Slow Day

Today was rather slow by comparison - only saw two patients.  In the morning there were lots of quickies here for some injections (either Supartz or corticosteroids) and one or two who didn't want a student.  Spent a lot of time sitting around reading JAMA articles.  I came across a few interesting tidbits.

1. Onchocerca and Dranunculus, both parasitic roundworms, are in the process of being essentially eliminated from the human population by the World Health Programme.  Onchocerca causes river blindness in South America, and Dranunculus is also known as the Guinea Fire Worm, and if you don't remove it slowly from a person's arteries then it will die and cause a reaction that will kill the person.  You hear about viruses like polio or smallpox being eliminated, or maybe malaria, but rarely about parasitic worms.     

2. Bladder cancer is higher in men than in women - I hadn't really thought about this before now.  Bladder cancer is strongly linked to cigarette smoking, particularly to a chemical in cigarette smoke: naphthylamine, which  is also found in certain textile dyes.  However, it was previously thought one of the reasons men were more susceptible was because men were more likely to be smokers, have unhealthy lifestyles, and work in environments that expose them to carcinogens.  Now that women are working in a lot of the same fields as men, the incidence has not increased an equivalent amount.  A study in 2007 showed that mice without the testosterone/androgen receptors who were exposed to chemicals linked to bladder cancer did not get any bladder cancer, compared to mice with the receptors who nearly all got bladder cancer (~90%).  It would seem that the same mechanism behind prostate cancer may be involved in development of bladder cancer in men.

3. JAMA includes a previous JAMA article from 100 years ago to the day at the end of each issue.  One of the old articles about digitalis/foxglove and its use as a medication for arrhythmias and other heart problems had a very interesting line in it.  After going at length about the benefits of high doses of digitalis, the author writes: "For that reason, a daily large dose of digitalis is advocated indefinitely to keep the weary heart a-going on its rapid journey to an eternal standstill."  That article was written in 1911, and the last part of that line has a very poetic, almost morbid sound to it.  Rather unexpected when I was reading the article.

At the end of the day I had to go to didactics, where a guy who reminded me a lot of Jim Carrey was telling us about Clopidogrel, and how it compares to Aspirin - his main argument was that Clopidogrel (Plavix) is treated like a substitute or necessary adjunct therapy for Aspirin, but in reality there is little evidence it is more efficacious than Aspirin, or that dual therapy would benefit anyone besides those with cardiac vessel stents or in an acute cardiac event.  It was interesting, he was going on a bit about drug reps and such - since I studied a lot of that in undergrad for my medical history classes, it wasn't anything that new to me.  Anyhow, time to get some reading done and try to recharge for tomorrow.

Finished BLS and ACLS

Since I shall soon be starting rotations in hospitals, I had to go through BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) training and certification. Didn't take too long, and BLS was a recertification so that was no challenge - ACLS was a lot of new material and new sequences of information, along with a refresher course on EKG reading so that was fun! I particularly liked the instructor, as he had 42 years of experience as a paramedic and emergency department (ED) technician so he had lots of case examples to share with us.

Some take-away points for normal people which I feel I should mention - as it may save you or a loved one one day:

3 main things to know for CPR

1. Are they breathing? Do they have a pulse? (if no...)

2. Have someone call 911 and tell them to try to find an AED (often in hospitals, schools, major office buildings, gymnasiums) - no use doing CPR if no one is coming to help.

3. Chest compressions - fast and hard - at a rate of at LEAST 100/minute, so we're talking about 2 compressions per second. When you do compressions, middle of the chest (approximately between where the nipples are), compress about 2 inches into the chest. On kids, 1/3 of the way. *FYI: If you are doing compressions properly, you may very well end up breaking their ribs - don't let that stop you - keeping heart circulation going is much more important than a broken rib or two*

If you are comfortable doing mouth-to-mouth on this person (child, husband, etc.) do only 2 breaths, head tilted back, covering nose, and then go straight back to compressions -compressions are WAY more important, so alternate 30 compressions then 2 breaths.

Another take-away note about Strokes...

