One Year...Check!!!

What a relief!  Seriously!  I am sitting in Idaho miles from campus enjoying my three week break.  These last few weeks of school have been nothing but a blur.  First, my wife and daughters took off to her parents for an early start to summer vacation.  And I, well, I hung out and finished up the last three weeks of the semester. 

Besides the usually 3 tests a week and lectures (I was so done with sitting in class!), I had my turn at the free clinic. The local free clinic provides affordable healthcare for those without an income or low financial standards.  In fact, it covers not only Medicaid, Medicare but, no insurance carriers.  Anyways, what has typically occurred is the student will go there and have a few minutes (20 - 30) to look over the patient's chart to gain an understanding of the history and condition of the patient. The first thing my professor, who works there tells me is that there is not much time.  I had five minutes before she had me introduce myself to the patient.  To add to the lack of time, the individual was a non-english speaker and the translator wasn't good at relaying everything.  

The hispanic patient had a history of headaches and neck pain (nuchal rigidity).  She had previously had an MRI on her head/brain and a lumbar puncture (LP).  The LP was to rule out meningitis.  The MRI  revealed what is called empty sella.  So, your pituitary gland sits in the sella turcica of the sphenoid bone of the skull. This little baby helps regulate and secrete specific hormones involved in the endocrine system. Based upon her labs and the MRI, the gland was either being smashed by a tumor or shrunk.  If a tumor is involved the hormone levels are typically elevated.  Hers were on the lower border of normal, which is indicative of empty sella.

Here is a skeletal model highlighting the sella turcica where the pituitary gland is located.  In fact, the boney structure surrounding helps protect it.

Another picture of the gland and sella turcica.

A close up of the gland via MRI.

Last picture showing what an empty sella looks like on MRI.

There isn't much they can do for this patient.  In fact, she just continues to live with the headaches. 

A fellow student visited with another patient.  This individual was suffering from "trigger finger."  Her fourth digit (ring finger) of one her hands had a nodule on the palmar side at the CMC (carpal metacarpal joint). Also, her finger was stuck in a flexed position. 

What's interesting is this disorder disclosed itself just after a steroid shot in that joint. 

We wrapped this semester up with 3 tests and a practicum exam.  One of our professors invited a few individuals from her church to play patients. We blindly walked into to a scenario.  We were to perform a focused history and physical (H & P) on these individuals.  There were four patients with four different diseases/disorders. We were assigned one patient only. The main purpose of this exam was to properly gather correct information, perform a specific focused physical exam, create a differential diagnosis and explain to the patient what type of labs or x-rays you would order.  

For example, my patient was an 62 African American male. His chief complaint was "shortness of breath."  The other patient's complaints were "tingling/numb feet," "abdominal pain," and "chest pain." 

After finals, I hopped on a plane and headed to Idaho.  I was extremely excited to see my family after 3 weeks of quiet, boringness.  It's amazing how much they grew within just a short period of time.  Anyways, Abby and I hit up the Temple.  Our goal has always been to visit the house of the Lord at least once a semester.  This time there was another reason, they have a new video.  If you have not visited the Temple lately, I would encourage you to go.  There is nothing better than inviting the spirit of God in your life.