Nearing the End of 2nd Year

Well, in a few short weeks my core classes will be finished and I will be mostly studying for Board Exams (USMLE, COMLEX) and gearing up for rotations. My third year rotations will mostly be taking place around Fairfield and Napa, with two rotations out in Stockton (psychiatry and hospital-internal medicine). That isn't until the end of year 3. My schedule only permits one month of vacation, which I intend to take right at the beginning so I can extend the time that Itake USMLE and COMLEX by a month - an extra month of studying will make a big difference, especially since that is ALL I will be doing. I am leaving a week between the COMLEX and the start of rotations to go on a vacation though - it's my only vacation, I should try to do something!

The unfortunate thing about Touro University is they do not let us finish school very early. We are in actual classes up to April/May, many mandatory, while other schools have already finished second year to give students time to study for boards! No wonder Touro students perform more poorly on boards. It's hard to keep up with boards and classes at the same time. Luckily a lot of the boards review is starting to overlap with what we are currently studying, so hopefully that'll help out a bit.

I also had an interesting extra-clinical experience - we are required to do a visit and then 6 month follow-up with a geriatric patient at a nearby retirement community. When I went to visit, it so happened that my patient had fallen in a parking lot that day and did not feel up to visiting the clinic, so the head nurse told me to make a house call. In a way, it's kind of ironic that my first "house call," once a traditional type of doctor visit, is probably the only one I shall make in my career. It was a little awkward, but kind of cool to examine a patient with an acute injury in the comfort of her home (in case you were concerned, she was barely injured - extremely lucky considering she is an 83 year old female with history of osteoporosis and is on anti-coagulation medications - she could have easily broken her hip, leg, or wrist, or ended up bleeding a ton).

On another "fun" note, we get to do rectal, breast, and vaginal exams on paid "patients" this week...not particularly looking forward to it, but at least I have experienced all three, so it's not an entirely foreign concept. We are getting into the genitourinary and pediatrics sections now so ... time to race to the finish line. I still have some fun stuff planned - next week double date to Sattui Winery for complimentary tastings, thanks to being wine club members. Anyhow, back to boards review...

Spring Semester and Boards

Well, just finished the 3rd week of Spring Semester - this unit is gastrointestinal, endocrine, reproductive, and dermatology - or GERD. Just signed up for our "Project Prepare" time slots, where we get to practice breast, prostate, and vaginal exams on hired "actors". We always kind of wonder what kind of people choose to do this sort of work, but hey, in this economy, why wouldn't they?

At any rate, the first week we covered mostly dermatology, and the second and third weeks have been focused on the endocrine system (so the pituitary, adrenal glands, pancreas, etc.). I am also getting geared up with my boards review program. I am taking Boards Bootcamp, where we get video lectures, as well as a study plan in the mean time. Near the end of the program we attend some live lectures locally. We got a super discount because at first we committed to the comprehensive program which was supposed to have weekly live lectures and cost 1700 or so, but we were going to get it for about 1300, then when we didn't get the minimum number of students to sign up, they upgraded those who did sign up to the elite program which normally costs 2200 (but we still only paid 1300). It's a lot to work on, but frankly I enjoy studying for boards more than Touro material - it just feels like it's better organized and more relevant. Anyway, I devote my Sundays to studying Boards material - works out well because my boyfriend works essentially all day on Sunday, and Monday-Thursday, so I don't feel like I'm neglecting him too much.

I have been managing to have a little fun on the side - spending time with my boyfriend, hosting a New Year's Party, heading out to a brewery here and there, a movie or two, played nearly all the way through Fallout: New Vegas. Even trying my hand at some new dinner recipes. Now I just have to re-incorporate an exercise regimen...

Oh, I also got all two of my wisdom teeth out a couple days ago - first time going under anesthesia. But there was barely any after-effect and I'm recovering quite quickly. It sucks not being able to eat much solid food, but because I only had wisdom teeth on my left side, I can still chew a little bit on my right without disturbing my stitches. The whole procedure was only about 25 minutes, I was surprised.

