Fighting for Good Health

While it seems that doctors are making buckets of money, lawyers have found a way to change this in concert with the political movers and shakers who are following suit. Many veteran physicians are encouraging young students to stay away from medicine for fear of endless paperwork, insurance battles and lawsuits. The face of medicine is changing.

Medicine Is A Business

What once used to be a profession geared towards healing the disabled and sick has now become a battle for safeguarding ones career. Often referred to as "CYA" (cover your a__) medicine, doctors are ordering more tests so not to miss pathology and treating minor ailments in vain. They put forth great efforts to serve their patients, but must protect their practice from suing patients, money-hunting lawyers and non-paying insurers. Some discussion with physicians about the subject often brings up ideas for reform with what sounds like logical plans to solve the issues at hand. In some markets doctors are paid almost 50% for their services as a result of under-insured patients or insurers who just won't foot the bill claiming there were non-qualified expenses. Since when can people utilize a service provider, demand services and pay nothing? When I go to the supermarket looking for home goods, they are certainly going to laugh when I ask them to put it on my tab.

In some places the "fee-for-service" model has done well. Patients want their health care provided and pay the provider an agreed upon fee. Both parties are satisfied and treatment is given. There is talk of requiring all citizens to have health insurance. I am still trying to understand why this would be a bad thing. I choose to drive a car; I get insured. I choose to receive health care; I get insured. Seems simple. Research has shown that people value things more when they have to "pay" a nominal fee for it. Even if there was a required co-pay, at least it would show sincerity of the purchaser to the provider that they have a significant concern needing to be addressed. It becomes taxing on the medical systems to provide free or discounted care more often than not. Perhaps that is why one third of hospital emergency departments have closed across the country in the last few years. Uncompensated services cannot last forever.

Whether paying in cash, through an insurer, Medicaid or Medicare, it seems fair to be offering remuneration to physicians for their hard work rather than trying to scheme ways to leave them empty handed. While each insurance organization has various offerings to their clients, some may come up incomplete, requiring users to seek for additive options. Medigap insurance plans for example, offer to fill in the gaps that Medicare Part A and B do not cover. It brings peace of mind to patients that experience a wider coverage of care and allows providers to give comprehensive services.

As I move into medical practice it is hard to know what medicine will be in the future. Policies are being written into law and health care reform is happening at the national level. Medicine as it is known today may be inside out and backwards years from now. Hopefully, parties on both sides of the fence find will be able to latch onto something positive so the face of medicine is tainted no more than it already has been.

Question of the Week

What are the issues, past and present including the proposed efforts of health care reform?

Answer & Explanation

Doctoring Through Humor

Every once in a while, funny things happen. This time, brilliantly dressed man, tall in stature with half a head of blue hair paced on the stage recanting memories from his career as a medical doctor and health activist. There was no shortage of clowning, which was only exaggerated when he literally disappeared inside his over-sized pants...yes really. 

Smile, It Scares the Blues Away

Recently, I had the opportunity to listen to and chat with Hunter Adams, better known as "Patch" Adams. Most people recognize the Hollywood title, and in person, he was simply fantastic. Patch is a one of a kind personality who has established the Gesundheit Institute, a free medical clinic where health is paramount for the individual, family and community. While in his final years of medical school, Patch had a vision on how to change the world and healthcare itself by eliminating the "red tape" that is found in bureaucratic medicine. His cheery disposition, desire to spread happiness and creative outlook stoke a positive reaction in most people who have the pleasure of his company.

On the verge of practicing medicine myself as a rookie doctor, I spent a couple minutes consulting with Dr. Adams. After expressing my enthusiasm for my fast approaching residency and my simultaneous anxiety of the same, he could not fathom why as this is the best time to grow as a young doctor. His words of advice were to "never lose the humor." There are so many positive experiences to be had that it would be a shame to miss out on account of fearing the experience itself. Through his discourse, personality and example, I am reminded that we can be whoever we want and that it is acceptable to be the one who doesn't follow the norm. Compassion is a characteristic that is given to benefit the lives of others, and in my eyes, Patch exemplifies this quality with great finesse. Thank you for your words and example.

Question of the Week

What can I do to contribute to a happier me and society?

Answer & Explanation

Infectious Disease

One of the perks of emergency medicine, OBGYN and surgical rotations is wearing scrubs to work. Between these specialties and vacation it has been a year since I last wore a dress shirt and tie on my rotations. Despite being a little less comfortable, it brings a different sense of professionalism to the game.

