Category Archives: Friday Rewind

The Friday Rewind 3/7

Time for the the Friday Rewind again! Here is the best and worst of what the week had to offer.

1. The Best of This Week

  • Earlier this week we had a hands-on lecture on how to perform the Musculosketal exam. I am not sure if it was the physician who taught the course or the fact we got to do it together as a big group–half of the med students were paired up in one room–but this was one of the most enjoyable classes I have taken in my first year. My medical institution is all about technology, which of course as a technology aficionado, I love. But it was very refreshing to hear a physician highlight the importance of the physical exam. No amount of technology can ever replace what we can learn through observation and our hands. I walked away feeling like my hands had new powers. I feel confident I can correctly identify any suspect sprained ankle or swollen knee–which I learned could just be bodacious fat pads, so it is good to know what you are looking for!
  • I had a 3 month follow-up with my cardiologist to discuss the new medication he put me on (pyridostigmine). I told him it helps with keeping my tachycardia at bay and limits my  palpitations  BUT it does nothing for the symptoms I really care about like chronic pain and fatigue. I was actually pretty surprised by his response. He said “great!” the medication is doing exactly what it is supposed to—we both knew it wouldn’t really help with the neurological symptoms but at least your heart is responding well. He said that this is probably as good as I am going to get and that in comparison to other POTS patients I am doing exceptionally well. Not having anything to compare to I didn’t realize I was actually a sterling example of the best case scenario for some people. This made me feel pretty good. All of my hard work in making sure I keep up with lifestyle changes has been paying off. He suggested my next step should be to try some eastern medicine things, which I am pretty curious about. I shall keep you updated with my foray into alternative medicine…
  • I am not exactly sure what this says about me, but I got a new vacuum this week and that made me really happy. We are about to start 2 weeks of intense examinations, we don’t even have any classes, just dedicated study time and exams– and nothing helps me prepare for exams better than a clean house. I spent the morning cleaning my entire home and now I feel ready to crush my histo and pathology exams on Monday. That is of course after I spend all weekend studying in my very clean home.

2. The Worst of This Week:

  • I had my anatomy dissection of the plantar foot this week. I love medicine but spending 3+ hours around cadavers is just not something I can get used to. I may still be jaded from my last exam but this is the class I have enjoyed the least in our training. Nothing will feel better than that Anatomy shelf on Friday, June 13th, which will mark not only the end of anatomy (forever!) but also the end of our first year of medical school!

3. Medical Breakthroughs of the Week: 

  • Researchers Report Treatment Clears HIV in Second Baby: Evidence is increasing that treating HIV-positive babies within a few hours of birth can dramatically restrict — and perhaps eliminate — infection.The baby, born at Long Beach’s Miller Children’s Hospital, was given triple drug HIV therapy starting within 4 hours of birth to a mother with untreated HIV.Tests at birth showed the presence of HIV DNA in the baby and testing 36 hours later — 32 hours after treatment was started — showed a plasma viral load of 217 copies per milliliter. A spinal tap when the child was 6 days old showed 32 copies of HIV RNA per milliliter of cerebrospinal fluid, Persaud reported. But within days, almost all signs of HIV had disappeared. The plasma viral load, for instance, was and has remained undetectable, defined as fewer than 20 copies per milliliter.

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis? (My medical school friends better get this histo themed challenge!)

Screen Shot 2014-03-07 at 3.43.46 PM

A) Adenocarcinoma

B) Candidiasis

C) Dieulafoy’s lesion

D) Schatzki ring

E) Systemic sclerosis

*Courtesy of the New England Journal of Medicine. Answer in the comments sections. 

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The Friday Rewind 2/28

It’s hard to believe it is already time for another installment of the Friday Rewind! Here is the best and worst of what the week had to offer.

