Summer Semester: more than half over.

I found myself in a pickle the other day. I had an online test due by the next morning, so I hit up the library for some serious quiet time.  I headed straight up to the 5th floor, which is the best level to be on during the summer semester. Looking at the closing time, it didn't dawn on me that it was only a half hour away.  Laying out my papers, notes and setting up my computer, I commenced on my three hour limited test. 

Ten minutes later, "The library closes in 20 minutes." The soft voice most likely came from a freshman.     Anyways, my situation became real. I can't close my laptop otherwise my test will end, but I have to leave the library.  And I know I can't finish this lab medicine exam within 20 minutes.

The library has a 24 hour 'cell block.' I now have a goal in mind, but how to get down stairs without losing connection. With my belongings packed, except my laptop I decide the stairwell is probably the safest bet.  The campus elevators are just too slow!  With a small prayer and fast feet I take to the stairs. As I descend, my visual oscillates between the path and the internet bars. Third, second and then the first floor. Not once did I lose connection!  I finished my test in time, but not without a good sense of anxiety. 

Lately, I have been attending the local hospital for some required observations.  The first time around, I hit up the Cardiovascular and Pulmonary units. First was the cath lab.  Here I was able to witness a couple of exams where the doctor feeds a catheter into the heart, adds some radiopaque contrast and takes images.

  The first patient didn't necessary have a cardiac conditions, but they wanted to rule it out.  He did exhibit typical signs for pulmonary hypertension, clubbing of the fingers, smoker of 40 years, chronic cough and barrel chested. They found nothing significant.  The second patient displayed occasional mid-back pain, but no angina. During the exam, he had stenosis (narrowing) of the right coronary artery (Similar to the image below).  However, it wasn't bad enough to place a stent.

What was interesting, the right ventricle should have a systolic pressure of approximately 20-25mmHg, but this guy had an increase up to 85!

I then ventured over to the stress tests.  Here, they hook patients up to a heart monitor and 'pop' them on treadmills.  During the fast paced walk, the nurse is taking blood pressures. The blood pressure is suppose to increase during the exam, but only by so much.  Also, they obtain an ECG (EKG).  With regards to the non-ambulatory patients, they administer a drug that causes the heart to think it is exercising (vasodialate).  The ECG and blood pressures are taking as well.  What is interesting, the nurse will give the patient caffeine post non-ambulatory exam. This acts as a vasoconstrictor, slowing the blood flow.

The following week, I headed over to Radiology land to view MRI and CT.  I, at first was a bit annoyed because I have a seen a billion of them done.  However, I let go and went in with an open mind.  One of the most interesting exams noted was, syringomelia.  What?!  It is damaged to the spinal cord caused by an fluid-filled hole.

For those of you who don't know what your are looking at, this is an MRI of the cervical spine (Neck region). The vertebral bodies to the left, spinal cord in the center and the spinous processes to the right. The arrows are pointed at the syringomelia or syrinx for short. Not sure how they fix these (I assume surgery is the only option), but if not corrected, it can cause some major damage to the individuals nerves, motor, sensory and even paralysis.

The Semester is Almost Half Over

I can't believe I am 5 weeks into this 12 week semester. Flying!  

Last week we were introduced to cardiac murmurs and lung sounds.  Our professors have this ancient machine, okay if you consider the 90's ancient.  This old piece of machinery attempts to replicate heart sounds.  I would include lung sounds, but those were recorded on a cassette tape, yes a cassette and then transmitted.  We all had to wear this semi-stethoscope, instead of having a bell and diaphragm it contained a transmission box. This box hung from the ear piece weighing approximately 20 pounds, okay not so much, but my ears would agree.

Anyways, six of us entered the room at a time.  We placed the  weighted semi-stethoscope in our ears and then our professor would present a sound.  After fighting for a proper position for a clear transmission I was able to jump through this test.

You know your in PA school when you google images of currant jelly stool...Intussusception. (Ya, I dare you...)

Week gap...It is now 6 weeks!  Half way through the summer semester!  The best way to describe it, intermittent lectors with exam fillers.  Lately, each week has consisted of either 2 or 3 tests.  Though, because of the numerous exams we will finish behavioral medicine a few weeks early!!! Yes!  Don't get me wrong, psychological disorders are interesting, but to incorporate it as a mainstay...no thanks.

Now, about these lecturers, most of our classes this semester are taught by guests.  It is interesting to have a variety of educational methods, but we have had a few with less than understandable accents. And some with a good sense of entertainment and humor. Others, I would have rather poured tabasco sauce in my eyes!

