Med student types

hehe... got this from a friend

OMM on an infant

For a clinical demonstration today, a doc did osteopathic manipulation (aka OMM) on a 3 month old.  The mom brought her baby in because he hadn't been sleeping well and had a hard time passing stool. The baby also got very anxious/uncomfortable during breastfeeding. While the mother was an osteopath as well, it's hard to treat your own baby, especially right after giving birth since there are so many hormones and emotions flowing through you.

It was incredible how the DO observed and treated. First she held him up and played with him a little. I think she said that babies are supposed to form C's (?) bc they've been in that position for so long. They are also supposed to straighten their arms to push up on you and help you lift them up... but they shouldn't straighten their legs because straight legs means they're hypertonic or something. She checked the baby's suction by putting her finger in the baby's mouth; there was little suck. Normally, it should be strong enough to pull a latex glove off your finger. Next, she checked the skull and said the bones were compressed as if it were a bowling ball. Babies' skulls should have a bit of space between the skull bones since everything is growing, but this baby's bones were tight together. ("No wonder this baby's unhappy!") 

The treatment was mind-blowing in a oddly mystical way. The doc did two major things. One made a lot of sense- that was to gently pull the cranial bones apart and give them some space to move. The second thing she did was feel up on the baby's palate to push on the vomer and I think the frontal bone (I forget exactly what she said she was going for), but she was trying to activate or release inhibition of the vagus nerve. The vagus innervates the viscera in the body including the bowels, so often after treatments like this, babies will need to poop a lot. She said there was one treatment where the baby pooped six times on the way home and overflowed the diaper! Anyway, so both of those things were meant to fix the baby's major issues. The baby was providing great suction at the end of the session as well. 

I have to admit, watching the treatment was hard for me. They had to apply constant pressure for awhile and the baby was squirming anxiously and crying a lot. I couldn't stop the waterworks thinking about how the mom must feel about her baby being in pain while she watched. I told Becka I didn't think I could do peds... at least right now, I am way too empathetic to hold in my emotions. But the positive effects probably outweigh that. It was weird, the baby was crying so hard and then all of a sudden it would stop. I guess because he felt better... It still sent chills down my spine though.

We were told that if you do OMM on a baby, you change their whole life. You can still fix issues when people get older but it just takes much longer and is much more difficult. Pretty wild stuff, that baby treatment.

Grades posted

So, when they ask you how you deal with failure in a medical school interview, it's for good reason... it will happen!

They posted grades on blackboard this afternoon. They threw out 4 of the 90 questions (I guess those became extra credit) and I got 63 out of 86 right. That's a 73%. Eek.

Our fundamentals course is broken down into 4 sections: structure (S), mechanism (M), therapeutics (T), and clinical sciences (CS). To pass, you have to get a 70% overall AND in each of those areas. This test had S, M, and CS, and I did not pass the mechanism section (26/40), which I'm guessing that was thanks to those crazy biochem questions for which I had not studied the minor details. So yes, here is some motivation to kick myself back into gear. I remember talking to Laka about this so many times last year after not doing as well on tests as we wanted-- you can't let it get you down.  Every time you fail is just a motivator to up your game. And Sheppard's blog provided another little pick-me-up... I may not have done so well, but I took this test with other minds in the top 1% of the country. This is not the end!

I actually skipped my first lecture today too... I was having trouble focusing in anatomy and decided it would be a more efficient use of time to rest my brain and take a nap. Charlie recommended I take a coffee-power nap, so I tried it as an experiment. After not sleeping enough every single night I've been here, my power nap became about 50 minutes instead of 15, but I feel pretty awake now.

Back to the books!

Exam 1: Lessons Learned

We had our first exam this morning: midblock 1 on fundamentals. It was painful. It was a scantron 90 Q multiple choice test. I guessed on most of the answers.