Another Hurdle

Well, just finished a pseudo-midterm - feels like I've been doing nothing but study lately - and in my spare time, computer games. I really need to get out more and exercise... Feels like I'm trying to do a million things at once, but I guess that's nothing all that new. I can't believe I'm almost done with my first year of medical school. It's rather intimidating because sometimes I feel like I've learned a lot, and other times I feel like I haven't learned anything. Now with the midterm done, I plan to just relax as much as humanly possible between now and Saturday night - Saturday we have a semi-dance thing on campus, it's a fundraiser for the group that is going abroad to Ethiopia and Tanzania. Unfortunately they're more established, better organized, and have the Global Health program director in charge of their group, so they have been putting on a lot more events than my group (Bolivia) and the Taiwan and Israel group.

The latest stuff we have been studying is all the respiratory illnesses - mostly those that cause pneumonia, bronchitis, that sort of thing. There was a section on pediatric illnesses and upper respiratory problems, which was okay. I'm not a fan of babies in general, and learning about the millions of ways that babies can turn out wrong frustrates me, since there are no laws permitting parents to relinquish their responsibilities for an incredibly unfit offspring. Definitely a controversial view, which as far as I'm concerned will only apply to myself and my future offspring, not the patients for whom I care (so don't worry), but human societies have practiced infanticide since before they were even humans - all animals practice infanticide if they do not have the resources or the animal is too unfit to survive and care for itself. It seems a crime to force parents to spend say, 5 years of their lives caring for a child that is 99.99% doomed to die - that's 5 years in which the child will be suffering, becoming progressively more mentally retarded, and slowly wasting away until its inevitable demise. It's an emotional drain for sure, not to mention a financial drain on the parents.

Like I said, I know it is my duty as a physician do everything in my power to keep a patient alive, and I will do that wholeheartedly - I just don't want to end up a slave to any offspring I produce with conditions that are incompatible with life for which medicine can offer no acceptable end.

In other news, still doing bacteriophage research. My medical Spanish classes have picked up again, so we're practicing those and we have our practicals next week. The trip to Bolivia is essentially ready, though I still need to get all my vaccinations...mental note: call the travel center. OMM is going well, I suppose - we're learning the high velocity, low amplitude techniques (the cracking techniques). I've had mixed success with them, so I definitely need more practice. Thank goodness we don't need to make an audible crack for it to be 'treated' - otherwise I don't know how we could get anything to treat during a practical after we've been practicing on each other for days.

Still working on balancing personal life with school, but everything's a work in progress these days... Now for the joy of computer games!

Spring Break

Hooray for spring break and being done with blocks exams for the time being. I ended up going to Monterey for a week, and then down to San Diego for the remainder of the passover time we have off. I have done essentially no medicine-related stuff all break - a welcome change and break for my brain. Looks like we get to start out with venipuncture and the respiratory system next block. Makes sense, as we just covered the cardiovascular system. It should be interesting.

In other news, we're needing to raise some money for the Bolivia trip (as in, get money to buy supplies for the hospital, mobile unit, and for the impoverished down there). I'll be returning to my research soon enough, and want to exercise a bit more so I'll join in the weekly karate class and do pilates on the side. I also got a LASIK checkup and my eyes are still healing perfectly and there are no complications. I also need to start making my own food more often - as much as I like letting my parents cook everything, sometimes I really prefer my own cooking. Anyhow, back to enjoying the last couple days of leisure that I have...

Spring Semester, Block 2

Next week is our second block of exams for spring semester - it will mainly focus on the heart and related diseases. So...that includes hypertension, angina, valve disorders, congestive heart failure, arrhythmias, pericarditis, cardiomyopathy, etc. AND their pathologies, drugs, treatments, and more. Fun times...over a hundred drugs to learn, again. There's some OMM stuff to learn in there as well, specifically tender points and some cranial technique theory. I'm interested to learn cranial - supposedly it's really good for headaches (among other things...). Here is the first 1/4 I have completed of my study board:

Today is St. Patrick's day, so it won't be long before we medical students, once again, imbibe alcohol and kill our livers and brains counter to the advice we're required to give our patients. I guess alcohol isn't quite as bad as the McDonald's lunch I had, but hey, my BMI is 21, my system can take a few hits for the greater good. (Hears Dr. Clearfield's voice in my head..."Even people in their 20's, who look perfectly healthy, can have early and even middle-stage coronary artery disease and atheromas in their arteries"...oooooo...scary).

