Tis the Season!

Christmas/Yule/Winter Solstice/etc. is here, and I am quite happy with the spoils. Relevant items include a 6 foot by 4 foot whiteboard, with which I can write all the drugs, pathways, etc. that I need to know. I also got a leather executive-style black chair to sit in - a huge improvement over my old chair - a lightweight thin wooden plank-type chair that would fall over every time I stood to go somewhere. Also, I bought myself a new mechanical pencil, a brand new five-star college-ruled perforated page notebook, and I have my highlighter, computer, and USMLE Step 1 prep book ready.

In other news, I got a new portable hard drive which trumps my other two in several ways. My first external hard drive was a portable 50 GB drive with two USB connections, one for power and the other for transferring data. This has worked out well as a storage for documents, pictures, etc. My next external hard drive was a 500 GB LaCie model, with a large external casing, a single USB connection, and a wall socket power cord. This third one has a capacity of 1 TB (1000 GB), it has a single USB connection, a soft case, and is less bulky than both of the others. All in all, I am tempted to scratch my old ones and just use this one, but I think I'll keep the others as backup devices. Why have one when you can have three, after all? I definitely need the space, even for medical school data. All together, the first semester at Touro University has yielded 4 GB of powerpoints, videos, documents, PDFs, pictures, and more.

I Must Be Crazy

Just got back from Tahoe, had a wonderful time of course. It was nice being away from the grind of studying medicine, but all the same I found myself missing Principles of Internal Medicine, especially while watching Outbreak. Infectious disease is one of my biggest interests, and I felt so bad watching that small town doctor flipping desperately through his medical books trying to understand why everyone in town is becoming ill. I definitely do not want that to be me. I do not want to miss something vital, I know I inevitably will, but I definitely do not look forward to it.

Anyway, now that I am back I feel the urge to read through Principles and work on studying for the USMLE. This is as good a time as any to start reviewing. Less to learn later. Just reviewing everything we have already covered, and trying to fill in the gaps. One thing about osteopathic schools, which is a tad unfortunate, is we do not get quite the detail on genetics and pharmacology of allopathic schools. Luckily for me, I like genetics and pharmacology stuff, as well as microbiology, which I think is also treated a bit more lightly. Anyway, back to the unnecessary studying.

OMS1 Fall Semester: Complete!

Well, this was an interesting first semester, but I am content with the results. Next quarter the goal is to get 90% or higher in Fundamentals in every section - OMM/Doctoring I don't particularly care about as long as I pass above an 80%. The tests are all over, hopefully we'll get some challenges that will improve my fundamentals score a tad.

Also, as far as the LASIK is going, I have come to the conclusion that I am not seeing halos at night, and everything is still nice and clear. Leaving for Tahoe tomorrow, and other than that, not too much to tell. Next semester we are starting on a bunch of stuff, so that will be rather stressful. But we shall see - my followup for LASIK is January 8 so hopefully I'll have more good news by then.

Hooray for Eyes

Here's the latest from Dr. Auker. I can now stop putting the Vigamox (the antibiotic) into my eyes! I still have to do the Vexol for another two weeks, but only twice a day, down from four. He did seem concerned that my eyes were rather dry, but my eyes have been dry before I got the surgery, so I know it's not associated with LASIK. After years of contacts, I'm not a very good judge of when my eyes are dry, so I probably wasn't putting the moisture drops in regularly enough. He put tear duct plugs in each eye, so that it will slow the drainage of my eye/lacrimal fluid. He also gave me more moisture drops - I was running low. The girl who got the low down from me before Dr. Auker came in checked my eyes again and I'm still seeing better than 20/20 - I am able to see 20/15 in both eyes, but it's slightly more difficult in my left, so my right may be slightly better than 20/15.

In other news, after dressing up "professionally" and wearing a white coat with a patient again, my mind is drifting to my dearth of decent clothing. I have no nice suits beyond the suit I bought for interviewing, I have no professional tops except a single blue blouse, and the only dress shoes I have are heels and uncomfortable. I wore tennis shoes to the patient encounter because a lot of the doctors I've shadowed wear tennis/sports shoes and it is only logical - if you're on your feet all day, you need durable, comfortable shoes, not ones that are just for show. I should probably invest in two pairs of "professional tennis shoes" - a white and a black pair. Ones that look like professional shoes but are actually really comfortable. But then there's the issue of body fluids getting on my nice shoes during rotations and residency...oh the scutwork shall be wonderful. Either way, no one commented on my wearing tennis shoes, though I think I was the only one in my group who did. I am painfully wardrobe-challenged.

Standardized Patient Encounter

Well, could have gone a lot worse, but I didn't leave feeling particularly confident. I practiced all day, had done 6 people in the past 24 hours, the last two times before I did the real thing I got under 15 minutes (the cutoff point). I did the exam exactly as I had practiced, maybe had a couple nervous pauses here and there that would have added about 45 seconds to my exam time had I been allowed to continue past 15 minutes. So, on the plus side - all the criticisms I got were things that I needed to incorporate into my already fine-tuned routine, rather than things that I simply "forgot" - except for one that I had asked another professor about earlier that he said was okay, but that my grader did not, so that was kind of annoying. The negative though, is that since I did everything exactly as I had planned, I thought I had done pretty well, so the amount of criticism I received was not expected.

On the plus side, if those fine-tuning things are the only thing I need to fix, that's reassuring. Also, the standardized patient and I got along quiet well, she seemed to think I was a nice student doctor and did not have any complaints about my examination. She reminded me a little of my aunt. A few of the other grading doctors gave students their scores, but people who had mine (one of the more in-charge doctors) and a couple others were not told. I am assuming it is because we are not supposed to know but a few docs bent the rules.

There was one thing I did that seemed to impress my grader - a lot of students are pretty nervous about approaching a patient's pelvis, so whenever we are told to find the femoral arteries everyone is very gingerly with their fingers. The correct method, as the teaching doctors demonstrated a few times, is to locate the ASIS and the pubis bone - around the middle of that diagonal is where the femoral should be - but almost no one does that. So I had a feeling they'd be pleasantly surprised if I located the femorals properly, which was the case (I was of course careful to explain to the patient before I did it, so she didn't think I was trying to grab her crotch, haha). I mentioned that to one or two other students before I did my exam, but with any luck they didn't incorporate it. Since it was pretty close to exam time, it's hard to add new techniques without messing up your routine, so hopefully I was one of the few students who did that and stood out a tad.

Tomorrow I have my followup with Dr. Auker about my eyes, which are still seeing nice and clear. Occasionally if they are dry it might be ever so slightly hazy, but it doesn't last long. Still using my eye drops all the time, too. Speaking of which, it's time already - now to get back to studying lymphomas, leukemias, tropical diseases, coagulopathies, anemias, and all the things that come with them.

LASIK Complete!

Well, I got my LASIK done yesterday - and I'm sure everyone is curious about the medical procedure. My first appointment was a while ago where they checked my eyes to determine whether I was a good candidate. Some of the criteria include nearsightedness less than -10.00, sufficient corneal thickness, no severe eye dryness, and little or no astigmatism or other eye problems. My eyes are somewhat dry, both were around -3.00, unnoticeable asigmatism, and a slightly thicker cornea than average, so I was a good candidate.

The second visit, they dilated my eyes and did other tests to get exact readings on my eyes, we discussed payments, methods of going about the laser eye stuff, etc. I went with the laser system for cutting the flap in the eye (instead of a hand held microtome) and LASIK (laser-assisted in situ keratomileusis). After a couple reschedules, my LASIK date was finally set for Dec. 4.

I was instructed to wear glasses (no contacts) for the week prior to the surgery, I had to take a Valium (5mg) 1 hour before the surgery, and have someone drive me to and from the surgery center. When I arrived, they took me into a room to analyze my eyes, I forget what the first test was for, but the second one was to map my iris (similar to iris-recognition for security) so that the laser could lock onto my eye. This was part of the "Custom Vue" LASIK, where they use Wavefront, WaveScan, and WavePrint technology to get a very accurate fingerprint of the eye, so to speak. Supposedly, it can also measure flaws in the eye 25x more precisely than traditional methods. Then they cleaned the area around my eyes, put in numbing drops and antibiotics, and we headed to the first station - the intralase machine (the laser which cuts the corneal flap).

