Getting caught up?

"There comes a time when for every addition of knowledge you forget something that you knew before. It is of the highest importance, therefore, not to have useless facts elbowing out the useful ones." (like directions) - Sir Arthur Conan Doyle

"Never regard study as a duty, but as the enviable opportunity to learn." - Albert Einstein

"Live as if you were to die tomorrow. Learn as if you were to live forever." - Gandhi

In an effort to solidify a few of the approximately 1 million facts, processes, diseases, concepts and terms that I learned during year 1, I'm breaking out "First Aid for the USMLE Step 1." After spending my first 2 weeks of summer beginning a research project at the Center for Addiction and Pregnancy and the 3rd week relaxing at the Outer Banks with Matt and his family... I figure I can hit the books for the last 6 weeks. Here we go.

Testing

Just checking out the possibility of blogging on my phone. It's tough and slow-going actually. And I can't post pictures or video unless I buy a better version of this app. So, maybe I'll just use it for short facts I learn in class. Here's one: the "rate your pain on a scale from 0-10" doesn't work on kids under 7. You have to show them faces that are really sad and get progressively happier and ask the child to point to how they feel.

iPhone

Matt surprised me today with a stop at Verizon :)

White Coat Dance

White Coat Dance

Brain tumors and stats

A primary brain tumor originates in the brain. This is in contrast to a metastatic brain tumor that originated in another organ, like the lung or breast, and then started growing in the brain secondarily. There are different kinds of primary brain tumors, but we had a "clinical correlation" session with a patient that had a malignant astrocytoma. This just sounds bad.

It was a normal day. The patient remembers taking a different route home from work that day than he normally would have taken and getting off 83 North at a random exit. He then sat at the stop light just watching it turn from green to red to green to red. The next thing he remembers is being in the back of an ambulance. He had a grand mal seizure while sitting at the light. Everything happened so fast. "Like a lightening strike," he said. Within a few weeks he was having brain surgery on to remove a very deadly brain tumor.

The problem is that this was a particularly bad brain tumor to have. At the time, before some new advances in treatment and technology, 50% of patients died within 6 months and 96% of patients died within 2 years.

But here's the thing. Dr. Brem made a point that I will not soon forget. That I can't forget for the benefit of my future patients. "Statistics apply to a population. Statistics do not apply to your patient." For an individual the "statistics" are either 100% or 0%. You can't be 96% dead.

The patient ended up getting a left frontal craniotomy. Then things went from bad to worse when he got an infection at the site of his surgery. They had to do another surgery and remove about 1/4 of his skull. His coworkers left hats in his office, maybe more for their benefit than his because people could see the pulse of his brain through the skin on his forehead. He didn't know who brought which hat, but he tried to wear a different one each day and hoped he ran into the person who gave it to him that day.

After several weeks, or maybe months, this patient's scans remained clean. So much so that plastic surgery to replace his missing skull was an option. This was in 1991.

Twenty years ago.

It has been hypothesized that the infection was actually what saved the patient's life. Maybe the infection pushed his immune system into overdrive right at the site of the tumor, attacking and killing any remaining cells that would have allowed the tumor to grow back. So now they are working on mouse and non-human primate models of this "inducing infection (or chemicals your body makes to fight an infection) at the site of the tumor." Crazy. How awesome is it that this patient's seemingly unfortunate turn of events not only saved his life, but might have made available the idea that could save the lives of others?

White Coats

Thursday night was our White Coat Ceremony! Usually med schools have this rite of passage event at the beginning of the first year, but I loved the fact that we celebrated this occasion at the end of our first year - after taking the time to get to know our classmates. I was genuinely happy to see everyone walk across the stage to get cloaked by their individual advisor (and Clinical Foundations of Medicine leader).

The class of 2014 put together a dynamite program, complete with an original poem, violinists and a pianist, an acapella song, a slideshow of pictures from the year and 5 or 6 dance numbers. (I'm trying to locate the video of the dances.)

White Coat Slideshow

The icing on the cake was the presence of my family. Matt, my parents, sisters, brother in law, and Matt's parents came to support me and got to see how wonderfully inspirational my classmates are as well as my mentors. It's always nice for your family to have a glimpse into your world. Stay tuned for a picture or two. :)

Anxiety Disorders

Anxiety disorders are the most common psychiatric disorders. They include panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, hypochondriasis, and specific phobias.

Panic disorder is having recurrent panic attacks that interfere with functioning. A panic attack is a spontaneous and intense fear that includes physical symptoms such as an increased heart rate, increased breathing rate, nausea, intense fear of dying or losing control, light headedness, chest pain, chills, sweating, shaking, and shortness of breath. I didn't ask about fainting in the eye doctor's office... but let's just put that in here.

Generalized anxiety disorder is a pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event. It is associated with sleep disturbance, fatigue, stomach and intestinal disturbance and difficulty concentrating.

Obsessive-compulsive disorder is having recurring, intrusive thoughts, feelings or sensations that cause severe distress, but are relieved in part by the performance of repetitive actions.

Hypochondriasis is a preoccupation with and fear of having a serious illness despite medical evaluation and reassurance.

Specific phobias include fear of anything that is excessive or unreasonable and interferes with normal function.

These disorders stem from personality traits that we all have. We are all a little anxious or afraid in certain ways for certain reasons.