Avoiding Disease

Currently rotating on a medicine specialty, infectious disease, I am learning more than ever before, the importance of antibacterial, antifungal, antiviral and antiparasitic medications. I knew there was a lot to know before, but I am now reminded of that fact where it counts, at the bedside. Every day we round on patients who have serious infections including tuberculosis, HIV, meningitis and more. When the patient's infection fighting army can no longer handle the battle, we are called in to bring the reserve armory. Donning special masks, gowns and gloves protects both the patient and ourselves from the exchange of harmful bugs during discussion and examination.

Washing hands is a necessity and stethoscopes are cleaned routinely on this service. If we are not careful, we can be the source of somebody's newest infection at which point it doesn't matter what your tie looks like -- keeping it secured is not a bad idea so it's not dragging through the patient's wounds and dressings. Medicine is a lot like figuring out a good puzzle, both in making a diagnosis and providing the right treatment regimen. Infectious disease aims to find the perfect medication for the job so we are not firing shotguns at thumbtacks every time building resistance to the arsenal we have available. It is a thought provoking field that can have a significant impact on patient outcomes as long as we don't let the disease bug them too much.

Question of the Week

Which of the following drug classes is responsible for both nephrotoxicity and ototoxicity?

A. Carbapenems
B. Penicillins
C. Tetracyclines
D. Aminoglycosides
E. Quinolones

Answer & Explanation

Peanut Butter and Jelly

The gourmet classic of any medical student is obvious; one slice of bread slathered in fruity preserves married to another slice plastered with smashed peanuts. It’s the “go-to” of meals when the cereal box has poured its last bits or the milk carton has gone dry.

The (Un-Starving) Nourished Student

Available on my shelf of kitchen space I have a small variety of cold cereals, half a loaf of bread, half a container of peanut butter and a can of beans. The half shelf in the refrigerator is barely enough room for a half gallon of milk, a handful of bananas, celery and a few remaining hot dogs. The granola bars are used to stock my work bag in case of a snack attack and I have some Tootsie Rolls to complement my meals as a small dessert. There is no question that my in-house meals are lack-luster and definitively not the most nutritious. The occasional meal is had at the hospital or a fast food joint on the way there which is surely not helping my case. I am just now realizing that I don’t even have said jelly on hand…how pathetic is that?!

Just when you thought medicine was about teaching healthy habits, you notice that those who teach it are having a hard time following the rules. Certainly, this does not go for every student as the outliers exist, but if you ask, there is commonly a stock of supplies to make the most basic of meals. Whether short on time to prepare meals, no desire to eat healthier, or an attempt at saving money we are probably not properly filling our fuel reserves. One student I work with is staying in a local hostile making the effort to find the nearest free meal even if it means walking into a nearby hotel for their continental breakfast! The best counsel I heard a while back: “somewhere there is a free lunch, and it is my job to find it.” It holds true, but when the advice proves futile I return to my meals of simplicity with minimal ingredients and little variety. So Mom, no need to worry, I am being fed and there is something from every food group.

Question of the Week

A known alcoholic man presents to the emergency department showing signs of confusion, unsteady gait and horizontal nystagmus. Upon questioning he tells you he does not remember much about the day but just finished eating a meal fit for a king. What is the first step in treatment and what structures are likely being affected?

A. IV glucose, mamillary bodies
B. IV thiamine, hippocampus
C. Oral glucose, hippocampus
D. IV thiamine, mamillary bodies
E. Disulfiram, amygdala

Answer & Explanation

Life as a Patient

Finally nearing the end of my hospital stay, I have gleaned a great deal of information and experienced my share of ups and downs. Surgery was a difficult experience as it left me with pain, wounds, and the after effects of anesthesia. Being in the ICU with all of its high-tech glory was much less fun than I remembered from rounds.


Post-Operative Recovery

Fortunately, I was able to avoid catheterization. Nonetheless, the anesthetics had a long lasting effect that disturbed both my gastrointestinal and urinary tracts. Every time I tried to drink fluids, my stomach would have nothing to do with it. I had to keep the emesis container within reach as there was no way of judging how my body would react. It was more annoying than anything as the cottonmouth was rather unpleasant. Between medicated naps and side aches from my freshly placed chest tube, all I could do was wait for the anesthesia to wear off with my barf bag in hand. Learning to adjust to my new wounds and pains was going to take some time, and all I could do was wait. As the clock rolled, I became hungrier and dared to try solids. It tasted good, went down well and sat well...but only for 10 minutes. It was then that I wished I had an emesis bag the most; a simple device I could put on and forget about. Luckily, it became easier to hold the food in and now I had to get my bladder to cooperate. With some serious concentration, faucets running and a friendly coaxing from my visitors, the bladder situation was overcome in due time.