This was the most uncomfortable part - they had to prop my eyes open clockwork orange-style, then attach a plastic fixture to my eyeball with suction, so it was completely fitted to my eye. Then the other end was attached to the intralase machine, and basically my eye saw those gray/white/black patterns you see in your eye when you press on it. Then I had to hold still for a moment and it cut the flap; I couldn't feel it, maybe there was a slight warmth. Then we repeated for the other eye and I went to another room for the LASIK laser procedure. They propped my eyes open again, taped my eyelashes back, added more numbing drops, and had me look up at the laser. The doctor folded back the flap on my eye. The laser itself was a green color, but there were bright dentist-like lights on either side, which were painfully blinding. As they focused the laser's position, there was a grid of red light that I saw pass over my eye. Then I held my focus on the green laser point for a few seconds as it did its work. I could smell flesh burning...not too pleasant. Afterward, the doctor replaced the flap on the eye and smoothed the lines of the incision to make sure it was firmly back in place. Then we repeated with the other eye and I sat aside for a bit while someone else had the same procedure done. Afterwards, my eyes hurt quite a bit - like there was sand in them and some of the chemicals made it difficult to open my lids. The doctor rechecked the eyes, said that the procedure went perfectly and the flap was back in place. About 2 or 3 hours after being back home the pain had gone away and I could open my eyes for brief periods of time.

As far as post-op care, I cannot use eye makeup, wash my eyes, do any strenuous activities or go swimming, and must put one drop each of Vigamox (Moxifloxacin hydrochloride) and Vexol (Rimexolone) into each eye four times per day, and use Systane (preservative-free) eye drops as needed for dryness. I also cannot rub my eyes and must wear goggles at night and sunglasses outside. I also have to be careful when doing activities that tend to cause less blinking, such as working on the computer, reading, or watching TV - essentially, I have to remember to blink or hold my eyes shut every so often. I have to keep up this post-op care for 1 week, but I have a blackberry app that lets me do as many different alarms as I want, so I have 1 wake-up alarm, 4 eye drop alarms, and 1 birth control pill alarm. I can make it play whatever song I want as the alarm, too, and change it for each alarm - if anyone's curious, this is the app.

The next day (today) I went back in the morning for him to check how my vision had changed, and I am 20/15 in both eyes - so better than 20/20 (standard). I have a followup in a week to make sure things are healing correctly, and other than that it went off without a hitch. It's great being able to see without contacts or glasses! It feels so weird that such a short procedure, which doesn't look or feel like anything changed with my eyes (currently, anyway) could suddenly make it possible to see super-perfectly clear.

As for the breakdown, Dr. Auker's costs for examination and supervision of the procedure were $2,350, use of the LASIK machine was $2,150, and the intralase machine was $600. My mom had originally offered to cover $3,000 as a gift to me, and when it turned out to be more, I covered the excess. So in total, $5,100 dollars for both eyes, $2,100 out of my own pocket, but I got 20/15 vision out of it so I'd say that's money well spent. I should point out that Dr. Auker and the laser center are more pricey than other options out there, and I do not know whether there is a substantial difference in quality - Dr. Auker treated my mom's eyes about 10 years ago when he was still with Kaiser and she is still happy with the results - he now has a private practice. Considering his experience, and the fact that he was performing LASIK successfully when it was brand new with good long-term results, made me feel more confident in his skills/knowledge and more likely to choose him over a cheaper alternative. To see his website, click here.

Bolivia! It's ON!

Today was fairly straight-forward, though I forgot to drink any caffeine so the day started dragging down during the myelosuppressive disorders lecture. My group had two OMM sessions to get through today - the first we had a short quiz (easy) on muscle attachments and worked on some rib muscle energy techniques, then after lunch I had a semi-practical where I had to demonstrate upper thoracic vertebra muscle energy techniques - passed without a hitch.

Now for the good stuff - we had a Bolivia information session today with the coordinator, Dr. Garcia-Russell. I really cannot wait to go - we'll be staying in La Paz with a local family, two or three people per family, and the overall price of the trip looks like it'll be $2,000 - broken down, about $1,000 for air fare, $100 for entry visa because Bolivia hates America (no entry cost for non-Americans), $150 for accelerated Spanish course (50 hours), $100 preceptor fee that goes to the hospital hosting us, $270 for the room and board for 3-4 weeks, and a few miscellaneous costs here and there. It's amazing how cheap everything sounds like it will be - and some local attractions include Lake Titicaca, nature preserves, etc. I was expecting to be staying in a very rural area, so being in La Paz a surprise. Here is a picture of the hospital: Arco Iris.


Check the link above for information about Arco Iris. It looks like it'll be exactly what I was hoping for - a place in South America where they speak almost only Spanish (and a couple indigenous languages, like Amaya), in a climate that is perfectly tolerable to me (it should be cold and sunny at 12,000 feet), and I get to learn more medicine and get a valuable experience. We will be leaving at the end of May, right as our block exams finish, and be in Bolivia for 3-4 weeks, the last week being reserved for social work with an orphanage. Our clinical experience will be rather basic, but we spend a week in Obstetrics, Pediatrics, and Emergency medicine, as well as accompany a Mobile Medical unit that goes through the streets and to schools. Some of my family may come down at the end of my internship to spend time in Bolivia or a neighboring country. I'll bring more news later! Now to do more studying...

Oh right, and LASIK is happening, for real this time, third time's the charm - this FRIDAY!

Faster and Faster

I used to be more on the side of patients when it came to doctor visits, but now I'm feeling a lot worse for the doctors... We have gone through the general screening exam, which includes neuromuscular, cardiac, respiratory, gastrointestinal, HEENT and taking vitals thus far. If we are allowed to do it at our own pace, no rushing, talking sweetly to the patient, etc. it takes us about 30-40 minutes to do it at this point. We are expected to speed it up to 15 minutes. I have been able to do it all in about 15:45 minutes, but it feels so rushed as far as barking orders and telling the patient to jump and sit that I can see even more clearly how a patient would feel like a physician doesn't care about them. Unfortunately, when we're expected to cram exams into a tiny amount of time...it's hard to do it in a way that makes a patient feel happy.

Of course, I'm betting that's where the magic of experience and bedside manner kick in. I'm going to try to practice the exam in 15 minutes but also practice my tone of voice and memorize concise, simple instructions so that I don't feel like I need to cram my words together. That, and I need to get a really good feel for the order and routine, as well as the phrases...ugh! So much to remember! We are required to say specific "lines" when we do examinations, such as "Patient is breathing easily, quietly, and regularly" or "Patient presents with no edema and is not diaphoretic or cyanotic." It really feels like being an actor/actress almost, since they really are lines.

In other news, I got a massage table, which I plan to use for massages, OMM, and exams - so that should help a lot. Also, we're focusing on hemostasis and hematological diseases at the moment - all very interesting and familiar since I worked in the laboratory for 3 years and I've seen all the lab tests before. Goal for this is to memorize the clotting cascade, the diseases, and the treatments, as well as go back over all the stuff I've already learned and try to commit it to memory.

Almost done with Block 2!

Just finished as much studying for Doctoring as I think will make any difference at this point. After the FOOM test on Friday, I was burnt out on studying until Sunday - so I was not very productive until then. Monday morning I practiced OMM techniques with a bunch of different classmates for about 4 hours before the practical exam, and I know for sure I aced two of the three portions. I only know because those two professors gave me feedback, and the third kept a nice poker-face the whole time - but I think I did satisfactorily at that station too. Then this morning we had our OMM written exam, where they describe positions, techniques, and segmental findings and we have to know the type of technique, what the diagnosis is, etc. We also have some "softer" portions, like history of osteopathy, particularly in California. I think they overdid it a tad on that, since our professor didn't finish the lecture on California, but should be good either way.

The Doctoring exam coming up in half an hour is going to test on portions of the screening exams - so far we have covered general, HEENT (head, eyes, ears, nose throat), Cardiovascular, Respiratory, Abdominal, and Neuromuscular. Since we're osteopaths, we also throw in a TART screen at each step, but the way it's integrated it almost feels "tacked on." The test is also going to cover Medical Jurispridence, a lecture I missed where we got to hear about all the ways we can get sued, how getting sued works, and how to try to avoid it.

We recently saw a video about Convocation too - it's essentially a DO Seminar/Convention where everyone from experts to first years goes to see different techniques, hear what's new for Osteopathy, etc. It's a little pricey, but I requested a bit more loan money this year than I needed, and it's being held at Colorado Springs resort this year, so I might as well take advantage of that. It is held on a weekend in March, but we shall see if I can attend - I might be on a vacation. Anyway, enough distracting myself - I should get focused for doctoring and then fun and relaxation for a few hours before I realize I have to start prepping for Midblock 3 that is happening in 13 days...

Block 2 Fundamentals - Done!

Well, I finished my Block 2 exam for FOOM, but I still have two written exams (Doctoring and OMM) and a practical OMM exam. I slept through my alarm on the morning of my Block 2 test, so I didn't have time to review virology, mycology, or pathology - if I had woken up early enough I probably would have reviewed material that would have given me 3 or 4 extra correct answers on the test. Either way, I don't think this exam will affect my percentages much...unfortunately. I'll just have to try a little harder this next block! Also I took a few pictures of the campus - it was a nice sunny day, so here they are:

In other news, my LASIK is finally scheduled for good - December 4th. After that - no more contacts! Hooray! Next week after the tests should be very nice - hopefully seeing a movie or two with a classmate, Kit's coming up to visit on Thursday, and I'll have a rather relaxed weekend. Next block we will be covering diseases of the immune system including HIV/AIDS, immunopharmacology, and blood.

