Sunday, April 29, 2012

Corneal Keratitoldyousoitis

Black lines are Wife's eyelashes. Read below to find out what the green dots are...

It's yesterday, 8:00pm. I tell Wife that I am going to take 30-minute nap before continuing to study. Does she want to join me? Wife responds that she can't read her notes or see her computer screen well enough to study for her classes.

Before I continue, here's some background info:

Wife has been complaining for days about her blurry vision in one eye. For days, I have been telling her to make a doctor's appointment. For days, she has been putting it off, hoping her vision would magically improve. Instead, it has been getting progressively worse - and now she can no longer read.


I demand that Wife put her shoes on and ride in the car with me to Urgent Care, an place sort of in between a regular doctor's office and emergency room, open every day till 10:00pm.

We wait for 30 minutes in waiting room. Wife gets a room.

We wait for 30 minutes.

Wife gets interviewed, blood drawn.

We wait 40 minutes.

Wife gets interviewed twice more, vision examined. All she can read is a very hazy big E - nothing else. Awesome.

We wait for 90 minutes.

Wife gets eye numbed, lids examined.

We wait 30 minutes. Fluorescent dye is applied, and the slit lamp test is executed with a black light.

The doctor learns that wife will be a nurse and I will be a medical student in the fall; he offers to let me take a look through the scope. I ask if I can snap a photo through the scope lens with my phone; see the header photo above. Very cool.

Doc explains that all of the fluorescent dots are millions of pockmarks where the fluorescent dye has pooled. I'm looking at the surface of Wife's cornea, which should be perfectly smooth, with no green puddling of dye whatsoever. The bacterial infection most likely resulted from Wife wearing dry contacts for too many hours each day. Dry eyes --> lower resistance to infection --> infection --> inflammation --> corneal keratitis and impaired visual acuity. Doc scolds Wife for not coming in sooner, as she could have sustained permanent deformation of cornea if she had waited much longer.

Ohbytheway, corneal infection and inflammation increases risk of contracting tetanus, so Wife gets a tetanus shot just in case. No fun.

Exams start on Monday. Wife won't be able to study well. Wife gets doctor's note prohibiting her from taking exams until Wednesday at earliest. We are instructed to follow up with ophthalmologist Sunday if necessary, otherwise Monday. Industrial limitations = no driving for wife this week.

We head to Walgreens to fill prescription of drops and eye goop to go under the lids. 45 minutes later we're pulling through McDonald's drive-through to pick up food. 1:30am, we ravenously mash greasy delicious food into our mouths. 2:00am, we collapse into bed and I whisper to wife "Corneal Keratitoldyousoitis."

Good times.

Friday, April 27, 2012

Cold Sweat

Today I had my second ever "Last Class of Undergrad Education." I had the first one when I thought I was truly finished back in 2007, never knowing that in a couple years I would be right back in class, striving for medical school. I love being in class and learning, but there is just something sweet about the feeling of accomplishment when you finish something like an undergraduate education. I am glad I was able to have that ignorantly-blissful "Last Day" five years ago, as this one feels a little less...meaningful. I don't envy my fellow premeds graduating this year - the "traditional" ones - because it feels like they don't really enjoy this moment of accomplishment now as much as I did in 2007. For us in this situation it is overshadowed a bit by the looming mountain that is medical school.

When I was walking with one of the aforementioned classmates a couple of days ago, he mentioned how I have all this "life experience" that he and many others don't have. At the time, I just thought of this as all the time I have spent working at my job, or learning how to communicate in a marriage relationship, but I didn't realize the impact that this nontraditional life experience has had on my outlook until today. Medical school doesn't seem quite as huge or daunting to me because it's only four years long - and it has been nine loooong years since I was a college freshman. Hard? Yes, I know it's going to be hard, but it doesn't seem like it's going to last forever, or that it will be insurmountable in its difficulty. Plus, I won't have to be working a full-time job while I do it... Because that would be impossible. *Shudder.*

And so. I have one exam next week, and that is IT. Unfortunately, I did a small calculation and confirmed something chilling. The two-part exam next week (half recent material, half cumulative) is worth 250 points. Everything for the whole semester is worth 715 total points. That's right - this one test is worth 34.97% of my entire grade, slightly overshadowing the other three exams, four quizzes, and the research project we did. Our professor noted that she has had students go from an A to a C by failing this exam because they slacked off and didn't study toward the end of the semester. Trigger a cold sweat.