On that note, a few of us ventured to the local hospital for a laboratory tour.  I personally thought it was  going to be a boring blood work tour. (Man, don't I sound like a pessimist during this post)  It ended up being extremely interesting. In fact, a pathologist assistant described her job.  She works closely with the OR docs in determining margin edges and cancer types.  For instance, the surgeon had just delivered a section of the sigmoid and rectum of a present patient (Fresh/hot of the press).  The cancer had not only thickened in some parts of the lower colon, but the disease had also eaten through the walls.  This allows feces to enter the peritoneal space and cause toxicity of the surrounding tissues and a lot of pain to the patient. So, her job is to take thin layers of the resected tissue  --> biopsy and inform the doctors on whether they removed all the diseased tissued and the type of disease.

Sorry about the graphic picture, but this is how it looked:

She also displayed a number of different diseased portions of body parts from previous autopsies and surgeries.  Everything from lung cancer, gallstones and 18 week old twin fetuses.  

Catching up

To start things off, I want to give a big shout out to my two oldest.  They had a dance recital last night and they both did wonderfully!  It was Grace's first and Hannah's, um maybe sixth? Grace did ballet and this was Hannah's first time dancing lyrical. Super pretty and talented lil girls!

Every year the AAPA (American Academy of Physician Assistant) holds a major continuing education seminar.  A couple of classmates and I headed over to DC to take part.  I found out rather quickly that downtown is ruthless when it comes to parking.  

Once we got established, we headed out: The Washington Convention Center.

This place was huge, but perfect for the amount of PAs that attended.

Even though the convention lasted for about 6 days, we had planned to only stay two.  We were told to  attend the first couple of days to obtain all the free junk. However, this year the exhibits didn't open until the fourth day.  Ya, a bit annoyed.  Oh, well. I at least got a couple of free pens and a shirt. 

The second day was all presentations.  One in particular regarding immediate treatment for burns was fascinating. The speaker showed videos on fasciotomy (nobody was prepared for the grossness) and surgical procedures for skin grafting. The basic idea for faciotomy is when injuries for example, a severe burn can lead to compartment syndrome.  The pressure placed upon the non-expandable tissue needs to be released.  This is done by cutting into the skin deep enough (usually the muscle) for excess fluids to be released. I can't help but think of a thoracic burn victim and his chest not being able to expand properly, so the physician will cut along the edge of the thorax allowing the lung to fully expand. 

We also listened to speakers on hematology, anemias and treatment for young broken bones.  I still have an interest in fractures and trying to diagnosis them via radiographs. Granted, I have always been a visual person, but I still lack desire for employment in orthopedics.

 What I have failed to mention is the fact that this convention occurred during memorial day weekend and remember it took place in DC...BUSY!  During my initial travels I saw a ton of motorcycles!  Some were local riders, but many of them came from varying states. One group held a flag stating they can traveled from California!

On my way home, I decided to drive passed many of the sites.  

This isn't my picture, but it replicates the exact  sea of motorcycles set out front of the pentagon.  I kid you not, there had to have been thousands of riders! In fact, the locals propped chairs on the over pass to solute the veterans on their bikes as they drove by. Motorcycle cops assisted in the crowd control on the freeways. I was amazed by all of the support. 

 I also did a quick drive by Arlington Cemetery.  Didn't see much because I was trying to get out of town before it became relentless.  However, Arlington Cemetery has always been on my wish list to see.  We, as a family are planning to visit it in the near future.

As I mentioned in a previous post, after studying certain disorders I start noticing little characteristics in individuals.  One in particular was the height and extremity length on a female.  I have no doubt she has Marfans syndrome.  This is an inherited d/o (disorder) which effects connective tissue.  The patient will present as extremely tall with long limbs and very skinny.  In fact, this female's hands went down to her knees, she was bone-skinny and you could tell that one lower limb was longer than the other because her iliac crests were not level and by her gait.  It can and usually effects the heart causing murmurs and other cardiovascular symptoms  

The positive note for this young woman was that she didn't let life hold her back and she is now teaching dance.

First Week of Third Semester

Just sitting here enjoying family time.  My mom and in-laws traveled from south eastern Idaho to celebrate my daughter's decision to be baptized!

It was a sweet and spiritual meeting!  

I am proud of her!

I just need to say 'Thank You' to my beautiful wife.  She coordinated all of this including meals and family time.  And I am grateful for my family and their willingness to travel across the country to celebrate this exciting time. 

The first week of the third semester became rather difficult with family in town and a large calendar shift.  Class times can be altered at any moment.  This semester incorporates a major load of lecturers (local doctors, PAs or NPs) and depending upon their schedule, we may have to shift ours to meet their availability. This is includes evening class times...bluh!

The list of classes include: Clinical Medicine II, Physical Diagnosis II, Clinical Lab, Behavior Medicine, Health Care Environment and Pediatric Medicine.  

