Wednesday, November 4, 2009

Chirstmas Carols and Turkey day

Quick vent;

Leave the playing of Christmas carols until after thanksgiving is past. It was before halloween and I've seen people here putting up lights. It's rediculous.

This means you Shum.

Whoop Whoop


Monday, October 26, 2009

Q and A

Holy crap I got a question!

First off, it is very nice for the few of you who actually view AND read the diatribes to comment on them. I am very happy knowing I am not the only one who reads this pablum.

A fellow second year at PCOM (would of been your classmate) asked:

I was just wondering what specialties you are considering? Are you going to take the COMLEX and USMLE step 1? Have you studied for them yet?

First off, I am considering Emergency medicine with a fellowship in Sports Medicine as my specialty. Truth be told, I have no idea since I haven't been through third year yet. I shadowed a EM D.O. and he had some of the funniest stories I have heard for quite some time. The sense of humor and mellow moods of the ER attending's and residents reflect a choice of profession which I could really, really enjoy. I also read every now and then and he has some gold written over there on his site. I like sports medicine because I am a jock and a hockey guy and I would love to be a team doctor when I am 50 or so. Although during our current system (cardio/resp) we were introduced to an interventional cardiologist. That guy is the man. First off, he is laid back and not overbearing when he teaches (an instant plus in my book). His license plate reads "HRTFXR" and he drives and Aston Martin DB-9. Yes, yes we all wrote on our personal statements how we want to be doctors to "help our fellow man" but DAMN!

He's got my dream car!!!
So that specialty has recently gained ground in my eyes.

As for the boards, I came into first year set on taking both. As of right now I am unsure as whether or not I will. I can't seem to take my own advice. I have yet to crack open First Aid while some of my classmates cling to their copy like folk from Kentucky cling to their bibles. If I had actually executed properly and done the first aid route I may be in a different position. So as of 10/26/09 at 1742, I have no idea what test I will be taking.

I will however start studying for the boards in December. I will probably utilize either Kaplan Qbank or USMLE world Qbank. Taking 1 hour a day wouldn't be so hard I suppose. I am not sure how your school does it, but NYCOM schedules our end of the year at the end of April, then administration brings in Kaplan to teach for about 5-6 weeks up through the first part of June. then we can take the exam. I probably will not go this route as to me that seems like cramming for the boards and that simply won't do. I am looking at kaplan classes that start in January/February so I can start just a tad bit earlier.

Get back to me young Student Doctor and tell me what your plans are, and I will offer updates on what ultimately I plan on doing. Thanks for your interest and question!

See you in new orleans! (if you are going)

Whoop Whoop


XBOX is to Cardiology as _____ is to Respiratory

Remember your SAT's? I sure do. I remember how that test was going to set the course for my future and collegiate options. Then came the first organic chemistry test. the test which was to decide if you could actually master the biological sciences (beside $&@#!#@% genetics) and see if medical school was actually a viable option while all the English majors smoked pot and watched reruns of full house. Then there was the MCAT, the mother of all graduate exams which would either fulfill your hopes and dreams or simply crush your soul.

Certain tests have milestones attached to them. For me, our last cardio/resp test is not one of these.

Cardiology is super fun. Beside learning the basics taught to you since high school (The pulmonary artery carries what type of blood?) you eventually marvel at how complex the organ the size of your fist works and inevitably confuses the bejesus out of you come test day. The heart is very, very complex and very fun to learn about. By far the best topic covered are EKG's and more importantly deciphering them. Although I read the book conveniently titled All you'll need to Know about EKG's, I'm pretty sure those rhythm strips were made by a child who's drawing with a crayon at Friendly's. Its amazing after a few hours of study how much information can be elucidated from that one piece of paper. Everything from heart rate to regular/irregular rhythms, to supraventricular arrhythmia's to myocardial infarction can now be diagnosed quickly within a minute. Although learning the basics of EKG's seems trivial now, i do take solace in the fact that I doubt House has any idea what those squiggly lines mean. Pathology of the heart is also quite interesting. Sure you cover atherosclerosis to the deal but valvular pathology is cool when you extrapolate the pathophysiology and combine with it your physical exam skills, you really, and I mean REALLY, know why the heart murmur sounds like it does and what exactly is causing the murmur to occur.

I suppose the only downside to cardio is the pharmacology. The heart is incredibly important which makes it a cash cow for drug companies. Therefore there are multitudes of drugs with only minor differences, which makes studying for pharm questions incredibly annoying. I am not a huge fan of pharm, but I do see the value in knowing what certain drugs do off the top of your head. The major problem is that there is an iPhone app for that and teaching us the pharmacokinetics and drug interactions seems pointless when we get on the wards, shun our knowledge and use Epocrates.

Then there are the lungs...

