Influenza

In the midst of the holiday season all I can think about is vacation. My body has officially decompressed and made the attempt to relax. In so doing, my stress compromised immune system leaves me vulnerable to illness.


Illness

With the visiting family gone, repeated meals of overeating, and very little fresh air, one of us were bound to get sick. Unfortunately, a few of us have and are doing our best to relish the remainder of our days off to return to normalcy. I do not fully understand all the bubbly noises and queasy feelings my abdomen has, nor do I understand the common sore throats and nasal congestion some of my family have to endure.

It makes me wonder what I would have done if I was completed with medical school and considered a physician in the eyes of those close to me. Would I suggest they see their family doctor or would I attempt to diagnose their symptoms? There is so much more to learn. In the meantime, I am watching Google's latest gadget - FluTrends - which is provided with help from the Center for Disease Control (CDC).

Using their time-tested search technology Google has honed in on specific search terms and put them to good use in identifying the spread of influenza. The CDC recognizes that Google FluTrends is able to show flu spread more readily than reported cases could.

Clinical Corner

Influenza

This viral beast can be the cause of much misery. Fortunately, there is an annual vaccine that attempts to fight the most common strain of the flu to help ward off potential illness. The CDC informational website regarding all things influenza.. In the meantime:

• Keep an eye on the FluTrends in your area (Historically February has the most cases)
• Reduce exposure to those who are infected
• Wash your hands regularly

A Welcome Vacation

This is essentially what I have looked like for the past five months. If my nose wasn't in a book looking for the answer, it was likely that I was in lecture or group study.


First Semester

The semester has come to an end and the final grades are not yet posted. Exams were an extremely nerve racking experience to have spent so much time preparing only to find I was partially being tested on the material I didn't review in detail. Fortunately, I had plenty of house to clean and other projects to occupy my time while I mulled over my responses. After a weekend of making furniture, I think I am prepared to see my grades for better or worse.

Overall this first semester started as an exhilarating experience. When the novelty of it all wore off and each day blurred into the next, the reality of medical school sunk in deep. Hard work, all the time. Coming into this I knew it would be the case, but the three classmates who dropped out didn't know what was coming. Medical school is difficult and rewarding at the same time. I am still very excited to be learning the art of medicine and have a much greater respect for the practicing physicians who have endured through a similar experience.

Living in Las Vegas I didn't expect to have a 'White Christmas', but we were all surprised when 3-8 inches of snow fell on our city. As the last time this happened was 30 years ago, everyone was in shock. The worst part yet is that schools were closed for a day including Touro, despite the final exams. As if that didn't add to our stress. Coming from a rich background in snowfalls much greater than 3 inches, I had a hard time swallowing a 'snow day'. Oh well, now to enjoy my two weeks of vacation before heading back to the grind.

Clinical Corner

Dietary Fiber

With oversized holiday meals, excessive treats and plenty of unhealthy goodies to temp us, I thought a healthy alternative would be good to discuss. Foods rich in fiber have many health benefits that we can not afford to neglect for now and our future.

Better than the sprinkle on fiber supplements are the foods with natural fiber (grains, fruits, vegetables etc). Benefits include:

• Relieving and avoiding constipation - Fiber absorbs water making it easier to pass food without straining the bowel.
• Prevent diseases - Cancer, heart disease, diabetes, diverticular diseases, and kidney/gallstones
• Weight control - In addition to giving the feeling of satiety, fiber will bind to bile made in the gallbladder. Bile is used to break down fats in the diet. Normally, very little bile is lost, but when bound to fiber it is removed from the body in greater quantities and the body loses bound cholesterol more readily.

Have a great holiday and remember to eat healthy. Other great reading and recipes.

Exam Week Three

Our last exams of the semester are finally here. Although they may not be exciting, it sure is nice to know there is a vacation only one week away.

Anatomy

Most recently we have focused our attention on the pelvic cavity and perineum in anatomy. This highly compact region holds an extensive network of veins, arteries and nerves that nourish organs of the reproductive, urinary and gastrointestinal systems. At first it seemed to be a mess of structures running this way and that with occasional stops at an organ or muscle. Now after hours of dissection, review and reading I think I have a better grasp on this intricate part of the body. While in the cadaver lab late at night and well into the next morning, my mind turned to those who have shared their bodies with us that we might be better physicians...if they only knew how much knowledge they have imparted.

I continually think of how lucky some of us are; to be in a healthy state is quite a feat. There are many problems that could arise during embryological development causing complications that would alter life, if it was even sustainable in the first place. The combination of embryology and the life giving organs of the body go hand in hand. It is amazing how everything works in concert to produce the person we see in the mirror.

Clinical Corner

Ectopic Pregnancy

Ectopic refers to a congenital displacement and in this case it is the fetus that has not implanted in the uterine wall. In the uterine (Fallopian) tube, the woman's egg will be fertilized by the sperm. Normally, they implant on the wall of the uterus to develop over the next nine months. When the fertilized egg implants itself elsewhere, it is considered ectopic.

Common sites of implantation include the lining of the uterine tubes, ovaries, the abdominal cavity or even the lower inner portion of the uterus. Depending on the location, it can be difficult to diagnose as ultrasounds are not always clear. Pain can result which often brings the mother to find medical help. This condition is a medical emergency as it can rupture the maternal organs or other structures within the abdominal cavity. Hemorrhaging (excessive bleeding) is possible, but the greater concern is for the mother's reproductive organs. Once they are damaged, it is likely that they must be removed and thus the likelihood of fertility decreases.

Rare cases have been reported where the fetus has grown to full term and been delivered. Although the causes are not fully understood, it is thought that damage to the uterine tubes may lead to an increased incidence of ectopic pregnancies. (Books to consider :Ectopic Pregnancy, Pregnancy)

Cardiac Physiology

Considering the fact that this muscle never gets to rest, the heart is a rather impressive organ.

Cardiovascular System

We spent the majority of this past week learning the cardiac and systemic blood flow. As it moves through the chambers of the heart, to the lungs, back into the heart and ultimately into circulation, the blood provides nutrients to the body that sustain life.

Lectures went beyond the anatomy and included cardiac histology for completeness. The physiology or functional breakdown of its parts gets quite complex. Through hormonal, neural, and metabolic control blood vessels change size to distribute the blood where it is needed most. This regulation is a core consideration for many diseases as the blood affects every body system.

During our Physical Diagnosis lab we attempted to hear the many heart sounds on our partners and associate them with the various actions that were occurring. If you have ever tried this, you will agree it is definitely a learned skill. No wonder cardiologists are consulted so often. In my research, I came upon the blog of a cardiologist/electrophysiologist from the Midwest that may be of interest to those considering cardiology as a career. Dr. Wes, as he is known, gives a great peek into the life of a specialty physician. As I am still trying to decide what field to work in, this was a good starting point to explore.

