Nutrition Facts

It seems odd to begin a post like this, considering we are well into March 2011, but Happy New Year (to those of you with whom I only communicate via blog).  My latest hiatus from Vital Signs was a bit longer than one exam cycle, you may have noticed.  However, I have something that resembles a good excuse: The Senate Newsletter.

Recently, the Senate Newsletter Committee underwent a drastic expansion is both manpower and responsibility (I believe Spiderman would argue that one actually follows the other).  In our case, though,  the little team of Brandon and.... well, just me, has expanded to four writers!

So we've quadrupled in size, but that's not all.  Over the past few months, news of the project has spread at a surprising rate.  Let's put some perspective on our reader growth.  The first issue was put out in October and, while it received good reviews, our estimates put the reader number at around 100.  Still, a third of the class reading the thing is no small feat.  Our latest issue was sent out at the beginning of February: 637 views to date.  Not bad, huh?!  Of course, this means there are a large number of readers outside of our first year class, as well as at least a couple dozen administrators & faculty that I received word from personally.  It will be interesting to see where our numbers max out eventually.

If you're interested, below are links to the 2011 Issues.
January: http://ge.tt/4yMCgnC
February: http://ge.tt/3vEln3I
March: Coming this Wednesday

Aside from newsletter activity, I've finally finished up with Physiology and Biochemistry.  In fact, for the past 10 days or so, I've been enjoying my Spring Break! It's an odd feeling to essentially sit around and do nothing after remaining so busy with school for so long.  Dare I say that I feel guilty for not being productive?  It's amazing the way we train ourselves with routine to the point that anything else seems more difficult, whether that new lifestyle is generally considered less hectic or not.

The new round of classes includes the following: Neurosciences, Genetics and Clinical Nutrition (hence, the title of this entry - cut me some slack, wordplay is tough).  At any rate, I'm quite excited for each of them in their own way.  During anatomy they left us wanting more when it came to the brain - we basically learned the names and structure of everything outside the skull.  This time, though, I am assured that lack of depth will not be an issue and I'll be sorry I ever wanted to learn more about the brain at all.  Hopefully we'll be taught the path a nerve impulse must trace to assist my jaw muscle contractions as I eat my words later this month.

Nutrition, which has historically been a weak spot for physicians, will be interesting as well.  Aunt Diane - don't worry, I'll be paying extra attention during those lectures!

The word for me lately has been 'research'.  I've begun working with a vascular surgeon at one of the hospitals nearby on a project having to do with the abdominal aorta (big, honkin' blood vessel that serves as a conduit for dispersion of oxygenated blood to the majority of our tissues and organs).  It's quite exciting for me to see another side of the research world: undergraduate engineering research, selling software to researchers, and now clinical research.  I am eagerly awaiting our summer break in anticipation of a month or two of more rigorous experience as an addition to the part-time exposure I'm accumulating now.

With that, I will sign off with the promise to be a bit more consistent with my posting.  As always, thanks for reading.

Medical Factoid of the Day: Which pain medication should you take for a headache?  Why?  We learned the reasoning behind all that doctor-recommended Tylenol in biochemistry over the past few months.  There are two primary reasons for taking acetaminophen (the technical name) over NSAIDS (non-steroidal anti-inflammatory drugs like Advil, Motrin, Aleve, and aspirin).  The first reason has to do with its ability to reach the cerebral cortex and other brain tissue.  Unlike NSAIDS, acetaminophen can pass through the blood-brain barrier, which exists to protect brain tissue from many of the potentially harmful solutes floating around in our blood - most drug metabolites included.  This allows it to reach the tissue that is most likely causing the headache in the first place much more effectively than other analgesics.  Secondarily, acetaminophen selectively inhibits the enzyme activity of COX-3 enzymes that are implicated with many inflammatory processes.  Interestingly, the entire COX family of enzymes are involved in inflammation, but COX-1 and COX-2 (which is more directly inhibited by NSAIDS) are not present at nearly as high a level in the brain as COX-3 enzymes.  Tylenol works best for headaches because it can get there physically as well as halt the most pain-producing pathways.  Interesting stuff, huh?

A Lot of Heart

The blogging hiatus has ended!  Our exams have been more spread out lately, which brings positives and negatives.  On the bright side, it's nice not having to prepare for one marathon eight-hour exam.  On the other hand, when exams are spread out to once a week or so, it feels like there is always one right around the corner and, although the studying might be slightly less intense, study breaks are essentially eliminated.  That's my excuse for not blogging lately and I'm sticking to it.