I like breathing, it keeps me going, but I care little for the mechanics and physiology of breathing. Its negative pressure, there are multitudes of bones, joints and muscles involved in the process. I am so over it. Although there is a heavy dose of pathology, which is always nice, the same 5 bugs show up which apparently cause everything, including stupid, stupid pneumonia. I suppose the good news is that we were taught about antibiotics in pharm last year so we didn't have to deal with learning them again, the bad news is that we have to remember them now. We deal with fungi again, for the 8th time. Aspergillus, Histoplasmosis, Coccidiodomycosis and blastomycosis? Never heard of those before *sarcasm*. TB makes a comeback as well. Asthma, emphysema and COPD show their heads in this unit, and you'll be oh so thankful for it *sarcasm again*. At least pharm is tamed for this unit, that's possibly the only good thing. That and when our class moves on the the next system.

Until next time

Whoop Whoop


PS- XBOX is to cardiology as board games with your parents are to respiratory

Sunday, August 2, 2009

The Last Summer

What to do, What to do

The 8 weeks between 1st and 2nd year are truly your last summer you'll ever have. Sure you may have 2 weeks here or there but never another large block of time. There are a few scenarios which you could pursue:

1.) Nothing

This is your last summer, are you crazy!? You have 8 weeks to do whatever you want, do not I repeat DO NOT spend them on medicine. Take a trip to the Bahamas, catch up with your undergrad friends who are happy out in the real world while you are still in school (which in this economy you certainly may be the better off of the two). Backpack across Europe, get in shape, hike the Appalachian train, just do something that you WANT to do and is FUN.

2.) Medical trips

Some schools offer medical missions to certain third world countries like Ghana, the Dominican Republic etc. These trips are fun as you learn actual medical skills and maybe even see a condition or two that you studied during first year. Most people I know who went on these trips absolutely loved it and wouldn't dream of doing anything else. These sorts of things also look good on a resume. Just don;t do it for that last reason.

3.) Former Job

If you have an old job at a hospital or you were an EMS, contact them during the last half of your first year and see if you can comeback. Most of you will still be living off of loan money still so its not bad to supplement your income. Do the same if you worked at BR or Foot Locker, getting paid is never a bad option. Just don't go out and get a job for the first time as no one will hire you for 8 weeks (the economy again)

4.) Work for your school

Aside from trips, the professors at your medical institution usually do some research. If you like a certain professor or a certain topic of research, approach them for a job. Most of the time they will say YES and give you a research project over the summer or longer if you would like. Never a bad idea and a resume builder or more if you work hard enough and your work gets published.

5.) Study

If you simply can't fathom the idea of letting 8 weeks go by without doing something for school, you are a gunner and I don't like you. Seriously, the best advice I can give is if you use First Aid (FA) to study with and make notes during your first year classes, reread those sections to get them fresh in your mind. I started school thinking that was going to be me but I did not follow through with that. I guess you could revisit old topics that you had trouble with, look over anatomy, or prepare yourself for the upcoming courses (Acid-Base disorders for example.) I really don't advise this pathway as you need time to relax and you have earned it. The only reading you should do is for pleasure, and so help me God, If i hear another pre-teen talking about "twilight" I may drop-kick her.

What I did

During the last few weeks of our integument system I developed Low Back Pain. I sought out OMT treatment which worked for a few days but symptoms kept returning with a vengeance. Even with the LBP limiting my mobility, i played all time pitcher for softball one afternoon. i carelessly bent down to field a grounder upon which i felt a searing pain shoot down the outside of my right leg. I flipped the ball to the first basemen, the batter was out, and I retired for the afternoon. As the days went by, the symptoms, mostly leg symptoms rather than low back became worse. I got to a point where I could not drive more than 10 minutes much less sit in a chair for 15 or so. I again sought out OMT treatment which revealed a lumbar radiculopathy during a straight-leg raise of my right leg. At this point the outside of the lower right leg and foot were numb 100% of the day. Thanks to some very good friends, I made it to all my doctor appointments and my brother came down from boston to drive me back home to Rochester, NY.

I saw my PCP's NP upon my arrival in rochester and she agreed with my doctors at school that I should go get an MRI of my lumbar spine. This is where I became fortunate. My mother is an NP of women's health and through her 25+ years of working, she knew another NP for a neurosurgeon. She told her of my condition and the neurosurg NP would access my MRI and send it to the MD. The MRI showed two intervertebral disc herniations at the level of L4-L5 and L5-S1. The herniation at L4-L5 was central and mild and the radiologist could not determine when that herniation occurred. The money shot was centered around my L5-S1 disc which showed a large lateral herniation compressing the S1 nerve root.

At the time of the MRI, my leg symptoms had been present for 6 weeks. During the later 4 weeks, I had been to PT in rochester to correct the radiculopathy dx'ed by both my doctors at the school and my PCP's NP in Rochester. At 6 weeks, my right leg was significantly atrophied especially my right calf.