Clinical Corner

With so many cases, conditions and diseases that come up I thought this would be a good forum to mention them both for my memory and for your reading pleasure. Should you happen to find information that is incorrect or interesting that you would like to add, please leave a comment for others to read.

Atrial Fibrillation

After a week of cardiology I could not resist considering an abnormal heart condition. Of the four chambers of the heart, the two atria receive blood from the body or lungs. Blood is pumped from an atrium into a ventricle as it continues on its way. This occurs as a result of electrical activity that starts in the atrium which moves by conduction to the ventricles. In a normal functioning heart, the rhythm is synchronized to move the blood through the chambers in order.

In a heart that is experiencing atrial fibrillation the conduction system is does not effectively reach the ventricles and the atria shake erratically. This will decrease the flow of blood and ultimately oxygen to the body with a potential risk of clot formation. This commonly leaves the individual weak and uncomfortable. This is one of the commonest heart problems and can be treated with medications or more invasive procedures if necessary. This video provides a more detailed look at atrial fibrillation.

Like you have heard it before, "use it or lose it." Regular exercise and a healthy diet will keep your heart and blood vessels in shape to meet the demands of everyday activities. Don't take good health for granted and your heart will thank you.

Gratitude

The Thanksgiving holiday was a much needed break from the rigor of constant studying. Now it is time to buckle up and hold on tight as the last couple weeks before our final block exams of the semester arrive. Playing 'catch up' and trying to absorb the upcoming information will be quite the task, but the winter interim provides enough days off to be an encouragement for focused studies now.

Thanksgiving

You would think that after months of dissection techniques have been explored and a variety of human tissues cut that some skill would be honed. As I attempted to carve my first turkey this year, I learned that human dissection and fowl carving are two completely different activities. As such, I had to censor my dinner table commentary to avoid unsettling the stomach contents of those in attendance. Despite holding in my joy for anatomical discovery, the feast could not have tasted better or come at a more appropriate time.

The opportunity to visit with family and reflect upon everything I have has left me truly grateful. It is often a simple thing to look at all the stress in life and wish it was lessened. I feel that the hard work we put into our goals and ambitions will often pay off with a greater sense of achievement when stress is overcome.

Medically Speaking

We are all indebted to those who have spent countless hours researching medicine throughout history. It is from their dedication that we have today's medical knowledge. More importantly are those who suffer from illness and seek care. Their trust in the medical system allows the practice to become better and gives a purpose for the continual research.

These patients will ultimately make us the physicians we are trying so hard to become. Whether difficult cases or unstable personalities, they have the power to shape our medical experience for good or bad. I often think back to the feelings I had while working in the Emergency Room with patients. With my limited knowledge and experience I was still able to make a difference in the lives of others through medicine. The smallest of compliments or gestures of appreciation often had a significant impact on my opinion of healthcare. Although needless to say, I am looking forward to working with the patients again in the clinical setting. In the meantime, my family and friends seem to appreciate what I bring to the table, and for that I am grateful.

Manipulative Treatment

Biped creatures such as ourselves put a lot of force on our feet plaguing us with unnecessary pain and discomfort. Fortunately, there are ways to provide a needed respite for sore, worn out feet. When massage leaves you aching, osteopathic manipulative treatments (OMT) may be an easy solution.



Osteopathic Manipulative Treatment

As osteopathic medical students, we routinely learn the manipulations of our practice. Various techniques allow us to fill our toolbox with multiple solutions to common structural problems. Most recently we have been working with the lower extremities including the feet.

After getting over the initial distaste of handling the feet of our colleagues, we set out to learn the principles that would heal our future patients. These treatments focus primarily on the muscles, bones, and connective tissues in an effort to relieve pain or discomfort.

As my best friend is commonly involved in activities that put great amounts of stress on her feet, it came as no surprise that she had started developing pain one morning. Before running off to class, I was able to employ some of the skills I had learned previously to 'reset' her foot and relieve the pain she was experiencing. Amazed, she let me know the pain was gone, which I initially thought was her way of making me feel better about myself. She assured me that this was not her intention and that the techniques had actually improved her level of comfort.

Little by little we are gaining the pieces of knowledge that will make us better professionals and physicians in the work place. I was fortunate enough to be able to use those skills at home and witness first hand, the positive effects of OMT.

Anatomy

Sticking to the lower extremity, I thought I would discuss the latest news in the anatomy department. With the thorax and gastrointestinal contents of the abdomen behind us, we have started our examination of the spinal cord and perineum. In order to get a better look at the structures involved, some intense dissections had to be performed.

The first was a laminectomy where the outer coverings of the vertebrae were cut away to reveal the underlying spinal cord. It is amazing to think that this well protected and delicate structure carries impulses that permit control of most of our body.

The second dissection required the removal of a leg as high up as the belly button, which included part of the lower spine . This exposed the contents of the groin for inspection while being able to observe the organic proximity of reproductive, urinary and gastrointestinal structures. I never imagined having to remove an entire limb for that purpose, but it gives us a better appreciation for the anatomy we are studying.

In only a month's time, we will have completed our first semester of medical school. It is exciting to think that we have made it this far and are slowly seeing goals become a reality.

Balance

It seems that every day is another drain on the energy built up during the few hours of sleep the night before. Do I still have a life outside of school?

Balance

When final exams are done or in my case the week of block exams, it becomes much easier to slow down the pace as far as studies go. Unfortunately, the material continues to come unrelentingly. Finding balance in student life can be a difficult task and some days I find myself deep in an anatomy book, where other days I am ready to sit back and watch a good movie.

There is no right way to do it, and every student has to learn what works for them. Let's face it, studying until 11pm or later is definitely possible with all the information available, but is it the best thing to do, or will it lead to burnout. I have actually found both to be true. Constant stress with little relaxation or time to get away is similar to the "all-nighter" mistake many of us have made. On the other hand, not studying enough when quizzes, exams or boards are approaching could be costly.

Personally, I have found that a dedicated time allocated to sufficient review of materials on a constant basis will actually reinforce important principles and topics. Leaving enough time for meals, sleep, and exercise is crucial to balancing the mentally heavy load of medical school. It may be wise to set up specific hours each day for study, sleep, exercise etc so that your body gets into a rhythm. This will make study time more effective while ensuring you get the most out of your free time.

Loose Ends

Now almost four months into the curriculum, I am starting to feel a little more at ease with the whole medical school experience. With time I have become more organized and oriented as to what is expected of me. There are still a lot of questions to be answered down the road, but for now the stress associated with the 'unknown' is being whittled away.