I feel like I've been slacking off on the USMLE First Aid book - in the sense that I have not opened it yet. I haven't been using my books enough in general. This final third block I swear I will do all the assigned readings before the lectures! I double swear! And I will cut down on the Left 4 Dead playing a little. During weekdays. If I have to wake up early. And have a short day also. Maybe.

Classes and Weekly Routine

Comparing my two blogs, I'm relieved that despite the uneven posting habits, I've essentially posted the same number of posts - go me. We're starting to get into the virus lectures, which is of course one of my main interests. I never really described our general weekly curriculum, so I'll delve into that briefly - I'm not sure how they do it at other schools, but I have a feeling we're somewhere in the middle as far as weekly hours. We also get an hour for lunch from noon to 1am.

Monday - usually a long day of lectures that set the tone for the week, lasting from 8am until 3pm-5pm. Tuesday through Thursday we have small group sessions in the morning and afternoon, and 2 hours of lecture each day. There are 3 divisions for the small group sessions, groups A, B, and C - I am group A, so I'll describe that arrangement. Tuesday we have morning small-group OMM lab, where we practice techniques, diagnostics, etc. from 8-10. From 10-12, we have lecture as a whole class. From 1-3, we sometimes have no class/independent study, it depends on how many classes are slated for that slot for those three days (2 classes, we have one afternoon off, 3 classes we have something each day). Usually it is a class-related workshop, working with new equations, concepts, etc. On Wednesday, we have morning "independent study" so we don't come in until 10, for the 10-12 whole class lecture. Our afternoon class is usually doctoring, where we practice clinical diagnostic techniques, examinations, etc. On Thursday, we have histology or pathology in the morning, and in the afternoon we either have more histology/pathology or another class-related workshop. Fridays we have lectures that may end as early as noon or as late as 5pm.

A few more observations as of late - one might think that after four years of undergraduate, some masters/higher level education, and clinical work, we would be desensitized to "sensitive" medical material, like genital warts or hypospadias. Nonetheless, I still catch a few students giggling at the mention of herpes and genital conditions. I'm sure by our second year most of the gigglers will have gotten used to it - or pelvic examinations will be extremely awkward for them (moreso than us non-gigglers).

Back in the Swing

Well, after getting sick, dealing with the second midblock, and finally partying it up for Halloween, it is back to the grind. Lately we have been focusing on antibiotics, bacteria, etc. - which is fine by me, being interested in infectious disease. We are starting to get our clinical experiences set up - I've signed up for my first one for December 3rd. From what I hear, we get to take histories from actual patients!

Also I have touched base with a professor who is researching lysogenic bacteriophages in Salmonella, and will be starting a project to determine the actual contents of probiotics, and to determine a useful way of checking their claims. I always wondered how dry pills could contain as many active bacteria as they claim. So, either probiotics/supplements or bacteriophage research - both of which I find extremely interesting. She is also the same professor in charge of the Bolivia trip, so I have communicated to her my intent to go with them next summer. The only concern I have is that they are doing a lot of PCR and I have never actually done PCR, since in our class labs, the TAs always ran those. Not too worry - it can't take that long to learn how to do.

We have a string of exams coming up, which should be interesting. I'll be practicing OMM all next week. One of the great things about going to a DO school is that if you have a muscle/bone/joint problem, you can ask a professor to take a look, and within 5 minutes you can be feeling much better. I had some hyperextended ribs/vertebrae, and when I inhaled it compressed my nerves and sent joits around my ribcage - usually it happens transiently, but this time it stuck around the next two hours of class. I went to my adviser's office to see if he could spare a couple minutes, and when I left I was breathing painlessly - as well as having had my shoulders, neck, and arms aligned.

Also, for any possible MDs reading this, I would like to add that at Touro, our professors are very adamant about not demonizing MDs. One of our lead DO professors, every few lectures when he speaks about the development of the DO profession, always makes very clear that MDs and DOs each have their faults and that neither is wholly responsible for the clashes between the professions. I know at other DO schools there is a strong sense of rivalry, but I don't get that sense at Touro, for which I must applaud them.

One Month Later...

It is a shame I haven't posted for a while, not that too many people follow this blog, but it is so easy to get wrapped up in medical school! I did well on the last Block exam, after which I had a Fall Break and went to visit my boyfriend in San Diego for a week. My LASIK still has not happened, due to endless rescheduling - the latest hiccup occurred 24 hours after I received the live intranasal flu vaccine (not H1N1). I was told I would experience some runny nose, maybe some tiredness, etc. - nothing too unreasonable. By lunch the next day I was ready to crash - I had a 101 degree fever, sensitivity/aches, chills, chest congestion, headache, fatigue. Essentially the flu - except more likely a reaction to the vaccine - all those symptoms were listed as 'mild side effects' for my age group. Symptoms lasted from Thursday to Tuesday, essentially destroying my weekend, and 4 extra days during which I could have studied for the second midblock exam that I had three days later. So much for that.

Now, I must explain a few things, as it is my duty to my profession. First, one cannot get the flu from the vaccine - whether it be intranasal or the injection. The intranasal vaccine contains live attenuated virus, an adenovirus that has been altered so that it can only thrive at temperatures below that of the human body. It has the antigenic markers of flu viruses so it can confer immunity when the immune system reacts. Second, the reactions most people experience with regard to the flu vaccine are an immune response to the adjuvant, derived from eggs (a common allergen even outside the context of a vaccine). Third, from what I understand from my immune system professor and the lectures, people tend to show symptoms to a virus like the flu within 24 hours.

Keeping all these things in mind, there is a slight possibility that I encountered someone who had the flu between the morning that I got my flu vaccine and the following day. However, I think it is much more likely, then, that I had a reaction to the attenuated live virus. I know this reaction is supposedly not typical, and I had the nurse file an Adverse Event Report, but I know it will be difficult for me to recommend live intranasal flu vaccines to any future patients of mine. I won't have much trouble recommending the flu shot, but unless a patient is in a high risk group, then I won't be recommending anything but the flu shot. For all practical purposes, the vaccine put me out of commission for 5 solid days during which I could not do anything productive. Trust me, a medical student with an upcoming exam will not easily be dissuaded from studying, no matter how bad they feel. It was miserable, I was pissed and frustrated, but at least I got my flu season illness out of the way - I better not get sick again...

Anyway, now I am focusing on learning tons of drugs - NSAIDs, antibiotics, chemotherapeutics, etc. Our recent topics have been pathology, neoplasia, antibiotics, immune system, NSAIDs, and inflammation. A friend of mine also recently got accepted to Touro, though she applied to some MD schools too and I know if she gets into one of those she'll matriculate there. Back to studies - will include more doctory stuff next time.

Setbacks and Progress

Alas, a few unexpected setbacks occurred recently - first, the LAN party was cancelled...blah. Next, my ophthalmologist had to reschedule my surgery since he got a short-notice need to go out of town, so I'm trying to schedule it for the Friday after I get back from San Diego. On the plus side, I just started my Medical Spanish elective, which of course reminds me of the fact I'm going to go to Bolivia hopefully, and I met with my faculty adviser just to make sure I'm on track. My performance on the last exams was above average - and that's saying something when the average is 89%. My goal is to be in the top 25%, so that will be difficult...but hopefully doable! If I knew the standard deviation that would be more helpful, but you do what you can.

We're also learning more about doing histories and general survey exams, so HEENT, vitals, etc. It's fun - feels like we're really becoming doctors. I am anxious to update my insect blog, I have at least two insects to take pictures of and write about, one of which isn't even pinned yet, so hopefully I'll do that tomorrow or during the weekend. Wicked is still happening, and I'm probably going to the Renaissance Faire with the family, so that's good! Anyway, I still have some reading to do tonight, then sleep!

Hooray for Tools

I'm watching the House premiere, got all my test results back (beat the average, that's what matters), and have a pretty easy week ahead of me. We're starting pharmacology, cell death, immune system, etc. and we also are starting to learn how to use all these nifty items we got from various companies. Here's a picture of them all assembled in their glory:

Golly gee, what else am I up to...next week we only have three days of class, since there are two Jewish holidays. Friday's my last face zap, Saturday night I'm going to a Touro student LAN party for Left 4 Dead at a friend's house (hey, we gotta have some fun), then Monday pre-op and Friday operation. I know I keep mentioning it, but it's exciting - finally I will have clear vision! No more being a slave to contacts. By the way, our professors this week are better than the last couple weeks' professors - both are very well-educated and decent lecturers (with decent powerpoints) so this shall be good. Anyhow, back to House!