Little did I know that the next few days would be worse. Inflammation, muscle aches, tubes, wires, medications and the list goes on. Now I was starting to understand what my post-operative patients had been experiencing. From one unpleasant experience to the next, I was now on the doctor's schedule awaiting instructions and decisions. My job was to report any problems, stay attached to all my wall connections, exercise my lungs and generally get better. I was happy to hear I was the most stable patient on the ward, which was to be expected as I was also the youngest. The TV was boring, my neighbor's moans annoying and the food not always appetizing. Getting up and walking around the unit was the most enjoyable activity I participated in during my stint. Something we so easily take for granted had now become the highlight of my day. At last discharge is in sight and I can soon recover in the comfort of my own home. This experience, however, has made a significant impact on my perception of health care and the way I intend to approach my future patients. What a great way to spend my vacation month.

Question of the Week

As a new patient on the surgery ward you are asked by the dietitian make your next meal order. Which of the following will have the worst effect on your health and recovery?

A. Turkey roast with mashed potatoes and broccoli
B. Chicken fingers and French fries
C. Meatloaf with mixed vegetables and a dinner roll
D. Shrimp pasta alfredo with garlic bread
E. Chicken salad wrap with clam chowder soup


Answer & Explanation

Finding Pneumo

Excited to finish my last core rotation and move on to my first elective, I wanted to make a quick stop at the doctor's office for a prescription. Unfortunately, the cough I had was not readily treatable by prescription and would have to be further evaluated at the hospital.

The "Patient" Rotation

Reluctantly, I made my way to the hospital to have the spontaneous pneumothorax treated. A chest tube and days later I still find myself suction tied to my room awaiting a change in pulmonary status. The first time I was given oxygen I almost recoiled as though they intended it for another patient and must have made a mistake. The nurse responded and said, "it's hard to be a patient, huh?" The truth is that I don't know what it is like to be a patient. Over the last few months I have been contemplating what it must be like to be stuck in the hospital bed waiting for providers, asking for medications and not on your own turf. What do patients feel with certain medications? How do they manage to clean up on their own? Is the patient food worse than the food medical staff get? Does it really take that long for call lights to be answered? Now I am learning first hand what patient life is really like.

Because of the suction device attached to the wall, I get a moving radius of 15 feet, almost like a dog tied to a stake in the yard. No walks in the hall and I can't even get to the other side of my room to use the waste bin. Fortunately, I have a window overlooking The Strip and the sun shines in its little square of heaven for a few hours every day. Despite an occasional delay in response to my call light, I've been very well cared for. Perhaps it has helped that I am a medical student and the staff are potentially peers. Perhaps they are just that good and I have been lucky to have such nice help. Either way, every part of this experience is new. There is no doubt in my mind that this short stint of time is teaching me more about medicine than I could ever learn in my medical training.

I am not refusing the experience or wishing it wasn't me. Rather, I am accepting it as an opportunity to learn what the other side of being a doctor is all about. I want to absorb it and unfortunately eat, breathe and sleep it. One thing is certain, patience is mandatory, both with self and others. It is not an easy process with  ups and downs around every corner. I was looking forward to starting a new rotation tomorrow in Emergency Medicine at an out of state facility. Plans have changed and I may no longer have that experience, but I feel it has been replaced with an experience just as meaningful. 

Question of the Week

Which of the following statements is true regarding spontaneous pneumothorax?

A. Primary spontaneous pneumothorax typically occurs in tall, thin, older adults.
B. The definitive treatment of a pneumothorax involves the placement of an intercostal drain.
C. Catamenial pneumothorax typically occurs during the end of menses when a patient is taking oral contraceptives.
D. Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax.
E. Pleurectomy is preferred over mechanical pleurodesis for recurrent pneumothorax.

Answer & Explanation

Heart Health

The recency of my month on cardiology continues to nag at the inner beast that wants everything bad for the heart. Making wise decisions in diet and exercise has been one of the hardest challenges over the first years of medical school.

Fighting the Urge

Now working a specialty offering a little extra free time, I continue to be confronted with using my downtime effectively. I find that even with just a small amount of physical activity my days seem to be more productive. In addition to generally feeling better, that pesky voice of guilt is silenced more often. So I'm hoping that my yoga sessions and runs have put a little counterweight against the fries and pizza I couldn't resist.

