Treatment over iChat

I am really excited to go to convo right now. :)  Convo, short for convocation, is a big gathering where a bunch of DOs and DO students come together to teach each other different treatments and do anything and everything related to osteopathy and osteopathic manipulation. One doc told me that every time he had gone to convo, he doubled his knowledge in the field.

My brother has had low back pain for a month and over ichat, his girlfriend (yay Miri!) diagnosed and treated him as I explained what to do. Successful treatment of a posterior lumber counterstrain point decreased some of the pain and a treatment of a left unilateral sacral flexion made him more symmetrical, but the pain was still there. Okay... so the psoas and ilacus tender points weren't tender. But...based on the injury and if he felt more comfortable sitting than standing, they are probably the cause of the problem. So we did counterstrain for that and tada! Back pain is gone. Things like this make me really happy.

Can't wait to learn more this week!!! Convo starts Wednesday :D

Delivering Bad News lab

Talk about an intense class. Our doctoring lab today was called "delivering bad news" and we were in simulated scenarios where we had to do exactly that.

We split into groups of about 9 students with one professor per doctor's office (it was in the clinical skills labs so the location was also as realistic as possible). For each of the 5 patients that came in, one student had to give them the news as the rest of the group watched.

We had some readings beforehand about how to deal with this kind of situation- how to interact, what to say, what to do, etc. But when you're actually in the situation, it is quite different from reading about it on paper. The standardized patients were also pretty darn good actors who were for the most part all taking the news badly.

The scenarios were as such:
-A 40 yo lady who's been trying to conceive for the past 10 years got pregnant and you have to tell her that her recent cramps and bleeding is because she miscarried.
-A 50 yo man has just had recent surgery for his pancreatic cancer. He's feeling better but you have to tell him they couldn't get everything out bc it's so widespread that it's inoperable and he has a few months left to live.
-A man whose wife has been in Iraq for a year has recently come home and while she was away, the man had unprotected sex w/another woman - so we find out he has contracted gonorrhea. Both the man and his wife come into the office and you have to tell him about his STD test results.
-Your patient has passed away and you have to tell his son/daughter that it happened in the short time (an hour?) that they were gone to run errands getting things ready so they could bring their father home.
-A 57 yo woman's mammogram showed possible cancer and you have to tell her that she needs a biopsy so they can catch it before it spreads if it is malignant.

So... I did the last scenario, and I learned a lot both from that and from watching everyone else talk to the patients. A big one for myself is that I need to not project on the patient how I think they should be feeling just because I went through a similar experience and felt a different way about it. I need to tune in to the patient's personal reactions to the situation and what the impact may be on *them*. Basically, you cannot "expect" things, but only respond to them. From others, I also learned that it's okay to touch a patient to be comforting if they seem sad, and to lead up to the bad news with what has happened so far instead of bluntly saying what the news is.

There is so much more I feel like we can learn by practicing how we communicate, and I am so glad we had the opportunity TO practice before being plunged into a real situation. I talked to my brother about setting up an acting workshop to explore some of the emotions that our patients may be feeling... think I'm going to try to make that happen soon. :)

First week back after break

So far this week...
-In anatomy, we cut a heart out of a body
-While learning the sacrum & pelvis (in OMM), we spent 2 hours poking each other's butts (it's getting to be extremely natural, but I'm sure to other people it looks very odd)
-We interviewed a standardized patient and did a full history and physical (I was totally fooled... I thought the patient was reeeeal! And then we found out that everybody's SP had the same name and problem and worked at OfficeMax)

I also went to an elective called the Art of Observation which was an awesome class!! From what we were told, the course began in response to a patient complaining that their doctor didn't even look at them. Yale took advantage of being near a museum and a course was made to get med students to work on their observational skills by looking at art. Afterwards, the course was picked up at other med schools around the country. In our first class, we looked at 3 portraits of women (projected on ppt slides) and spent 5 quiet minutes observing each. Then we went around the class and shared what interesting details we noticed and what we interpreted about the pieces (including if we could see any possible medical issues... eg. maybe this pale girl is jaundiced?). It was basically like going to a museum with friends and discussing art.. with a tiny medical twist. But it was super fun being artsy fartsy for an afternoon.