Here is what I learned about exams:
1) When the second years tell you it will be a breeze, that's not true.
2) The questions are much more detailed and specific than the practice exams (um.. how many ATP come out of every single step of any metabolic process?)
3) How to study- review and take notes on the lectures the night of the lecture, then answer any of the objectives related to those lectures so you can just review them before the test. (I learned this a little too late...) ... I really appreciated that Hopkins gave us first semester freshman year to adjust by making everything pass-fail. I am not a huge fan of the rankings and percentage grades on transcripts here...

The test was on anatomy, biochem (metabolism and enzymes- like a semester's worth), homeostasis, and histology. Some interesting knowledge things I learned are as follows (correct me if any of the info is wrong):

WHY HIGH FRUCTOSE CORN SYRUP IS BAD FOR YOU:
Your body runs on glucose. If you eat sugar, the dissacharide of sucrose dissociates into glucose and fructose and while the liver has to use the fructose immediately, if there is extra glucose, it can be stored away as glycogen. If you have an influx of fructose, it goes straight to your liver which has to metabolize it immediately and that can overwhelm it.

WHY THE ATKINS DIET IS BAD FOR YOU:
1) Too many fats. Ketogenesis happens when there is a high rate of fatty acid oxidation in the liver (this happens when there are a lot of fatty acids around, when there isn't enough glucose, or when your body cannot metabolize/use glucose as an energy source as is the case for insulin-dependent diabetics). Ketone bodies are created and exported by the liver and those ketone bodies lower blood pH. When you have too many of them, it causes ketoacidosis which is too acidic of an internal environment for your body to function optimally.
2) Too much protein. A by-product of the breakdown of amino acids in protein is ammonia which is toxic to the nervous system and if not converted to urea (its detoxified form which can be readily removed from the body in urine), it can cause death. Amino acid skeletons can also be converted to ketone bodies which as written in point #1, can make your system too acidic.


There were some other things too but I should probably pay attention to this lecture on "The Patient." It's very public health and has to do with our healthcare system and how it compares to those of other countries.

Freakout commence

We have our first exam Monday. It's a 90 question midblock to be taken in 2 hours. There is so much material that my mind is swimming and I do not know how I am going to know all of this. Aaaaaaahhhhh med schoooooool

Arts and crafts

In other news, I have started a project that I have no time for whatsoever...
So far, I have a little sacrum/coccyx and lumbar spine made from white felt. There is room for the spinal nerves to go into the sacrum and the sacral hiatus and foramina are there too.... One day, it is my dream for this to be a full fledged human with reflect-able muscle layers and organs!  We will see how that goes...

Astrology and medicine

I don't know if it's just me, but I've noticed that there is a disproportionately high number of virgos in our class compared to what I'm used to. Based on the description, it makes a lot of sense. Here is one of many:

Virgo is the sixth sign of the zodiac, to be exact, and that's the way Virgos like it: exacting. Those born under this sign are forever the butt of jokes for being so picky and critical (and they can be), but their 'attention to detail' is for a reason: to help others. Virgos, more than any other sign, were born to serve, and it gives them great joy. They are also tailor-made for the job, since they are industrious, methodical and efficient. The sense of duty borne by these folks is considerable, and it ensures that they will always work for the greater good.

Does anyone else believe in this?

Wows

In anatomy lab today, we found breast implants on our cadaver. Surprise! We started dissecting the front/thorax and as we started pulling back the breast we were like .. what.. there's mesh in here... and silicone! AAH! Everyone in lab came over to see it, it was the coolest thing ever. Unfortunately, we punctured both implants so they couldn't be saved. The silicone felt like bouncy, sticky honey/mousetrap glue. The lab prof said in 2-3 days it would be all over everything and gooier and stickier.

After we had gotten through much of the superficial muscle and saw the arteries/veins/nerves in the upper chest, I got to use a bone saw to cut through the ribs and reflect them inferiorly to see the inner organs. Our cadaver had died at 65 from ovarian cancer which seemed to have metastasized to the lungs because the left lung was stuck to the ribcage and the right side had parts that were quite hard. (EDIT: They messed up the descriptions of the bodies for the tables... our body is of a 70 year old female with emphysema and tobacco abuse). I touched the lungs of another table's cadaver where there was very visible lung cancer and the lungs had a lot of black spots and hard bumps. One lab professor also pulled out a lymph node to show us- that was interesting to see too.