Disappointingly, I've slowly watched my belly grow and my view of the ground become more limited. The belt has been loosened a notch to accommodate my horizontal expansion in an effort to breath more comfortably. This is not exactly what I had in mind when came to school. Now cursed with this food baby, I feel compelled to do something about it. Time is not more plentiful than before, but when productivity increases as a result of healthy living, there is a definite benefit to setting aside the time.

Question of the Week

A confused elderly man who was wandering around complaining of abdominal pain is taken by ambulance to the emergency department. He is unable to give a coherent history. Urine analysis shows ketones without glucosuria. Plasma glucose is 100 mg/dL. What is the most likely explanation for these findings?

A. Congestive Heart Failure
B. Emphysema
C. Alcoholism
D. Inflammatory Bowel Disease
E. Rheumatoid Arthritis

Answer & Explanation

Cardiology

Each month has provided interesting rotations. This month is no different as I am now currently working on the in-house cardiology service and trying to keep "pace."

The Heart

The 'ticker patrol' moves swiftly through the halls as a sea of white following our attending from patient to patient. It's obvious the cardiologist is concerned about his heart; early morning runs, always using the stairs, and driven to maintain a healthy diet. He sees first hand how people destroy one of the most important organs in their body simply by how they live. His brisk demeanor, lively teaching style and caring bedside manner have taught me more about being a good physician in a week than some preceptors do in a month or more. He loves what he is doing and it shows in every aspect of his practice. How appropriate for one who cares for the heart.

We feel for pulses, look for venous distention and listen for the "Lub Dub" as reassuring signs or good cardiac function. I continue to be amazed by the amount of information one can pick up from some tests, especially the electrocardiogram (ECG). This electrical picture of the heart tells a story of where a heart has been, what it is doing and what may happen if treatment is not given. Yet the ECG is only one piece of the puzzle that can be complimented by other studies and tests, all in an effort to preserve the life giving organ.

I remember the first time I performed CPR on a patient like it was yesterday. It was a child not more than 5 years old. The room was filled with so many health care providers that there was barely room to move. I was the last to attempt resuscitation efforts. Not long after I started, the parents entered the trauma suite to be with their child for the last time while the heart was pumping blood to the tissues. In between compressions I distinctly remember looking around and noticing that there was not a dry eye present. It then hit me that my compressions were no longer for the child, but for the parents who longed to have their child once more. It is no surprise that we use the heart as a symbol of love, for it carries that emotion throughout humanity.

Question of the Week

With the new year it is time to say goodbye to a rather useful resource, wikitestprep is no longer in operation. The question then is this:

What other free resources are available to students wanting to prepare for the medical licensing board exams? 

Please leave your answers in the comment section.

Regularly Irregular

Looking back, jobs with some regularity are quite nice. In a short matter of time your body gets used to the internal and nightstand clocks. The schedule can be set and forgotten as there is little variation. Medical school is not regular in terms of scheduling, not at all.

Getting Shut-Eye

Being a medical student seems to be one occupation that has regularly irregular sleeping habits. Whether there is an exam coming or a night on call at the hospital, it seems that the sleep schedule is the first thing to go. Sacrificing sleep to get an extra hour or more of study is the norm. It's no wonder caffeine is such a hot commodity among students. Now on clinical rotations I find myself sacrificing sleep so I can see patients at the hospital before rounding with the doctors. As it turns out, this is usually for my practice and there is little effect on the patient's care from my efforts. That is a nice thought to accompany the five o'clock wake up call.

Soon enough I will be sleeping at the hospital to fulfill "call" assignments. Of course it is all in the name of medicine. Certainly the culmination of stress, lack of sleep and lack of exercise is costing me to lose years from my life expectancy. How is it that a career so focused on health can be so detrimental to my own? Oddball hours here I come. I'm just crossing my fingers that when my head hits the pillow at night I can put all my thoughts behind me and actually sleep soundly until the beeper or alarm sounds the reveille.


Question of the Week

Among physiological changes in the elderly, alterations in sleep patterns are common. Which of the following best describes changes in the sleep cycle that accompany aging in the elderly?

A. Decreased REM sleep and decreased slow wave sleep
B. Decreased REM sleep and increased slow wave sleep
C. Increased REM sleep and decreased slow wave sleep
D. Increased REM sleep and increased slow wave sleep
E. Increased REM sleep and no change in slow wave sleep

Answer & Explanation

Rehabilitation

With great power comes great responsibility. Physicians are among some of the highest educated individuals and yet they are at an increased risk for drug abuse and addiction. Despite their "power", there is a responsibility to lead the way in safe practices.