If you or someone else starts having signs of a stroke (one sided muscle weakness, face drooping on one side, difficulty speaking) - CALL 911 - DO NOT DRIVE THE PERSON OR YOURSELF (unless you are less than a block from a hospital MAYBE). Reason? You may feel well enough to drive yourself, or you may think you can drive your family member, but if an ambulance picks them up, then not only will they get en-route care, the hospital they deliver the person to will be completely prepared, with the neurologist, cardiologists, etc. all notified and ready to take care of the patient. It can take 45 minutes of assessment and evaluation once you get to the hospital before they decide it's a stroke and can do any therapy - by then, it may be too late.

Why is this so important? Fibrinolytics - you basically have a 3 hour window where you can be given a medicine that will essentially dissolve the clot in your brain. I have known people who drove themselves while having a stroke, or who started having a stroke in the middle of a golf course and played through to the end before going to the hospital - if you want that shot at a Fibrinolytic, which will GREATLY INCREASE your chance of restoring brain circulation, get to the hospital ASAP.

Bottom line: If you have a loved one, pass on this information so they get the fastest possible care, or so they know what to do if this happens to you. Time makes a MAJOR difference when it comes to blood not getting to your brain.

Enough with the public service announcements though - time to get back to studying for board exams! Wooh! Diuretic medications.

Mostly done with 2nd year

Finished all our normal curriculum classes - feels like it's time for a break but alas, must start really hankering down on preparing for boards. I moved my board exams to later, since I will be doing a vacation first, so I have a bit more time but my prep program has a live lecture series that begins at the end of May so I need to get cracking!

As far as the last few weeks of school, they went by rather quickly, with lots of studying and crossing fingers that I wouldn't have to re-mediate anything. It's getting warmer, so perhaps I can take a break to collect insects again soon, but a medical career sure does eat up your time. I'm also trying to adopt a healthier lifestyle, incorporating more exercise and diet changes. We'll see how long that lasts.

Got back from Monterey recently, went for a week-long vacation with most of the family - I say most because my dad recently had a hernia repair complication and had to stay home to recover from that. Funny how you learn things in practical settings that they don't really discuss in medschool - like how to approach a patient who comes in with an internal bleed. Solution? If their H&H doesn't drop too low, and if the bleeding stops on its own, even with tons of swelling, you can expect the body to resorb a certain amount, and it is usually less risky than surgically draining the fluid or going in to repair a small bleed.

On another note, I've discovered I have a very particular allergy, to two products produced by the Estee Lauder parent company (Brands are Origins and Clinique). The brands are significantly different and the two moisturizers I used only share a handful of ingredients - I've narrowed it down to butyloctyl salicylate (but this is common in a lot of sunscreens that I think I have been exposed to before) and micrococcus lysate (an ocean-microbe's dissolving organ enzyme). My money is on the micrococcus lysate, because it is used in very few products and is relatively new on the market (2009) so I am curious to see if that's what it is. There is one more product out there that I know of that contains the micrococcus lysate but not the other compound, so if i test that on some skin it should produce a reaction if I have the right compound isolated. Kinda fun to experiment on oneself, but I kinda want my face and neck to stop being all inflamed and itchy. And my test arm.

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.

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.

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.

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.

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.

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.

Relishing the News

I have gradually grown to oppose dietary supplements, culminating in my history of medicine paper documenting the history of the industry (which is quite interesting). I rarely do double posts on the medical blog, but felt compelled to share a recent article. In this article, it has been found that those who take vitamin C and E supplements do not receive some of the benefits of exercise, such as increased resistance to oxidation and better control of insulin production. To spare the nitty gritty, it stems from vitamin C and E neutralizing the oxygen radicals produced from muscles respiring. As a result, the body does not receive damage from the radicals and therefore does not launch a response to the oxidation - the vitamins took care of the problem. This is not to say that antioxidants are bad, but just that megadoses of vitamins C and E is not a good option.