Today was hard for me with the smells though. Since everyone was cutting open ribcages, the smell of formaldehyde was overwhelming the room as it spilled out of the insides of bodies. Also, I don't think a lot of groups were using the odor neutralizing spray (20% Infutrace, 1% phenol), and we have been dissecting for over a week now. The combination of the smell of the formaldehyde and some table's greasy yellow fat made me gag. I don't think I could handle surgery...

Dissection instructions picture from our book:

Yesterday was also really interesting. We spent about an hour and a half doing an exercise to learn about diversity. It was aptly named the "diversity shuffle" which upon reading I thought... is this a dance? But instead, our class showed up at the gym and all started on one side of the room. As a professor called out phrases, we would move into the center of the room if it fit us. "Step forward if you identify as... as woman... Asian-American... if you are under 30..." "Look around you. See who is standing with you and who is not. See how it feels. And step back." At first they were basic demographics. There were about 7 or 8 other multicultural people (is that my group? I don't know... maybe?). Then the phrases started getting deeper. "If you grew up poor...if neither of your parents went to college...if you were raised by a single parent... if you had drug or alcohol problems in your family... if you or someone in your family was incarcerated... if you know a close family member or friend with HIV/AIDS..." and finally "if you've ever watched someone die." So many people walked out on the last one- at least half. I know it was definitely emotional and hard for some people, and I felt it from the other side, especially when the same group of people walked out for a bunch of the same ones. My heart was breaking for them and their past, but was also feeling proud for them being here in med school. There were so many things that were called out for which we walked out to the middle of the room in silence, and without even speaking to each other, we all learned so much about each other.

We split up into small groups to discuss the exercise and how we think it will affect us in the future. Will there be prejudice against us? Will we have any towards patients and others in our practice? How did we identify and how did it make us feel? Sometimes it's hard to admit something sensitive, and we must be aware of that.

Finding Balance

I'm having trouble focusing in this embryology lecture so I'm going to write now and read up on the material later. It's day 5 and there has been a deluge of information thrown at us. The past two days have included embryology, basic life saving (CPR/AED/choking), histology, and finding balance.

I really wanted to write about the finding balance class because I think the ideas are going to help me stay sane whenever I feel overwhelmed. An integrative medicine doctor named Lee Lipsenthal (from Washington, DC!) created this series for other doctors because he realized that many docs were angry and couldn’t get past it. Medicine is a stressful profession- what other job allows you to work for 80 hours a week? Most people go into medicine because they really really want to and still the average age of physicians stopping practice is 57 because they burn out. Your emotions can also change a hundred times in an hour as you go from patient to patient. You have to recompose yourself if one patient dies and then you have to talk to another one. We have really high expectations of ourselves as well. A number of studies have been done showing high rates of depression and burnout in medical students as well as reports of belittlement and abuse... where does that abuse come from? Other medical professionals higher on the totem pole and patients as well!

So the question is, how do we handle this stress?

We were told to write down:
1) What our stressors are right now
2) What happens to us when we are stressed
3) What we do to decrease stress
4) Who we are and what our core values are -> we will have to remind ourselves
5) Write down 5 things we're really good at

All of these things created awareness of who we are and how to handle ourselves when we fall into stressful situations. We also watched a video (I really wish I could find it to post it), and in the video there were images of a guy driving through New York City. First the soundtrack was a bunch of harsh noises, honking and screeches; generally a very stressful feeling. Then the same video was played with joyful, classical music in the background. The difference was incredible. The video meant to show how our perception of situations is the ‘soundtrack’ playing in our heads while we watch the world go by. Your self-talk is that background music and when you feel like it’s turning into a negative tone, you have the ability to change that.

We spent the last seven minutes of class in a guided breathing meditation. Something I realized when my thoughts were straying was that pushing them away made them come back faster. Acknowledging that the thought was there and then bringing it in and keeping it with me made it much easier to focus on the meditation.