Almost...Almost...

Man, such a week. On the plus side, I keep overestimating how difficult all the tests will be. I suppose I should be glad they don't want to torture and weed us out - they do need our money, after all. Just came out of my FOOM exam about... 2 hours ago. I took my time, and out of 64 questions I think I missed 4 (after careful review and conferring with others). I really wish the FOOM and anatomy practical exam were not so spaced apart though...it was scheduled to end at 10 and my anatomy exam time, the earliest of the 3 times, is not until 1pm. I live too far away for it to be worth driving home, so I'm just hanging out at school.

In about 20 minutes or so I'll start cramming for the anatomy exam - there's a list of 30 or 40 things we need to be able to recognize - shouldn't be too hard. Between 12 and 1 I get to pick up a parking decal, so I won't get ticketed in the future. After my exam, I get to pick up my medical equipment - that is going to be cool. If I had more energy, or were staying home this weekend and not going to San Diego, I would totally play with all these things and look in/at my family's ears, noses, eyes, hearts, valves, and lungs. When you get the stethoscope, you know you're on track to be a doctor.

Anyway, this weekend shall be fun and relaxation. Then I can look forward to my 5th and final face treatment on Friday, my pre-op appointment for LASIK on the following Monday, and my actual LASIK surgery on the Friday after that. That weekend I go to see Wicked with the family, and then on the 5th I'm off to San Diego again, but for a week! Good times ahead.

Blocks coming up...

Here I go off studying again - after which I fly down to San Diego for the weekend and then come back for Pharmacology. On the plus side, we should all be getting our medical equipment soon, so we will start learning how to use all the common doctor tools! In the meantime though, it's study study study! I'll have to corner my parents at some point this weekend and do all the techniques on them. I'll have a checklist and practice them all!

A friend of mine also made a program that I can load with a word bank to self quiz - I'll probably make a few versions of it - one that quizzes on anatomical stuff, another for actual disease names, etc. I'll also probably distribute it to my classmates, see if any of them would like to try it out. So...self-quizzing and practice quizzes; drawing out the muscles, landmarks, and the nervous system; reviewing histology slides; and practicing OMM seem like a decent way to study for this thing. So, until further notice, I am locked in my room studying with my study buddy:

Tests again...

Just when the Mid-Blocks finish, the week after the next it is time for the 1st true Block exam. Thanks to my more efficient note-taking strategy, I feel less stressed about it at least. And I have a 3-day weekend visit down to San Diego to look forward to when it is finished, but I feel like I need to step up a gear or two. The last two weeks we've been focusing on the nervous system and genetics - both pretty familiar to me. The osteopathic doctoring stuff and OMM questions will be the challenging ones - there is a lot of terminology that I haven't forced myself to learn yet. Also the anatomy lab will probably be a challenge.

Today in our team-based learning groups, we had a session on the autonomic nervous system, and the detail we were expected to know seemed much more sufficient, but the reading material we were given as prep was sorely lacking, in my opinion. As far as clarity and ease of understanding...it was just not very good. I need to look through my old UCSD textbooks to see better discussions of the nervous system. I hate to make any negative comparisons, but I definitely appreciate the caliber of my science lectures at UCSD more now that I have seen another school's. It's not just the faculty, I think there are some really smart faculty here, it's just the presentation, the accompanying texts, the organization, and the powerpoints that seem to be lacking. Course, the school is a lot newer, with many new faculty, and UCSD WAS recently ranked #2 university by the Washington Monthly magazine, so it's not a fair comparison.

Anyhow, this weekend will be a lot of studying - good old-fashioned writing stuff down and trying to put it into memory, rather than my last bout of studying where I was frantically typing up answers to questions and hoping I would remember the answers 60 pages of typing later.

Getting in the Grooooove

Today was quite productive - I turned in this autonomic read-and-answer-Q's packet, filled in and turned in the "Meditation" sheet, attended my classes very attentively, worked on my objectives, and talked to classmates and professors a decent amount. The meditation sheet was an assignment from our "Managing Stress" class, designed to keep medical students from freaking out or dropping out or going postal. I just put lying with my kitty on my chest - she purrs so nicely! She even massages me half the time.

Anyhoo, I'm renewing my studying zeal - finding a new way to focus, study, attend lecture, etc. It's working out pretty well so far - it's even helping in my absorption of my Japanese audio lessons. Say what you will, but I think I'm decently proficient now - Japanese is pretty easy anyway, since the language is so vague you can get by without knowing much vocabulary. It's the writing system that'll take me a while to get used to...

Now for some good old studying! Again! Kit comes down this weekend, and after next week is the first block exam, including an anatomy and OMM practical.

Another test down the hatch

Today was the practical for OMM techniques - mostly soft-tissue type techniques. I managed to do the technique satisfactorily as well as diagnose where treatment was needed - the latter part was not necessary, but kinda looked good at least. We also had a lecture on membrane potential, which I personally think was really helter-skelter and poorly explained. Maybe I've just learned about membrane and action potentials a lot, but I feel like the professor had really poor diagrams and was not getting the message across effectively.

At any rate, I really cannot wait until Friday - we get a three day weekend on account of Labor Day, I'm getting my 4th face treatment, and Kit's coming up to visit. This week we are essentially learning the basics of neural biology and learning a little more about surface anatomy. We do get to look at nerves in histology, which should be interesting. I really should study some more for the block exams that are coming up - September 14-18.

First test: Pass!

First test went pretty well - certainly passed. Studied all weekend. I have a better study method now, so hopefully next time the cramming won't be quite so intense. I'm finally able to relax...a tad. Tomorrow I have a mini-practical in OMM, so I have to review those techniques, practice on my family, and then hopefully do a decent job tomorrow. The techniques we have learned so far are soft tissue techniques, inhibition mostly.

In addition to the midterm today, we also had several lectures. The woman who taught our neurohistology course was one of the two faculty who interviewed me, and she is definitely a cool lady. The other professor is one of the jolly OMM doctors. I think I really lucked out on my faculty interviewers - neither of them was much of a hardball.

Also, we had a lecture on lymphatics today, and there were a few interesting factoids presented. The one that caught my eye the most was the statistic that ~20 million people in the US caught the Spanish Flu, and of them 500,000 died. ~100,000 were treated by DOs with a mortality rate of 0.25%, whereas the portion treated by MDs had a 6% mortality rate. I think it probably had most to do with the fact that MDs were probably experimenting with a ton of medicines to try to determine their efficacy - not necessarily a bad thing. Yes, it was unfortunate for those who were given dangerous medicine, but there was so much quacky medicine out in the early days of the profession that it had to be ruled out somehow. DOs probably stuck with lymph-facilitating techniques, which at worst are harmless and at best a catalyst for recovery.

Gone Studyin'

Another day...

Well, the white coat ceremony was on Sunday - it went well enough. We all went out to lunch afterward. Very little to say about it, except that I am glad they did not make it longer than they had to. The pictures are up on facebook, for those of you I permit to see my profile stuff. Interesting little tidbit though - being a Jewish sponsored school, the rabbi did a talk at the very beginning and blew a shofar, or ram's horn instrument used for Jewish services. I've been steadily working through our class objectives - have to get through them all by Monday, as that is when our first major exams are - the midblock exams.

We also just started learning some actual OMM techniques in lab - this week we are focusing on soft-tissue techniques. I need to practice on my family a bit before Monday, I think we have a practical portion of the exam. The details about what is being tested is a little hazy. Also, today was Club Day, and there was a blood donation bus, so I donated and checked out what clubs there are on campus. I joined Internal Medicine, Osteopathic Physicians and Surgeons of California, the CMA/SCMA (free, otherwise I wouldn't have), and Undergraduate Osteopathic Student Association of some kind - I don't remember exactly the abbreviation. I was considering SOMA, but it's a bit pricey compared to the others. All in all, it was nice to hang around and see what clubs there are.

Radiation, oh my!

In our radiology lecture today, we were discussing how x-ray machines work, from traditional film x-rays to angiograms and radioactive dyes. There was a chart I thought was interesting that compared the chances of getting cancer from a typical dose of radiation to the chances of other life-endangering conditions:

So basically, getting a chest x-ray is about as risky as spending 3 days in the US, or eating several spoonfuls of peanut butter. I definitely did not think peanut butter was so dangerous... Apparently there is a mold that grows on plants such as corn and peanuts, and it produces a toxin that can be highly carcinogenic. The bacterium is named Aspergillus flavus, A. flavus, and thus its toxin was named Aflatoxin. There is another species in the same genus that also produces the toxin, but A. flavus was discovered first so its name was used. I'm not saying we shouldn't eat peanut butter, I'm just surprised that there was such a risk.