TUNCOM is making progress in their ongoing accreditation process. As one of the newer medical schools, it has to show the accreditation board that the curriculum is sufficient and that students are getting the education they seek. Policies and programs continue to change, developing the already well structured programs. The rapidly growing student body compounds this process, however, as we were able to meet with the board and discuss the matters that concerned us most. Even as a new student it is nice to be heard.

I am continually amazed at how much we learn in such little time. Trying to absorb anatomy, physiology, biochemistry, histology and everything else has definitely kept me busy. If we keep learning at this rate, I will have more information than room to store it.

Exercise

I have come to a depressing realization. Being a medical student definitely has its financial drawbacks and sitting at a desk all day taking notes does not come close to the lifestyle physicians encourage.

Move

After spending the last two weeks studying late into the night preparing for exams, I rarely found time to get up and use all the pent up energy I consumed at meal times. Stress levels remained high, lethargy dragged me down, and jiggly body parts just drove home an important message...I need to get up and move a little more. Certainly, this is easier said than done, but if I will be instructing others to change their habits, why not change my own?

Exercise has been researched and studied for years. It is one of the few things we do besides eating that actually affects all of our body systems. Current recommendations suggest at least 30 minutes of cardiovascular exercise most days of the week. This could be anything from walking, swimming, or even the latest craze, Nintendo Wii Fit. Moving regularly will enhance mental and physical performance in addition to changing how we react to everyday stress.

Healthy Living

When it comes to living healthy, there are more resources available to us than we could possibly imagine. You don't have to be a member of a local gym or spend large amounts of money to reap the benefits of good health, but it does take dedication and a desire to experience true fitness. During my undergraduate studies, my professor Dr. Zimmerman said, "the best thing you can do for your body is train a marathon...the worst thing you can do for your body is run a marathon." I would love to run a marathon someday, however, I am not quite in a position or mindset to do so now. For the time being, I plan to concentrate my efforts in three areas: nutrition, strength, and cardiovascular.

Nutrition has changed significantly with restaurants offering large portioned meals at reasonable prices. This does not guarantee that what you are eating is any healthier than the alternative of cooking for yourself. The government sponsored food pyramid helps us balance our diet to ensure we are getting the right nutrients. When it comes to cooking, AllRecipes.com helps you put together meals with the ingredients you have on hand. I will be honest in saying I like to eat, therefore I will be focusing on proper portion sizes as well as caloric content when satiating my hunger.

Strength exercises are vital to maintaining bone strength and muscle tone, something I have been lacking as of late. I am planning to start out each day with at least 10 minutes of strength training. With very little time and less to do in the mornings, I feel this is a reasonable goal for starters.

The part I miss most in my healthy habits is a good dose of cardiovascular stress. With just enough I can keep my metabolic pathways in check, maintain a healthy blood pressure, and rid my body of toxins simply by getting the fluids moving. There are some great tools on the market to help measure your success. A pedometer is an inexpensive way to measure how far you move and a heart rate monitor is ideal for determining how your body responds to your workout. Both are reasonable for the novice as well as the pro.

DVDs make at home training simple, unless you prefer detailed books, nevertheless, the most important part is that you make it a habit to move. I would love to hear if you have any other suggestions. And to all the plastic surgeons, I am sorry, but you will likely not be seeing me soon.

Exam Week Two

Highlighting the culmination of the last six weeks, this picture does not give justice to the vast amounts of knowledge one can obtain from studying the actual anatomy.

Anatomy

Our anatomy course has most recently led us into the depths of the human thorax and abdomen to explore the respiratory, cardiovascular, nervous, and digestive systems located in these cavities. At first the information never seemed to end until I realized it was likely there would be no end. With our second week of exams already here, I continue to find things I did not learn the first time around.

It is for this reason there are medical specialists who know everything there is to know. Obviously, medical school is the learning grounds for medical knowledge and is meant to be the foundation for a successful career in the field.

Complexity arises where every individual is different. Slight variations in anatomy, surgeries, and body mechanics make the anatomical studies unique with every cadaver. Despite the hours of time spent with one, the next may have alterations that tell a different story. Physicians learn what occurs most frequently and divergent findings become the abnormalities to be treated. Although anatomy may be a difficult subject, if we do not learn it now, we will have to do it later. Learning it now while I have the time seems to be the better choice.

Exam Preparation

Exam block week 2 is here and I am starting to wear thin. Long days of lecture and late nights of reviewing past material is exhausting work. I am realizing that my first exam week was a training period for study habits. Rather than starting early, I started late, causing excessive unneeded stress. This time around, my study group made a concerted effort to dedicate more time to our review of materials early on. It sure has made a considerable difference in the stress levels since cramming is not an issue and I actually get to sleep at night.

Here's to a good week of exams, remembering all the important points, and getting enough sleep each night to be able to function properly the next day. And if Friday can hear me, please get here quick.

Endocrinology

Hormonal regulation is much more complex than I first imagined, but it is incredibly interesting too.

Endocrine System

Our recent studies have initiated investigations into the complex world of glands and their secretions. Complemented by histological examinations of cellular breakdown, endocrine physiology, too, has been presented for study. Our first stop was the pituitary followed by the thyroid.

The endocrine glands regulate bodily functions trying to keep us in a healthy state. When secretions become too low or too high, normal functions are compromised and disease ensues. The thyroid in particular has me quite fascinated, perhaps due to recency.

Thyroid

This butterfly like gland found just below our voice box controls many functions and is most commonly known to have an effect on our body's metabolism. It requires a minimal level of iodine from our diets which can be found in many water sources, salt, meat, fish and vegetables. In cases of hyperthyroidism (too much hormone) individuals commonly lose weight and have tissue swelling. The opposite, hypothyroidism, causes weight gain and can lead to the growth of thyroid tissue also known as a goiter. As with every other part of the body, thyroid cancer can have deleterious effects similar to those mentioned above.

These are only some of the effects of thyroid hormones and many others are integrated with various body systems. My first thought was why not give low doses of thyroid hormone to help people lose weight. It sounds like a rather easy solution until you start to factor in all the other problems that would arise from altering the normal hormonal levels. Needless to say, I am still a neophyte when it comes to all of this, but for the moment it piques my interest.

Elections

Politics have never really been of interest to me. In fact, I have chosen not to vote until now, which has been the stem of many arguments in the past. I reason that if I can not be an educated voter, it does not benefit anyone to cast a vote based on public appeal or photographic prowess. With all my time off during the holidays, I took a moment to become politically educated in an effort to participate in the upcoming election.