More and more, I realize how much I want to specialize in Infectious Disease. The fact that the thought of a lecture on anything related to bacteria, viruses, fungi, or parasites is enough to brighten my week is sure sign enough. I'm really amazed at how little surgery or other superspecialties appeal to me - cardiology? Meh. ER? Nah. Surgery? Too many hours standing over someone's guts while nurses wipe sweat off your face. I have the hand dexterity, focus, and attention to detail to be a surgeon, as I've been told many times, but it just holds no interest. Gimmie someone with a bug in them! I'm going to send a letter to an Infectious Disease DO to see about shadowing - as much as I love infectious diseases, I know very little about what an ID specialist would actually DO. Hopefully I'll mail that out and hear from her soon!

Bolivia and Research

Things are progressing as usual at school. We're studying drugs for treating hypertension, dyslipidemias, arrhythmias, angina, etc. Essentially this is the phase where we learn how to treat the diseases in the renal, cardiac, and respiratory systems, which we learned about last block.

In the meantime, I've gotten started on some research, fortunately with the same professor who is going to Bolivia with us. I'm glad I am on good terms with all the faculty so far - I have heard of a few students who think certain professors dislike them, and I haven't gotten that vibe from anyone yet, so hopefully I won't. The research is related to bacteriophages, as I mentioned before, and we will be growing bacteria (Salmonella) and determining under what conditions their bacteriophages become most activated to the lytic phase (where they reproduce themselves and lyse their host cell, looking for more hosts, compared to the lyosgenic phase where they lay dormant in the host cell's DNA). The professor I am working with, as well as others in the lab, seem to be really laid back, It's kind of a "when you can help out, come on in - put your studies first" situation. After the high-stress environment of working in a hospital laboratory, and even the strict environment at UCSD, this is a welcome change.

Also, the Bolivia trip is beginning to materialize more. We are about ready to book our flight to La Paz, are going to put together a presentation of pre-research about Bolivia, and are getting materials ready for the trip. I'm very much looking forward to the experience - Spanish immersion, health education, learning how to diagnose and possibly treat diseases we rarely will see here in the US. Anyhow, back to studying.

Fun and the Future

Even with so much to do, medical students can still have a little fun. The last weekend I went to a house party, with drinking and silly stuff, then to a shooting range, then a BBQ and a turkey dinner, and then played computer games all night. It's nice to know that we can kick back occasionally, but we better enjoy it now, because it's going to get a lot worse. The number of drugs we need to memorize is steadily adding up - I wish I knew them all as well as I know drugs like tylenol or omeprazole, typical OTC drugs that I've known about most of my life.

We're getting into hypertension lectures, angina, coronary artery disease (CAD), congestive heart failure (CHF) and similar problems. It's funny, with all the talk about eating healthy, and how CAD can be seen as early as in teenagers or people in their twenties - the food I'm craving the most right now is fast food. I haven't craved it in ages, but here we are.

Every so often, the curriculum at our school throws in a "Managing Stress" class, where we are told ways to deal with stress, as well as the kinds of stress we are going to encounter (which of course gives us a lot of stress right then and there). Today, the doctor teaching the class was talking about how the first two years of medical school are a breeze compared to third and fourth years when you begin your clinical rotations and have to use whole different sets of skills (communcation versus booksmarts). Then she went on to say you think rotations are bad, wait til residency - where there will be hallways or stairwells essentially devoted to hiding and crying when your attending shouts the crap out of you. I imagine something like Dr. Cox from Scrubs, except no one is laughing. She then added how even then, you start your internship somewhere and it's just as bad - with more power comes more responsibility, which comes with more and more work. It's like being spider man except that everyone knows where you live and you're expected to work 16 hours straight.

As she talked about us being on rotations or in residencies, I couldn't help picturing how some of my classmates would be during rotations - getting picked on by the attending, or stepping into a patient room with an air of authority and asking them what the problem is and trying to help. Now that I know more about a doctor's thought processes, and my classmates' strengths and weaknesses, it is hard to picture myself as a patient of theirs - putting my problem in their hands and trusting their judgment. Though, in my mind at least, I always picture my classmates looking very proper, professional, and knowledgeable in these situations. I suppose that means I have a good amount of respect for my peers as future physicians and human beings (well, most of them - there's always a couple you wouldn't want as your doctor). Hopefully I'll pull everything together and become as awesome a physician as I picture most of my peers becoming.

