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!