With a future career in the balance and a basic understanding of the current candidates, this election was the first in which I have participated. Here are a few references that simplified my hunt for knowledge:

• Register to vote online - Simply fill out the form, print it and mail it in
  
• Presidential candidates - Compare, side by side, the officials running for office
  
• Local candidates - Get to know your state and local candidates
• Voting - Learn where your local voting station is and the hours they are open
  

Histology

The histological remains of an embryonic chicken undergoing endochondral ossification is quite a beautiful site. (The images come from Dr. Thomas Caceci, who details the properties of bone formation as part of a histology course.)




The Chicken in the Egg

Using specialized staining techniques, this skeleton takes on two very contrasting colors as a result of the cellular make up in the various structures. The dark red is calcified or hardened bone whereas the lighter blue shows cartilaginous features that are not yet bone.

Through this process of bone formation from cartilage, bones elongate and like animals, we grow. In adulthood, this image would have a stark contrast where the majority would appear to be stained red. Looking at the junction of bone and cartilage, we enter the world of histology.

Histology

Affectionately called "histo," this course in cellular anatomy is rather beautiful. At first exposure it is difficult to see past the bubbly circles, fancy colors, and wavy lines. The meanings of each are crucial to understanding what you see in the microscope. When the initial shock of looking at what appears to be the drawing of a toddler, it is actually exciting to understand the defining features of a histology slide. Perhaps it is the nerd in me, however, this is where we see photographs of medical pathologies.

This is what we commonly view when we are attempting to identify and study structures. This image captures the border between the hard bone and the soft cartilage (aka. the epiphyseal plate). A close look would show the cartilage cells maturing as they progress towards the bony portion.

We study skin, glands, bones, and every other part you could imagine. Each has identifying characteristics that "tell a story." Not all stains are created equal and a variety of colors are available to bring out unique attributes in each slide.

Physicians use histology for the purpose of finding illness or its causes. Muscle histology for example is performed from a muscle biopsy or sample and can be used to diagnose specific diseases identifiable in the specimen. Histology jobs are common in laboratories as many tests will determine the doctor's treatment.

Resources

Many great resources are available if you are looking to brush up on your cellular knowledge or simply enjoy unique images. A microscope and expensive slides are not necessary. Histology atlases and other texts have phenomenal photographs that may be interesting even if you are not taking a course. To think that our bodies are made up of such tiny structures that are vital to proper functioning is mind-boggling.

Sukkot

The month of October has been great as far as vacation time away from school. We only attend classes two or three days a week. With all this time off, it is hard to motivate oneself to study intensely. In the meantime, I have researched the observed Jewish holidays and enjoyed my break from the books.

Sukkot (sue-COAT)

Commonly referred to in prayer as the "Season of Our Rejoicing", Sukkot falls five days after the holiday Yom Kippur and is the last of three pilgrimage festivals in Jewish tradition. The word Sukkot means "booths," which is used today as a symbolical reference to the temporary shelters used while the children of Israel wandered in the wilderness for forty years.

This holiday is often referenced as the "Feast of Tabernacles" as the holiday was dually associated with the festival of the harvest. Sukkot extends over a period of seven days and the use of a sukkah (singular form of sukkot) for eating and sleeping is encouraged. I was amazed to see the diversity in adherence to this commandment that brings to mind thoughts of the wandering children of Israel.

Sukkah come in all forms and can be seen in many predominantly Jewish communities. Local restaurants provide them for Jewish patrons, some companies offer portable options, and with space permitting, they may even be seen on the balconies of some dwelling units. Traditionally, they are small enough to cover the food table and those who dine under the sukkot.
















General requirements for the sukkah are as follows:

• At least two and a half walls
• Covering - Something cut from the ground (tree branch, stalks, etc)
• The top is not to be tied together, but laid out loose
• Rain covers may be used when not fulfilling a mitzvah

Plants of Sukkot

"Arba Minim," as it is known in Jewish culture, is a ritual that employs four plants to "rejoice before the Lord." It is believed to have an agricultural significance as well as symbolic variation among Jews. The four plants are as follows:

• Etrog -a citrus fruit, commonly a lemon
• Lulav - a palm branch
• Aravot - two willow branches
• Hadassim - three myrtle branches

The six branches are held in one hand and the etrog in the other. The four plants are waved in the four cardinal directions, up and down while reciting a blessing. Symbolically this acknowledges God's omnipresence.

Some believe this holiday to be similar to the adopted Thanksgiving practiced in the United States. Now you can say you are in "the know." Chag Sameach.

White Coat Ceremony

I walked in a student and walked out a “Student Doctor.” Bally’s Resort and Casino event center in Las Vegas was filled with family, friends, and healthcare-professionals-to-be. We literally walked into the beginning of our new profession.

Coat of Honor

When we matriculated, we knew the goal was to walk away a physician educated in the art of medicine. Some have said that by the end of four formative years in medical school, the white coat is donned four years too late. Rather than waiting until our two years of classroom work and two years of clinical studies are completed, the esteemed white coat was presented to us this last week as a manifestation of the profession we are entering.

A historical tour of medicine reveals that the white coat is reserved for the medical professional. With more experience, it is appropriate for the coat to become longer. Thus a medical student wears a coat that reaches to the waist whereas that of a seasoned physician will hang at the knees. Both are a symbol of the provider's dedication to the practice of medicine and the patients with whom he or she interacts.

Dignified Ceremony

Seated guests looked for ‘their’ student as they processed to the chairs at the front of the hall. The color guard presented the nation’s flag and I participated in the a cappella group that sang the national anthem before taking my seat among my colleagues. As TUNCOM is a Jewish institution, the governing Rabbi offered an invocation in the Hebrew tongue. The Dean of the school took a moment to express the significance of this event and then read each name one by one.

Students crossed the stage and handed their white coat to a member of the faculty who shook the coat before handing it to another professor who then assisted the student into their coat. This symbolism represented the formative classroom and clinical years respectively. Once the coats were received, the students stood to take The Osteopathic Oath:

I hereby affirm my loyalty to the profession I am about to enter.

I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature’s laws and the body’s inherent capacity for recovery.

I will be ever vigilant in aiding in the general welfare of the community sustaining its laws and institutions, not engaging in those practices which will in any way bring shame or discredit upon myself or my profession. I will give no drugs for deadly purposes to any person though it be asked of me.

I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.

I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me. I will be ever alert to further the application of basic biological truths to the healing arts and to develop the principles of Osteopathic medicine which were first enunciated by Andrew Taylor Still.

In the presence of this gathering I bind myself to my oath.

Similar to the Hippocratic Oath given to allopathic counterparts, this oath embodies the characteristics of sound, dedicated physicians. It is a standard of care physicians attempt to deliver every day around the world. Although the formalities of the evening may be over, the journey is still in its infancy for the many medical students who wear the white coat and experience this honored rite of passage.

