, the hospital personel prefer it to. That way everything is schedualed. No frantic calling of the doctor at some odd hour. There are also medical reasons. If the baby is "late", there is more of a chance of merconium aspiration, which can very likely cause pneumonia.

From what I observed on my peds/OB rotation, the C-section babies usually had a little lower APGARs, usually due to cyanosis. They had rounder heads, and they were a little more phlegmy for a while.

C-sections done carefully are very cosmetic. Also, another reason they are opted for is because a tubal ligation can be done very easily at this time. Lots of C-sections that I observed also included this.

PedOncoDoc
03-19-2010, 12:13
Well, to be fair, the hospital personel prefer it too. That way everything is schedualed. No frantic calling of the doctor at some odd hour. There are also medical reasons. If the baby is "late", there is more of a chance of merconium aspiration, which can very likely cause pneumonia.

From what I observed on my peds/OB rotation, the C-section babies usually had a little lower APGARs, usually due to cyanosis. They had rounder heads, and they were a little more phlegmy for a while.

C-sections done carefully are very cosmetic. Also, another reason they are opted for is because a tubal ligation can be done very easily at this time. Lots of C-sections that I observed also included this.

By hospital personnel, I assume you mean the private practice OB- GYN's who have boutique practices - there are typically house OB/GYN's that will do overnight procedures and deliveries, but the boutique doc's can't bill for that so they'd rather keep it in the confines of the typical workday so they can do it themselves (a risky and self-centered practice if you ask me). The pediatricians in most busy labor & delivery hospitals are in around the clock and the NICU is always around so this doesn't affect us baby-docs much.

Meconium aspiration is mainly a risk in the setting of fetal distress, especially post-term. Meconium aspiration is becoming less common, and the NRP (Newborn Rescucitatoin Program - like BLS, ACLS, etc except for peripartum newborn care) has modified it's practice to minimize the risk of the baby taking his/her first breath prior to deep suctioning. We've had to reprogram the old OB/GYN's not to give the meconium babies vigorous stimulation to get them to scream so we can tube and aspirate/clear the airway to make sure the baby's mouth and thrioat are clear before stimulating them to breathe. Onr rare instances I've had to tube a baby 2-3 times to suction all remaining meconium but almost invariantly the tube is pulled, the baby gets a rib massage, screams and does fine. The ones who come out screaming or get too much stim before they get in our hands are the ones who have the risk for a problem, and not all meconium aspirartions lead to pneumonitis/pneumonia.

We get more concerned about the near-terms than the post-dates for the reasons I mentioned above.

olhamada
03-19-2010, 12:17
Meconium aspiration is mainly a risk in the setting of fetal distress, especially post-term. Meconium aspiration is becoming less common, and the NRP (Newborn Rescucitatoin Program - like BLS, ACLS, etc except for peripartum newborn care) has modified it's practice to minimize the risk of the baby taking his/her first breath prior to deep suctioning. We've had to reprogram the old OB/GYN's not to give the meconium babies vigorous stimulation to get them to scream so we can tube and aspirate/clear the airway to make sure the baby's mouth and thrioat are clear before stimulating them to breathe. Onr rare instances I've had to tube a baby 2-3 times to suction all remaining meconium but almost invariantly the tube is pulled, the baby gets a rib massage, screams and does fine. The ones who come out screaming or get too much stim before they get in our hands are the ones who have the risk for a problem, and not all meconium aspirartions lead to pneumonitis/pneumonia.

We get more concerned about the near-terms than the post-dates for the reasons I mentioned above.

I thought tubing for suctioning went out of style as most aspiration is now thought to occur in utero - although I still like to do it when thick/particulate mec is present.

olhamada
03-19-2010, 12:31
By hospital personnel, I assume you mean the private practice OB- GYN's who have boutique practices - there are typically house OB/GYN's that will do overnight procedures and deliveries, but the boutique doc's can't bill for that so they'd rather keep it in the confines of the typical workday so they can do it themselves (a risky and self-centered practice if you ask me). The pediatricians in most busy labor & delivery hospitals are in around the clock and the NICU is always around so this doesn't affect us baby-docs much.


Let's be fair, this is a bit misleading. Solo OBs have to be able to get sleep at night as well. Thus the scheduling of inductions and repeat C-sections. You guys are making it sound like OBs schedule C-sections back to back so they can go play golf, and that simply isn't the case.

Laborists are the growing thing now a days, but most women want to be delivered by their OB not by someone they have never met.

And yes, private practice docs do have to fight for every dollar they get because more and more is being taken away. When you look at malpractice premiums of $250,000 in Florida or even $75,000 here in Tennessee, along with suffocating overhead and decreasing reimbursement, every delivery counts.