Medicinal Pitfall

Employment in an environment where medicines are routinely used and available can have deleterious effects on clinicians and other health care providers. Studies have been performed to learn what fields of medicine are at greatest danger of drug abuse and the results usually show increased potential in those that distribute medications frequently. In school we are taught about the signs of addiction, where to seek help if needed, and tactics to overcome the problem. Despite this training, many physicians become addicted as a result of stubbornness, pharmacologic education, and ease of access. Check out some of these addiction facts that may shed a different light on drug abuse.

During a rotation I was surprised to work with a physician who openly discussed his past history with pain killers. He told me that the rehabilitation program he finished was one of the best things to have ever happened to him. For a long time he was in denial that there was even a problem until it interfered with his job and the patients he treated. Some addictions may seem minimal, but the psychologic drive to obtain more is very powerful. Chemical impulses can make even the most mundane stimulus phenomenal.

Addiction can happen to anybody. Fortunately, there are resources available for those who want to find freedom from chemical dependence. Whether it is a private facility, land-based hospital program or an online resource like this Vicodin rehab guide, help is available. As for physicians, most are able to keep their licenses and continue the career they have established once rehabilitation is achieved. Sadly though, it continues to be a problem. We may never know the problems others are facing, but if they come to us for help, wouldn't it be nice to have the right tools?

Question of the Week

A 35-year-old woman is found unconscious in her apartment next to an empty bottle of pills. She is brought to the Emergency Department and given flumazenil, and shortly thereafter regains consciousness. Which of the following drugs did she likely ingest?

A. Diazepam
B. Eszopiclone
C. Hydromorphone
D. Oxycodone
E. Zolpidem

Answer & Explanation

Treatment Options

The urgent care has its fair share of injuries and acute illnesses of which infections are common. It came as no surprise that my precepting physician asked me the best antibiotic treatment for specific infections. Although slow on the start-up, by the end of the month I was right more often than not.

Treatment Modalities

Bacteria have been known to take over our illness for centuries. The fight to halt their progression is still in its relative infancy as companies develop the latest antibiotics to cover certain strains of bacteria. Recently, the war against these microscopic armies has faced some retaliation via mutated strains that have developed resistance. One well known suspect is the staphylococcal organism responsible for Staph infections. Growing resistance has required a new approach to treating these infections. Despite having an arsenal of antibiotics for treating infections already in progress one company, Oasis Advanced Wellness, has a line of products that are intended to augment the immune system and avoid illness in the first place.

I was recently introduced to Oregasil, an oregano oil, that claims to have natural antibacterial properties. Its chemical component carvacrol not only inhibits the growth of certain bacteria, but it is said to taste like pizza! When was the last time you took medication that actually had a good taste? In laboratory studies, this compound was reported to be comparable to the standard antibiotics streptomycin, penicillin and vacnomycin. It is very unlikely that your doctor will prescribe a product like this, but is good to know that such formulations exist for those who prefer the natural approach medicines.

Another interesting product they offer is their Bio D-Mulsion supplement. There is a growing percentage of people who are deficient in Vitamin D. Usually we consume it through our diet, but the largest amount is actually obtained through our skin when we are exposed to the sun. For those who do not get adequate amounts of ultraviolet radiation they are at risk for health complications from Vitamin D deficiency. Thus there truly is a place for supplementing this crucial vitamin when not obtained naturally. Among its benefits, Vitamin D is known for strengthening bones, improving cardiovascular integrity, and boosting immunity. When considering your overall health, start with the basic vitamins and minerals and you'll be on the right track.

Pimped Question of the Week

A patient comes to the clinic with a 6cm, indurated, and raised lesion under the skin of the axilla that is warm, tender and erythematous. They state that they were bitten by a spider while they were sleeping, but did not see it upon waking. What is the most likely organism in the lesion and what is the initial recommended treatment?

Easing the Pain

Like something seemingly out of a torture camp the Transcutaneous Electrical Nerve Stimulation (TENS) unit is actually designed to relieve pain and discomfort through a small portable device. 

A New State of Comfort

Finally able to breath again and catch up on my sleep, I still find my back and neck sore from the long hours of hunching while studying for exams. A good night's rest and a session of yoga at the gym quickly helped ease some of the tension that built up over the last couple weeks. For some people, however, pain can be an ongoing problem that limits their daily functioning and even compromises optimal health. Recently, I heard about muscle stimulators and their non-invasive approach to easing sensory and motor deficits. Despite their evil look, some people swear by their effectiveness as adjunct to common medicine.