Sunday is the white coat ceremony, and in the meantime I'll be hanging out with Kit - he's visiting for the weekend. We have been going over a lot of biochemistry, but most people in class are having some trouble with our professor's lecture style. I imagine it would be very difficult to understand the jumps from one cycle to another and the brevity of his explanations if one had never taken biochemistry. Lucky for me, most of this is old hat. I'll spend most of next week working on those objectives, and hopefully the first exam (August 31) will go well. I also got my approval to take the Medical Spanish elective, which doesn't start until September 31. On Monday I'll be finding the professor who is teaching the advanced nutrition course so I can take that, and also I'll make an appointment to get another tuberculosis test - the physician who did my physical doesn't think the stuff I sent from Kaiser is official enough, and I can't get the records unless I go to San Diego in person, so screw it - I don't mind getting a bubble in my arm if it'll finally end this ordeal. Besides, if I don't have all my immunization stuff in, then my grades won't be disclosed and I'll be left out of clinical activities.

Nearly Through Another Week

Amazing how much less reading it feels like I have this week compared to last. I got some OMM treatment today for my lower back, but apparently there is something going on by my left scapula that one of the doctors think I should get checked out. Alas, there was not enough time today, but perhaps next week. We had our third back dissection the other day, where we sawed open the spinal column to view the spinal cord. We're beginning to finesse the dissection a little better, after doing a rather poor job on the back muscles. We're in the middle of biochemistry, so lucky for me it should all be review. Our first exams are the week after next, and next week has a lot of short days! All the better for studying!

I'm sure it's different at other medical schools, but here all of our courses have "objectives," certain topics we are expected to master. For example: Know what an allosteric enzyme is, understand how it functions in Hb. There are lists for each class and I am going to go through them all and answer them as fully as possible. Also, for the record, birth control pills really mess with your head. Long story short, I was forced to go back to an old prescription and it sunk me into depression for about a week. I wanted to wait until my new health insurance came in, since the cost for the pills under my Anthem Blue Cross coverage is 70% the retail price, as opposed to a single copay. I decided I couldn't take much more of it, so I got a month's worth and started, and every day I feel better. I really understand the meaning of the symptom "no longer enjoys things that used to bring joy" - particularly now that I can enjoy them again. Also, if anyone's curious, Microgestin FE 1.5/30 was bad for me, Yasmin/Ocella was good. Though I've heard mixed opinions about both.

Anyhoo, this weekend will be packed - Kit is coming up for the weekend, my sister is getting back from camp, the white coat ceremony is on Sunday morning, and I'm going to go see Ponyo in theaters. On another note - I'm 1/3 of the way through my Japanese audio lessons! Sleep time now.

Good News

One of the programs offered at Touro, and many other medical schools, is the opportunity to go abroad and learn about foreign cultures, diseases, languages, and train as a physician. It was described vaguely by one of the directors of the Global Health Program, and it sounded like it would be the entire summer - two months or so. Anyhow, I met up today with a second year who I knew back in high school and she and her roommate both did the program and their internships only lasted 3-4 weeks - which is much more conducive to my particular goals. Also, they said the medical spanish program does not require very much fluency, so once I take that and the global health elective in spring, I should be all set! Hopefully I will have worked through most of my spanish audio lessons by then, so I'll be prepared! I'm excited, hopefully it'll all work out! I should bring some jars with me...I'll bet the insects there will be amazing.

Today we also had a stress management course, which seemed to try to prepare us to expect and prepare for the worst. I think I'm a little better off than some other students, who are either living by themselves or have families, and those who are type A individuals. I am definitely not a perfectionist, and in medical school it sounds like perfectionism is a bit of a curse. Anyway, I did not get much studying done last night, so hopefully I'll be more productive tonight. Plus, tomorrow we start Histology, which I'm worried will be a bit challenging.

More OMM and BLS

Today was my appointed 'basic life saving' skills course time. So, I got to spend a super fun 5 hours or so learning CPR... I wish they didn't have to train people in it every two years - maybe every five unless some drastic change is made to the procedure. We also got to do more OMM today - basically just palpated our randomly assigned partner on the back, neck, chest, hips, and legs. Tomorrow should be a decently easy day, since the only other course besides embryology is "Stress Management." I think I'm doing pretty well, to be honest - I seem to be more on top of reading than the average person here. It probably helps to have come almost straight from college.

We were assigned to watch a movie for one of the osteopathic classes - "The Doctor." I haven't watched it yet, but it'll be nice to watch in some down time. Other than True Blood, House MD, and a couple animes, I don't have much on my list to watch. I've been relying on caffeine a lot these days... One thing recommended by other students is to follow along in the USMLE First Aid as we go through certain topics in class, so that we know to what we should pay attention. Our embryology professor also mentioned that we don't need to memorize stages, that it's more important to understand disease and treatments. I don't know that I trust that though - I would want my doctor to remember how a zygote or embryo differentiates. Maybe I just hold myself to a higher standard than the boards. I find that unlikely. After a few more minutes of relaxing, it's back to the books!

The Fruits of my Labors

I felt so much more prepared for anatomy lab today after all that COA cramming. I'm sure it would be easier if I had been exposed to anatomy before this, but the last time I studied muscles was my middle school's health education segment of PE. Also, they gave us more guidance about what to do today, which I felt they should have done the previous day too. It's interesting, by the time you've worked through a lot of the fat, your hands are covered in slick yellowish oil, since the fat has essentially liquefied a bit. I am in the A group, and we lucked out in that we do not start more than one new unit each day - tomorrow we start embryology, and on Friday we start histology lab. As a result, we have sufficient time to get used to embryology before we have histology. For the time being this is my new favorite book...

I also signed up for some electives - there are a few decent ones to choose from. I was tempted to take medical biochemistry, since it goes into laboratory tests, but it is a two unit class and I really wanted to take advanced nutrition and medical spanish (each worth one unit). In the spring it'll be more medical spanish and global heath care. I'm looking forward to doing more OMM tomorrow - it's great to have pseudo-patient encounters, even if they are our classmates. Speaking of osteopathy, we had another one of the "pep-talk" type lectures today where we are told what is so unique about osteopathy, how it is a philosophy that will change our lives, how important it is that we're becoming doctors, etc. I wonder if MD students get similar pep talk classes? I was considering taking pictures of the campus today, but reconsidered. I think there are sufficient pictures on the website if anyone wants to browse through them.

Nose Deep in Clinically Oriented Anatomy

One of our largest, densest texts is Clinically Oriented Anatomy, which our anatomy professor, during his very informal first class, told us we didn't really need to read in much depth. I think that was very misleading (he just wants us to read the easier beginning anatomy text he wrote himself). Also, they put up a lecture powerpoint for the anatomy lab, and even have a section on the schedule which logically is the lecture for the lab, but apparently we are not being lectured on the anatomy lab lecture powerpoints, so we have to go over them in depth beforehand by ourselves if we want to know what's going on in lab. I also know I wasn't the only one - no one else in my group knew what to do either. I don't think they were very clear with us about that, so I feel a little betrayed, but what can I do.

...except go into insane overdrive. Now I'm taking it upon myself to learn all human anatomy without the aid of lectures. Since we're also starting embryology and histology next week, I feel a pressing need to memorize the anatomy stuff before we start those subjects. I wish I had taken physiology or embryology as an undergrad - it would have made things easier for me now, and probably next week. I also dropped my phone in the toilet recently, so I went to Verizon and got a new phone - a PDA since there are some medical apps which are apparently crucial during rotations 3rd year. I ended up getting the Blackberry Storm - 8gb, all touch. I can't stand those little roller balls on the traditional Blackberries. Anyway...back to COA.

Last of the "Day X" Entries

My entries will start having more of a topic format than a daily routine format, since accounts of daily activities can get rather dull, even if it is about medical school. Today we had history of osteopathic medicine, cultural competency, and interviewing, which explains certain strategies and considerations when interviewing a patient at a doctor's visit. After lunch, we all went to the anatomy lab and started on the back dissection. Our cadaver is a 96-year-old woman who died in a curled position from dementia. Unfortunately a lot of her muscles were deteriorated when she died, so muscles like the latissimus are very thin and fragile. It's a lot to memorize, and I'm going to devote most of my studying this weekend to learning all the names of the back muscles and review dissection techniques.

Next week we start on embryology, patient interviews, and basic life saving techniques. Hopefully I'll be meeting up with a friend of mine from high school who happens to be a second year here. It's exciting. I'm still waiting on the form from the doctor down south so that I can enroll in student health insurance, but I guess I'm not in much of a hurry. There was a party tonight but I guess I just don't feel like being social after a long week of meeting dozens of people. I think I've been doing a pretty decent job remembering everyone though. Also, Non-Sequitur had a cute comic today about patient noncompliance.