This is just one of many recent studies disproving the long-term health benefits of vitamins C and E in preventing heart attacks and cancer, as well as the lack of long-term benefits from taking a daily multivitamin. Like with weight loss, people always want fast, easy solutions to difficult problems, and the artificial solutions are almost always worse than the natural solution. Want to lose weight? Take ephedrine or hydroxy-cut and get a heart attack. Want to eat what you want without gaining weight? Binge and purge, while your teeth rot out. Want to eat more junk food and less fruits and vegetables? Pop a multivitamin and lose money and the benefits conferred from actual food. When it comes to one's long-term health, there is no magic solution, and people seem to refuse to acknowledge that. In an age of instant-gratification, perfect health is still unattainable at the click of a button.

Chagas Disease

I recently collected an insect from the family Reduviidae, or assassin bugs, ambush bugs, and thread-legged bugs. Why is this medically relevant? Insects of the genus Triatoma, or bloodsucking cone noses, are the vector for Trypanosoma cruzi, the parasite which causes Chagas disease. It is found in South America and Mexico, and cases of Chagas disease have occurred along the southern border of the United States. The insect likes to hide in thatched hut roofs during the day and then emerges at night to feed on human blood. It is approximately 3 cm long. The insect transmits the virus through its feces, not its bite, however scratching a bite can contaminate it with the feces, and thus the parasite.

T. cruzi can also be transmitted via contaminated food, blood or organ transplants, and from mother to fetus. The disease progresses initially with swelling at the site of infection, if from a bite, and fatigue, fever, rash, headache, vomiting, etc. The most telling acute symptom is Romaña's sign: swelling of the eyelid on the side closest to the bug bite. Immunocompromised individuals or children can die from inflammation of the meninges (meningitis) or heart muscles (myocarditis) in the acute phase. The illness then proceeds to the chronic phase if untreated, and its eventual symptoms include heart disease and intestinal malformation. It is estimated that 8-11 million people are living with Chagas disease, most without knowledge of it because the acute symptoms are short-lasting and can be falsely attributed to other medical problems. It is now routine to test all donated blood for Chagas disease in addition to other blood-born diseases. There is no vaccine or drug to use as a preventative measure, so the only guideline is to avoid poorly constructed housing and to use bug nets and insecticides.

Magic Blue Pills

After seeing the movie "Taken" for the second time, I was reminded indirectly of those magic blue pills - Viagra. Example of indirect train of thought: girls get sold to powerful people such as sheiks, sheik in the movie was overweight, overweight leads to erectile dysfunction (ED) which is funny considering that he was buying women for sex - hopefully he had some on hand.

First, some statistics. I do not have access to the lists of data from Pfizer, Inc. but Wall Street Journal quoted the following from Pfizer's data: Viagra use results in sex 66% of the time. Men with ED who use Viagra, when compared to the placebo group, experience an increase in erection duration from 3.6 seconds to 1 minute. 50% of men do not refill their Viagra prescriptions, even though it is supposedly effective for ~75% of the population. 48% of users suffer at least one side effect, yet the percentage of men who discontinue due to side effects is 1%.

Side effects, for those who are interested: 23% experience headaches, 17% experience flushed faces, 12% have upset stomachs, and a more obscure side effect (3%) experience vision with blue-green tinges.

Some additional statistics about erections: With every increase in age by one decade there is a decline in erectile function of 12%, and for every 20 pounds of weight gain (beyond optimal, obviously) there is a 3% decline in function.

Now, how to tell whether you have physiological ED or psychological ED. During REM sleep, men and women experience physical arousal, so if a man does not experience erections during REM sleep, it indicates that the ED is a physiological problem treatable by Viagra or similar medications. However, if a man does have erections during REM, then it is psychological ED and Viagra just ignores the real problem. A cheaper method than going to a sleep lab that my cognitive science textbook recommended was wrapping a line of stamps around the penis and checking the perforations in the morning - if they're broken, then there were erections during REM.

On a final note, I thought this article was fascinating. Apparently, the CIA has begun using Viagra as one of the many less conspicuous methods of gaining favor with foreign warlords, particularly tribal chiefs in Afghanistan. It is a very logical move since supplying them with guns or money is dangerous and obvious. However, offering an elderly tribal chief medical treatments for his family, cosmetic treatments, or Viagra for help with his four young wives is more subtle and even more successful. Check out the article if you have a chance - it shows that the CIA does have a few intelligent creative thinkers on staff.