I'm glad we had this class early on and I hope other schools have it too. If you're in medicine and reading this, I hope you are keeping balance in your own life! Keep your soundtrack positive! :)

Day 3

Eeek I am so behind! But I must update! To review things... :)

A lot of today was anatomy stuff. We had two lectures on it between the morning and afternoon, followed by lab where we used a bone saw to perform a laminectomy and remove some of the lumbar spinous processes. It took kind of forever, and I didn't even do it because I didn't have goggles or glasses (and yes, I guess I was too lazy to go find a pair and put them on too). But it was very cool to see the spinal cord and the cauda equina (horse hair) nerves, and everything else down there. We also exposed more of the upper back region, cutting deep to get to the suboccipital triangle.

Other lectures today included "The Osteopathic Principles" and "Introduction to Osteopathic Diagnosis: Anatomical Landmarks, Surface Anatomy."

With things like osteopathic diagnosis, we get an incredible amount of practice palpating/touching and we are taught to relate to patients early (as you saw from my previous entries, from day 1).

There are also four osteopathic principles which define osteopathic physicians from allopathic physicians in how we think:

1) The body is completely united; the person is a fully integrated being of body, mind, and spirit.
This is the “Triune of Man” – Dr. A.T. Still. An example would be if you injure your toe, that force has propagated through your entire body- the whole body felt it. Or how dogs coming into a hospital help lower your blood pressure-> the relaxed mind helps the body. Think of it as a triangle with health in the middle, and if one part is off, so is your health.

2) The body is capable of self-regulation, self-healing, and health maintenance.
This is the search for health over disease.Wolff’s law says if you apply force to a bone, more bone will grow where those forces are placed. As you use your body, it remodels itself. Our goal is to optimize healing potential if there is something wrong, or if healing is needed.

3) Structure and function are reciprocally interrelated.
This is where the OMM stuff really starts coming in. Structural and functional systems all work together integrally and if the structure isn't right, the function will have problems also.

4) Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
In other words, the doctor has to come up with the treatment plan for the patient and the therapy is based on taking the other three principles into consideration. It’s an integrative/holistic approach.


In short (from our lecture slides), "With the significant exception of OMM, it is not so much our modalities of medical practice that sets Osteopathy apart...It is the clinically applied Osteopathic Philosophy in which we strive to find and facilitate our patient’s health, in the face of the overwhelming contemporary medical focus on disease."

And in that vein, we were told, "You are all infectious agents and we’re going to inoculate the world with you.”

:)

First weekend

What is a typical weekend like in med school? Not sure yet. But this was the first one after classes have started and one of the best parts about it was discovering Vallejo's farmer's market on Saturday. Check out my stash of fruits and veggies...

...all of this was for <$10. The tomatoes were 75 cents a pound and many of the other things were $1.50 a pound. I don't think I have ever seen fresh, local produce for so cheap in this country.

Today, I went to anatomy lab with a friend to learn the bones for our first section on the skeleton, went shopping, and played tennis. I have been trying to study... I will need to finish this blog post to do that :p

Day 2

Our whole class was together today for class and lab. Due to a mistake in the schedule, we all showed up at 8am and found out our class was actually at 9! Aaah. I would have loved that sleep, but it's okay.

Our first class was "Interviewing" as a topic in doctoring (9-10am). We discussed things like how to make a patient feel comfortable (e.g. knocking and asking before entering which may seem obvious but some doctors don't do it, confirming that conversations are protected), how to get as much information as possible out of a patient in a short amount of time (what if your patient does not feel comfortable talking, if they are talking too much, or you don't have time to address everything on their list), how to phrase questions (probe, don't lead), how to deal with sensitive issues (e.g. sexuality and relationships, domestic abuse; tone matters!), and how to use body language (use eye contact, don't write too many notes). Part of this was also not jumping to conclusions and allowing the patient to say as much as possible, using silence or whatever methods you need to let them talk. If the patient feels comfortable, they will give you more information that will allow you to help them!