My take-home message: I will be hitting the books [note: books = digital notecards] hard this weekend. I want to end this thing with a bang, not some sort of pathetic, wet flop...

Thursday, April 26, 2012

The Medical School Insider - Great Resource

Occasionally I'll post a short blurb about a resource or app that makes the cut into what I feel is a valuable resource to anyone (student or just an ambitious future-planner) interested in medical school.

Well, The Medical School Insider just made the cut. It's a website put together by Mike Frazier, a med school grad and former admissions committee member from UCLA. If you've got a question about any part of the process - premed, med school, or residency - most likely he's already written an answer somewhere. His site offers a plethora of information which is only augmented by his blog and his book, 10 Steps to Accepted.

While I was already through the admissions process by the time his book was released, if it's anything like the rest of his stuff, it'll be a valuable resource to many future medical students in the years to come. This guy knows what he's talking about, so check him out!

Tuesday, April 24, 2012

Emergency Medicine - Mean Patients

When volunteering in my local emergency department, I was always impressed by the professionalism, patience, and servant leadership often displayed by ED doctors and staff. It is hard enough to strive for so many years to become a physician - taking all the classes, studying hard, sleeping less than you'd like, making sacrifices in relationships, finances, and free time - without having to feel belittled and disrespected by the people you're trying to help.

Emergency Department doctors go through all of that preparation only to end up having some (not all) patients yell at, spit on, insult, despise, and even physically assault them. I once heard a patient scream the most vile string of insulting curses that I had ever heard - at his doctor, who was just trying to calmly ask questions about the man's abdominal pain.

Sometimes, these negative interactions are because the patient has a mental disorder, or is under the influence of a substance. All too often, it's simply because the patient is a mean, nasty person who feels like he's got all the control. Somehow, there is a sense of entitlement that surfaces in some patients who go to the ED for care, and I've never understood it. It seems like when you're in the most need, that's when you would be the most polite, in the hopes that your doctor would then take better care of you. I understand the urgency that can come when you're scared you might die, or you're in intense pain, but what I'm referring to is something different. I'm talking about the patient that pees on the floor because he doesn't want to walk to the bathroom or ask for a bed pan, or the woman that screams at her nurse when denied a beverage until after her test results. These are the patients that nobody wants.

When I think about the possibility of becoming an emergency physician, I think interactions with people like these would be one of the hardest parts of the job. Being the one in charge and shouldering responsibility, thinking on my feet, doing difficult procedures, or filling out tedious paperwork - those tasks I think would be easier to handle. Staying calm and treating my patient with courtesy and respect while being yelled at, slapped, or spit on... Not so much. Losing a patient and delivering bad news would definitely be the hardest part overall, but I think dealing with vile and disrespectful patients while keeping my cool would be a close second.

This was all prompted by an article (linked below) I read earlier today by Dr. Jay M. Baruch, MD. He explains the situation well when he writes, "The emergency department might be the only sphere of human exchange where one party—patients (and sometimes family)—are permitted to insult, threaten, and even spit at the very people on whom they depend for help, while the offended parties—physicians, nurses, and other health care providers—must not only tolerate the abuse, but treat their tormentors." He goes on to tell about a specific interaction and his reaction. It's well worth the read: Dr. Douchebag - A Tale of the Emergency Department.

Sunday, April 22, 2012

MCAT Question a Day App for iPhone

Just a shout-out to all you iPhone users out there - there's a great app out there for studying in small chunks when getting ready for that whopper of a test - MCAT Question a Day. I used this one (and mentioned it in my post from way back when on How to Study for the MCAT) and I loved it even though it wasn't as pretty back then as it is now - except when I got one wrong, of course...
 Check the app out here!

Saturday, April 21, 2012

MSU CHM - Final Decision!

Ever since I truly dedicated myself to learning about all the different medical schools to which I applied, Michigan State University's College of Human Medicine has been my top choice. This is for a wide variety of reasons, many of which are embodied in the above photograph. This photo is of a huge engraved stone slab that graces the main entryway into the Secchia Center, CHM's Grand Rapids campus. I identify very strongly with the ideals written here in silver, which is why I feel that the "fit" between me and MSU CHM is a great one. These ideals are why I have gotten involved in many programs that seek to help members of at-risk communities. Ultimately, they are many of the qualities that I want to personify as a physician someday.

And so, let it not be a shock when I tell that you that I have officially decided to attend MSU CHM this coming fall!! I haven't shared every single high-and-low detail of my admissions process here on my blog, but this I gladly share. I am SO EXCITED to start my medical education there in August!!!

