Med School Memory Part 1

Studying in medical school was especially difficult for me.  Although I sat in front of the class, I still missed a lot of what was said.  Having a note service helped, but still some things were missed.  Therefore, I spent extra time reading.  Getting up at 0400 hours was not unusual.  I would go for a run in the morning, and then hit the books.  My support system evolved around my closest friends.  But none of them usually got up early with me.  I would read for an hour, sipping a Red Bull, or local convenience store coffee.  Taking multiple small breaks so I would not fall asleep was essential.  Then came the lectures.  They started at 0800 and seemed to go on forever.  Breaks were lifelines of emotional oxygen.  At lunch, I would break out my peanut butter and jelly sandwich and go to town.  Sometimes I would try to take a power nap during lunch.  Another 3 to 4 hours of afternoon lecture, and then we were free. 

I saved money by checking out my text books from the library.  I had to read and re read chapters right there in the library.  I would use Kaplan study seminars on video tape to get ready for USMLE Step 1, or 2.  After studying I would probably go to the gym and work out.  Staying sane meant physical exertion and activity.  I enjoyed intramural sports like flag football or basketball.  In the evening, I would try to relax and that was when my roommate Eddie would be studying.  Thinking back, I thought the medical school years were the best of my life.  However, I am wrong, because these are the best years.  The circle of life.

The Hippocratic oath part 3

The study of Medicine allows us to utilize pharmaceuticals.  We trust our knowledge of the pathophysiology of the human body to determine which drugs are safe, and which ones are not.  We trust our knowledge to benefit patients and not harm them.  We studied the physiology of medicines and their effects on the body, and therefore feel confident when we prescribe them.  The 3rd part of the Hippocratic oath says:

"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

Our healthcare system has now evolved to include many different therapies that assist patients back to health.  Physical therapy improves strength, flexibility, and range of motion.  Occupational therapy improves activities of daily living.  In home care, senior services improve the lives of senior citizens.  New medicines improve different aspects of our illnesses.  Chiropractic medicine improves alignment and pain.  The healthcare system is massive and impressive.  As a physician, I have promised to utilize regimens to improve my patients' lives.  I am happy to be a social servant.  It is not just a job.  It is a calling.

Allergies

Our immune system is amazing -- it continues to evolve as we age.  It builds immunity and develops allergies all through our lives.  What our immune system thinks is foreign is something we cannot control.  We sneeze, itch, drain, cough, and feel miserable without having a say.  It just seems unfair!  If we feel miserable enough, we go to the doctor or the pharmacy for relief, and go on our merry way.

The main bad guy is called, "histamine."  He's mean!  It is released on our skin, in our airways and in our gastrointestinal tract.  When we have an "allergy," one or all of those systems are reactive.  We may have a hyper-response on our skin that causes itching.  We may have nasal congestion, itchy eyes, and ears, sneezing and sore throat or even asthma if the allergy response affects our airways.  And we may have abdominal cramps, diarrhea, inflammatory bowel, colitis, if it affects our gastrointestinal tract. 

Hopefully, our reactions are minimal, and controlled with little or no medication.  But if we have severe enough allergies, than we should get help.  If you have questions you can email me at runsinthewynd@gmail.com  or tweet at @askjustusmd .

"Are you sure you can hear well enough to be a nurse?" I remember the question as if it was yesterday.  Before medical school, I was a nurse.  I remember school and walking the halls of the School of Nursing in Bacone College in Muskogee, Oklahoma.  It seemed like it was never going to end.  The mornings would never end, the lectures continued without end.  I obviously had a sleep disorder because I fell asleep almost during every lecture.  It was embarassing because I was in the front row! 

I had to be up close to the professors because I have a hearing impairment.  I wear hearing aids every day.  I was born with sensorineural hearing loss, as was my baby sister.  We both wear hearing aides. 

The question haunts me because it sounded discriminatory.  At the time, I obviously was naive and innocent, and nothing should stop me from becoming a caregiver.  I didn't answer it truthfully.  I said, "of course!" and went my way, but deep inside, I needed help.  I bought super strong hearing aides and a super strong electronic stethoscope, and thus began my journey to become a caregiver for the sick.  It has been the best journey in my life.

The Hippocratic Oath part 2

The teachers pave the many trails of education.  Directly proportional to the time they spend teaching is the success of the student.  Most teachers I hope still believe in what they do.  When I read the 2^nd paragraph, to understand it clearly, I understand more importantly the value of the Art of Medicine.   During the years of medical school, internship, and residency, I respected those who taught me.  They have given me their time and energy, and thus invested in me trust for the common people. 

Considered an art long ago, now an advanced science, Medicine has now become so ubiquitous as to be a part of government intervention.  The United States government now invests nearly 4 billion dollars into Cancer research alone.  The medical community is truly blessed to be able to research newer ways to assist in treating patients.  None of this would be possible without our many professors of medicine.  Hippocrates saw this as an art however, back in the ancient times.  The second paragraph divulges into the arena of those who taught the art. 