Yom Kippur

Once again Touro students find themselves at a time of holiday. Almost ten days ago Rosh Hashanah started and we are now in the midst of Yom Kippur, or the "day of atonement." It is considered to be the most important Jewish holiday, representing repentance and the atonement. An extended fast is performed during this time which is accompanied by considerable prayer. A normal day usually consists of three prayer services whereas this special day commonly has five.

Yom Kippur falls ten days after Rosh Hashanah when it is believed that God writes the fate of individuals into the book of life. The ten day period between offers time for repentance at the start of the Jewish New Year. Yom Kippur is the day when the "verdict" of God is sealed. May your Yom Kippur be a day of renewal.

Rosh Hashanah

Shana tova. This traditional Hebrew or Jewish greeting is an expression of the Jewish New Year or Rosh Hashanah (ראש השנה).

Rosh Hashanah

Touro University is a smaller branch of the larger Touro College and as such holds true to its Jewish history. As Jewish men and women come together to celebrate this new beginning, I thought it would be appropriate to understand the significance of this important day in Jewish culture. Touro institutions give their students vacation time during this time of Holy Holidays, or Yamim Noraim, which is considered one of the most important holidays.

Rosh Hashanah is considered as sacred as the Shabbat and is therefore a day of rest. The shofar, a trumpet made from a ram's horn, is sounded to wake those who "slumber" and alert them to their impending judgment. Symbolically, prayers are offered near moving bodies of water where bread or pebbles are thrown to signify one's sins being "cast off." From the first day of Rosh Hashanah, individuals are given ten days to repent and leave their sins behind before the arrival of Yom Kippur when names are written into the book of life or are "blotted out of the book of the living."

Similarly, traditional Jewish foods characterize this sacred holiday. As a "sweet" new year is expected, apples, honey and pomegranates are commonly served. Recipes include meats from the head of animals are used symbolically as Rosh Hashanah is literally translated to mean "head of the year." Challah, a round bread, represents the cycle of the year. Other typically Mediterranean foods are served such as dates, gourds and beans.

Though I am sure many students will use this three day vacation to catch up on their studies, it is great to know why we have the time off in the first place. This respite to a hectic life certainly plays a significant role in global appreciation.

Ketiva ve-chatima tovah, "May You Be Written and Sealed for a Good Year."

Heart of Gold

No longer pumping the fluid of life to the vital organs of its owner, this human heart has been cut out for the purpose of scientific and medical learning from someone with a heart of gold.

Medical Science

In my undergraduate anatomy course I took for granted the skill with which our human cadavers were dissected. Now in medical school we are responsible for learning the anatomical structures by careful use of the scapula and scissors. To preserve important structures and improve the overall appearance takes patience, effort and a careful hand.

This week we were responsible for opening the thoracic cavity. What may seem like a brutal task actually provided numerous learning opportunities. We explored the lungs in the pleural cavity and the heart in its minute detail. After removing the outer protective layer, the chambers of the heart were opened to reveal how a muscle so small could allow mankind to live.

It is a rather awe inspiring task to hold and clean the heart of another individual who likely has children, grandchildren and other family members. They laughed, cried, worked, served and struggled with the stress of life just as we do today. On top of it all they had a desire to donate their bodies to medical science for the purpose of educating medical students. Teaching others long after their hearts have stopped beating. I could never have imagined I would be in this position when I was younger.

There is so much yet to be learned as we deconstruct each part of the body to gain a working knowledge of its importance. Many resources are available for learning and identifying the thousands of structures. Lever soap only scratched the surface when they used the slogan "for all your 2000 body parts." The following is a list of helpful tools when trying to commit the body to memory:

• Flash Cards - Popular Netter Flash Cards make studying anatomy more portable
• Cadaver Anatomy - Learn and be quizzed with photographs from real dissections
• Mnemonics - Make life a little simpler with medical mnemonics
• Gray's Anatomy - Historically one of the best sources
• Anatomical Models - Three dimensional models can tell more than a picture

Weekend Getaway

Living in the world's capital of entertainment, I find it hard to get away from the tourist traps occasionally. Las Vegas has a large array of events, shows, and activities available for all crowds and personalities. When it comes to inexpensive shows that deliver, you have to look a little harder. Craigslist is a great place to look when student loans are looming more than ever.

We were able to obtain tickets to a celebration in honor of Giacomo Puccini. For those who may not know, he was a writer of Opera over one hundred years ago. It was nice to leave the scrubs at home, dress up a little, sit back and admire the talent of classical opera. Although Italian is not my forte despite my heritage, the performance still fulfilled a need for something other than textbook culture.

Office Space

The den of a medical student, where learning is bursting at the seams. There are no skeletons in the closet and plenty of books to go around.

The Office

I am learning to spend the greater part of my home-life in the company of Mr. Bones. The office was on the priority list for completion from the day we moved in. Having the right place to study at home or on the road makes a big difference.

I chose to surround myself with anatomical anomalies which have proven very useful. Gifts from my childhood now line the shelves and fill the room with study aids or tools of the trade. Imagining the structural layout of the human body is just not the same as handling a 3-dimensional model or the real thing. But cadavers tend to carry a rather unpleasant odor that is better left at school.

Study environment has a lot to do with the success achieved. Productivity increases when the setting is just right. Some things to consider:

• Temperature - Warm temperatures can lead to drowsiness
• Comfort - Posture and seating, if poor, will reduce attention as the pain worsens
• Nutrition - Decrease sugary/fatty foods and caffeinated beverages
  
• Breaks - Study for an hour or two and then take a break to get a snack, shoot hoops, or get some fresh air - it's important to get up and move around at least a little
• Groups - Input from others can be extremely beneficial, not to mention it is easier to stay on task when multiple people are sharing valuable time
  

Exam Week

This weekend has proven a respite from the stress of continual studying. We finished our first week of block exams and are quickly moving forward to the second. The great news is that I passed and will now be able to sleep better at night. One exam each day led to some really long evenings of study. It was certainly not the most difficult obstacle in my life, but being the first set of exams made it an uneasy experience.

With our last exam finished, the weekend was open for a little taste of freedom before starting the new material. Some found there ways to the mountains, others to the lake, and me, well I put up lights. I feel like that was my right of passage into manhood, holding so many electrical wires in my hand at once. Just don't laugh when I tell you the power was turned off first.

Week of Wits

It's time to get out my trusty no. 2 pencil and put on my thinking cap. Our first week of block exams is already here.

Test Masters

Test masters know that you must fill in the Scantron test sheet very carefully to avoid mechanical errors. Don't let your mark leave the box or bubble, erase any changes completely, and above all else get your identification number right.

