There seems to be a few decisions for me to make these days. The first one was: how can we continue with the CittiKitty potty training for Callie in a way that is happiest for all of us?
She had a couple accidents when we first moved to the second ring. I don’t want her to be stressed about the process, but at the same time I know that once it’s all figured out, we’ll all be much saner than with the litter box. So for now, we’re sticking with it and as of yesterday, she seems to actually be doing quite well. In order to facilitate this, I did four things:
1. We invested in a new toilet seat cover. The original was hard plastic and very slippery with a slight downward angle that made it very difficult for Cal to stand on comfortably. It was also really cold all the time and I was happy to switch for people use as well! The new one has more of a matte finish and is softer and easier for her to grip. The brim is a little wider, too.
2. The toilet-paper method. This is something I have invented to supplement the CittiKitty training techniques. Essentially all you do is take a long strip of TP (about 10 squares or so) and stretch it across the bowl of the toilet. Then you place the CittiKitty tray on top of it and gently push down the TP showing through the hole to make a bit of space. Sprinkle some kitty litter on it. This is great to do for the first day or two after removing one of the rings. It helps her feel a little more secure and obscures the long drop into water below while she figures out how to adapt to the new larger hole without worrying about the water. After successfully using the toilet once or twice (with replaced TP each time getting progressively lower to the water/2nd tray below), you can leave off the TP completely with just the 2nd insert tray below to block most of the water (but we had the first 2 rings cut out of that one as well).
3. We removed the insert tray. This step really freaked me out because I was very nervous that she would be too scared of the open water below like she was initially. I was also concerned that she’d scratch ALL of the litter down the drain and I’d have to keep buying $12 bags of litter every week. However, she’s been fantastic. She hasn’t had an accident in 2 days since we’ve removed the lower tray and she doesn’t scoop ANY litter down the hole when she pees and only scoops a handful down when she poops. She has been using the CittiKitty as intended. I am ecstatic.
4. LOTS of rewards. I keep her treats in the bathroom and when I think she has to go and is feeling nervous, I’ll go in there with her and set her nicely on the litter and give her some positive reinforcement. Usually she figures it out and goes and immediately I get her a treat. Sometimes she doesn’t and in those situations I’ll leave and let her be in there for a few minutes alone. This fixes the problem 90% of the time. What you don’t want to do is say “oh, she really has to go but seems scared, but I’ll just let her wander the house until she decides to go in the potty” because she WON’T go in the potty, but somewhere else. That was Sunday (first day of ring two).
I think each time a ring is removed the following steps will be taken:
1. Remove ring.
2. TP method for two days
3. Day 3-TP method with TP very low in the bowl
4. Day 4-Bathroom positive reinforcement
5. Day 5-7: Free range with treats after successes.
Another decision coming up is WICHITA. I’ll have more in another post later, but basically first year students at KUSOM have to decide where to do their third and fourth year clerkship rotations. There are 50 spots at the Wichita campus and 120 (I think) at the KC campus and regardless of our choices, that’s how many people will end up at each, even if it means that some people do not get there first choice. There’s a lottery process if our picks don’t line up and final placements are final in November of 2nd year. Most people want to stay in KC and some choose Wichita. Usually what happens is that 10 or 15 people end up assigned to Wichita despite wanting to stay in Kansas City. There are pros and cons to both locations and a lot of it has to do with personal reasons based on family or location or what specialty you think you’ll be pursuing. I have to submit my initial decision by mid November, so I’ll get on here and lay out my thought process soon. My little sister lives in Wichita which is a compounding factor…but KC has arguably more academic medical specialties to follow…but you get a lot more hands on experience in Wichita…but…but…anyway, it’s a tough decision.
Another thing I’ve been thinking about lately is my specialty choice. Now, I’m pretty firmly sure that I’ll be choosing pediatrics. I’ve been pretty peds focused for about three years and my Kansas Medical Student (KMS) Loan dictates that I must choose a primary care specialty in order to ensure that I do not have to pay any med school loan money back (except for a small Stafford loan that I also take). These acceptable specialties (set by the KS legislature) are: internal medicine, pediatrics, geriatrics (IM with a supported geriatric fellowship), family medicine, and emergency medicine (recently approved residency). All other residencies do not count and loan money would then have to be repaid at 15% interest. The great option with peds is that I can do that residency, practice for four years in an underserved KS county, and then decide to do a fellowship in almost anything and then practice wherever. I could also do a med-peds residency (since both IM and peds count, a joint residency is okay, too) and do a fellowship after service. I’m having a current dilemma, though, in that I am sort of falling back in love with women’s health. I volunteered yesterday at JayDoc (also a great topic for another post!) and it was Women’s Health night. The patients are under or uninsured and we provide the services completely free of charge. I was able to assist on several prenatal exams, including a pap exam and ultrasounds. I also helped counsel women on sex and reproduction and found myself completely at ease and loving it. I’ve been focused on women’s health for a long time but for some reason at some point I decided not to go into obstetrics/gynecology. The last few months I’ve been saying “I need to not get too involved with the OB/GYN interest group because I’m afraid I’ll fall in love with it” and I’m starting to worry that I might fall for it anyway. The problem is that KMS does not cover an OB/GYN residency and basically I’d be screwed on paying back a crazy amount of money. If I decide that I have to do OB/GYN I would need to cancel my KMS Loan immediately so that I do not end up with loans that I have to pay back at 15% interest…and just have a normal insane amount of med school debt like most physicians. But, I’m not sure. I’m not even a little bit sure. I’m still 85% set on pediatrics. Really, I wish there was a specialty that was OB/GYN/Peds because that’s what I want to do. I want to be a woman’s primary care doc, help her through pregnancy, deliver her baby, and then be the baby’s doctor, too! Oh well. So this is a decision I have to think about a bit. I don’t really have to know for sure until like June (it’s too late to get rid of KMS for this year). If I’m still deliberating then, I’ll probably take the KMS again. We’ll see. The fact is that many many women use their OB/GYNs as their primary care physician and the specialty really should count toward the goals of the KMSL program (to get primary care docs in areas in Kansas that really need more physicians), but right now it doesn’t count. Maybe I need to write some letters to my representatives! 😀
Of course the other big decision is political. I know who I’m voting for, do you?! Whatever you want to see this country become and whatever your beliefs about who can do the best job, just make sure you get out there and vote! I’ll be driving back to Topeka to cast my ballot! Don’t forget to research the other positions up for grabs. Most change and action that directly affects your life comes from local politics, so invest wisely!
That’s it for now, folks. I’m off to study some major histocompatability complexes and antigen presentation. FUN!
PS. I rocked that Gen-Neo final exam, even on three hours of sleep! Next time, though, I’m limiting my caffeine intake! 😛