Right afterwards, we had "Osteopathic History" as part of the OMM course (10-11am). There were a few bits about the beginnings of public health, drugs, and medicine leading up to the time AT Still created osteopathy, but his thoughts on health were announced in the proclamation "The human body has much in common with a machine, one which ought to function well if it is mechanically sound." This meant that if one part was broken, the whole thing couldn't function properly. He created a clinic in Kirksville, MO before he started the first osteopathic med school in 1892. At the clinic in 1895 alone, he treated 30,000 patients. He was so successful that the city added trains so people could bring in patients who wanted to be treated by Still. Basically, everyone wanted his hands to treat them.

We amazingly got 2 hours off for lunch today and went back for anatomy lab from 1-3. I felt much more comfortable today dissecting and think I am really good at separating muscles from fascia. ;) Not to toot my own horn but that's what happens when you like detailed arts and crafts. We were still dissecting the back and got to see the erector spinae muscles (iliocostalis, longissimus, and spinalus), splenius, levator scapulae, serratus posterior, and the occipital nerves (greater, lesser, least) and artery. Being in anatomy lab really really helps you learn the muscles because you have them right in front of you and you are like "what is this?" and you try to match what you see on the cadaver to the pictures in the book... and then it just makes sense. Some of the docs were walking around to help again, but since we were all in lab today, we also could go around to check out the other cadavers (our anatomy test will be on everyone's). The greater occipital nerve was displayed prominently at table 11 and thank goodness because I wouldn't have found it otherwise. It looks like just a slightly raised part of whatever tissue it's on if it's not sort of separated, since it's the same color (whitish). But they run anterior-posterior (transverse, we could say) while whatever else is running on the coronal plane. I apologize if this is too much for some of you reading this, but it helps me remember by writing about it :P. Also, if you are wondering, we cut each muscle along the spine and reflect it back to see the layers below.

Anyway, the rest of my day was spent 1) playing tennis, 2) bouldering and slack rope walking at a rock gym (I suck at both those things btw), 3) eating pho, and 4) chatting with roommates. So there you go, end of the first week of med school (we toasted to it!). I cannot believe I have only known my classmates for a week or less and so many of us are so close already. Then again, everyone has similar interests, we're all nerdy, and we all are somewhat type A personalities (how else did we get here?), so I guess we were bound to get along. :) Til next time!

P.S. Despite what the post says, I am writing this at 2:30/3 in the morning. Probably should go to sleep... a few hours ago.

First Day of Med School

After a whirlwind three-day orientation, we had our first full day of classes today!

In short, during orientation we:

1) were introduced to our new profession ("you are all in, all the time")

2) did all our administrative stuff

3) met each other (all 137? of us went on stage in front of the rest of our class to introduce ourselves and we have an amazing group of people!)

Our class (some people are cut off):

Every night, there has been a social event of some sort as well. On Tuesday there was an ice cream social for Mare Island residents and yesterday there was a big sib/little sib barbecue, which was a nice way to meet some of the 2nd years.

As for the first day of *osteopathic* medical school, today was awesome. Class was awesome.

My first class was 8am: osteopathic manipulative medicine (OMM) lab. This was by far my favorite thing ever and I am so sad that we only have this lab once a week. We got into our partners and traded off being the patient on the table and the doc doing the palpation. We felt around for the tendons, muscle groups in the arm and lower legs, and some random things in the head (inion, mastoid and transverse processes, etc.). We also had to take off our shirts (sports bras on, don't worry) so we could feel for things in the back. First we had to feel for heat with our hands without touching the skin and see which areas in the back had more heat (but it was hard to tell if the palmar or dorsal side of our hand was more sensitive to heat). We tried dragging our fingers down the sides of the vertebrae to see where the skin dragged, at varying speeds. If you do it at a harder pressure, the skin should blanche first and if it stays red, it means the muscles are more aggravated. The areas that are red also tend to be warmer and have more skin drag. There is something called thermal diagnosis that is a much more intensive version of this but the point is that you can tell what's going on inside by looking at the skin. You see why I love this?