As you might have guessed, with so much time passing since my last entry, I sure do have a lot to tell!  A week or so ago marked the end of Histology & Embryology.  The final exam was cumulative and encompassed roughly 1,000 pages of material including class notes, microscope slides and other supplemental information.  It's a nice feeling to get the first class behind me and it seems like I learned equally as much about 'studying in medical school' as I did about Histology.  Overall, I performed very well with my scores improving consistently on each exam.  If the trend continues (along with a lot of hard work) I will remain on pace to "honor" year one.

Earlier today I finished another class: Anatomy.  As far as I can tell, I won't experience another like it in medical school.  The lab component was... unique to say the least.  I am told that it will take a while, but I'll eventually be rid of the perpetual formaldehyde (an embalming preservative) smell from my nostrils.  Well worth it as far as I'm concerned.  Hard to believe I can say that I know virtually all of the muscles (and their insertions and actions), nerves, arteries, veins and organs of the entire human body.  Even more unbelievable is the fact that WSU managed to pack it all into our heads in just a few short months!  The absorptive capacity and rate of the human brain (any, not just mine in particular) never ceases to amaze.

Next on the update list is my recent intramural sporting success!  As you may or may not know, I am quite the dodgeball enthusiast and, as in previous years, I again organized a dodgeball team comprised of my classmates and I.  Playoffs were last Tuesday: a one night double-elimination tournament for the top four teams from the regular season.  My team, of course, took home top honors - the champs!  Check our our victory photo below.

Earlier that day I had the opportunity to view quite an amazing procedure.  A cardio-thoracic surgeon contact of mine invited me to 'scrub in' on an open-heart surgery!  The procedure was an LVAD (left ventricular assist device) implantation, mainly targeted for patients waiting for a heart transplant or deemed poor candidates for heart transplant, but still exhibiting heart failure.  A schematic of the LVAD device and its function is shown below.  I cannot express how absolutely enthralled I was at viewing a beating human heart two feet from my face.  In the near future I plan to shadow a few more surgeons in other specialties such as orthopedic, vascular, colorectal and any others I can get my hands on.

Next week I have a Clinical Medicine final exam, then the beginning of Physiology as well as Biochemistry.  I will be adding to the blog more frequently now that the majority of my exams are over, so keep an eye out!

Thanks for reading.

Medical factoid of the day:  During heart surgeries that require access to the atria or ventricles (pumping chambers), blood is rerouted through a heart-lung bypass machine.  This allows the surgeons to work on the heart without depriving the body and brain of oxygenated blood.  Usually the return flow from the machine is sent through the aorta, which routes blood to the body.  Since the machine does not perfectly simulate native flow, tissue and organ damage can occur over long periods of time while on the machine.  To combat this, surgeons substantially cool the blood, slowing the metabolism of body tissue and reducing the negative effects.  When the surgery is complete, the blood is warmed back up to body temperature and returned to the heart and lungs.

Cutting Class

Hello Readers!

It's been a while, hasn't it?  My apologies for the delay in posting this past week.  It sure has been a hectic October thus far.  We had our second exam at the end of September, marking the halfway point of Anatomy and Histology.  I wish I could tell you that it flew by, but honestly, it was a grueling couple of months.  Hopefully that doesn't sound too negative.  I can assure you that through it all I am still having quite a fantastic time!

Student Senate has finally kicked into gear with the first couple of Class of 2014 Senate meetings now under our belt.  Notably, I've started a Newsletter Committee to keep the class informed on senate issues as well as other important deadlines for the SOM (that's School of Medicine) as a whole.  Click HERE to download.  I created this one myself to get us started, but they will get better and better as the Committee gets on its feet.

A couple of surgery lectures sparked my attention this week.  One by the Residency Director of the Orthopedic Surgery Program at Henry Ford and one by a cardiothoracic surgeon from the same hospital.  As a nice change of pace, these guys gave it to us straight.  It was motivating, inspiring, a bit intimidating and absolutely thrilling to learn about the path one must take to make it in those professions.  To say the least, 99% of the cream of the cream of the crop fall short.  As the good doctor put it, bring your 'A game' or choose a different specialty.  I think something along these lines might be for me.

