I’m presenting Ehler’s Danlos Syndrome type VI tomorrow in our biochemistry small group. I won’t bore you with the details… it basically gives someone horrible joint pain (and rubbery skin). The wierd thing is, med school presentations are quite different from undergrad ones. I was about to go into gene length and the organic chemistry basis of collagen crosslinking when my partner looked at me funny and told me to think about my audience.

She’s right, you know. I guess Ochem was a necessary evil for a lot of premeds, and now that we’re done with it, we can just kind of forget about it.

So, tomorrow’s presentation will be Ochem light and diagnosis/treatment heavy. I miss you, undergrad research-oriented days.

So today we had our first physical exam class. Our instructor (a 4th year med student) was awesome, and basically gave us a tutorial over what are going to be our standard instruments over the rest of our lives. Always found in the “black bag” carried when making house calls, among other things.

	Stethoscope Used for listening to stuff. Also, not limited to listening to heart sounds, as I have mistakenly thought in the past. Can obviously be used for cardiac purposes, but also for gut sounds, blood turbulence through arteries (in conjunction with a blood pressure cuff, allows you to take blood pressure), lung sounds… etc. etc. etc. One of the big challenges in any medicine is visualizing the problem- this can take the form of high-powered MRIs, CT scans, and X-rays… or can be just as simple as listening to a heart sound and diagnosing a murmur. This is why you see docs stereotypically walking around with stethoscopes around their necks. They’re so damn versatile!
	Reflex Hammer We’re supposed to move away from the familiar, triangular reflex hammers, and towards the newer, circular ones. The reason for this is that in order to diagnose the strength of the reflex (which, by the way, is what the doc is checking for when he smacks your knee- reflexes are a measure of how well your muscles are communicating with your brain, in a sense. If they are too strong or weak, its time for a neurology consult), you need to reliably test it with the same force every time. So, the new circular reflex hammers allow you to position the hammer at 45 degrees, drop, and observe. Same force, every time. Brilliant.
	Opthalmoscope I’ve actually used this guy before. Essentially it’s a high-powered light with a number of different heads attached to it. The heads allow you to magnify the inside of people’s ears, focus on the retina of the eye, look in the back of someone’s throat, etc. Obviously the insides of people’s eyes are not particularly amenable to looking into without specialized instruments.
	PDA You’d best believe it. This will quickly become my indispensible best friend. In past years, medical students, residents, and attendings alike have walked around hospitals with white coats literally BULGING with books. Quick-diagnosis books, drug-interaction references, etc. etc. etc. There’s no way to remember it all, and when you’re in the room with a patient you can’t very well have every textbook known to man, so there is an entire cottage industry built up around providing quick-reference tables that can be carried around. The beautiful thing about the advent of the digital age is that most of these have been digitized. Instead of 10 reference books, you have one PDA. Quick, small, awesome. I’m kind of excited. Also, there are now ways to access patient records through electronic means, which means that many more things can be streamlined. Prescriptions can be checked against past drug allergies. They can also be electronically wired to Walgreens. …now I just need $400. Paypal box coming soon.
	Brain Nah, I’m just being cheesy. I’ve got no use for that.

So we had a really awesome lecture from this old cardiologist yesterday. I feel like we’re starting to get into some stuff that could be very useful in practical applications- how to read EKG’s, how to listen to heart sounds with a stethoscope, etc. He also gave us his quick primer on how to diagnose someone in congestive heart failure (CHF) from 6 feet away.

Turns out he was on a plane once, and an old, handicapped man started looking pretty bad as the flight went on. All of a sudden he starts breathing very quick and shallow. People try to get him to lie down on the ground but he won’t have anything of it- he fights to stay seated. Finally, his jugular veins are totally distended and bulging out of his neck.

The cardiologist asks for everyone’s belts and ties, and proceeds to tournequit the old man’s arms and legs as close to the shoulder and hips as he can get. Within minutes, the guy is feeling fine.

Now that’s the kind of medicine I think would be awesome to do.

In case you’re wondering how it all works, CHF occurs when the heart is unable to pump blood through the lungs (often due to fluid buildup in the lungs… hence “congestive” heart failure). This prevents the heart from being able to pump the blood to the rest of the body- and you get a massive backup of blood in the venous system trying to force its way into the heart. This is why the man had distended jugular veins.

The on-an-airplane treatment (i.e. when you can’t give them lasix or other drugs that will minimize the fluid buildup) is simply to prevent as much blood from getting into the heart. By tournequiting his arms and legs, the doc clamped down his veins and probably saved his life. Sweet. Turns out patients in CHF also will do anything to stay seated- lying down makes them fight for breath even harder.

Also, at the end of his talk he gave us a miniature moral lecture, on how he was a doc in WWII who helped the jews out of the concentration camps. He made specific note of the fact that in his last 40 years of practice, he’s never turned anyone away from his office because they couldn’t pay. People were clapping for a full minute after he finished. He was pretty inspiring… I doubt this post does him justice.

… and I have a test in my hardest class the next day. Who DOES that? I’m getting a class petition signed to get her to change the date. Apparently they tried last year to no effect. Gail, you’re on my list.

We’re learning how to read EKG’s today- I’m kind of excited. I think it’s one of those things that I associate with doctors.

Also, I should make a note of the asylum training we went to. One of the CUP programs that we can do is to help a doctor perform a medical asylum evaluation. i.e. a person coming from their home country needs to be evaluated for physical evidence of torture, and they need a doctor to write the affadavit. Well, we’re one of the places around the country that does it (apparently we gets a lot of asylum seekers from Africa because the weather is very similar).

It seemed wierd to me that the medical students would be allowed to do this. Between 40-50% of asylum seekers are granted asylum, and that’s only the ones with the aid of lawyers. Stats for people doing it on their own are much lower. Seems to me like with those kind of odds, you’d want a doctor who routinely performs these types of examinations, not a medical student. I get the impression that one of the doctors from family clinic (actually, the guy who prescribed the Prilosec to the woman with ulcers a few months back… if you remember that far) does them relatively often and is the person in charge- but at the training they were very up on the medical students being the ones DOING the exam.

I figure there are a lot of things that a completely untrained medical student can do. Performing a medical eval on specific types of torture… now that’s just a bit out of our league, and those people deserve all the help they can get.

Day 1… andddddddd GO!

So I went in for a dermatology appointment today (had a cyst that’s been bugging me on the back of my jaw… not like you care). Anyway, the dermatologist started telling me about what it’s like, why I should pick derm, and then said whenever I have free time, I can come and shadow her! She was pretty upbeat about how cool it is. It’s procedure-based, so you tend to fix the problem when people come in to see you (kind of important, really… shares something with surgery in that respect), and you get to see all sorts of cool infectious diseases and skin disorders. Plus, it’s pretty obvious WHAT you’re going after. Skin’s on the outside.

The other thing that she said that scared me a bit was “it seems like you’ve got all the time in the world to decide what you want to do… but realistically, that’s not true”. She’s not sure that our 3rd and 4th year give us amazing exposure to all the range of things you can do. So, I get to shadow her. I’ll let you know how it goes.