Although not effective in all cases of chronic pain, TENS Units are an alternative approach to the use of medications and more invasive methods of treatment that aim to reduce neuropathic pain. By stimulating nerves to release inhibitory (GABA) signals, the sensation of pain can be reduced. Among the research is a case that shows there may be some benefit to the use of such systems in restoring sensation where it has previously been diminished. For additional information about LGMedSupply's products visit their online customer blog. Otherwise, if you have used a similar device, I would be interested in hearing your feedback on the subject.

Board Prep Question of the Week

An 18-year-old girl from Southeast Asia presents with symmetric ascending weakness below her knees. She has been unable to walk for 3 days. Physical exam reveals mild hypotension and papilledema. Upon respiratory support and administration of IV immune globulins and plasmapheresis, her condition resolves after 2 weeks. Which of the following is the most likely etiologic agent of her condition?

A. Acid sphingomyelinase deficiency
B. Arylsulfatase A deficiency
C. Infection with C. jejuni
D. Infection with JC virus
E. Microsatellite instability on chromosome 4

Answer & Explanation

Spring Break

Spring break is finally here, I just wish that truly meant time off and possibly an exotic location. Alas, one more block to go and then it's time to buckle down for board examinations. Spring break = head start on board prep.

A Breath of Fresh Air

I am not really certain if it was the excitement of break or the fast paced material, but this last set of exams was tough. Now, I am mustering all that I can to collect my mental capacities for the final chapter of a 25 year career in classroom education. That means extra sleep, exercise in any form, and semblances of healthy nutrition. Finding a way to create extra memory in my noggin and not lose too much of what was learned before will be a challenge. Crunch time is here.

In the meantime, when I am not stressing about the next three months, I like to imagine the cabana I hope to one day use in the Maldives. Believe me, I have already started saving for that trip years ago. Nevertheless, while my financial resources sort themselves out, I think I might stay close to home for a while. Perhaps a visit to the local state park, but nothing too costly; after all, student loans have already sent me out to drift.

Board Prep Question of the Week

A 28 year-old male of Jewish descent presents with abdominal pain, diarrhea and fever. Physical exam reveals a tender abdomen and a perianal fistula. A biopsy reveals chronic inflammation in the small intestine involving all layers of the intestinal wall. This patient may be treated with a monoclonal antibody which blocks which of the following cytokines?

A. IL-3
B. IL-5
C. IL-8
D. IFN-Beta
E. TNF-Alpha

Answer & Explanation

Second Exam Week Five

We are on the verge of having one more set of exams behind us. With some quick arithmetic, that means spring break is almost here, and it's time for board studies to kick into full gear.

Lifespan

Somewhere along the way, one of our teachers mentioned that just by choosing to become a physician and going through the process, we would be decreasing our life span a significant number of years. Finding enough research to support this claim, on the other hand was not easy. Now, more than ever, I think I understand it's foundation. The never ending struggle to be on top of things and keep up with all the stress has had a deleterious effect on me mentally as well as physically.

Although this week's block exams may not lead to my demise, this profession might. Considering the alternatives, I am OK with this. As for life expectancies related to health conditions, World Life Expectancy has broken down the statistics to map out diseased counties. Unless you live in the middle of nowhere, it seems that we are all geographically at risk for something. My interpretation; eat healthy, exercise regularly and live happily.

Board Prep Question of the Week

A 4-year-old girl came home from day care and developed fever, abdominal pain, and diarrhea containing flecks of bright-red blood and pus. The girl did not ingest any food at day care. Which is the most likely causative organism?

A. Enterotoxigenic Escherichia coli
B. Campylobacter jejuni
C. Shigella dysenteriae
D. Vibrio cholera
E. Yersinia enterocolitica

Answer & Explanation

Mangosteen Juice

Every now and then I have the opportunity to investigate new products on the market. With energy drinks in every store and super juices making their way to the shelves, our beverages can get a bit overwhelming. The makers of Xango, a competitive nutritional fruit juice company, have developed the recently popularized mangosteen juice.

The mangosteen fruit comes from Southeast Asia and has no relation to mangos. It is a small purple fruit about the size of an apple that has a white tart core. Chemical analysis suggests the fruit contains various xanthones and tannins which may have anti-cancer properties in addition to being an anti-fungal, antimicrobial, and anti-inflammatory compound. It is no wonder that mangosteen juice has been used medicinally for generations.

Although this post has been sponsored by Xango, it certainly sounds to be a healthy alternative to the growing energy drink brands that boast more caffeine and sugar than your mother is willing to give you. As with any medication, too much can be a bad thing. Recommendations suggest smaller doses to avoid sedative or abnormal clotting effects. I assume it is for this reason that Xango promotes mangosteen juice as a supplement. So if you ever get the chance or have already tasted this unique blend, leave a comment and let me know what you think.

