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.