Episode 20: Baby Blues

The sun rises over the San Joaquin Valley, California, today is Jul 17, 2020.

It feels good to talk about prevention when an effective and safe vaccine is actually available! This is the case for the Pneumococcal Conjugate Vaccine 13 (PCV13 or Prevnar 13®).  

In November 2019, the CDC issued an update on PCV13 vaccination. PCV13 vaccination for ALL immunocompetent adults 65 years and older is NOT recommended. Instead, it is recommended to make a shared decision when these patients do NOT have an immunocompromising condition, CSF leak, or cochlear implant, and have not previously received PCV13. 

Some candidates for PCV13 include patients residing in areas with low pediatric PCV13 uptake; those traveling to settings with no pediatric PCV13 program; those with chronic heart, lung, and/or liver disease, diabetes, or alcoholism; and those who smoke. 

PCV13 is still recommended in a series with Pneumovax® (PPSV23) for all adults 19 years and older (including those 65 years and older) with immunocompromising conditions, CSF leaks, or cochlear implants. A single dose of Pneumovax® for ALL adults 65 years and older is still recommended (1,2).

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“Perfection is not attainable, but if we chase perfection we can catch excellence.” –Vince Lombardi

Perfection is a very complex concept. Have you seen a surgery that was performed perfectly? I have. Believe it or not, there are perfect surgeries. Some musicians can play a song perfectly. I think perfection in some areas may be attainable. Another example, I think a person can be perfectly punctual for a time. That’s perfection. 

However, in most cases, perfection may not be attainable, but we should at least aim for excellence. And today, we have a resident who is in her pursuit of excellence, she is doing very good in her residency. Her voice may be familiar to you because she has recorded many of our introductions, and people have loved her voice. Welcome Dr Der Mugrdechian. 

1. Question Number 1: Who are you? 

My name is Alyssa Der Mugrdechian, I am a 2nd-year resident in the Rio Bravo Family Medicine Program here in Bakersfield. I am a native to the Central Valley having grown up in Fresno, California. I am of Armenian descent and my family settled in California after surviving the Armenian Genocide in 1915. Coming from a family of mostly educators, I am the first to pursue Medicine. 

I went to UC Irvine for undergrad and majored in Biological Sciences, and my journey to becoming an MD took me to Ross University on the beautiful island of Dominica. 

Though I have traveled a lot during my schooling, I am happy to have the opportunity to have returned to the Central Valley to complete my residency training in an underserved community close to my family and friends. 

For fun, I like to draw/paint, I also enjoy cooking, traveling, going to the beach and going to any Disney park as often as possible.

1. Question number 2: What did you learn this week?

This month my rotation is Gynecology. I am generally seeing patients for gynecologic issues, OB follow ups and routine post-partum visits. During these appointments, a very important question that can often be overlooked is whether the patient is coping with post-partum depression. Furthermore, another important distinction to make is if it is in fact major depression vs. baby blues.

Post-partum Depression (PPD)

The post-partum period can encompass the first 12 months after giving birth, however there’s no set length that’s been agreed upon. 

Major depression is not confined to the post-partum stage, it can also arise during pregnancy.

Factors that increase risk of developing Post-Partum Dep