First Day

Today was the first official day of classes. It went well, and I am trying to be very thorough with my notes so they will be a good reference for later when I'm studying for the COMLEX and USMLE. Every now and then I'll hear someone say COMPLEX instead of COMLEX and it kinda grates on my nerves...I can tell when professors hear someone say it that they are annoyed, thinking "If you knew what the acronym stood for you'd say it right." For those who are curious, it is "Comprehensive Osteopathic Medical Licensing EXam" - I don't see a "P" between Medical and Licensing. At any rate, we started out with an introduction to the study of anatomy. It was interesting because Dr. Hartwig is a fan of Latin, so he was giving us all the Latin roots of words and making cracks about how PhDs are teachers, not doers. I only wish I had taken some caffeine this morning - there was a slump of extreme sleepiness I had to fight through around 10:00am - 11:00am. The two morning classes were both part of the Fundamentals of Osteopathic Medicine course (FOOM).

After those classes, we went to lunch and I got my library card, changed my computer access code from the default, and checked in with SHS again to see if the doctor had sent in the forms yet. Negatory. After lunch we started in on Osteopathic Manipulative Medicine (OMM) and got to start familiarizing ourselves with our classmates' backs. We're doing a back dissection tomorrow - interesting stuff. After that, we went to Osteopathic Doctoring class (OD) where we discussed ethical situations in which professionalism is the heart of the issue. We also discussed the different methods of doctoring.

I finally got some caffeine and a day planner - that'll come in useful. Now I need to get some reading done, plan out lunch for tomorrow, organize notes, etc.

Orientation Day 3

Well, today was the last day of orientation. Perhaps it felt less exhausting because I was not overstretching myself to be social. We were given several lectures describing how to get the most out of our education, introducing the faculty, and outlining the classes we are taking: Osteopathic Doctoring, Fundamentals of Osteopathic Medicine, and Osteopathic Manipulative Medicine. I also got to meet my faculty adviser today - who happens to be a teacher for the Osteopathic Doctor classes. He's really cool - I think I lucked out as far as advisers go.

I got a lot of busywork done today - I called the doctor to make sure she sends in that form for student health, I turned in the form for medical equipment, I got a suitable sports bra and exercise clothing, and a notebook. I hit a road bump in that the old Longs Drugs is being converted into a CVS/Pharmacy, so it has almost nothing stocked as it prepares to remodel. I still need a day planner, pencil lead, a click eraser, and some new pens (ballpoint and uni-ball). I also started listening to the Japanese lessons, which is very enjoyable - I don't miss music too much since I'd kinda overplayed everything in my stereo. I'll save all the new stuff for exercising. I'm debating whether to get a 24-hour Fitness membership or to make do with the on-campus mini-gym. I have all this loan money, and being half-naked in OMM classes makes me want to get in shape!

Tomorrow's the first official day of classes, so I have to do some readings, print stuff out, all that good stuff. I'm looking forward to getting into the classwork - I feel like I'm ready to get going! Before all that, first things first: gotta label all those insects from SD! Also, I'll take some pictures of the campus and post those!

Orientation Day 2

Hello all - today is much easier to get through. Somehow, it has felt more interesting as well. The day started off much like yesterday, with breakfast and a nice heartfelt speech, this time from the dean, about how great it is we're going to be doctors. After that, we had representatives from OPSC (Osteopathic Physicians and Surgeons of California) tell us about their group. I'm planning on joining - we need to support our advocacy groups! We then had someone speak to us about student health services.

At that point we broke into groups and I got my checks from the financial aid office (approximately $9,000 was left after everything). About $2,100 of that will be going toward my LASIK on October 2nd at 9:00am - I just confirmed the appointment, I can't forget the time! Then I checked in with the student health services, I got my photo ID, and ensured my laptop is compatible with the network. Now I've finished eating at the COM/COP barbeque and the last things on the agenda are voting for student government representatives and a possible tour of the campus.

I still need to get some gym clothing...and apparently we already have homework but I'll worry about that later. We get out after the elections, so I'll be home at least by 3:00pm. I've been taking Excedrines all day so I'm not nearly as exhausted. I also need to label the insects, so I better take care of that before school starts, or I never will!

Orientation Day 1

Phew, so exhausted! So I guess everyone wants to hear the details. All-in-all, it was a long day. Orientation started at 8:30 but most people checked in and were having the continental breakfast by 8:00. First we all sat in an auditorium and the various personnel introduced themselves, their departments, and what their role will be in our lives. This mainly included the librarians, directors of student affairs, etc. We were told a little information about our class - we have the highest average GPA (overall and science) of any TUCOM class to date, but our MCAT was still about 28. Berkeley was the biggest feeder school at 22 students, the highest from any one school in TUCOM's history, and there are slightly more women than men. The school's rabbi also said a few words and a prayer.

Next we filed into one of the classrooms and heard a heartfelt speech about how great it is what we're attempting to accomplish. We were then separated into smaller groups to accomplish a few tasks. In turns we get to be assigned to clicker groups, go to the bursar's office and get our checks, get our photo IDs, do a laptop check, and go to student health to get our insurance figured out. There're probably a few other details in there I missed but meh. We heard a talk from the student government leaders and had lunch with one of them for Q&A.

After lunch we spent two hours where each of us was filmed at the podium giving everyone a couple-minute long autobiography. There are about 10 people with children, and quite a few married couples. I can't imagine attempting medschool with children - they are very brave! We are a very diverse group. At the end of all this, a couple reps from medical technology companies came to tell us about the sets of equipment Touro has arranged for us to buy at a "discount" from them. Tomorrow we get to see their stuff and make decisions for ourself - I'm rather indifferent - I'll just go with the Lithium-Ion battery set and the Littmann stethoscope unless the earpieces are too uncomfortable.

I'm really tired, and thankfully tomorrow will only last til about 2:30pm, not 4:30pm like today. I'm going to watch some True Blood now to relax...

Counting Down

The days draw closer, it's very exciting! Monday is Day 1 of orientation, which will last approximately 8-5. It will be the same on Tuesday and Wednesday. Thursday is the first official day of classes. I already read through the chapters about insect, spider, mite, reptile, and marine organisms that can hurt you in my "Principles of Internal Medicine" text - the largest of them all. It is 2,754 pages long, with a 16 page appendix and 150 page index. It has about 400 chapters, and I read the last three chapters. It makes me excited to get started!

I've already started to plan out my back-to-school routine. There are a few side-goals I would like to work on in addition to the whole "doctor" thing. Firstly, I will be listening to language lessons at least on the commute to school, and possibly the commute back from school. The languages I plan to learn, in order: Japanese, Spanish, German, Russian/Chinese. I'm pretty strong in Spanish, but I need to refresh my memory and learn more conversational stuff. As for Japanese, I took one class, and have watched anime for over 8 years with subtitles, so I love the language and am familiar with it. Plus, I love almost everything Japanese, so that one is the top of my list. German is for all the music I listen to and for when I visit one day. Chinese I may learn simply because so many people speak it, and Russian because I want to visit also. Second, I want to get a workout plan going - perhaps I will aim to do 30 minutes on weekdays at the gym on campus. 10 minutes on arms, 10 minutes on legs, and 10 minutes on the abdomen should be good. Plus it would be a good way to de-stress after eight hours of classes.

Where and how to study, and on what to snack are other concerns of mine. I'll be borrowing Dad's nice book stand, I am already in the habit of brewing 92oz of unsweetened iced tea and drinking that in place of sodas, and there are a few study foods I am putting on a mental list: dried cranberries, popcorn, blueberries, baby carrots, raw sliced bell pepper, almonds, etc. I still need to work on my insect collection, photography, art, writing, etc. but I think languages and working out are the highest priority for now.

In other news, LASIK will be happening! My pre-op appointment is September 28, and I'm trying to get my "surgery" scheduled for October 2nd. I'm also counting down til the Tokio Hotel album is released, coincidentally also on October 2nd (theoretically).

The Books Are Here

Well, I came home to 30 textbooks waiting in their boxes. Didn't take me too long to tear through them all. Now I just need to double check the list and make sure I got all of the ones I needed - I actually ended up with an extra one, but I have already found someone on the school listserv who will buy it from me. I'm all moved in back home too, though I need to get some gloves still! Darn! Almost forgot about that. I'll be staying inside the next two days at least on account of my face - we shall see how red it gets. Anyway, here are the book photos as promised.

Also, as far as the physical, apparently I am missing proof of immunity to Hep B and Varicella, so I won't be able to send out my form to student health services until the doctor gets the results. She was a Touro graduate as well, so I asked her a few things here and there, between the wonderfulness of a physical. She went to UCSD like I did, then applied only to Touro and got in, then applied to just one residency (at UCSD) and got it. It's funny how some people apply to 50 medical schools and get into none of them, then some apply to one or two and get them all. She also said that most of her friends were happy where they matched as well, which is reassuring. Especially since hers was one of the first few graduating classes at Touro. Hopefully match day will not be a nightmare for us.