Yes, this is a large load for a summer semester!  14 credits in 12 weeks!

So far, Pediatrics has caught my interest.  I don't believe it is the field for me. However, I am intrigued by fetal/maternal risks and how the neonate should present based upon his/her gestational age and size.  The heart functions (blood pattern) differently in a fetus than when the baby is born.  Anyways, some great information. 

Physical diagnosis II will incorporate H & P (history and physical), but now we will be presented with a patient (fellow student) and will have to assess, create a differential diagnosis and propose a plan within a 15 minute span.  Also, we will also be diving into the 'why's' regarding the physical exam.  In other words, what should we be looking for  and how a disease may present. 

Clinical Lab is all about what type of labs to order and what information will be provided with each.  

Behavioral medicine is just that.  We'll be reviewing the DSM V (The bible for Psychologists) to assist our decisions in whether or not a patient needs behavioral attention or not.  One thing I found interesting, the DSM has removed Aspergers and dementia from their possible disorders. These terms may still be used in the medical field. 

Health Care Environment is a course covering governmental and insurance type topics.  Luckily no tests, but we will have an assigned topic and will have a debate upon it.  

My goals this semester are to stay on top of each topic presented.  I will pre read and review each presentation.  I have attempted this same tactic, but each semester seems to catch up to me rather quickly.  Eitherway, I am doing it.  

Wrapping up the Semester!

This semester has been the most demanding yet! For me anyways.  Last semester I had the ever time consuming anatomy, which I greatly enjoyed. However, this semester was all about writing, something that has never come easy for me.  The last thing I ever want to do is write a 12 page paper (wrote three of them during this semester) or for one of our cases, a 26, single-spaced paper. The research (stayed up way too late for much of this) and understanding how statistical values are applied were daunting tasks as well. Though, I learned a great deal about medical articles. 

Last, but not least the drives to retirement facilities.  We would attend these required visits and perform an 'incomplete' physical and history on an elderly patient. The main challenges included their lack of mobility and their desire to talk...they would tell you the same family story three times before you could move on.  Though, some of them were absolutely amazing!  At 95 years old, walking, ability to read and teeth still intact.  That is an accomplishment!

We have been given the task of  "Long Term Care" patients.  We have two elderly individuals that we over see on a monthly basis.  It reminds me of home teaching. (For those of you not LDS, in our church we are assigned a couple of families to visit once a month.  Our duty is to make sure they are doing well and receiving spiritual nourishment.) Anyways, we get to visit with them, check with their physical and occupational therapists and over all make sure they are doing well. It is a great way to follow up on any new prescriptions, such as medications, radiographs or even exercise.  It gives us a sense of what the doctors are thinking. 

One of my patients isn't all there mentally.  A few of the other students have the same style of patient, so I wonder if the professors planned it this way.  Anyways, upon my first visit she was busy eating lunch during which time I went through her medical record.  Afterwards, I stepped into her room and asked her how lunch was.  Her response was, "I was at work!" 

"O, what do you do at work?" 

"Well, don't ask me that..."  She had been diagnosed with beginning stage of dementia.  In fact, she had no idea who the man was standing next to her in a picture.  The man happened to be her husband that had passed a few years ago. 

This picture is just a token of how one should prepare for exams: 

Finals!  O, finals snuck up quick!  Like most students, the thought of having to study 16 weeks worth of information within a day or two is just mind blowing!  I do everything I can to procrastinate it knowing that it's going to come raging out like a ferocious lion! 

The on campus libraries open their doors like a 7/11: 24/7 during the last couple weeks of the semester.  You'll find students camping out in the study rooms and the parking lots crammed! Seriously, they bring sleeping bags!

Recap of my finals week: Thursday we finished up our last Pharmacology test, which covered the gastrointestinal drug therapies.  We then had the weekend to study for the pharmacology final and finish up our research paper for biostats.  This paper included research for diagnosis, prognosis and treatment for corneal abrasions. To be honest, pharmacology was one of the more difficult classes for me, but I was able to pull through and got the necessary grade. 

We then had the rest of Monday and Tuesday to study for pathophysiology final for Wednesday. This was our last patho class ever!  Crazy! We then had the rest of Wednesday to study for our Clinical medicine final on Thursday.  This wasn't a typical final covering multiple fields of information, but it only covered the cardiovascular.  The CV alone is rather intense. I was just greatful that my case study, the one that ended up being 26 pages was all about both right and left sided heart failure. Having previously studied the content helped, especially by this time into finals week where most of my  ambition to study had been lost.  

I made it!  Two semesters are done! And now, I am enjoying a quick one week break with my family. 

This Semester...!