I can't wait to get a sweatshirt of this, the modified Spartans logo with the CHM x-ray skull in the center. Very cool.

Yesterday was MSU CHM's Second Look Day, which is basically a chance for everyone who has been accepted to get another look at the two campuses (in Lansing and Grand Rapids) as well as interact with faculty and current students. We began the day in Grand Rapids for tours of the Secchia Center and student Q&A panels, as well as presentations by representatives of different departments (i.e., financial aid, student affairs, etc.). We then hopped on buses for lunch during a guided tour of Grand Rapids before heading to Lansing. After continuing with a bus tour of the Lansing MSU campus, we toured the various facilities of the medical campus including the Clinical Center, Life Science building, the Radiology Building, the Learning Assessment Center and Anatomy Labs, and Fee Hall. 

We ended the day at a small expo in the Breslin Center, home of MSU's basketball team. Though the wood floor of the court was torn up for maintenance or something, I was able to get this pretty cool panorama from center court. It's interactive - check it out!

I got the chance to personally thank Dr. Joel Mauer, the Assistant Dean for Admissions, for the personal phone call he made to notify me of my acceptance to the school. I have never heard of any other schools giving every student a personal phone call when they've been accepted; it's usually done by email or snail mail. He responded that he feels like that method of delivery really exemplifies the personal attention that MSU CHM gives to each of their students, and I cannot agree more.

The day was incredible, and I couldn't be more psyched to start my education at this phenomenal school. The staff are incredible, the students were easy to get along with, and I think I will enjoy the different course formats once I get used to the swing of things. In short, yesterday got me pumped.

I will be requesting the Grand Rapids campus for a variety of reasons, first and foremost because it will be closer to my wife. That's right - we are going to need to live separately for a couple of semesters as Nicole works on her Nursing degree. Luckily, it sounds like the school will be accommodating in this matter, so I don't think it will be a problem to get placed in Grand Rapids. Plus, I already have a SWEET deal worked out to allow me to rent the basement from my wife's sister and brother-in-law for way less than I could find a room anywhere else. Blessings abound, and excitement increases that much more...

Thursday, April 19, 2012

Relaxed Morning

This is Naiya. She likes to lie on top of this old seaman's chest we have so she can be in the sunlight and occasionally look out the window. Obviously, she also likes to just sleep up there.

It is a lazy morning, no doubt about that. No class, I don't have to be to work until 1:00pm, and I just got done Googling rumors about the 2012 Macbook Pro... I'm relishing in days like this before the flurry of activity that will start in August. Tomorrow is Second Look Day at MSU CHM, and I can't wait. Right now though, I think I'll do a little more reading. Maybe take the pupper for a walk later. Already did dishes and cleaned. Just made a cup of coffee... Mmmm... Hah, Naiya just rolled over - gotta add another picture:

Sunday, April 15, 2012

MCAT Notecards Cheap - Jintus Study Online Now!

A while back I posted about how I studied for the MCAT, touching heavily on how I used digital notecards to study on-the-go as a nontraditional student. I have since decided to create an online store - Jintus Study - where I will make all of my notecards available cheap online. I recently posted about my motivation for doing this, also explaining how the store will function. Most of that is information is available on the store page as well (see the new tab at the top of my blog or just click here), so check it out when you've got the time!

Right now, I only have my Organic Chemistry cards available online. I hope to have all of my Inorganic Chemistry cards online in the next few days, but it might take me a bit longer to mobilize everything I have for Physics and Biology. You'd probably be surprised to learn just how much goes into creating the digital "products," configuring all the settings, creating descriptions for each product, bundling products together, creating pricing rules, page design, etc. The good news is that I already have all the cards made, so this stuff is really all that's left!

Anyway, I will definitely be updating each time new cards go live on the store. If you know of someone that owns an iPhone, iPad, or iPod touch who is getting ready for the MCAT (or is just taking Organic Chemistry right now) and might benefit from this, please help spread the word! For the curious, below are some linkes to Mental Case, the app used to create and display Jintus Study cards, followed by a short promo video.

Mental Case for iPad
Mental Case for iPhone / iPod Touch
Mental Case for Mac

For iPad / iPhone / iPod Touch:

Thursday, April 12, 2012

About My "Store-To-Be" - MCAT Notecards

Update: The Store is now live - click the My Store tab above, or just click here to visit.