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

Nowadays in med school we are taught all of the science of medicine.  We learn the mundane details down to the chemical reaction between the molecules in all physiological pathways.  We learn the various organic structures in pharmacology.  But we forget sometimes about the Art of Medicine. 

Hippocrates reasons that the bonds of our fellow colleagues include an understanding of what Medicine really is.  While the scientific method wasn’t constructed until way after Hippocrates wrote his treatise, the basis of most science started with an Art.  Early astrologers painted stars before they realized that a mathematical construct could predict when stars would be in certain points in the sky.  Early inventors practiced many voluminous drawings of possible technology prior to creation of the machinations detailed by scientific knowledge.

I remember watching a German film in med school Ethics Class, "I Accuse! (Ich klage an!).”  In this movie, a woman with multiple sclerosis asks her husband, a doctor, to permanently relieve her of her suffering. He agrees to give her a lethal injection of morphine. At his trial he argues that he committed an act of mercy, not murder. He is acquitted. 

Medicine in some countries practice assisted suicide, and we learned that ethics and law dictate a lot of what we are able to do with our patients.  I remember the patient actors and actresses who play acted their disease process and we were graded on how well we listened, how our diction sounded, and how much compassion we showed.  It was good practice, and I just now remember that it was part of the art of medicine. 

Teaching Ethics in Medicine, the principle of beneficence, self autonomy.  Directly corresponding to a Constitutional right to life liberty and pursuit of happiness, medical ethics opened our eyes.

The professors themselves were varied in style in personalities, and color.  I learned a lot from few and a little from a lot, but I always respected them as the expert.  I depended on every word they said.  Having a hearing impairment required me to pay very close attention at the front of the class.  That attention I paid in lectures is the same attention I pay to my patients.  I am intending to help someone, so I need to be listening intently. 

Now practicing medicine has allowed me to teach others, my patients, my nurses, assistants, and anyone who is willing to follow the wonderful education of medical knowledge.  I hope to help set a good standard for others to follow.

The Hippocratic Oath part 1

On the wall in my office sits a large framed art piece.  Ronda, my mother-in-law, drew and painted a beautiful rendition of Old English style writing, with large colorful drawings of different anatomical structures, including the vertebral spinal column, pelvis, a shoulder girdle, and an intrauterine fetus.  She had burned the edges of the page to give it an “aged” look.  As I began to read, I remember taking this oath both on the first day of medical school and on graduation day.  That was nearly 5 years ago.  The first paragraph says:

“I swear by Apollo, the Physician, Asclepius, Hygieia and Panacea and all the gods as well as goddesses, to keep according to my ability and my judgment, the following Oath and agreement:”

I wondered long ago who and what those entities were.  Why did these names have a place in our oath?  What was the reason that we have Greek traditions in this society?  How is modern medicine evolving?  Ancient practitioners believed in many different entities.  Medicine men of the Native American Tribes believed in Mother Earth.  Mayan practitioners believed in the Vision Serpent.  The Greeks and Romans impressed upon us in many ways.  We still have a Senate, and architecture all over the U.S. replicating Doric, Ionic, and Corinthian structures of old. 

Before Christianity was spread to the Greeks and Romans, the gods and goddesses were worshipped as those who could take away disease as well as cause them.  The goddess Febris, could cause fevers and cure it.  The Hindi goddess, Sittala, did the same.  Apollo was bringer and reliever of plagues as depicted in the Iliad.  The goddess Hygieia, the daughter of Asclepius, was the guardian of health or disease prevention, and Panacea, the goddess of healing. 

I remember reciting these words but not knowing what they exactly meant at the time of entering medical school, and then having an idea of how it related to the modern practice of medicine when I graduated.  It was revolutionary when it was written over 2500 years ago.  Prior to this time, doctors and magicians were practitioners of the same science.  William Osler wrote in “Evolution of Medicine,” that magicians and sorcerers were the only ones to cure disease, while doctors treated symptoms.   

Medicine in the past was an assortment of concoctions, potions, poultices, fumigations and the like.  We still have that today.  We still have spirituality that existed prior to Christianity and worshipped many different gods, where today we have religion based from many important figures, including Jesus Christ, Mohammed, Siddharthama Gautama Buddha, and the first Brahmins of Hinduism.  While centuries have passed and sorcerers and magicians and physicians practiced different traditions, we still practice new ones today.  Today, many Americans swear on the Bible an oath to tell the truth the whole truth and nothing but the truth so help me God, in a court of law.  Also, in America we have freedom to practice any religion, thus different oaths. 

The Hippocratic Oath, as the first of its kind to separate humanistic medicine and the practice of the inhumane, was and is fundamental for all physicians to remember.  It is an oath worth repeating and remembering.  We are trusted professionals, and we serve the public, the common people, because we care.  We swore to that.