Reflexology

I saw it in action in the oncology wing at Hopkins. Once a week (for the past 2 years supposedly), the cancer center has brought in licensed massage therapists to the chemo floor to do a variety of techniques while the patient is getting infused, as a way to blend Eastern and Western medicine. The treatments include oncology massage, reflexology, reiki, and others! I saw lymphatic drainage on the list, but I'm not sure how much it is like the OMM version since when I started describing some of our techniques, they seemed to be different from what the therapist knew.

The concept of course for reflexology is that points on your hands and feet map to different parts of your body. The tender points show where there is some sort of problem. It seemed pretty accurate, since for colon cancer, the tenderest points mapped to the GI system. I really want to learn more about this and try some stuff out. Here's a pretty neat link in the meantime:
http://www.reflexology-research.com/whatis.htm

1/8 of a doctor

WE HAVE OFFICIALLY COMPLETED OUR FIRST SEMESTER OF MEDICAL SCHOOL!!!


After 9 didactic exams, 6 practical exams, and various quizzes and other assignments....
In the past 4.5 months, we have learned:


The basics:
-Foundations in: Anatomy, cell bio and signaling, embryology, histology, homeostasis, immunology, inflammation, metabolism, pharmacology, and physiology
-Bacteria, fungi, parasites, and viruses - and drugs used against them
-Neoplasias - and drugs used against them
-Immune diseases and HIV - and drugs used against them
-Blood systems: All about blood (cell structures and functions, groups, hemopoesis, hemostasis), hemostasis disorders, anemias, myeloproliferative disorders, leukemias and lymphomas, and systemic viral/bacterial/tropical-protozoal diseases - and the drugs used to treat them
--> in total, about 350 drugs with their uses, mechanisms of action, contraindications, and toxicities (drugs includes NSAIDs, glucocorticoids, DMARDs, therapeutic prostaglandins, autoimmune tx, antivirals, antiretrovirals/anti-HIV, antibiotics [the most at ~86 of them], chemotherapeutics/antineoplastics,  anemia drugs, pro- and anti- coagulants, antifungals, antimalarials, antiprotozoals)

Doctoring: 
-How to take a history
-How to do a full physical exam (HEENT, respiratory, cardiovascular, abdominal, neuromuscular) with osteopathic components included (TART), and how to report findings if dictating
-Clinical reasoning in coming up with a differential diagnosis

OMM: 
-Structural and motion testing exams (for screening and scanning), diagnosing somatic dysfunction
-Soft tissue treatments
-Lymphatic/sinus treatments
-Muscle energy on the upper and lower extremities, spine (OA through L5), and ribs (for inhalation and exhalation dysfunction)
-Through brown bags and treatments, also: bone bending, cranial treatments (for orthodonture, etc), counterstrain, balanced ligamentous tension, sacral/other unwinding, etc...
-Osteopathic history and theory


Earlier on in the semester, I said I was failing, and really, it was just because I wasn't studying enough. No more cramming! Medicine requires constant reinforcement, so now at the end of every day, my friends and I go through the lectures of the day and review as much as we can.

Also, our class's google group listserve is always bursting with activity discussing the material and sharing study guides that we've made. We have an awesome collaborative learning environment between our whole class :)  I looovee itttt <3 <3 <3

It's been a busy semester, and we've learned a lot!
CONGRATS EVERYONE ON GETTING THROUGH IT!

Signs of stuff going on inside

Docs often use left arm pain as a sign of a heart attack.

So why is it such a stretch to say that pain elsewhere are signs of dysfunction in other places of the body? Anatomy explains so much!

Wish I could write more... studying OMM theory right now and saw a note about that ^.

tongue diagnosis

Dr. Oz says if your tongue is pale, it means you're anemic because there isn't enough blood being made to color the tongue red.  Hm!

I like the idea of using the tongue to diagnose, and the Chinese have pretty much mastered it. I particularly like this site to do prelim self-assessments. :)

ode to google reader

Happy 12th birthday! 
Google, you are amazing.
You simplify life.


Okay so I wanted to mention if you aren't doing this already: use google reader to follow blogs! If you have gmail, Reader is located in the upper left hand corner as a link along with Calendar, Web, and Documents. You can follow people by clicking "follow" on their blog page, or by clicking on the "+ add a subscription" button and pasting the link in there (especially helpful if there is no "follow" button). 


It is such a great, convenient tool. It's so great. Did I mention it's great? I like it.


And in other news, 
the interesting tidbit of the day:
"Topical honey has been used successfully in a comprehensive treatment of diabetic ulcers when the patient cannot use topical antibiotics." The reason honey can be used as an antibiotic is because it is a saturated mixture of monosaccharides (mostly glucose and fructose) with a low water content. Most of the water molecules in it are associated with the sugars and thus few are available for microorganisms to grow in.