The most frequent question that I get from readers (I never thought I would have this many pageviews, by the way - thank you for reading!) through the Contact Me page centers around my method of preparation for the MCAT. Many premed students have a hard time finding productive ways to cram all that biology, chemistry (organic and inorganic), and physics into their heads and still be "with it" enough to actually take that monster of a test. The process requires a huge amount of dedication and organization, and many students are searching for the "right way" to study. While I don't believe there is one "right way" for everyone, I definitely believe that some ways are better than others for many people.

I was in that exact situation one year ago, and the method I found that worked for me was digital notecards, specifically using the Mental Case software - read here for Mac, here for iPhone, and here for iPad. While the paid versions are great, you can use free versions if all you want to do is use previously-created notecards. While the software does give you access to some cards that were made and posted for free download through online exchange servers, those cards never had any quality images or chemical reactions (which you CONSTANTLY see on the MCAT) and frequently had errors. I didn't trust them. When I was going through all the free cards I could find, I constantly worried that if I used them, the material I was studying would be wrong, forcing me to relearn things once I found the errors. I decided it would be better to start from scratch and create my own study materials.

Before taking the practice tests and the actual MCAT, I used a variety of textbooks and all my old notes from premed classes to retake notes and create notecards. I ended up with 3,630 notecards of MCAT prep stuff - 620 cards for Organic Chemistry, 236 for Inorganic Chemistry, 2,371 for Biology, and 403 for Physics. I've added another 1,200+ for Biochemistry since taking the MCAT. Obviously, I went into much greater detail with the biological sciences for MCAT prep, but that was because it had been twelve years from the time I took freshman year biology in high school to when I was taking the general bio sequence over the two semesters leading up to the MCAT.

I made all those notecards, hundreds with hand-drawn images, chemical reactions, and atomic structures either done on paper and scanned into my computer or done on my iPad and digitally copied into Mental Case. I used them to study for the MCAT and was very happy with my competitive score, which helped me get accepted to med school, which I will be starting in the fall. Obviously, this system worked great for me. I now have all these notecards just sitting here - what am I to do with them?

I'll tell you what.

I'm going to make them available for other students to download. Unfortunately, this cannot be done for free, as it takes a lot of time to get everything ready for public delivery and presentation, and the online storage / hosting services are far from free. I am going back through to clean everything up, rewriting messy chemical reactions, rescanning images, and bundling everything together for online service. So far, I have most of the Organic Chemistry cards hosted online, and hope to have that subject and Inorganic Chemistry available (along with a "soft opening" of an online store here on my blog) within the next two weeks.

I really believe in this method of studying, both for its convenience and efficacy. Not only does it make a great way to study wherever you are without having to carry around inconvenient notebooks and flashcards, but all the stacks of cards are fully searchable. This was probably more useful to me than the ability to set up lessons or even tracking my learning progress (see the next paragraph). Can't remember the Henderson Hasselbach equation? Just type in "Henderson" in the search, and it immediately shows you all cards where that is mentioned. Can't remember the three stages of transcription, how an SN1 reaction rate can be increased, what reagent to use in preparing a vicinal diol in anti- conformation using epoxides, Bernoulli's equation, Coulomb's Law? It's all in there, just a quick search away.

It's easy to set up lessons, and the software automatically remembers the cards you get right and wrong using unique learning algorithms to create schedules based on spaced repetition. You can also opt to use an interpretation of the Leitner System, which moves notecards left or right through a series of virtual "boxes" - left if you get it wrong, right if you get it correct. When the card ends up in the right-most virtual box, the software considers that card "learned," automatically presenting cards you get wrong more often. It's simple, and it works. I highly recommend this software, which is already very widely used among students with Apple devices. I am way more productive in my studying than I was when I just used more traditional methods of simply reviewing notes and reading the textbook. I still do those things, but when it comes time to prepare for a test, this is how I study - and not just for the MCAT.

I plan on continuing to create these notecards as I go through medical school, posting the cards on this "store-to-be" for each class so that people who come after me won't have to spend the time creating the cards if they don't want to. I will send out an update once the store becomes available, and I plan on making sample notecards available for free in each subject. I will also update as each subsequent stack/subject gets released to the public. For now, feel free to ask me any questions you might have, either in the comments below or by using the Contact Me page. Also, please let me know if you (or someone you know) would benefit from this, as I'm trying to get a feel for just how many people might be interested in study materials like these.

Wednesday, April 11, 2012

No Milk? Make a Microwaved Bacon Omelet!