For example, TNCare pays around $1,200 for a full year of care including 9 months of prenatal, delivery, and postpartum care. That's about what you'd pay a plumber around here for 4 hours work. Assuming a 100% TNCare practice, a solo OB has to deliver 63 babies just to pay for insurance, then another 250 deliveries to pay for overhead. Let's say the average OB delivers 150 - 200 babies/year, he/she's not even breaking even and hasn't yet taken home a penny. Now most do have a mix of private patients which probably double that fee, but do you know what the anesthesiologist makes for an epidural? Close to $2,000 - and that's not even for a full day's work (they probably put in 15 of those a day in a busy hospital).

Much different than the guys who are employed by a group or hospital, huh?

PedOncoDoc
03-19-2010, 13:31
Tubing infants with MEC who have'nt breathed yet became SOP in the NRP 3-4 years ago and I'm not aware of any changes since then. It was an old school practice to tube them all regardless and that has changed.

I was bad-mouthing the solo-practice OB's a bit, but they tend to be the most common culprits of the C-section for convenience. Yes, they need to sleep too, but they assume certain risks and responsibilities when they decide to go into a solo practice for whatever reason. I never intended to imply they needed time to work on their golf game - merely they are so damned busy and overworked that they try to schedule as many things ahead of time as possible so they a slight chance of being able to adjust/accomodate if an unexpected event occurs. If an OB can't commit to being there for his/her patient, the doc should consider joinging a group practice or letting house-doc's ("laborists") do the delivery if it is afterhours and be up front with their patients about this. The flipside is, if the OB who did the prenatal care can be there for delivery it is more satisfying for everyone involved. There is better continuity of care, the medical history is better known by the OB and the delivering mother typically is more comfortable with the whole delivery knowing a stranger won't be providing the care.

Don't even get me started on the malpractice part of the equation. There has been little to no change in cerevbral palsy rates in the past 30 years in spite of increased awareness, monitoring and physician intervention which suggest prenatal events, not peripartum problems as the underlying cause. But the general belief is someone has to be blamed for a kid having special needs and doctors are an easy target. The reality is that lawyers want to make money and heart strings are easy to pull.

::rant off::

PedOncoDoc
03-19-2010, 14:19
OUCH! Jeez, doc, you could yell "incoming" or "fore" or somethin'!:D

As long as you're not one of those ambulance-chasing, don't care about the science and evidence - the doctor has to be at fault type, you shouldn't be taking offense...I guess we now know your area of practice. :p Besides - if I've got someone in my frontsights I'd rather not give them a heads up - work smarter not harder.

:D

armymom1228
03-19-2010, 15:42
With all due respect...
Ms Schofield fell ill with flu-like symptoms a few days before giving birth, and was treated for several mouth ulcers

AN 11-day-old baby girl died

Please to note, this all happened in a very very short period of time.
The key word here is "a few days before", or rather phrase.

Mom could have been exposed several weeks before showing sx. In that time the virus could have crossed to the fetus via placental blood. Mom only showed sx a 'few' days before birth. It would have been easy to misdiagnose as mom had not hx of herpes simplex and, from the sounds of the article, had no history of risky behavior.

Finger prick takes 5 minutes to show you have it, not that you have developed antibodies to it that would have been passed to the fetus.

Source of test times is here. (http://www.herpes-coldsores.com/herpes_tests.htm) More info at source.

For what it is worth, AO is psych, not OB/Peds. Just working the scenario thru in my head. After having 3 healthy bratlings, my heart goes out to the mom. It must be horrific for her.
YMMV
AM, RN

PedOncoDoc
03-19-2010, 15:50
With all due respect...




Please to note, this all happened in a very very short period of time.
The key word here is "a few days before", or rather phrase.

This is one of those unavoidable, horribly tragic stories. It could have happened anywhere, in any 1st world country (or 2 or 3rd for that matter).

More info on the test is located here. (http://www.herpes-coldsores.com/herpes_tests.htm)

Tests take 12-13 days to come back. This is one of those cases that, no matter what we did, would have more than likely have happened as it did.
Infection occured X days before she shows sx. Even if mom was cultured 3 days.. assuming 'few' equates to 3, before the child is born. The virus has already crossed the placental blood barrier and infected the fetus. In theory, the child has already been dealt her death sentence as cold as that sounds. Mom gets cultured and the tests take 12 days minimum to come back. By that time the kid is dead..
Suxs gianormous ones, but it sounds like it was unavoidable.

For what it is worth, AO is psych, not OB/Peds. Just working the scenario thru in my head.
YMMV
AM, RN

PCR is more rapid and highly specific - can be resulted in 24-48 hours. Immunohistochemical staining also can give rapid results (within hours) google Tzanck smear and oral HSV for info. Either could have been performed on a mother with oral sores and viral symptoms (suggestive for primary HSV-1).