Caffeine and Touro

Well, I submitted my second deposit to Touro-CA for $1,000 today. I am really horrible with fax machines and phones - I don't know how to transfer calls for one, and I am so used to my cell phone I forgot that all other appliances require a "1" before an out of area phone number, so I wasted 5 pages thinking that the machine on the other end was busy (the option is busy/no response). I am getting more and more used to the idea of living at home again - I almost look forward to it. It'll be my last chance to really be a part of the family again, before I'm a truly independent adult and starting a family bud (only scientists can think of yeast while talking about starting their own family). Also, the prospect of saving an estimated 17k per year is very exciting - nearly 80k cut off my loans. The commute would be great also - 35 minutes each way, no traffic. Whether I stay at home more than a semester hinges on how well it works out for me, and for Kit (my boyfriend). Being long-distance and not having my own place will be difficult. We've worked out a contingency plan though, so we're prepared.

On an unrelated note, my cognitive science textbook has some very interesting tidbits thrown in, most recently on caffeine. It is a cool mechanism - as we are awake, adenosine accumulates in the brain and is thought to induce sleepiness. Caffeine acts as an adenosine antagonist, so it competes with adenosine for binding spots on adenosine receptors, but does not produce drowsiness when bound to the receptor. As more adenosine receptors are tied up with caffeine and not adenosine, the accumulated adenosine has a weaker effect. This explains why using caffeine too late has no effect, and why you "crash" after ingesting a lot of caffeine. First, if caffeine is administered after adenosine molecules have bound to a significant number of receptors, then you will be too sleepy for the caffeine to reduce the effect much. Second, if you have caffeine in the receptors, adenosine accumulates in the space near the receptors, so when the caffeine dissociates from the receptors you get a rush of adenosine binding and the subsequent drowsiness.

Vesalius

The first page I saw when I flipped open the cover of my cognitive science text book was page 3, including one of the woodblock prints from Andreas Vesalius' De humani corporis fabrica (On the Workings of the Human Body). Now, after my history of medicine class and my colloquium on localization of brain function, I have a profound respect for Andreas Vesalius - his work is simply remarkable. His work was the next step after centuries of following Galen. The detail and completeness of the text is staggering. I think I would like a copy of the translated text, including all the woodblock images, as a reference. It's pretty pricey. On a side note, the woodblock images were the inspiration for the poses and exhibits at the BODY WORLD/BODIES exhibits.

As far as other news, I sent in my $2,000 deposit to Touro-CA, and I received today a notification that they received that first deposit along with a reminder that I need to send them a second deposit of $1,000 by March 15th. Once these deposits are over, I'll be able to relax and earn money for a bit before I have to cash in checks on loan from the government or private institutions for the next four years. If I live with my parents, since they are about 35 minutes away from Touro-CA and in the opposite direction of traffic, I might be able to avoid taking out a private unsubsidized loan. I seriously think Wells Fargo would give me a better deal than the average grad-saver plus. I should plan to finish and submit my FAFSA by the end of next week...

Origins

It's always fun to discover the ancient roots behind modern medical practices, terminology, etc. Here is a passage from my cognitive science textbook Psychology of Behavior on the origin of the terms "Dura Mater" and "Pia Mater" to refer to two of the layers of the meninges:

A tenth-century Persian physician, Ali ibn Abbas, used the Arabic term al umm to refer to the meninges. The term literally means "mother" but was used to designate any swaddling material, because Arabic lacked a specific term for the word membrane. The tough outer one was called al umm al djafiya, and the soft inner one was called al umm al rigiga. When the writings of Ali ibn Abbas were translated into Latin during the eleventh century, the translator, who was probably not familiar with the structure of the meninges, made a literal translation of al umm. He referred to the membranes as the "hard mother" and the "pious mother" (pious in the sense of "delicate") rather than using a more appropriate Latin word.

