Hello Kidney

Just finished my month as senior resident on the Inpatient Kidney Service. Incredibly busy with very sick children all month. Learned a lot, worried a ton. Now have several more grey hairs and probably need a new eyeglass prescription. It's worth it though, I'd do anything for these kids, they are AMAZING. And ridiculously cute.

In case you don't know, the kidneys are really important to every day life.  A litany of potential problems, and possibly all at the same time! Hyperkalemia, Hyponatremia, Hypocalcemia, Anemia, Hypertension, Uremia, Hypertriglyceridemia, Hyperphosphatemia, Proteinuria, Hypoalbuminemia, Thrombosis, Infection, the list goes on...

Any little thing can go wrong when you have kidneys that don't work very well, especially when you are small. Many of our children with severe kidney disease live for years on dialysis until they are big enough for a kidney or until they find a matched kidney donor.

Try to imagine..

• Having a little baby and needing to connect them to peritoneal dialysis every night for 12 hours a night. 
• Trying to give a toddler 10 medicines every single day, and they taste bad.
• Your tween-age sister needing urgent dialysis for kidney failure because of a diarrheal illness a week ago
• Every time your school-aged kiddo has a fever they needed to be hospitalized to rule out a serious bacterial infection

A few acronyms from the month:
STEC, HUS, ESRD, ARPKD, CKD, HD, PD, AKI, ATN, SBP, BUN/CR, UP/C..

Electron Microscopy of Kidney's Glomerulus. Thx WikiCommons!

Kids with chronic kidney problems are at higher risk of infections than us regular folk -whether it be from immunosuppressive medicines to preserve their kidney transplant, extra fluid that can get infected or having a central line/catheter that puts them at risk for infection. Just in case you weren't a germ-a-phobe already, here's a list of the infections I've dealt with recently:

• Adenoviremia
• CMV colitis
• Cryptosporidiosis
• Clostridium difficile colitis
• Enterococcus faecalis bacteremia
• Infectious Mononucleosis
• Streptococcus pneumoniae meningitis
• Ecoli O157H7 

Bottomline: The next time you pee, thank your kidneys. They don't get enough credit for all their hard work!

Love & Birds

In case you missed it, here is a sweet article from the NYTimes from Friday about how a bird feeder in the city impacted one couple: How a Bird Feeder Revived My Marriage

I've been working my 80 hour weeks at the hospital recently. 28 hour call Friday night. Hold your little ones close and give them a kiss. Too many are spending their summer hospitalized. I'm doing my best to get them better and home before the school year starts.

Black Vulture!

What kind of bird did Max see? The best birder I know and amazing friend Wendy in Kansas got to the answer first: a group of black vultures!

Black vulture in flight! Copyright AllAboutBirds.org

Black vultures live year round as north as Pennsylvania and as south as Patagonia. They are frequently in large groups, have a black bald head, and white wing patches that can be tough to see.  They are raptors as you know, and like all vultures are usually scavenging and eating carcasses (someone's gotta do it!).

Chillin. Thanks Wikipedia

Thanks for all the guesses! When I first saw the photo Max sent, my first thought was double-crested cormorant because it's the only bird I've ever seen sitting and drying their wings out, but the neck looked too short to be a cormorant. With more research I found out that anhingas and vultures also do this behavior, so then asked if the birds appeared bald. Max did some sleuthing on his own and on ebirds.org found out that someone else had seen a large group of black vultures in the same area and this confirmed our identification.

Double-crested cormorant. Copyright AllAboutBirds

Size and shape, color pattern, behavior, and habitat were all used to correctly identify this bird! It came down to a bald, black, large bird in a big flock fanning out its wings in Pennsylvania in the summer time. Voila!
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What Kind of Bird is This?

From my friend Max, on a bike trip in Pennsylvania:

"Do you know what kind of bird this is? A whole bunch of them were sitting on the fence and doing this weird thing where they sat with both wings outstretched. There were so many of them, and they were so large and totally unperturbed by humans. I was quite curious."

Hmmm... 

What do you think? 

I'll post our amateur bird detective conclusions tomorrow! 

Birding in Action!

An "action shot" of me birding! This was an early morning along the Ritz Carlton Half Moon Bay oceanfront trail.  A few minutes before this pic this great blue heron ate a mouse. A WHOLE LIVING MOUSE. That was insane. I watched the entire thing through my binoculars and I still get the heebie-jeebies thinking about it.

Copyright Mark Pederson :)

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