Classes Overload

Well, looks like classes are going to be pretty hectic - our class schedule has been put up and good grief, it's going to be intense. We spend two weeks on metabolic biochemistry and organic chemistry - the equivalent of which I spent at least a year on at UCSD. We do spend a significant amount of time on embryology, to my surprise - I wasn't expecting it to be such a major class. Then there's the OMM stuff, tons of miscellaneous "how to be a doctor" classes, etc. But it looks seriously intense - check it out. I am going to spend so much time reading. I wish they would hurry up and post the information about my class statistics - I'm curious how we measure up to the freshmen classes of earlier years.

In other news, this will be my last week in San Diego - I drive for Norcal on Sunday morning. Tomorrow I get to go to my physical, which will be evaluated by a TUCOM-CA graduate, coincidentally enough. So once I get her to sign the papers saying I'm in tip-top condition, I can mail those off and soon be enrolled in the student health insurance program. Hooray for cheaper copays! Anthem SmartSense pays for squat. Friday is my aunt's birthday, so I'll be taking her out to CPK for lunch, and between now and when I leave, Kit and I will celebrate our 3-year anniversary. Technically the day is on August 8th, but I shall be up north and he'll still be down here, so I'd rather celebrate while we're still together and before the stress of school attacks.

In miscellaneous news, here are two interesting medical procedures I'm getting done: Probably LASIK, and on the 27th is my third treatment of skin laser stuff; the correct term is photodynamic therapy. LASIK is pretty simple - They reshape my cornea with a laser and tada! After I heal I can see without artificial lenses. The photodynamic therapy has light (preferably blue light) bombard my skin after it's been chemically treated in order to reduce pore sizes, redness, and acne causing bacteria. So far I've had two sessions and my skin is starting to look better. Well, I've gone a whole week without an acne-related skin breakout - so I'd call that progress. Not that I had bad acne to begin with, but it's not pretty and I'm glad my mom is sponsoring my treatment - a late graduation gift.

More Supplies

Today I went to the UCSD bookstore to determine my white coat size - I figured they would have the same size scale and similar styles. Sure enough, they had the same sizes as the ones Touro plans to order, so I ended up deciding on medium 10 - the 8 and 10 had the same sleeve length, but the 10 was more comfy, so I went with that one. I didn't buy the coat, since Touro is purchasing them with our names for the ceremony, but I did buy two new pairs of scrubs. One is the color of JD and Elliot's below, the other is navy blue like the one I already have. I could have just bought one pair, but my old pair I ordered online for cheap and it ended up being a bit too big...plus the material of the ones at UCSD felt nicer and I wanted a couple NICE scrubs. Speaking of scrubs, I hear the show has continued after that hiatus due to the writers striking...but I have since moved onto HOUSE.

Other supplies we need to get before anatomy lab include non-latex gloves (or at least powderless) and it's optional to get eye goggles. I doubt I'll get the goggles... They're going to provide us with our own anatomy dissection kits and there will be representatives on campus to give us deals on stethoscopes, sphygmomanometers, and whatever other gadgets I'll be needing. I'm also all registered and about to send off a few more forms. When I go back home, I should have about 20 packages in my room waiting to be opened - all textbooks of course. It'll be like Christmas! For the time being everything is going on my credit card until Wells Fargo disburses my loan money on the 22nd.

Judaic Principles

One of the benefits of attending a school founded with Judaic principles in mind, is all the holidays and days exempt from examinations. The calendar was just released for the 2009-2010 school year and in September alone we have Rosh Hashanah, Yom Kippur, and Tzom Gedaliah - producing 2 days where exams may not be administered, and 5 days the university is closed. There is a nice weekend on which Kit may be able to come up and visit. It is also right after an exam block, so the timing is good. Also, it looks like the set date for the White Coat Ceremony is August 23rd in the afternoon - the college of pharmacy and the college of medicine are both having their ceremonies that day. The below is where ceremonies usually take place - does it not look a bit like UCSD?

Some other programs at Touro, in addition to Pharmacy and Osteopathic Medicine, are for Master of Science in Physician Assistant Studies, Master of Public Health, and Master of Arts Education programs for teachers. Also, according to the Osteopathic Medical School booklet from last year, Touro is expecting to enroll 135 students for the freshman class. My science classes at UCSD were almost never that small - usually twice as many students per lecture hall. Touro still doesn't have the class finalized unfortunately, so I cannot see the demographics yet - I want to see how we measure up GPA and MCAT-wise to previous classes, and which were the feeder schools. Here are the statistics from last year, if anyone is curious.

Here is also a Photo Tour of the campus. They were very wise to take the photos on a rare sunny day in the bay - we all know the San Francisco Bay Area is not the sunniest place on earth.

Getting Closer

Every little piece of news brings me a bit closer to the first day of medical school. The latest tidbit is our hefty book list, each text costing about $50-$75, with a few costing in the $200s. I know I'm geared up for school when simply the NAMES of the books make me excited to start! Principles of Internal Medicine, A Guide to Microbial Infections... information that I will actually use in the real world at my job! First things first, though, I will need to get my loan money before I can afford such a pricey set of texts.

*Just bought them all - about $1,400 all together. I'll take a picture of them all once I get them - I have a feeling they'll look rather impressive.

Trade schools really are a great option after or in place of a traditional 4-year bachelor's program. I hate to see people waste their education, like when they major in something general like art or political science and then never use their major to get a relevant job. That aside, I am very glad to be out of the public education system right as the state budget is collapsing. Private institutions do not seem nearly as affected by recessions and state budget crises as public ones. I am proud to have graduated from UCSD, but I feel the reputation of California's public schools will not last much longer if they lose funding, increase class sizes, lay off teachers, and eliminate research and other academic programs. They may go the way of Athens after the Golden Age, still claiming to be the intellectual center of the world because it gave birth to great philosophers and playwrights, but I suppose that is closer to Berkeley's fate than UCSD's.

White Coat Ceremonies

Well, considering my dream, and the fact that the Touro White Coat Ceremony is drawing closer, I thought I would research a little more about the ceremony. I was surprised to learn that the ceremony was first performed in 1993, and is now practiced in over 100 medical schools. The idea behind the ceremony is that it lends identity and unity to the profession, and reminds physicians to lead their lives and practice medicine honorably and ethically. The ceremony was founded by the Arnold P. Gold Foundation at Colombia University College of Physicians and Surgeons. The foundation sought to focus on medical students and residents so as to positively influence young physicians and instill humanistic principles.

The ceremony itself includes several elements. There is the recitation of a medical oath (Hippocratic, Osteopathic), which represents the public acknowledgment by the students of the responsibilities of the profession and their willingness to assume such obligations in the presence of family, friends, and faculty. Students are cloaked in their first official white coats, there are notable speakers who address ethics and responsibilities in medicine, and after the ceremony there is a reception for the faculty, students, families, and speakers. Some schools also equip students with engraved stethoscopes and White Coat Ceremony pins.

Surprisingly, there is some debate about the benefit of this contemporary tradition - most notably a sense of elitism, premature recitation of the oath and celebration, and encourages antiquated notions such as paternalism. There is a really interesting article by the BMJ Journal of Medical Ethics about it. Personally I think sure, it might be a tad elitist, welcoming a select few into the secret doctor world that lay people don't understand, but it'll be fun and is a nice way to encourage camaraderie within the profession. Plus, it's a big deal, starting medical school - I don't see much wrong with celebrating the path we are about to take.

By the way, the Journal of Medical Ethics is FREE and viewable after registering with the website. It has a lot of nice reading material.

Closer and closer

Now that it is getting closer to the orientation (August 3rd), we have our class listservs up and everyone is posting information about themselves. It is great how connected everyone can be through facebook and email - the internet is really amazing for networking. Though, it seems the hottest topic for everyone is finding roommates or comparing housing prices. This will be my smallest class since 8th grade - my high school class numbered around 400, and at UCSD over three thousand. Now? Probably between 125 and 200 students. I am really hoping to get to know a lot of people and feel an actual comradery, maybe even a sense of school spirit.

As much as I am looking forward to it, I am already having nightmares about medical school. In the first, I did not have a white coat for the opening ceremony and there were 15 minutes left before everyone was meeting in the auditorium - frantic scrambling ensued. The second dream starred me as a new physician out in the world, and I had no regular patients and couldn't even dress wounds or put my password into the computer to look up a patient chart. I thought these jitters were supposed to happen in a few weeks? July 26th is when everything begins for the most part - I officially end my employment with Kaiser and begin moving my stuff back home.