If there was clinical suspicion and rapid, appropriate testing acyclovir could have been started on the mother, testing could be performed on the infant and the infant could have been started on acyclovir pre-emptively waiting for results to come back.

Of course - Monday morning quarterbacking is much easier and hindsight is 20/20, and all of this is speculation - who knows how things would have turned out if treatment could have been started, but historical data suggest a much more favorable result.

Regardless, the loss of human life is tragic.

armymom1228
03-19-2010, 16:27
PCR is more rapid and highly specific - can be resulted in 24-48 hours. Immunohistochemical staining also can give rapid results (within hours) google Tzanck smear and oral HSV for info. Either could have been performed on a mother with oral sores and viral symptoms (suggestive for primary HSV-1).

If there was clinical suspicion and rapid, appropriate testing acyclovir could have been started on the mother, testing could be performed on the infant and the infant could have been started on acyclovir pre-emptively waiting for results to come back.


So, say your wife is 3 days from her due date and she mentions feeling like crap... sniffly.. you gonna run all kinds of tests? or just give her apap and .... and you are under socialized medicne. Way to much left out of the article to really formulate a decent hypothesis doc. You are approaching it from your AO..:D
Remember, she was under socialized medicne with a GP or an OB doc, that routes pt calls to the staff nurse who is not thinking agressive meds or HS.

BTW, what a the worse side effect of aclovir? <--thats a rhetorical question.
again under socialized medicne. That kind of agressive medicne won't happen with out abundance of proof Mom has engaged in behavior that would indicate testing necessary.


Of course - Monday morning quarterbacking is much easier and hindsight is 20/20, and all of this is speculation - who knows how things would have turned out if treatment could have been started, but historical data suggest a much more favorable result.

Regardless, the loss of human life is tragic.

Absolutely. Too much info has been left out of the article for us to truly make a decent informed opinion. I happen to agree in the agressive tx option for what it is worth. We both agree it was tragic. Mom will likely blame herself forever.

As I said, my AO is psych... docs like you have my eternal gratitude for what you do.
AM

armymom1228
03-19-2010, 16:38
The reality is that lawyers want to make money and heart strings are easy to pull.

::rant off::

Oh hel, don't even get me started on Lawyers. The kind that have ads on tv, may they burn slowly in hel and be forced to endure eternal tabasco sauce enemas!

What that sort doesn't realize that the time I spend doing stupid stuff to prevent a lawsuit takes away from the time I could be rendering better patient care. Instead I am at the desk doing paperwork. Its a catch-22 cycle.
AM:mad:

357SIGFAN
03-19-2010, 18:11
Oh hel, don't even get me started on Lawyers. The kind that have ads on tv, may they burn slowly in hel and be forced to endure eternal tabasco sauce enemas!

What that sort doesn't realize that the time I spend doing stupid stuff to prevent a lawsuit takes away from the time I could be rendering better patient care. Instead I am at the desk doing paperwork. Its a catch-22 cycle.
AM:mad:

Lawyers have their place, but they have over-stepped it in almost every area. However, I would not be so keen to blame the lawyer only. Very seldom does a lawyer initiate a lawsuit without a client. Sometimes a lawsuit is warrented, though. I had an X gf who spent time in a hospital and her nurse pushed phenergan over 5-10 seconds into a peripheral vein (hand). Had it caused permanent damage, I would have been in favor of a lawsuit. Incompetance does have a penalty, however, I view that as bordering on malicious, given all the information/education out there regarding IVP Phenergan.

As to the HSV testing, they can do anti-body typing for HSVI/II and differentiate between them. Since most genital HSV is HSVII, and almost everyone (90%+) have HSVI, I think* an HSVII test would be a good idea as part of a pre-natal check up. I have even seen results listed on patient charts, whether this was igg typing, or just visual examination, I do not know. When I had an HSVII typing test done on myself, it took 3 days to get results. (I had heard being in a medical program of any type turns you into a hypochondriac. Correct. (in my case)).


*OB/Peds is NOT my strong point, though. Kids just aren't my thing, and I can't work in an OB/PEDs setting as the hospital system I am partnered with does not allow male nurses in those areas. My clinical rotation was a lot of holding down the nurses station and eating doughnuts with a bit of observation thrown in.

armymom1228
03-19-2010, 18:59
Lawyers have their place, but they have over-stepped it in almost every area. However, I would not be so keen to blame the lawyer only. Very seldom does a lawyer initiate a lawsuit without a client.