People often forget the non-Western origins of many medical practices. Ancient India was famous for its medical skills, particularly cataract surgery. The Middle and Far East had many renowned medical practitioners and scholars. Many medical texts from the Islamic empires were translated to Latin and used up until the 17th and 18th centuries. In fact, medical knowledge in Europe was quite stagnant after Galen - it was practically heresy to question Galen's texts, and in the autopsy theaters the medical doctor would be on a pedestal, reciting from Galen, while a lowly barber would be dissecting a body below. Whenever anatomical differences occurred between an actual human body and Galen's descriptions and drawings, it was assumed that the body was deformed. Most of Galen's anatomical knowledge came from animal extrapolation, since human dissection had been taboo in Europe for the longest time. So, while the rest of the world was advancing and exploring medical knowledge, the "civilized" world held Galen's texts from ~200 CE as indisputable.

Put Down Those iPods!

I always objected to the bud earpieces on a comfort level - I just could not get those little things in my ears comfortably. Looks like I dodged a bullet. Most people listen to those buds with the volume so loud I can hear them from a few feet away. In my youth, I always sprang for the huge DJ headsets, which felt like they made sound easier on the ear. I used to listen to music pretty loudly, despite my parents telling me I was killing my ears. Somehow, those warnings never felt very finite - I might have a slight buzzing in my ears after an hour or two of listening, but it always went away. Even though I have since stopped pounding the music into my ears, most of the damage is probably done - at least I never stuck those buds in my ears. I always thought those smoker's lung vs. healthy lung ads were particularly convincing, so perhaps these images will be convincing to a few (c/o my CogSci class):

The first image is pristine, healthy cochlear cilia, or in simple terms, "the hairs in your inner ear that interpret sound for your brain." The second image is cochlear cilia with mild-moderate damage, and the third image is cochlear cilia with a lot of damage. Unlike lungs, which take a long time to recover but do to a certain degree, damage to cochlear cilia is PERMANENT. I seriously expect half the people in my generation to have significant hearing loss by the time they are 40 years old on account of the mp3 player/bud headset craze. Do your ears a favor - if you want to listen to music for more than half of your lifespan, turn down the volume.

How I Got Here

If any other pre-medical students or passerby are curious as to what activities and qualifications got me to this point, that is the purpose of this post. With that in mind, here is my combination of activities, with minor activities left out:

• 4 years member of pre-med student org, 1 year social chair, 2 years president - involved coordinating CPR training, volunteering in Mexico, guest speakers, etc.
• 1 quarter and a half of research (Autism)
• Certified phlebotomist, worked at Kaiser for 3 years
• 7 months shadowing D.O. physician
• Double major, Biochemistry and History
• GPA: Overall 3.4, BCPM 3.1; MCAT: 32R
  

I only write this for the record, or so I can refer people here later. In the meantime, I am anxiously waiting to hear from TUCOM-CA, and the interview at WesternU is next week! I have a good feeling about this!

As an afterthought, I had the pleasure of attending my history of ancient Egypt class tonight. We covered the relevant topic of ancient Egyptian medicine. Several interesting tidbits came up. For one, Egyptian physicians were exalted, of course, and even more specialized than medicine today - each physician specialized in a particular ailment (head trauma, stomach pain, broken legs, swollen throat, malaria, tuberculosis). Imagine going to the hospital and seeing the "influenza doctor" for treatment, or the "lower back rash" specialist. At that time, it was probably feasible - as they could not easily differentiate intestinal blockage, swollen appendix, or extreme diverticulitis - it would all fall under the jurisdiction of the "lower stomach pain" specialist. Today, there would need to be at least a thousand physicians in a single hospital to match the number of known individual diseases, symptoms, and conditions. As for their treatments, they used pills, liquid drops, liquid, food, and combinations. Some common effective treatments were castor (oil, fruit, root), prunes, and coriander for digestive problems. Fitting that many of the earliest treatments involved herbs or foods which affected the digestive tract, such as anti-diarrheals, laxatives, diuretics, anti-diuretics, and gas/bloating relievers.