Mastery of the Scantron is crucial if you expect to succeed. More importantly though is the time and effort dedicated to acquiring the knowledge behind the answers. I thought the transition from high school to college was significant. I guess I simply had nothing to measure it by because I was mistaken. Moving up the ladder from college to medical school has been ten times more intense than my last educational leap of faith. We cover more material, in less time, and we are expected to know it well enough to heal the patients we see. You had better believe I am going to be studying more.

Study Time

Just like MCAT preparation, these exams have consumed the greater part of my daily routine. It goes something like this:

• 8:00 Get to campus
• Study and review materials
• 12:00 Partly study, partly eat lunch, and partly get away from it all (thanks Youtube)
• 1:00 Back to the grind
• 5:00 Break for dinner
• 5:30 Plant my nose back into the books
• 8:30 Prop my head up to avoid falling asleep
• 11:00 Leave campus

No sooner than I walk in my front door I am already questioning the material I covered 12 hours earlier. At that point it is just better to call it a night, so I can do it again the next day. Fortunately, the anatomy exam is first this week with a different exam each day, some easier than others. The goal is to stay fed, awake and sharp. After this week, we start all over with a new subject or two and more detail in the old ones.

Study Aids

One of the problems I have noticed is that there is so much information it is hard to limit yourself to the study aids. Certainly, if your course is using a text or Power Point presentation those would be the optimal resources. Other helpful ideas include:

• Computer flash cards - Flashcard Machine or Flashcard Exchange
• Study group - Two heads are definitely better than one
• Review sessions - Too many will eat up study time, whereas some will highlight important information
• Application settings - An example of this would be the cadaver lab for anatomy
• Websites - Wikipedia is your friend though it may not be perfect, don't get too carried away with the rest

All this studying has its consequences too. My birthday yesterday had to have been one of the most boring as I sat in a room studying for hours. I now have 'Dunlap's disease' (my belly dun-lapped over my belt) as we sit and have limited time to exercise. All the new terms are running around in my head and somehow I have to get them into my fingertips so they can make it onto the Scantron. I just hope I remember my I.D. number when the time comes.

Rationed Time

The long days that never seem to end are certainly anticipated experiences. Only in the beginning of the whole process, I am learning to ration my time to the many tasks that demand my attention.

New Home

We finally closed on our new home and moved in last week (hence the missed post). It took our mortgage broker a long time to finalize the transactions and was more than a headache with a new problem or delay every day. Being first time home buyers has been quite the hassle and I know many medical students wrestle with the decision to become home buyers or simply rent.

In making our decision we had learned that renting a unit in Las Vegas would cost nearly the same as a mortgage. Our struggle was mostly with the mortgage lenders being flexible once we found the house we wanted. We waited until the very last minute before making the deal official.

All I can say is that if you are entertaining the thought of home buying, start well before matriculating. We ended up staying with family for almost a month. It was great to spend time with them, and we will forever be grateful for their hospitality. We just hate to have out-stayed our welcome. Renting sure sounded tempting on occasion, but our new home was worth the effort.

Student Loan

Reimbursement for the expenses of medical school cannot come too soon. With all the costs of living increasing and becoming more abundant, staying financially afloat is a rather fancy dance. I can come up with a lengthy list of debts, but if you are reading this you could name them just as well.

My financial institution is finally funding my tuition and reimbursement checks. It is a huge relief to know we will be able to buy groceries next month and have a roof over our heads. Visit the past post for more student loan info.

Exams

I knew medical school would move quick, but I had no idea we would cover an entire book in less than a couple months. Midterms were only one month in and next week will be our first week of exams. "Block week" as they call it, occurs three times a semester, testing our memory and endurance skills. With 24 credits this semester, I should start having nightmares any night now.

Somehow I managed to make it through my first couple tests despite the late...late nights of studying. This method is not recommended for two reasons: 1)Taking a test while fatigued makes information recall ineffective and 2)It's bad for your physical health. Of course I would like to have performed better, but the information was spilling out of my head by the time I took the test. I think I need to reformat my cerebral hard drive and free up a little space.

Student Organizations

I have been blown away and slightly annoyed by all the organizations vying for my money. Who knew there were so many student medical associations? Each one asks for membership money but none really have a significant impact that seems evident. The benefits they have expressed usually include free meals, discount suture clinics, and the ever popular screen printed tee-shirt.

I may be new to this medical school thing, but I'm not an idiot. My intention is to pass and earn a degree. If that means I cannot join an organization my first week of school, please support me in that decision. Perhaps down the road I will share a portion of my student loan with you so I can say I belong to your club. Maybe in the meantime you could come up with better reasons than a free lunch to be a member of your organization.

Pathways Galore

You may not fully understand it (like myself), but it is happening right now inside your body. The breakdown of sugar into usable energy or glycolysis is one of the many biochemical pathways our bodies use to function.

Biochemistry

Once again, the week has been occupied with many hours of in and out of class biochemistry. Only two weeks into the semester, we have finished three quizzes and a significant portion of the textbook's material. It is comforting to know that I am not the only student in the class that has a difficult time following every lecture. My routine has become a state of confusion during lecture that is cleared when I read the book to clear up the details. It takes a lot of time, but the material is making sense that way.

It has become clear that there is a lot of memorization to be done. Once the amino acids are crammed in my head, it is time to learn the pathways: glycolysis, the tricarboxylic acid cycle, oxidative phosphorylation, and the list is going to keep growing. We usually chuckle when the professors say there is no need to memorize the pathway, but know the starting materials, products, and enzymes involved. Adding it all up, we really do need to know the pathway in detail. When was the last time your doctor broke it all down in the exam room?

Osteopathic Manipulative Medicine

OMM as it is called is one of those classes that is unique to schools of osteopathy. In fact it is, at this point, one of the more enjoyable courses. We will be learning how to find problematic points of the body, manipulate them, and ultimately seek healing as a result. We take turns acting as patient and provider while learning the body and manipulations. I have a feeling this will be my family's favorite part of medical school as I have to practice on someone in order to study. As we are not too far into the curriculum, it ends up being more of a massage than a corrective technique. Over time, I imagine that will change.

In order to be considered an osteopathic physician, we have to be enrolled in OMM during each semester of school. Hence, this is a long term course that will build from semester to semester as we progress in our techniques. It is unfortunate that many osteopathic physicians do not employ these skills and perhaps do so because their practice does not incorporate them explicitly. Many people are convinced after only one treatment that OMM has significant healing results. Fortunately, or else osteopathic schools would not exist.

Anatomy

No relief in the anatomy department. We have explored the chest, shoulders and arms in great detail. Thankfully, my undergraduate education provided a strong foundation for most of these anatomical anomalies. We have yet to be tested on anything, which will be quite an eye opener I am sure. Just when you feel secure in your understanding and memorization, you have to be humbled by the intellectual development of your professors' years of experience and training. Needless to say, our memorization skills are improving at a rapid rate...or maybe I am just being hopeful.