Upon the neurosurgeons notification of my MRI results, he scheduled me for an appointment on thursday and upon Hx/PE (history and physical exam) set a surgical date for the following tuesday. I underwent a hemi-laminectomy with diskectomy procedure which lasted about 2 hours. I was kept overnight in the hospital and d/c'ed the next morning.

I am 5 weeks plus 5 days post surgery and recovery is going very well. I have limitations put on me by the NP which I will adhere too until the end of september. I plan to resume normal sporting activity starting in january 2010.

I was very lucky to have my 8 weeks off. Had this happened during the middle of the school year or during third year I would of had to taken a leave of absence from school/rotations to heal up.

Take your 8 weeks of your last summer and make them the most fun you have ever had. That's the most important point of this diatribe.

Until Next time

Whoop Whoop


Coming Back Online

I can only be scolded so many times.

When I first started this blog I was doing it to keep my friends from undergrad as well as my coworkers informed of my progress in Osteopathic Medical School. Well it seems that with the death of the death of the coverage of michael jackson I have mustered some free time to begin writing again. I'm sure this will make all 5 of my readers happy (if I haven't already been deleted that is) as I will continue my journey down the road which is now named "2nd year of Medical School."

But first, A recap.

I left you off last time with a mild discussion of what Part I of Neuro felt like, coupled with anatomy, Physical Diagnosis (DPR) and OMM lab. Let me continue from that point in time. Neuro I is by fat the hardest course in medical school. You begin to loathe the cranial nerves, you have to learn a brand new language to describe the brain which is not the same as the language you learn in anatomy. You spend hours making color coded drawings of where each nerve goes, of certain cross sections of the brain, and the quickest way to find peace in the middle east. Albeit an easy task.

After part I of neuro, Parts II and III seem just a little bit easier. Granted we still had tests every two weeks which never made life fun but we are resilient medical students and we made it through, Huzzah!

Aside- One major downfall to Neuro is that it occurs in winter on Long Island. Compared to western new york long islanders have it made. Still there is no reason for you in your range rover young lady to scream around the corner at 65mph and not assume you are going to go careening into the ditch and hit the guard rail all the while with Starbucks in your hand. Its called snow, it comes with this phenomenon called ice at points, these factors make driving difficult. Therefore, slow down just a bit so the way I go to school isn't obstructed by way more police and fire vehicles that are needed. It may also have helped to actually brush off your vehicle completely as many of your kind see fit to only clear the driver side window and drivers portion of the windshield before taking part in your commute. Its annoying, dangerous and makes me want to test the battering ram capabilities of a 2000 Dodge Grand Caravan SE.

After neuro came heme/immuno. Like the cellular basics of blood? Like anemia? Clotting factors? Parasites and other organisms? Then this system is for you. Truth be told Heme/immuno seems like a godsend after neuro. It requires some memorization but overall concepts are stressed making it easy to transition from studying pathology to pharm. Its the IMMUNE system as well, you master the concepts here and you are golden in the realms of disease treatment because you know why and how the immune system is failing the keep the patient healthy. Some of my classmates hated heme. It's understandable as we have one more system to go before we see the light of our last full summer before the staunch reality of the 2nd to 3rd medical school endeavor.

Our final system was integument or derm. Here come the rashes, exanthematous eruptions, warts, STD manifestations, more unpleasant pustules and papules etc. etc. etc. If you are hellbent on dermatology as a career then I would go leaps and bounds over what work I put into this unit. We had two tests, one of which i studied for 1.5 weeks for the other 4 days, guess which test i scored higher on?* During the latter half of the system I developed some serious health issues which I will post later. Let's just say it wasn't at all fun to be me. Most of our days were spent BBQ-ing, celebrating some irrelevant national holiday or going to the beach. In truth most of us were relieved to have made it though the 1st year of medical school and mentally checked out so we could wind down and relax a bit while the weather became nice.

So there you have it, the rest of 1st year in a simple post. How'd I do?

Fundamentals -- Very Well
MSK - Fair
Neuro I,II,III -- Good, Well, Very Well
Heme/Immuno -- Very Well
Integument -- Good
Anatomy -- Very Well
OMM Lab --Very Well

All in all I was proud of myself for the effort I put forth. It's true I don't think Harvard or Yale will be calling my name as sometimes i chose to coast rather than gearing up on certain topics, but I wasn't very interested in the first year material as it was the basic science that lays the foundation for higher learning. 2nd year is more interesting due to more hands on lab time as well as learning Tx options to match with diseases. Needless to say I am hoping to blow everyone out of the water grades wise. If it wasn't for those stupid quizzes come june...

As for the summer between 1st and 2nd year I will address that in another post, but here's the menu for 2nd year

Cardiovascular and Respiratory Systems concurrently
Genito-urinary and Reproductive concurrently

I'll be sure to let you know how it goes...

Whoop Whoop