I spoke with the cardiothoracic surgeon after the lecture and have lined up some shadowing opportunities later this month in the operating room with him.  That will be a better metric of how well suited I may be for the specialty.  Surgery-related research over the summer was also indicated by him as a strong possibility if I so choose.

So things are rolling in the career research department.  After pushing it back a few weeks due to my exam schedule, I am finally getting into the ER later this month as well.  Everything I hear from those who know tells me that the earlier I know what I want to do, the more beneficial it will be for my future. A group dinner at my mentor's house (Chief of Medicine at Detroit Receiving) on Friday evening should also yield some valuable contacts and insight.

For now, though, it's back to square one: hitting the books with another month of intense learning ahead of me.  It seems that with each week I am refining my study habits and techniques further to evolve into the most efficient learner I can become.  It's analogous to fine-tuning a machine (although I certainly don't claim to be as productive as one) in that you find which modes of study work best, and at what pace.  For some material it's best to switch gears to a more hands-on approach than textbooks can offer; namely, the dissection lab.  Other times it seems that shifting down to a more repetitive practice like notecard review is the most energy-efficient way to go about things.  My guess is that each subject will warrant its own type of study, necessitating an ever-changing style of learning.  I suppose it's for the best, though.  That way I won't get bored! Only kidding, of course.

I think that if I listen very carefully I can hear the faint call of an anatomy book in the distance, so I ought to be getting back to my desk.  Thanks for reading, as always, and see you soon!

Medical Factoid of the Day:  Approximately 80,000 Americans every year are in need and eligible for heart transplants.  On average, 2,000 hearts become available.  While that statistic is indeed quite staggering, all hope is not lost for these patients.  For some cases there are measures that can be taken to bridge the gap between heart failure and when a heart becomes available.  Ventricular assist devices have made astounding leaps over the past decade and currently give approximately an 85% survival rate of one year or more for patients that are considered suitable candidates.  Considering my biomedical engineering background, I find some of the specifics of these devices quite intriguing.  The most intriguing statistic, unfortunately, is that despite the unrelenting awareness and education efforts by modern healthcare the heart donor rate has not risen in three decades.  Simplifying the situation dramatically, we as Americans must either convince each other to donate on the order of ten times more hearts per year or ramp up research efforts to fight heart disease on other fronts, giving a reasonable percentage of these patients a fighting chance.  Shockingly, with the Baby Boomers soon reaching retirement age, all of these frightful numbers will nearly double in the next twenty years.

Making Headway

Greetings!

What a week. There is much to catch you up on! But before I get to the fun stuff, let's set the scene a bit. This week we began the head and neck unit of anatomy. This includes learning about the vasculature, musculature and nervous tissue in the brain, spinal cord and surrounding structures. In addition, we have two new classes starting to go along with histology, anatomy and anatomy lab: embryology and clinical medicine.

Of course, the content of embryology is pretty straight forward - human conception and development. I am already astounded that any of us make it to birth. Honestly, there are so many complicated steps that birth indeed deserves its label, the miracle of life.

Clinical medicine, or clin med as we affectionately refer to it, marks the beginning of our training in bedside manner. We are learning about effective lines of questioning and how best to develop trustworthy rapport in a very short amount of time. I am almost certain that our professor was making a joke by showing a Monty Python clip in lecture, but the point was well taken. Those British goofballs were prepping an operating room with all of the most expensive equipment, but couldn't tell what was missing - the patient! The ironic point was - everything else ought to be secondary to focusing on the patient.

OK, now onto the good stuff. On Tuesday I cut open a human skull and took out the brain. It was spectacular. Of course, I was the one working the circular saw (wouldn't have it any other way). The complexity of our innermost workings never ceases to amaze. There were a few neurosurgeons wandering around the lab to answer our questions and it was fascinating to hear about some of the functional deficits associated with certain events, i.e. vision loss in one eye following blunt force trauma to the skull, sudden losses of consciousness.

People, it just keeps getting cooler and cooler.

Friday was elections for Class Senate. I thought it might be interesting to get elected Class Vice President. So I did.

It sounds easier than it was when I put it that way, though. There was considerable competition from two other qualified candidates and my victory was made possible only by a very well received three-minute campaign speech before the student body. Public speaking is like a sporting event. Adrenaline rush before you get up there. Those few deciding moments with no room for stuttering or verbal missteps. You leave it all at the podium and, let me tell you, there is no better feeling than coming out of it a success. Nothing better.