Back to School

Would you believe I made it through the second day of medical school and still had a smile on my face?! So, I had to force it a little. The first week is behind me and classes are under way.

Orientation

Touro University has chosen to start the school year with a two day orientation that gives the new medical students an opportunity to meet administrators, professors, and the other students. We worked out technological kinks, signed a lot of paperwork, and learned a little about the background of our new school.

As TUNCOM is still rather young, there has been a lot of change from year to year. Each professor has been assigned four or five students whom they mentor. Mine happens to be one of our biochemistry professors. A large portion of our teachers have foreign backgrounds; my mentor hails from Russia.

What did I take away from orientation you may wonder? Medical school is going to be really...really hard and keep us extremely busy. However, they want us to succeed and will help us get there (I wish I could say, "or my money back.") I really believe they are looking out for our best interest. On top of all that, we received our ID badges and multiple kosher meals. When was the last time you had kosher pizza?

First Day of School

Bright and early, we all filed into our lecture hall (for the next year), turned the room into what looked like a laptop convention, and received a two hour orientation to anatomy procedures. As creepy as it may seem, a room with 40 cadaveric patients is an awesome sight. It was soon time for our first lecture...biochemistry.

Anyone who has taken a course in biochemistry knows that there is a lot of information to absorb learn in an hours time. Fortunately, we only have a little more than a month of biochemistry, and I am sure they will cover everything. That being the case, they sure have started us on the right foot. After six hours of biochemistry, I think we were all ready to go home and catch up.

All the Rest

We had full days of school from 8 in the morning until 5 at night. A break for lunch and dinner were followed by more intellectual feedings. I don't know about my counterparts, but I was studying until 11:00 or later each night and trying to get up early enough to exercise before classes. The days are full; what else could I have expected?

Our first quiz was this week and we have already started dissecting our cadavers quite extensively. They want us to finish anatomy early on so we have a good understanding of human geography for the remainder of our education.

Murphy's Law

You know, 'if anything can go wrong, it will.' These are not problems with the school, but issues none the less. I am reconsidering my decision to save $400 by not purchasing a laptop protection plan. The girl next to me spilled her soda on her laptop only two days into the year. At least it wasn't a month later, but she still had to purchase a new one and this time she bought the protection plan. This warranty will usually cover everything from spills to running over your computer with a car. Unfortunately, you still run the risk of losing stored information.

When I chose my lender, I thought I was getting a great deal and saving quite a bit in the long run. Perhaps I should have gone with a well known lender. Only a few days into the year and they called to let me know they were changing their company organization and would not be able to guarantee when my loan would be available. That is bad news when your bank account cannot afford a $40,000 tuition cost. With my new lender, I think things are now moving in the right direction.

And with that I would say to anyone who has gotten this far, enjoy your free time. At least do it for those of us who don't get much.

Welcome to Las Vegas

The biggest part of the move was a success and I am now writing from the Las Vegas valley. The moving truck barely made it up the hills at 45mph and coming down them topped out at 70mph. Due to the slow speeds, the trip took an extra hour to arrive. Perhaps the bugs smacking into the top of the truck are what slowed us down the most.


Hotel Las Vegas

As usual, our grandparents offered a very warm welcome upon our arrival. It's one of the things we look forward to each time we visit with them. Until the documents are signed and we close on our home, they have opened their one room hotel to us their guests. Although we do not expect to be here too long, it will be at least two weeks before closing.

Our truck rental only covered three days, so we made a little room in the garage and emptied our belongings before the heat became too much to withstand. We were surprised at how little we actually had and how quick we were able to unload. It was likely in anticipation of finally seeing the home we are in the process of purchasing.

Vegas Vacation

The home is beautiful and just what we expected to be getting from the pictures we have seen. We can not wait to move in and have the whole procedure finished. Meanwhile, I have been enjoying my last week of vacation before school starts. With so much to do, every day has something new to offer. One day I'll get a little sun next to the pool and the next I fill my appetite at one of the many buffets. I have to learn when to stop, it is starting to hurt.

Having air conditioning, in and of itself, is a super vacation. With no assignments, exams, or appointments to worry about, this has been a relaxing week. Just what I need right before starting the long days of medical school.

Back to School

With orientation and classes less than a week away, the final preparations are under way. I stopped by campus to get my photo taken for my ID card and was surprised to learn the students from other fields of study have been in classes for over a month now. The osteopathic students are the last to begin. A schedule of our classes for the next five months was distributed, showing what we have to look forward to in the near future.

We start as first year students with two days of orientation before classes begin. Oddly, there is no set schedule every week and classes vary from day to day, but the average day starts at 8:00 in the morning lasting until 5:00 at night. The nice part is that Fridays are shortened due to the Jewish sabbath. Jewish holidays throughout the semester offer many days off, especially during the month of October.

Looking at the course load seems a little daunting at this time, but the subject matter is exciting to consider. After all, this is the stuff I and my classmates have been waiting a lifetime to study and we are just now on the doorsteps of experiencing it all firsthand.

We are celebrating my grandpa's birthday this weekend, buffet style, what a great way to start the last weekend of my relaxed life. After next week, they will not be common occurrences for some time. Welcome to Fabulous Las Vegas, Nevada!

Time to Hit the Road

After months of preparation, we are minutes away from leaving to our new home in Las Vegas. The truck is packed, has a full tank of gas, and the keys to our rental unit turned over to the management.

Budget Rental Truck

When I visited the post office to change our address, I was surprised to see a coupon for 20% off a Budget rental. Of course it might be too late now, but in the future I will be sure to look at the coupons before planning my move completely. We are still excited about the savings we obtained with Budget nonetheless.

Our truck is the larger 16' as the 10' truck would simply be too small. We still have extra room in the truck. It certainly relieved a headache of not being able to fit all our belongings into one vehicle. We have little furniture to transport, so fitting our collection of boxes was no problem. I would still recommend getting a truck slightly larger than what you expect to use.

Cleaning

Once our belongings were packed into the truck we were prepared to clean the apartment from top to bottom. The saying "many hands make for little work" is so true. I would like to express our appreciation to all of our friends and family who helped load our life into the truck and willingly cleaned with us. It went extremely fast; only one hour to load the truck and a few to clean.

We borrowed an inflatable mattress from some friends for the night as everything else was packed away. With everything done, it is a relief to be finished with this side of the move. The irony is that it only gets harder from here.

Fuel Economy

As I have never driven anything as big as our rental truck, I will be taking it slow on the road, not to mention it contains all of our earthly possessions. We plan to drive between 60-65mph to decrease our drag and increase our savings. Not to mention it will ease my nerves and improve our safe arrival.