I have forgotten to get milk for the past three days, which means that I have been getting inventive with breakfasts because I can't eat cereal. A couple years ago my dad gave me a couple egg-cooking plastic containers for use in the microwave. I have used them a several times, but never before in a blog post, sooo...
Step 1: Toss some precooked bacon and a couple eggs into the cooker. No need for any grease or butter, thanks to the bacon.
Step 2: Break up the egg yolks with a fork, otherwise they explode. I found this out the first time I did this and they exploded violently enough to blow open the cooker container and leave egg bits all over the microwave.
Step 3: Add some cheese and pepper to taste, then microwave 1m 20s...
And here you have it - a tasty omelet-like thing with minimal cleanup and no milk required!
Thanks to the quick and easy nature of this breakfast, I had plenty of time left over to write this post! Now I just have to see about how I can help my wife get unsick. That's right - in our almost three years of marriage she has NEVER been sick, until now. Even through the less-than-sanitary conditions of the Bloody Wall Hotel, her immune system stayed strong. I think it's all the 2-hour nights of sleep she has been getting to manage working and being a full-time nursing student, but that is just me... Eesh. Get better soon, Nicole!

Monday, April 9, 2012

Hairs = Cut

Why? Because it's almost summer...
And because I can.

In other news, Second Look Day at MSU CHM is a week from Friday. I've RSVPed and can't wait! More on that closer to the day. As for now, it's time for a shower followed by some Anatomy auditing and then work... I've also been putting more time into notecard preparation, bundling, and web design for the online study materials store I've been envisioning... Again, more on that later. Have a great week!

Tuesday, April 3, 2012

Cheetah Robot Sets Speed Record

In non-medical geek news, I ran across this Popular Science article during a study break this morning. It took me back to the days of jaw-dropping amazement at seeing the Big Dog robot, created by DARPA / Boston Dynamics, with its eerily lifelike movements as it traversed uneven terrain, even catching itself from falling on slippery ice. Check out 1:27 in the video below to see why I always fancied it to be reminiscent of a newborn foal in its wobbly-kneed gait... Also, if you're like my wife and enjoy cute things (well, if a potential ancestor of civilization-destroying robot killers can be considered "cute"), you'll want to check this out too.

I love seeing robot videos like this, and while the idea of surgical robots might scare some people, I think it's awesome. The fact that the precision and deftness of robot movement can far surpass that of humans is exciting, especially when working microscopically. Frankly, the ways in which technology is changing medical training is really interesting to me. I recently read an article about how simulator training for surgical laparoscopic procedures was just as effective and even faster in reaching that efficacy than traditional training methods. Cool stuff.

Anyone have any favorite robot videos / technology-in-medicine news they'd like to share?

Sunday, April 1, 2012

Viagra Came From What?

Structure of Sildenafil, or "Viagra." IUPAC name: 1-[4-ethoxy-3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3-d]pyrimidin-5-yl)-phenylsulfonyl]-4-methylpiperazine.
I wonder why they call it "Viagra."
Did you know that Sildenafil, "Viagra" in market-speak, was originally developed as a drug to treat hypertension? I just learned this in Biochemistry, and found it pretty interesting. You see, it's all based on a little molecule called nitric oxide, or NO.

In humans, nitric oxide acts as an important signaling hormone in vasodilation, which lowers blood pressure. While it can come from a variety of sources, one way our bodies produce it is by the catalytic activity of NO synthase in the following reaction from arginine to citrulline and NO:
For people with hypertension (high blood pressure), having a drug that can help lower your blood pressure is a very desirable thing. Doctors in England were originally developing Sildenafil to do just that. As it went through drug trials, they noticed that it had the unique side effect of inducing erections in male test subjects.

Sildenafil enhanced a nitric oxide signaling pathway in the penis, resulting in inhibition of a specific phosphodiesterase. Phosphodiesterases degrade cyclic guanosine monophosphate (cGMP), which does a ton of very important things in tissues all over the body. In the penis, it helps regulate blood flow. So, more cGMP, more blood flow. When Sildenafil inhibits phosphodiesterase expression, cGMP levels rise, and you have a marketable treatment for Erectile Dysfunction (ED). Since Sildenafil was the first drug of this kind that could be delivered in pill form, they slapped a label on it and started making awkward commercials to air during Sunday afternoon Nascar races and Monday night football games.

Interesting how so many medical discoveries and inventions in general are nothing more than coincidence and mistakes...

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