Studying, Advocating, Consoling...so much to do

Well, spring semester has been coming on fast and furious - been extremely busy. Have also had tests every other week, essentially, and our first Block exams of the semester are next week. We have had two standardized patient encounters with our small group - where we must take histories and perform a physical exam. It's amazing the things you notice yourself and your classmates doing when interacting with patients - strengths and weaknesses, the importance of listening... We have also practiced doing SOAP note write-ups (subjective, objective, assessment, plan) and worked on differential diagnoses. The ailments of the patients are in line with what we are learning, so we can apply what we learn clinically.

Tomorrow we get to explore a new aspect of the physician-patient relationship - breaking bad news. We will have 12 minutes to break bad news to a standardized patient who has been trained on how to react convincingly to the news, including shouting or crying. We will be faced with one of these: a son whose father unexpectedly died, a woman with a suspicious breast lump who needs a biopsy, a man with inoperable pancreatic cancer, a childless woman who just had a miscarriage, and a man with an STD from an affair. Should be interesting and nerve-wracking - but I imagine it will be more difficult for some of my colleagues than for me. Working in the lab, I definitely got to deal with very angry patients, and one woman I drew as a trainee had just learned her husband was going to die - that was a difficult one. You really don't know what to say to a stranger who suddenly starts crying, especially when they're still holding back so much pain and you know almost nothing about their situation. I almost cried myself that time - but sometimes all you can do is squeeze a person's hand to let them know you're there with them, even if it's for just a moment. I'm usually someone who insists on a 3 foot personal space bubble and never hugs people unless they're family (and even then not so much), but somehow I was able to recognize that at that moment, she really needed to feel physically that someone was there with her. If you're really with them, and not just going through the motion, time almost seems to stand still for you both in a good, or at least meaningful, way. They say, "You can touch patients during a bad news situation if you think they would be okay with it," and you kind of wonder, "How will I know if they would be okay with it?" Well, that was one of those moments, and I could definitely tell even with no experience - though my rule is that if in doubt, it's better NOT to touch.

On a more positive note, last Thursday we were bussed by the Osteopathic Physicians and Surgeons of California (OPSC) to the state capitol to speak with assembly members and fellows about the recent merger between the Doctor of Osteopathy and Doctor of Naturopathy boards. Essentially, bill AB X4 20 merged the boards because the governor wanted to make it look like he was cleaning up the government - busting excess bureaucracy and saving money. However, both our boards are funded by those in the profession, no tax money is involved, and they approve licenses as well as oversee malpractice issues. NDs do not prescribe medications without supervision (and even then, no category 2 drugs) nor do they perform surgeries - so having them oversee us, or even have us oversee them, is not fair to either profession. I was the designated group leader to the assembly member whose fellow we spoke to because apparently I live within the district (14). Definitely nerve wracking, but everyone seemed to think I made a very eloquent case. The fellow we spoke to seemed very supportive of our cause. One of the senators (Lee) has submitted two goldenrod bills to his boss for approval, which we need in order to get numbers on them, support, and signatures. It was really enlightening to see how the process works in state government, and that people in the offices actually will listen to you and you can make a difference. We also got to speak to one of the governor's aids right before he was going to a meeting with Mr. Schwarzenegger himself, with the promise of at least mentioning the issue with him, so that was exciting. There were a bunch of school children outside of the governor's offices as we walked in and they were all asking us to say "Hi" to the governor for them, ask for more money for schools, it was adorable. All in all, a very exciting day - here we all are in front of the capitol building!

Also, on one final note, the founder of Touro University, Bernard Lander, last night at the age of 94. All the Touro campuses were closed out of respect. I don't really know what to say about it, as I never met him or knew much about him before now, but I am kind of wondering how it will affect the universities. At the least, I was productive and used the day to get more caught up on classes.

Latest in Whiteboarding

Well, I'm trying to catch up on all my anatomy, but more will certainly follow - I need to work on respiratory material that we're starting to learn, put up some OMM diagrams, and maybe some useful doctoring notes. As we go, though, I feel like there's material we already learned that is slipping away from me! It is so much material, I'm definitely going to have to do some studying over the summer somehow - I hate that I try to remember stuff from first semester and some of it is already disappearing. Tomorrow is Monday, which means 8 hours of lectures, so I have to be sure to bring a decent sized lunch. Also, there's a basketball game between our class (2013) and the second years (2012) - hopefully it will end better than the last game between our classes...