My tribute to wikipedia will come another day.  For now, I'd like to acknowledge its contribution to me getting through med school. Thanks Wiki! :)

Is there a doctor in the house?

I flew home on a red eye last night to this morning. On the first leg of my flight, a lady in the row behind me kind of passed out. All of a sudden there was a lot of commotion and the lady next to her was fanning her and trying to get her to respond- "Can you hear me? Where are you?" The flight attendants paged overhead asking if there was a doctor in the house to come back. A guy figured out quickly that she needed at least some saline, so he put an IV in her, kneeling right there in the aisle! Others were holding the bag in the air so it could drip. It was intense! After a little while, the lady's eyes were open again and she said "I'm fine I'm fine!" But the doc told the pilot she needed to go to a hospital, so we made an emergency landing in Salt Lake City, where the paramedics came to get her. I'm not totally sure what the problem was, mostly because I kept falling asleep, but that was definitely something I've never seen happen before. And I must say, the IV on the plane thing- quite badass. Tis motivation to be one who can do that.

Now I'm home for the week. I watched Dr. Oz for the first time today since my dad is a fan. It was a pretty interesting show and a great way to get medical info out to the public in an easy to understand way. :)

I'm rewatching some of our OMM videos right now and here's a good tip from lab 2:
If you are looking for ribs 11 & 12 on a supine patient, sink in your hands (fingers straight) just inferior to the costal margin and run your index finger posteriorly along the bottom of rib 10 as a guideline: your middle finger should run into (or roll over the tip of) rib 11. Same deal for 11 & 12. Alternately, lift the patient's back towards you with your arms slack and the ribs will sink through the tissue onto your fingers. Roll your fingers a little superior and inferior to really feel them. Use your finger pads for everything because they have more nerves/sensation than your finger tips.

Exam 2: Time to re-evaluate again

Okay, I actually failed my first fundamentals block exam pretty badly. New plan: study the lectures the night before and re-enforce by going to class!

We had our first blocks last week. That means, we had a full week of exams... as such:

Monday: OMM lab practical exam--> at 3 stations with 4 minutes each, 1) find 4 landmarks on the body, 2) do a soft tissue technique, 3) do a lymphatic drainage technique, and describe what you are doing.

Tuesday: Fundamentals exam from 8am-10:30am. 92 multiple choice questions and 12 histology slide identifications. I took a nap at 4:30am and I think knowing more actually impeded my performance because I second guessed myself on about 10 right answers and changed them to wrong ones. :(

Wednesday:  Doctoring practical exam. This was no biggie. We had to either find all the cardiac listening spots and areas you could take a pulse or describe and point out where all the lobes of the lung were, in 6 minutes.

Thursday: OMM theory exam in the morning and anatomy lab practical in the afternoon. The anatomy lab practical involved us going around the cadavers and ID'ing the pinned/tagged body part or what it does. There were 64 identifications and we had 1 timed minute at each station before rotating. There were always two people at each station and one would ID the red pins and one would ID the yellow ones, so we would all do 2 laps. I don't get why they don't tag things with pins all the time because it would be so much more effective to learn by seeing it in 3D!

It was a huge relief to finish all that... the weekend was a nice break. A highlight was going to the Mare Island Museum. The island has a ton of history! A Marine veteran showed us around and told us all the stories of what used to happen here. 44,000 people used to bus or ferry in every day to work on Mare Island in the Naval Shipyard. It was mostly civilians that were building ships and submarines for Uncle Sam in the war effort. A lot of things have changed (buildings gone or now out of use) but it was really interesting to see how things were in the heyday. Some of the old battle ships are still around too. 

So after the exams and the weekend, we are back to class for a few more days before fall break. I just wanted to throw out one interesting tidbit from studying today (I think I'm going to try to make this a consistent thing): 

Striated muscle cells in skeletal muscle and the heart can only undergo hypertrophy (cell swelling/increasing in size) because they have a limited capacity to divide (cannot undergo hyperplasia like smooth muscle cells). Therefore, the ripped bodies you see on weightlifters are not muscle cells multiplying but instead just getting larger, as a response to an increased workload. WHO KNEW! For more o' dat, you can read up in chapter 1 of Robbins Basic Pathology.

Cheers :)