I feel like I have been neglecting my little group of followers.  I have been enveloped in the program which has kept me from updating this blog.  It's a good thing, yet I feel bad for not keeping everyone informed. Maybe I can put a Reader's Digest version regarding the last few weeks' events on here...

First off,  spring break!  That was sooo like 4 weeks ago...I think.  lol!  Anyways, I feel cheated!  A whole week off to do nothing and what happens?  It snows!  It dumped the white stuff for a couple of days.  And because of H'burgs lack of snow removal equipment we stayed in the house for a couple of days.  Hannah's school was cancelled.  Granted, they close school if there is any sign or threat of a snowflake, but still.  Now, my feelings of being cheated don't stem from having to stay in the house, but the factor that JMU closed school for two days, so I would have gotten out anyways! "I want my two dollars!"

I have previously mentioned the Biostats class which is a great learning class!  This last group project was all about prognosis.  In other words, forecasting or predicting the patient's outcome for a given duration. We are given approximately a 1.5 weeks to take our patient information, find background questions (answers to the who, what, when and why) and then find studies associated with the patient's situation.  The journal articles have to be applicable to our given patient and then we have to validate the article and it's provided material and results.  'WHAT?!'

I will just give a quick example. Our patient was a 35 y/o that had a lump in the inner, lower quadrant of her right breast.  After an inconclusive mammogram, she had a surgical biopsy.  The surgeon decided on a wide excision.  The biopsy brought back two positive lymph nodes, positive estrogen receptor and negative progesterone.  She had other prognostic factors as well which I won't bore you with.  We, the four of us set up shop in the library for hours.  I found that if I wasn't in class, I was at the library.  I  would go home to sleep and restock my food supply and then back to the research.

Man, I don't know how computer guys look at screens all day?!  I would get home and I would see a white rectangle!  Anyways,  I found a new passion in working through study journals.  I am still trying to fully understand all the statistics and how to either prove them wrong or right, but it is definitely interesting.

Disease and disorders...I feel like I'm judging people now.  Let me try to explain.  I had just learned about PCOD, (polycystic ovarian disease).  A disease that many women in their 20 -30's, that are obese, have hirsutism (abnormal facial hair on women) and irregular menstrual cycles are effected by.  Acne can be included in these signs and symptoms as well.  Anyways, I was in the process of paying for my fast food (blah! to fast food!) when I noticed the female cashier had a mustache, acne and was over weight.  The first thing I thought was, that girl is a prime candidate and should probably get tested for PCOD, if she hasn't already. You see what I am saying, I can't look at people the same. I have noticed clubbing of the fingers, neuropathy and now I have been noting peoples skin.  Does this ever stop?  

Spring Break!!!

Submitting my last assignment, I pressed 'Enter,' as if it were the precursor to freedom! I was reminded of the dramatic slow motion better portrayed in movies.  The zoomed-in shot of the villain, his finger progressing ever so slowly...'til BOOM! Okay maybe not so much, but I did feel a bit of excitement as I completed that final quiz!

    There were two major tests and a quiz that stood between me and a whole week of no classes! I swear the professors feel like we need to earn our spring break and I feel they place all tests the day or two prior to the vacation, so that we can appreciate it more.  Though, I would much rather take all exams prior to a vacation than having to worry about them during such time and take them after. 

Last week I headed to the 'Free Clinic.'  This small facility is associated with the Shenandoah Hospital in Woodstock, VA. Not the historical Woodstock, but the tiny, woodsy town that mirrors most other cities of VA.  Both doctors were absent that night, but there was an NP (Nurse Practitioner) and a NP student.  That was the first time I had ever heard of the NP program at JMU...anyways, I shadowed the NP for a few hours. During such time, I realized quickly that diabetes runs more rampant than I had thought.  I would say that 80% of our patients had a stage/type of diabetes. Also, if not all of the patients were poor or jobless, this increased the work load for the clinicians.  It made it more difficult to find an appropriate drug for the patient.  It wasn't so much as which brand or generic, but where might this individual obtain the right drug for the least amount of money.  They keep lists of all the local pharmacies and what they charge for each drug. (A local pharmacy even gives out certain medications for free, of course with a prescription.) These were definitely the underprivileged individuals. Granted I worked for a 'refugee-type' facility back in Utah, but this was still a great 'eye-opener.'

One particular experience associated to drug therapy, a gentleman stepped on a nail, which protruded through his work boot and produced an open wound.  The NP busted out her Sanford(a drug book that most clinicians carry.  It has the smallest font known to man!) and found the right drug.  The antibiotic needed to not only work on diabetics, but the major decision maker was whether or not the nail had a direct impact (minus the shoe) with the skin or not. Two separate drugs just because of excess material.

Well, Spring Break here I come!