So the studying begins again. About 19 days until our next exam. Still don't have all of our scores back from the last exam, but so far I am satisfied. A slight improvement will put me into course-honoring territory. Considering that the first exam is historically the worst for everyone, I am in very good shape.

That's all for now. Thanks for reading!

Medical factoid of the day: The auriculotemporal nerve is a terminal branch of the trigeminal cranial nerve. It provides sensory innervation to the skin of the temple region on the side of the head. During development this nerve encounters the developing middle meningeal artery, which supplies blood to a protective membrane, the dura, that surrounds the brain and spinal cord. However, instead of coursing around the artery during development, the auriculotemporal nerve splits then comes back together, creating a very rare "needle and thread" appearance with the middle meningeal artery.

Exam Nerves

Hello again!

As the first Anatomy/Histology exam draws nearer, tension in lecture has increased to a palpable level. It seems like most of my classmates are relatively prepared, but still remain on edge since none of us truly know how this first experience will turn out. My philosophy thus far has been to spend my energy on studying rather than worrying, but I realize a healthy dose of anxiety does wonders for motivation.

Along with a couple of review sessions, this week included our very first nerve conference. It consisted of several patients with relevant nerve damage allowing us to question them about their deficits. It was then our job to use our anatomy knowledge to discern exactly which nerves and branches of nerves might have been damaged. Perhaps more than anything it served to remind us of why we are learning all of this information in the first place. It's easy to get wrapped up in the day-to-day struggles of cramming dozens of pages of lecture notes into our skull. Seeing a few patients every now and then is a nice reality check, and a much more effective source of motivation for me than that "uh oh" feeling.

Next week will be an exciting one. Tuesday will be my first round of free clinic work. I look forward to learning the ropes and speaking with the uninsured of Detroit. The clinic is largely Spanish-speaking, which will be an excellent opportunity to shake the cobwebs off of what I learned back in high school.

Alissa has been enjoying her last few days of freedom as she begins year two of physical therapy school on Wednesday. Understandably, she wishes she had a few more weeks to enjoy the summer (I wish she did too, for her sake). Selfishly, though, it will sure be nice to see her a little more frequently with her being back in Detroit for classes!

Wednesday, of course, is also the day of my exam: an eight hour marathon of practical anatomy identification, written anatomy questions as well as histology. Should be fun. I feel well prepared already, but certainly will not be taking any of the coming weekend hours for granted.

Until next time!

Medical factoid of the day: When the nerves of a muscle are irreversibly damaged, causing the muscle to atrophy, surgeons are often charged with the task of moving other properly functioning nerves and muscles into the defect. To accomplish this, surgeons look to several places in the forearm, wrist and hand where functional redundancies occur. For instance, one of the muscles that extends the little finger (extensor indicis) is assisted to a large extent by a superficial muscle called extensor digitorum which runs down the top of the forearm and hand. If a flexor of the hand is knocked out, extensor indicis and it's accompanying innervation can be relocated to the flexor compartment with only mild short-term extension deficit in the little finger. Amazingly, the extensor digitorum soon grows to compensate for the missing muscle.

Scrubbing In

Greetings!


With the first ten days of medical school behind me, I finally feel like I'm falling into a comfortable routine.  Orientation was a gradual introduction to the considerably more fast-paced week that would follow.


It seems an accurate assessment to say that I am already responsible for as much anatomy and histology material as I would have covered in an entire semester at U of M. All is not lost, though! The expected pace of absorption is surprisingly manageable (so far) if I simply stick to the 'ol lecture-gym-study regimen. I also have the sneaking suspicion that squeezing in a few meals each day will be very much a key to success :)


Wayne's facilities are impressive and the instructors knowledgeable. There seems to be a common thread of pragmatism underlying their lectures, making our newly acquired wisdom easily relatable to the procedures and protocols in gross anatomy lab.


The type of bond that will be formed between many of us through this 4-year gauntlet is already apparent. Excitement, intimidation, reverence: just a few of the emotions elicited at the proposition of joining such an elite fraternity of professionals.


For now, it's back to the books.


Medical factoid of the day: During select surgical procedures, it is beneficial to clamp the axillary artery. This can be done without depriving the upper extremity and shoulder of blood because that area of vasculature exhibits collateral circulation. This means there are two completely independent routes oxygenated blood can take to reach the same destination muscles.