A Productive Day

Well, one of my tasks was very simple, the other much more frustrating. The matter of getting my immunization records was a hassle because I am no longer a member of the HMO which holds all the records of my immunizations, and because I was a member of two different regions, Northern and Southern California. I was on the phone for forever, getting shuffled around until I finally ended up at member services and I was told I could send the form to them and they would give it to my old doctor. I heard this from Northern California. So I tried to do it down here, assuming it would be the same, and I was told it would not be possible to have a doctor sign it because I am no longer a member. I am now stuck sending official immunization reports from the office of medical records, and hoping Touro accepts them and is able to put two and two together. On the plus side, I was driving to so many different Kaiser locations that I came across one that was having a blood drive, so I stopped to donate and get an ice cream coupon! Blood for ice cream, a very sweet deal. I also got some art supplies, so I can work on creative endeavors in my spare time. I also made my appointment to see a D.O. for a physical (Osteopath pride!) - July 23rd, and she's a graduate of Touro University (California)!

The second task, which involved calling Wells Fargo and sorting out my student loan situation, was much more pleasant. I got my loan application numbers, got my Master Promissory Notices, and took out that second loan for $13,500 which will be at 7.5% interest, lower than the "recommended" Federal PLUS loan for graduate and professional students, which has a fixed interest rate of 8.5%. The title of that loan is MedCAP (Medical College Access Program, an alternative loan for health professionals). I knew my history and good credit with Wells Fargo would pay off. It's a shame I didn't qualify for a Perkins loan (issued by the school, $2,000 maximum per year, fixed 5%) but maybe if I file early enough next year I will get it and/or a grant.

Baby steps

I must admit, I am a bit of a procrastinator. Not just with studying, but with everything, including financial aid and certification deadlines. Each time that I nearly do not make a deadline is a lesson, and usually I learn. I think I am slowest with snail mail correspondences. I finally mailed the financial aid award letter back to Touro, indicating that I accepted the $8,500 federal subsidized and $32,000 federal unsubsidized Stafford loans. Based on my calculations and some estimates from Touro, I will need about $13,500 more from a private loan to cover personal expenses, equipment and texts, plane flights for Kit, car maintenance and gas, health insurance, etc. It may be more than I need, but I'd rather have extra than not enough. I need to call Wells Fargo tomorrow and see how to go about dealing with them, since I don't know what information they want from me and I don't think I am supposed to fill out an entirely new loan application (at least not for the Stafford stuff) - just sign the Master Promissory Notice. I also need to call a doctor within my PPO to get a physical for school. Joy.

Now, I need to decide how to best spend my time, as I am starting to feel a bit listless with so little to do. I could work on my book list, keep collecting insects, computer games, cook new things...I have writer's block so that is frustrating. In two weeks I will be going to Monterey with the family for a week, then I will be going back for the 4th of July, and then at the end of July I move back home. I kind of wish I weren't going back for the 4th, since it's a whole week that I could be spending with Kit AND working, and I'll be living with the family for the next four years... The 4th wasn't my idea. At least I'll have summers - it'd be nice to leave home next summer and spend the months with Kit. Such a long road...but it'll be worth it (my new mantra).

Something to Remember...

Sometimes, in my line of work as a low-level hospital worker, I learn things that disappoint or shock. The latest discovery is related to time-dependent blood tests. I would say that at least 75% of the people who work in the laboratory drawing blood do not have education beyond high school and vocational training - those who do have more education are usually working toward getting into a nursing program. For those who stay in the lab, sometimes the vocational training is not thorough enough and common sense just does not exist. The following case demonstrates how important it is for all people in the medical field to have a basic understanding of medicine; they need to understand why they have to do the things a certain way and the consequences if they do not follow instructions.

Some phlebotomists, particularly on the graveyard and night shifts when it is not very busy, do not want to waste time going up to get multiple samples of blood from the same patient. This is understandable if the person is a hard stick and there will be no difference if the blood is drawn at that time, or at two different times. However, some tests are measuring a person's metabolism of certain medications, and are supposed to be drawn right on time, sometimes as often as every two hours. Vancomycin is one of the common antibiotics which requires blood tests to determine the trough and peak levels of the medication. Learning that some lab assistants draw all the tubes at the same time and then write fake times (as in, they draw a tube at midnight but write that they drew it at 2:00 am) is rather alarming. If I were a patient's doctor and I thought their trough and peak levels were lower than in actuality, I would have to increase their medication and possibly cause harmful side effects. The ramifications of giving doctors incorrect information can be fatal - hearing this almost makes me want to draw all of my future patients' blood samples myself! Alas, it is not feasible, but it will at least make me think twice when I get back unexpected drug level reports.

Spider Bites

The most infamous spiders in the United States, as far as being dangerous to humans, are the brown recluse and the black widow spider. The brown recluse is understandably dangerous, as their toxin causes necrosis, and a chunk of flesh as large as a softball in diameter eventually rots away unless there is early intervention. However, I am going to discuss the black widow. I shot some photographs recently, and recalled discussions in Neurobiology of Cognition about latrotoxin (named after the genus of the black widow, latrodectus).

Latrotoxins are the active ingredient in black widow venom which causes symptoms, known as latrodectism, in humans. The toxins are large molecules, and the most studied of the latrotoxins, alpha-latrotoxin, acts presynaptically to stimulate the release of neurotransmitters. The toxin forms a tetramer, so four alpha-latrotoxin molecules group together and form an ion pore. When the tetramer enters the cell membrane, the pore allows an influx of calcium ions, which results in neurotransmitter release. At nerve endings, it causes muscles to remain contracted, resulting in muscle cramps and pain - particularly in the abdomen. Rarely, people with heart problems can suffer complications. Luckily for us all, antivenin is readily available and there has not been a death since the 1940s.

Bilirubin Babies

Every day that I work in the lab, I usually end up drawing blood from a newborn or a child under 10 years old. The children are pretty easy if they are over 1 year old, since you only have to hold them down screaming and finish it fast. If you work quickly and confidently, the parents can handle it pretty well. Of course, I realized today that now when I see children ages 1-10, I feel guilty/apologetic because I am used to thinking that I am about to inflict pain upon them and see that terrified, betrayed look in their eyes. I'm talking about when I am not even in the laboratory - just seeing a cute five-year old girl in an elevator makes me feel bad because I "know" that in a couple seconds those curious, happy little eyes will change. I'm pretty desensitized in the lab, but out of the lab when I attempt to look at a child happily, I feel like I am a wolf in sheep's clothing.

At any rate, I also draw blood from newborns. 95% of the time, the purpose for the blood draw is that it is a bili baby. A bili baby is a newborn with elevated levels of bilirubin (hyperbilirubinemia). The most obvious symptoms are jaundice, or yellowing of the skin and the whites of the eyes. Prolonged exposure to such high levels of bilirubin can cause brain damage, hearing loss, eye muscle problems, physical abnormalities, liver damage, and death. There are two reasons a baby may have hyperbilirubinemia. One is increased destruction of blood cells, usually caused by antibodies from the mother if the baby and mother have different blood types. The other is accumulation of bilirubin because the newborn's system is not excreting as much as it produces - primarily because the liver is immature and unable to process the bilirubin. For this reason, preterm babies are more likely to suffer hyperbilirubinemia: their liver is not as developed.

Treatment for hyperbilirubinemia is phototherapy. Light is absorbed through the skin and helps convert the excess bilirubin into a more excretable form for the infant. In extreme cases, blood transfusions are necessary. For babies under 7 days old, the average acceptable level of bilirubin in the blood is 10 mg/dL, 6 mg/dL for babies less than 24 hours old.

Circumstances

Today at work I encountered a woman who was getting tested for various things, and her entire hand was inflamed from a bee sting. She told me how she had been stung once before and had not had a reaction to it, but this second time it was progressing up her arm. I recalled that years ago I had been stung in a pool, and because my skin was so cold from being in the water, as was the bee's venom gland, I did not have any lasting reaction from the sting. I suspect it is because the fluid was not warm enough to diffuse into my skin, my skin was taut from being cold, and my flesh was cold so the venom that did get into my skin did not permeate very far.

With that in mind, I asked her about the circumstances of her first sting, since a lot of people get stung in or around pools. Sure enough, her first sting was in a pool. After a little research, I found that there are a lot of factors that affect a person's allergic reaction to something like a bee sting, including temperature and a person's emotional state (panic can cause a chain reaction that makes the patient worse). Another thing to consider is that the first time a person is exposed, she may not react at all, but after that point the body may build antibodies and recognize the allergen when exposed a second time. It is very possible to develop allergies after previous exposures, such as health workers developing an allergy to latex. The second time this woman was stung, she was riding a motorcycle with her significant other, on a hot day, and panicked because they were on a freeway and couldn't stop for her to examine the situation. I imagine that tiny details such as these can make huge differences when evaluating a patient history.