Giving Thanks

In this season of thanksgiving, I reflect on that for which I am grateful. My supportive family and friends are at the top of my list along with endless opportunities to serve my community. I am usually not grateful for the ability to grow so much hair on my lip, but this month is a little different.

Local Volunteer Opportunities

With the little time we have outside of classes, it is refreshing to give back to the community on occasion. Since we are in medical school, it commonly comes in the form of optimizing health through sports physicals or public screenings. Recently, I joined my peers in a 5k walk for chronic hypoinsulinemia on behalf of the Juvenile Diabetes Research Foundation (JDRF). In addition to raising money for a good cause, we caught a little fresh air and exercise at the same time.

In an ongoing effort to address prostate cancer awareness, men all over the world are "changing the face of men's health" by growing a mustache for Movember. I joined my classmates as Student Physicians for Fuzzy Philtrums, with the goal of contributing our follicular skills to this beneficial cause. If you have a prostate or love someone who does, please contribute to this noteworthy cause by sponsoring my fuzzy philtrum with a small donation. All proceeds go to the Prostate Research Foundation in cooperation with the Lance Armstrong Foundation. (After clicking the above link, you will be able to provide your contribution information online, if you have questions, please leave a comment.) Your generosity is greatly appreciated.

Board Prep Question of the Week

A 29 year old female with type 1 diabetes goes on a trip to the Caribbean and loses her insulin on the way. Three days after her last insulin dose she goes to the hospital. Lab work shows hyperglycemia and increased anion gap metabolic acidosis. Which of the following pathways is mainly responsible for providing the substrate of her acid-base disorder?

A. B-oxidation of fatty acids
B. Catabolism of branched chain amino acids
C. Citric acid cycle
D. Gluconeogenesis
E. Glycogenolysis

Answer & Explanation

Not On My Watch

Iatrogenic (caused be medical personnel) and nosocomial (obtained in the hospital) infections are unfortunately a sad reality in healthcare. When we visit the doctor, the last thing we want is to become more ill than our initial visit from an avoidable cause.

Healthcare Associated Infections

Hospitals are rightfully expected to get you better but that's not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staphylococcus (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

The fast pace medical environments such as clinics and hospitals make it easy to understand how healthcare professionals can facilitate the spread of infectious diseases from one patient to another. As simple as it is, hand washing is still one of the most effective means of reducing the spread of infection. Research has shown that alcohol based lotions equally accomplish the task in less time, hence the common practice of their use in medical facilities.

Healthcare associated infections not only have a significant financial impact on the medical system, but they are detrimental to the health of patients everywhere. The global campaign, "Not On My Watch" aims to educate healthcare providers how they can participate in reducing the spread of infection. If we all do our part, we can play an important role in the health of others and our own.

Board Prep Question of the Week

Five days after a mitral valve replacement, a 63 year old woman becomes hypotensive, tachycardic, and febrile. She is rushed to the CCU where an emergent transesophogeal echocardiogram shows multiple vegetations on the new mitral valve. Blood cultures are taken the patient is started on vancomycin and gentamycin. The initial Gram stain shows gram positive cocci. What additional bacterial characteristics are likely to be found?

A. Catalase negative with no hemolysis
B. Catalase negative with partial hemolysis and a positive quellung test
C. Catalase negative with partial hemolysis and no capsule
D. Catalase positive, coagulase negative
E. Catalase positive, coagulase positive

Answer & Explanation

Pathology Education

The second year of medical school certainly has a lot of information compared to first year. Fortunately, it is focused on the pathological abnormalities, which make learning the material much more fascinating. [Image provided by the National Cancer Institute]

Pathology

This field of study often associated with autopsies and coroner's investigates both the abnormal macroscopic and microscopic findings in anatomical tissues. Learning a subject that takes years to master is quite a challenge for the novice pathologist.

It has been difficult to narrow my study of the subject as there are so many sources to pull from. The professor has his way of disseminating the information and pathology review books are quite different from that style. I have learned that with more exposure to the subject, the better it falls into place. As with anything, repetition is bound to make a connection sooner or later. Since there is a grade at the end of all this, in this case I am hoping for sooner.

We started the year with cellular pathologies and more specifically when cells get out of control. One of the leading concerns today is cancerous growth whether on the skin, in an organ or rampant throughout the body. Although I certainly do not have a cure for it, I am just starting to appreciate what causes cancer and how it is manifested. Often times it is the result of a genetic deviation from normal that no longer suppresses rapid cell growth. However, there are environmental factors that contribute to the development of cancer too.