You truly have not lived until you have heard the Johnny Cocoran Firm's ads on Baltimore TV. :(:(

According to those ads and many more I have seen, ALL nurses are neglectful abusers who only live for the miniscule paycheque we recieve for doing nothing. :(
YMMV
AM

PedOncoDoc
03-20-2010, 06:10
As to the HSV testing, they can do anti-body typing for HSVI/II and differentiate between them. Since most genital HSV is HSVII, and almost everyone (90%+) have HSVI, I think* an HSVII test would be a good idea as part of a pre-natal check up. I have even seen results listed on patient charts, whether this was igg typing, or just visual examination, I do not know. When I had an HSVII typing test done on myself, it took 3 days to get results. (I had heard being in a medical program of any type turns you into a hypochondriac. Correct. (in my case)).

Most US OB practices do perform HSV-2 testing routinely as part of prenatal care. You seemed to miss the major point from the article that this woman was experiencing a primary HSV-1 infection with oral stomatitis. The multiple mouth sores were the pointing to the underlying illness, as recurrence/outbreak only leads to 1 or 2 small "cold sores." The systemic symptoms of fever, body aches, etc, are indicative of a systemic infection and with multiple cold sores HSV-1 has to be on your differential. True, most people are carry teh virus by the time they get to adulthood, but the exception is the one who is going to have problems, such as in this case.


*OB/Peds is NOT my strong point, though. Kids just aren't my thing, and I can't work in an OB/PEDs setting as the hospital system I am partnered with does not allow male nurses in those areas. My clinical rotation was a lot of holding down the nurses station and eating doughnuts with a bit of observation thrown in.

Sounds like you're not getting the training you're paying for if they are excluding you from rotations based on gender - any of our lawyers want to comment on this? :)

craigepo
03-20-2010, 08:46
As long as you're not one of those ambulance-chasing, don't care about the science and evidence - the doctor has to be at fault type, you shouldn't be taking offense...I guess we now know your area of practice. :p

:D

Do you really want to have this debate?

armymom1228
03-20-2010, 09:49
Quote:
*OB/Peds is NOT my strong point, though. Kids just aren't my thing, and I can't work in an OB/PEDs setting as the hospital system I am partnered with does not allow male nurses in those areas. My clinical rotation was a lot of holding down the nurses station and eating doughnuts with a bit of observation thrown in.

Sounds like you're not getting the training you're paying for if they are excluding you from rotations based on gender - any of our lawyers want to comment on this?

Sounds like you're not getting the training you're paying for if they are excluding you from rotations based on gender - any of our lawyers want to comment on this? :)

Not a lawyer but I bet the State board of nursing would love to be informed.
Under the rules that govern nursing schools our practicum has to include... and it is not sitting at a desk eating doughnuts.. excluding based on gender is also probably massively illegal. personally I would have already been bitching to the school and pointing out that under the nurse practice act that governs my schooling the school is violating the rules and could lose thier right to teach nurses. Not to mention, a nursing student that is content to sit at a desk and eat doughnuts as opposed to actively bitching about not getting what he is paying or what he is legally required to get to sit for his boards, is NOT someone I want on my floor. In fact if I were to find out what school I would be delighted to file a complaint with the state board myself. I have been called a few nasty things in my day for my attitude towards work. I guess the Army rubbed off on me more than I realized. :rant off:
AM

ps Doc? don't you have better things to do than sit here and type on hosp time... i mean if you are not busy I got a few babies over here with crappy diapers that need changing and hey, we have some kids that peed thier bed lastnight with sheets that need changing and Oh yeah.. how about starting some IV's for me.. we are shortstaffed this morning, can you pass meds for us too? and chart and make a run to pharmacy to change out those iv bags..they sent ringers not D5, thanks bunches...smooches.. AM:D:D

SF_BHT
03-20-2010, 10:14
OK OK OK

Might want to get back on TOPIC........:eek:

Boy we have wandered.....;)

PedOncoDoc
03-20-2010, 10:19
Do you really want to have this debate?

Roger that. I apologize for not using the standard pink for ribbing/sarcasm/joking. I have no intention of opening up that can of worms.

armymom1228
03-20-2010, 10:58
Roger that. I apologize for not using the standard pink for ribbing/sarcasm/joking. I have no intention of opening up that can of worms.

Hey doc? how about that order you wrote..the one that 4 nurses and a pharmacist are still trying to decipher??? is that an r or a z or a g or..oh hell.. print, big letters, crayons please we are short staffed, tired and really don't want to ... well the order reads, to us anyway.. take one iv bag and shove it.. no thats not it.. oh well.. pharmacist just gave up too.. :D:lifter

Richard
03-20-2010, 11:04
I always assumed dysgraphia was a requirement for admission to medical school based on my experiences with MDs and their Rx pad scribbling. :D

Richard

PedOncoDoc
03-20-2010, 12:32
I always assumed dysgraphia was a requirement for admission to medical school based on my experiences with MDs and their Rx pad scribbling. :D

Richard

Sad but true story - In 2nd grade my teacher told me to fix my handwriting or become a doc. I claim I took the easy route on that one. :D

Thankfully we're totally electronic in my hospital.