A couple nights before departure, I used the internet to plan our trip and the best gas prices along the route. Using a combination of Google Maps and Gas Buddy I found the cheapest gas prices within the last couple days and the exit numbers to get us to the stations along the way. Before leaving I compared the most recent prices of the day and we are set. It is quite convenient as the average price is $4.08 and right in the middle of our trip is a station selling gas for $3.90! Of course driving two vehicles will not help, but any savings will help at this point.

Cheers to the last post in Utah and to a future in Las Vegas!

Packing Boxes

It has finally come down to cardboard, tape, and furniture. The last few days have been spent packing away books, utensils, supplies and everything else all in preparation to load our moving truck next week.

The first thing you see upon entering our home is a wall of boxes containing our life for the past two years. Thankfully it wasn't longer or we may have had more to pack. During my time as a postal employee, one of the carriers saw a box with a sticker on it and said, "Fra-gee-lay, that's French meaning 'to drop'." Evidently the fragile markings don't do much for security.

We spent some time with family this weekend and plan to spend more time with friends in the coming days as we say our goodbyes. Commonly a biter-sweet activity, there is no easy way to do it and feel like everything has been said or expressed.

As the months turn into weeks and then into days, I grow more anxiety towards the future and its complexity looming overhead. Some times I think I am that box being held by others who are saying "fra-gee-lay," shrugging their shoulders and dropping me to the ground below. What an amazingly stressful time.

Discount Books

I am growing what seems to be a never ending stack of books. A couple of months ago, Touro sent me a list of 'Required' and 'Recommended' text books for First Year students. At last, the time for real-deal medical books has come...or so I thought.

Buying Medical School Books

After receiving some feedback from veteran students and practicing physicians, I saved hundreds of dollars. Actually it was rather intuitive; do NOT purchase the 'Recommended' books. They certainly may contain some useful information, but I think I will have plenty to read within the covers of my 'Required' library that superfluous texts will only add to my lack of time.

With that decision made, the list was cut in half, leaving me a little less in debt. The remaining 20 books, however, are starting to make my shoulders ache just thinking about carrying them to class.

Since I have not yet received my loan reimbursement, the new problem is being able to pay for $2500 worth in books. My solution has worked thus far and costs approximately $250 every pay check. I made an initial order and waited for the shipment to arrive before selecting the next handful of texts to purchase. It is exciting to think I am one order away from having all my books and the projected total is a little more than $1000.

Bargain Prices

Some students opt to borrow or share texts with their neighbors. Good idea, but I plan to spend some serious time with my books. TUNCOM has an online bookstore that gives back to the school when used to purchase texts as many schools probably have. This is great for the school, unfortunately there is very little discount to the student.

There is an option for getting the books for free, since that includes the military, that option is out for me. As most students are doing now, I turned to the internet's vast library of cheap books. Although there are many online stores for purchasing text books, the two with the greatest savings are no surprise. Between ebay's half.com and omnipresent Amazon, there is a lot of saving power.

The part I like is that you are helping other people sell their books. I imagine down the road I will have to sell mine too, so it is a way to build up positive karma I suppose. Perhaps you are more into funding a 'better' cause. In that case you may be interested in purchasing books for full price and then some at Better World Books who make an effort to stamp out illiteracy.

If used books are viable options, prices can be significantly reduced. Other considerations may be older editions, borrowing, and buying the books as soon as possible. I learned this the hard way. When I first performed my book search, the prices were almost one third of the original. Now only weeks away, costs are up as the cheaper selections have already been bought by others.

Between the Book Covers

As I searched the confines of Amazon, I came across the 'wish list' feature. When you find something you like, you simply click the wish list button to add it and others can see what you want. My list became an organizational tool for me, but if you have a gift giving event coming up, you may consider sharing your wish list with others. Who knows, perhaps they will be able to help cut down on the costs for books and supplies.

With work and preparations to move, opening these books has not been the first thing on my list of priorities. They certainly look attractive though. Knowing I will have plenty of time to digest the material, I am enjoying my vacation now while I am still ahead. For now the mystery will maintain my intrigue.

New House

So the house may not be new, but it will be new to us. After a long, grueling month of wondering where we will live once in Nevada, we finally know. We had to shop online and have family visit the home before we decided to make an offer. When we did, the days just seemed to drag on waiting to hear if it had been accepted. Normally, it is a rather quick process, but we were in the market for a foreclosed home owned by the bank. They are not the quickest people when it comes to making a sale, but if the money tickles their fancy, your chances seem to be better (I can't imagine why).

Rent or Buy

After two weeks of waiting and finally deciding that our offer had been rejected, we started to look at other options including a dreadful return to rental units. Fortunately, before all hope was lost, we heard back from our buying agent that the selling agent was fired. As the French would say, 'tant pis' (too bad), but we were grateful it was that and not that our offer was rejected. Another selling agent stepped in and offers were re-accepted. Our agent helped us choose a strong offer and we submitted a second with toes and fingers crossed this time.

The next day we heard back from our agent with some of the best news we have heard in a while. Our offer was accepted among all that were submitted! We finally made it to the 'first time home buyers club' and haven't looked back since.

Now it is a matter of getting through the hoops of paperwork, escrow, home loan, earnest money, insurance, and whatever else comes with the news. We are extremely excited to be on our way to owning our own turf, carpet, walls, driveway, and stone backyard. Well, the stones in the backyard are not the most exciting part, but we are learning to like whatever comes with the house.

Summer Fun

Our dilemma is in our enthusiasm to leave Utah. Sure our families want us to stay nearby, but we have seen enough and want to establish a home of our own in a place that does not have the letters 'U' and 'T' anywhere in the mailing address.

As a result, we have enjoyed (probably too much) the last months of our stay in Rental Kingdom. Dishes, laundry, groceries, cleaning all go undone while we find more entertaining excuses to keep us occupied. We get around to the mess or task when the cupboards or dresser are empty. The lack of air conditioning doesn't seem to help much as we would rather not move from the whole in the couch more than once because we might drowned in our own sweat.

When we aren't stuck in our sauna of an apartment we like to get out for ice cream, cold drinks or a movie in an air conditioned theater. If we feel a little more daring we go out for walks or find a trail to somewhere fun. It might still be in the heat, but at least we can get some Vitamin D while we are out and about cavorting in the sun.

Move-In

We were hoping to be able to move-in a couple weeks before school started so that we would have some time to get settled in our new environment. It seems that will be delayed a little longer than we would have liked. If all goes well, we can expect to be moving in the first or second week of August. Just a note for the future to plan well in advance so this doesn't happen again. For now we are seeing three walls and a front door made out of storage unit steel. Hopefully it will not last for long so we can be in our new home soon.