OMM lab:

Next up was anatomy lecture at 10am. Our professor had really good ways of describing things and related things in anatomy to how a doctor would think about it with a patient. He also explained the latin roots of words. Examples: The sagittal plane was named after the arrow-shaped fontanelle in a baby's skull (sagitarrius, the archer uses arrows) which faces the same direction. Also, if you want to remember which direction flexion is (vs. extension), every joint flexes when you curl into the fetal position.

We had one hour off for lunch (12-1) and then we split back into our groups. Anatomy lecture was the only time today where our whole class was together but for the rest of it, our class is split into three groups. Because we all do everything together, it feels like summer camp. I mean, you usually pick your courses in undergrad (or grad) and go to each of those classes on your own. There isn't a schedule that is followed by everyone. But in medical school, everyone is in the same classes and everyone is always together. It's actually really nice. I think we will be able to pick some electives later but those will only happen for a few hours on Friday afternoons.

So my next class was osteopathic doctoring where we talked about ethics and professionalism in the doctor patient relationship. We discussed cases and how to handle them. Is it appropriate to cry with a patient? What do you do when a 75 year old lady comes in for the first time and demands valium or she will fire you? Students had a lot of really interesting viewpoints and things to say. There is obviously no clear cut answer, but it's great to think about these things.

The last class of the day was at 3: ANATOMY LAB. Touro has one of the best labs in the country because it has to stay clean according to Jewish tradition, meaning there is really good ventilation to prevent living air from mixing with dead air. We broke into groups of five to each cadaver. We learned the lab rules (did you know formaldehyde can bind to petroleum based products like gum or lip balm?) and learned how to put on a scalpel blade. Before dissecting, we spent a moment of silence to thank our cadavers for donating their bodies to science and letting us learn with them. I was a little hesitant about cutting because I didn't want anything to go wrong, but the professors came around and dove right in, pulling skin/adipose tissue, cutting the fascia/connective tissue between the adipose and the muscle. We got to see the trapezius, the rhomboid major and minor, the latissimus dorsi, the serratus anterior, and the obliques.

It feels like two days have passed already, but we are learning a lottttt. I am way behind in studying now. Gotta go! :)

Pre-orientation

Hello hello. Yes, it was my goal to start a blog to document my medical school experience. Tomorrow is the first day of orientation and I have already met so many awesome people!

If you are reading this and are not sure what a DO is, my second year roommate had a great way to sum it up. DO is basically MD+physical therapy+public health. The American Osteopathic Association describes osteopathic medicine as focusing on preventive health care and receiving specialized training in the musculoskeletal system. DOs also use their hands to diagnose injuries and illness and encourage the body's natural tendency to heal. We have to take the osteopathic boards and the regular boards that MDs take. It's too bad many people still don't know about this.

I arrived in California two weeks ago, got all my furniture into my room (1), received the packages I shipped to myself (2), and got a car ...and I couldn't have done this as quickly and easily with the help of my wonderful family. In this time, I also got to see Napa (3), spend time with relatives, and hang out with new classmates at the Jelly Belly Factory (4), Six Flags (5) and at houses on Mare Island. It's been great. Here are some pictures numbered as such.

1) My room... the bed is an air mattress from Costco.

2) I heard the guy at the post office go "ohhhhh!!" when he went in the back back to get my packages. They were wheeled out in a large cart.

3) At the Greystone Culinary Institute of America in St. Helena. The food was delicious, and they have a nice little wine museum inside.

4) Inside the Jelly Belly Factory. No photos were allowed on the actual tour but we got to have samples of the jelly beans at different parts in the process (just the inside, the rough bean, and the polished finished one).

5) Group of first years at Six Flags Animal Kingdom in Vallejo. It's weird to live 15 minutes from an amusement park.

I do miss DC with its wonderful public transportation, free museums, and the weather (it gets chilly here!), but new friends are making the transition easier. Vallejo does have its perks, e.g. palm trees, cheap weekly farmer's market, proximity to SF and Napa, sunny days and consistent temperature (always 70s during the day and 50s at night). And I hear first semester is pretty nice with all the Jewish holidays we have off. DC/Bmore friends, I hope to see you in September! Ciao for now! :)