Apologizes for the quality - I have not yet found a decent way to photograph my whiteboard

Post-Mini CVRR Exam...

Well, since the last post, so much has been going on that I haven't had the right state of mind to study...what with the first week of school and seeing everyone, coming back from winter break, and having a party/Gala packed weekend. So, alas, my studying last week was essentially nonexistent and very little studying was accomplished when I visited Kit over the weekend, so I ended up doing an all-nighter last night and I am feeling the pain right now. Anyhow, hopefully tomorrow I'll wake up feeling more energized and be able to charge back into studying!

We've been getting into more detailed cardiovascular exams, dissecting the heart, learning about the heart and various ways of looking at circulation. We're starting the respiratory system now but I want to go back over the circulation stuff a bit since I feel like I probably missed some of the details during my rabid speed studying last night. Hopefully will be having some normal fun this weekend, make some headway on my studies, and feel all prepared for next week.

Awesome Anatomy Lab!

Sometimes you have a really fun time learning things - when you get quality time with professors, they don't seem rushed, and you have prepared, you can get really involved in the active learning process. We had small groups today, and were examining the inner thorax, mediastinum, the lungs, and the heart. There are so many knowledgeable professors, it's great! Also, all the information was being absorbed in my head like a sponge, and becoming more cohesive.

Some of the highlights include finding essentially all of the key terms we needed, learning how to insert a tube through the rib cage to remove air or fluid, following the arteries and veins into and out of the heart, and getting information about x-ray films of the chest. This was quite a fun lab. It also helped my studying - I updated my whiteboard. I barely have any room left for tomorrow's material, or the heart stuff from today, but nothing we focused on today was particularly new. Unfortunately there were a lot of graphs, so I probably need to memorize and understand those...

Week 1 Has Begun!

Well, Week 1 is well underway, starting the cardiovascular system. We opened up the thorax on Monday, peeled away the skin on the chest, saw the pectoralis major, pectoralis minor, serratus anterior, external intercostales, deltoid, subclavian muscle. Also the rib cage, the sternum, manubrium, clavicles, etc. I also dug around and found the subclavian vein, cephalic vein, axillary vein, axillary artery, and brachial plexus. Next we took out the ribs (bone saw) and observed the lungs, heart (still in pericardium), a bit of the trachea, etc. One of the other cadavers had severe lung cancer - he had bulges the size of golf balls on his lungs and the interior of his ribs were black on that side. There was also a male cadaver with breast cancer. On one of the cadavers I was able to see the right and left vagus nerves and the left phrenic nerve also.

I have been making good use of my new giant blackboard - as for OMM we have started the pelvic area, learning landmarks, anatomy, and lateralization tests. I'm glad I had a girl partner for the first one - I'd rather not feel stuff for the first time on a guy - least now I know what to look for and won't feel like I'm groping around their crotch and butt aimlessly. The science lectures are all about how the heart works, mostly action potentials right now - which I have learned multiple times - AP biology, then cognitive science 1, 10 and 11, then in some biochemistry classes as well, and now here. At least I have some fun stuff planned for the end of the week - a party and the shooting range. Seriously, medical school is way more fun than undergrad was! Oh, and also my disbursement check is ready at the financial aid office - I need to get it tomorrow and figure out my budget for the Bolivia trip - if I have some extra money, I may go to Convocation. If not...well, there's always next year.

Spring Semester...

Monday is the first day back at school, and I am not particularly looking forward to it. I just got rid of my year-long writing block so now I want to work on that! Alas, it will have to be put aside. It looks like we're starting in on the cardiovascular system, and will be dissecting the chest wall, the heart, etc. I don't really want to go back to the anatomy lab... One more weekend to enjoy freedom before entering the grind of school again. I won't have a break again until spring break, and then not until I get back from Bolivia. I think I'm going to pass on Convocation this year, simply because I already have one expensive trip planned. Maybe next year I'll go. Anyhow back to enjoying the last break I have for months...

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.

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.

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...

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.