Cramping, Intermittent Diarrhea and Abdominal Pain: What am I?

These three symptoms are included in a wide variety of illnesses, but the most common is possibly an inflammatory bowel disease, or irritable bowel syndrome.  If these symptoms occurred after a cold, it could be a viral gastroenteritis.

When someone has inflammatory bowel disease (IBD), parts of their GI tract will “flare up,” and cause many symptoms such as irregular stools, bloody diarrhea, and abdominal cramping.

I have noticed also, some patients will develop fatigue, malaise, a low grade fever or night sweats.  Joint pains have been associated with IBD.  But usually the first symptom is fever.  Fever is simply your immune system working overtime to get ride of an infection or inflammation.

If you have emotional stress, or history of emotional, psychological or sexual abuse, or dietary indiscretions, you may have recurrences of IBD. 

If you have these symptoms and also complain of pain around the anus, you may have Crohn’s disease.  Crohn's Disease is an autoimmune disease where the immune systems attacks the colon.  Weight loss is seen more in Crohn’s disease because the colon doesn’t absorb digested foods as well.
 
It can take years for someone to be diagnosed with IBD.  If you or a family member complains of recurrent abdominal pain, fevers, and diarrhea, please come in to see your doctor.   

Feeling tired all the time? What is Chronic Fatigue Syndrome?

Fatigue is feeling down with little energy.  The loss of the “get up and go,” is a common complaint.  The problem that doctors have is we don’t have a test for fatigue.

Fatigue is a symptom that a person expresses to us.  We can’t get a lab test for it.  We can’t image a portion of the body for it.  Doctors are scientists and we work with facts that are scientifically validated.  So we are at a loss sometimes when one complains of fatigue.

Chronic Fatigue Syndrome (CFS for short) has been called many names in the past including “Myalgic Encephalomyelitis,” and “post-viral fatigue syndrome.” 

The newest data and updates on it support a few facts that we know about it including that it tends to occur after a viral illness, tends to last longer than 6 months, and includes symptoms such as: mild fever, recurrent sore throat, painful lymph nodes, muscle weakness and muscle pain.

The reason we call it a syndrome is because there is a number of symptoms that occur in CFS.  In addition to the above symptoms, one could have migrating joint pain or stiffness, recurrent headaches, sleep disturbances, and even neurological deficits like forgetfulness, and confusion.

CFS is debilitating and depressing because people who feel tired all the time will get depressed. 

When a physician evaluates you for CFS, they will check your blood pressure because most times low blood pressure is found.  Also a slight temperature or fast heart rate could be found.  

We would then check labs including ruling out Lyme disease, lymphoma, leukemia, HIV, and thyroid disorders.

Treating CFS is also a difficult thing to do for doctors.  Mostly rest, moderate activity, no exercise, and if any infectious etiology is found, then antibiotics can be used.  If the etiology is truly viral, there is no treatment. 

Vitamins and supplements have not been found to be effective, but Coenzyme Q 10, and vitamin
B 12 may lessen symptoms.

An herbalist may prescribe Astragalus Ten Formula which combines Asian ginseng, licorice, and astragalus in powder or tablet form.  However as all with many chronic illnesses, one has to accurately get a diagnosis to get adequate treatment.

Thanks for all the questions and comments.  Have a great day and let me know if you have any questions.

runsinthewynd@gmail.com

Growing Old Pains

No one likes growing old.  The most common phrase my elderly patients tell me is, “it sucks getting old,” and I believe them.  It is one thing after another. 

For doctors who treat elderly, many different issues are important to discuss including how well you function with simple activities of daily living.  A patient is either highly independent or very dependent based on how well they bathe, dress, toilet, transfer, or feed them selves. 

Not only are activities of daily living important to assess, we need to know how your hearing is, how well your balance is, your cognition, in fact, we need a team of professionals to adequately evaluate an elderly person, including social worker, nutritionist, physical and occupational therapists.

Doctors can and should do a general physical exam on elderly to evaluate nutritional status, balance, hearing, etc. 

The social worker evaluates suitable living arrangements whether in a family’s home or in a skilled nursing facility.  The social worker is very important in attending to many of the needs of the family as they make hard decisions for their elder parents.

Physical and Occupational therapists are specially trained in evaluating the functional limits of elderly people.  They evaluate how well the range of motion is on all extremities, flexibility, strength, ability to walk, etc.  They are super important for evaluating for any disability, and provide recommendations for proper management of those disabilities.

Balance and fall prevention is an important evaluation of elderly, as falls are number one cause for hospitalization in people over age 75. 

Polypharmacy, osteoporosis, dementia, and depression are all issues that doctors try to evaluate.  Sometimes appropriate elderly evaluation takes more than one visit. 

If you can get these evaluations done over 2 or 3 visits, the doctor will have a good idea of assisting you in the “golden years.”

Thanks for the questions and feel free to email me at runsinthewynd@gmail.com