Examples of carcinogens include UV light, occupational chemicals, and even hormones. We are exposed to them in various amounts depending on our habits, environments and genetic vulnerabilities. There is little that can replace healthy eating, regular exercise, and minimal carcinogenic exposure. So until next time, don't get too much sun and stay away from those asbestos infested workplaces; it could mean the difference between life and death.

Clinical Corner

Asbestos Exposure

Despite workplace safety measures, exposure to asbestos has been linked to mesothelioma, a malignant cancer affecting the lining of the lungs and/or abdomen. Where pleural mesothelioma can cause difficulty breathing due to fluid in the lungs, peritoneal mesothelioma affects the intestines causing weight loss, pain, and fluid accumulation in the abdomen. The latter is also associated with bowel obstructions, anemia, and fever.

It is most commonly seen in individuals who work closely with asbestos or their families, but may not be symptomatic for years. Mesothelioma is diagnosed by a pathologist who obtains a biopsy for histological examination. It is treated by surgical removal of the organ involved, radiation or chemotherapy. It is difficult to treat and therefore has a poor prognosis. For this reason there are clinical trials being performed in an effort to find better outcomes.

Bicycle Transportation

We've only had three days of class and I already feel behind in my work. Between previewing lecture notes, reviewing lecture notes and reading the texts, I seriously wonder if I will have enough time to do anything else. At least getting to and from school will now be beneficial in relieving some of that stress. Check out my new wheels!

Scheduling Overload

Somewhere between the end of first year and the start of second year I lost a lot of important information mentally. As we cover certain subjects again, I can feel that sense of lost recognition. The professors certainly did not wait to open the flood gates and started in full force. After pharmacology and pathology were introduced, I felt my time would be well occupied. But it didn't stop there, they tacked on behavioral medicine, medical microbiology/immunology, clinical systems, osteopathic manipulative medicine (OMM), and objective structured clinical exams (OSCE).

On top of all that, I plan to squeeze in time for work-study in the anatomy lab, tutoring, several interest groups of which I'm an officer for two, and act as a "big sib" to a couple of the first year students. I smell burnout in the near future.

Stress and Anxiety Relief

In an effort to reduce some stress and use my time efficiently, I purchased a great bike at a great price thanks to Craig's List. Last year, I was in the worst shape of my life due to classroom inactivity. I'm hoping this year will be different. Amid the busy schedule, I don't see a whole lot of time for exercise and plan to ride my new bike to school instead of taking the car. Surprisingly, it takes almost the same amount of time to travel due to an abundance of traffic lights. At least this way I will be getting some movement into my otherwise sweat-less chair routine and burning useless calories in the process.

Summer Exercise

We've already had a few days with temperatures above 100 degrees and Summer is officially here. It's time to enjoy this summer vacation before school starts again.

Mental Exercise

With some free time on my hands and in an effort to avert the quickly growing student loans I currently have, I tried out for the game show Wheel of Fortune. As exciting as it would have been to tell everyone I won thousands and a vacation getaway, my Wheel experience ended in the second round of auditions. Phrase, only vowels remain... B_TT_R L_CK N_XT T_M_. Left without much money and a stubby pencil as a souvenir, I am grateful for the mental workout.

Physical Exercise

High on my list of priorities for this summer has been eating nutritionally and getting in shape. Exercising right is time consuming and physically demanding. With the right tools and knowledge, workouts can be fun and rewarding.

In my search for exercise tools I have come across a fantastic website that crawls the web for the best deals in online stores. They provide definitions and guides in choosing the right product that meets your needs without the bias of commercialized businesses. With filters to narrow your search, it could not be simpler to shop the internet.

I have been looking for heart rate monitors for a while now, because meeting or exceeding 60-90% of your maximum heart rate is a significant part of an effective workout. Using a heart rate monitor will provide instant feedback that helps determine your level of exercise intensity, a major component in physical training.

When exercise intensity is not elevated, pedometers serve well to be riding your waist. They help track steps taken throughout the day which correlates with overall daily activity. Using a pedometer can help you reach the recommended amount of 10,000 steps per day by taking the guesswork out of counting the steps yourself.

What better way to model your new electronic wear than with a new pair of trail running shoes. Whether your in the gym or on a nature hike, your feet are often the most important part of your training. Recommendations are to replace your old shoes every 300-500 miles to avoid injuries from lost shock absorption and uneven tread wear.

With luck and a lot of effort, by the time second year comes around I'll be a little healthier and more prepared to take on the new year as long as I keep moving.