1. The Best of This Week

  • Participating in a colonoscopy simulator research study. UCI is just one of six institutions in the nation that has this technology, which made it pretty exciting to test out. It felt just like a video game, except for the colonoscope controller, but apparently the real thing is  comparable to what I was able to experience. Although I am not a big gamer– actually I am  among the limited few in my generation who never played video games– I scored a respectable 100% in polyp removal!Main
  • Learning about a whole spectrum of genetic disorders and diagnostics that were completely foreign to me until this week. I didn’t get a chance to take a genetics course as part of my post-bac program so all of the clinical correlates we’ve been learning are brand new and intensely interesting to me. It is estimated that all people carry about 20 recessive genes that cause genetic diseases or conditions. Of course, it’s only when a person has a child with a partner that carries the same recessive gene mutation, that there is a chance of having a child with a recessive disorder.  This has got me thinking a lot more about potential future children and the unfortunate (silent) things my husband and I could be passing on to them. On a separate note, I think this officially signals that I am getting old, as these are the new mundane things I worry about. You know you are crossing over into true adulthood when you watch movies and start siding with the parents vs the rebellious teen lead…
  • Now that I live in California I can’t get away with adding on those extra “winter” 5 lbs. It has been in the 70s (except for the much needed rain we are getting right now) and I really need to step up my healthy living routine. No more lazy microwavable meals! I am back to eating fresh, homemade dinners full of veggies and good for you things. I also stepped up my work-outs (as much as my back injury allows) by adding a nightly brisk walk with my husband. We did 3 one-hour night walks this week, which were not only good for our health but also time well spent catching up on future dreams (like the mountain home we want to one day buy…).

2. The Worst of This Week:

  • I was all set to travel to Mexico tomorrow morning to help run an underserved clinic I am involved with — until I came down with a nasty case of gastroenteritis. In an unfortunate twist of irony–I think this is what you are supposed to come back from Mexico with not go there with–I am too unwell to see patients, which made me feel like a cast-off, harboring some dangerous microbes. Very disappointing since I had been looking forward to this trip for a few weeks now.
  • Realizing I have 5 exams on the horizon, two of which are national shelf exams. A shelf is a cumulative exam in a particular topic (Physiology and Histology in my case) that you take together with other medical students across the country so your school can see how well you stack up against other med schools. Fun.
  • 8 am classes. Yes, becoming a physician means lots of early mornings and limited sleep. But being forced to be in class due to some ill-thought out mandatory attendance rules makes me grouchy. I also felt sick for the last few days, so that combination made me particularly cranky. If I didn’t say hi to you this week in class, please excuse my rudeness!

3. Medical Breakthroughs of the Week:

  • In keeping with our genetics trend for this week: Rocky Road for Mitochondrial Transfer
    Altering mitochondria during in vitro fertilization (IVF) as a means of preventing disease transmission won’t be moving to human trials any time soon, according to experts at a 2-day FDA hearing.Mitochondrial transfer — which some have termed “three-person embryo transfer” — was developed to prevent transmission of mitochondrial disease from mother to baby. This type of disease is rare in the U.S., with about 1,000 to 4,000 cases per year.Although there are different approaches, the basic idea of the procedure is to use the nucleus of the mother’s egg cell to retain her genetic identity while replacing the diseased mitochondria, which surround the nucleus.Researchers have been working with the technology for decades but have often found their efforts stymied.

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

A 23-year-old woman presented to the emergency department after 1 day of fever, sore throat, arthralgia, and rash. Diffuse erythema that blanched on pressure was noted over the face, neck, trunk, and arms, along with posterior cervical lymphadenopathy. The next day, the fever and rash subsided, but she reported pain in the oral cavity. Examination revealed petechial hemorrhages on the soft palate that disappeared spontaneously in 2 days.

Screen Shot 2014-02-28 at 2.16.32 PM

a) Adenovirus infection

b) Infectious mononucleosis

c) Measles

d) Rubella

e) Sarlet fever

*Courtesy of the New England Journal of Medicine. Answer in the comments sections. 

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The Friday Rewind 2/21

After considerable delay, the Friday Rewind is back on the blog! For those of you who remember this MedSchoolDiary feature, here is the best and worst of what the week had to offer.

1. The Best of This Week

  • Feeling ultimate redemption knowing that my study methods do work and kicking ass on two exams. Ahh, it feels good to be back! All of that anatomy induced self-doubt has melted away.
  • The freedom that comes with completing two exams and not having another one for what seems like eternity (I think 3 weeks?!). This lets me get back to focusing on things that genuinely excite me– like spending time in the Emergency Department; taking on a new and exciting research project; reviving an old research project; finally getting around to finishing a case report I was working on; and generally spending less time cramming information and more time with my husband doing the things we enjoy so much together–like our infamous movie watching marathons.
  • The feeling of happiness that comes with walking into the hospital in my white coat with my stethoscope in my pocket and a badge that identifies me as part of the patient medical team. In early 2009 I had a moment of clarity. I was at Johns Hopkins Hospital about to see a world renowned cardiologist and as I walked through the doors of the hospital I wasn’t thinking about the medical condition I had to deal with. All I could think of was how much I wanted to be one of the doctors in their scrubs and white coat walking through the doors. They all looked so preoccupied. I imagined the patients they had on their minds  and the moment in my life when I might one day look like them. Every time I catch a glimpse of myself in my white coat or the way patients walking into the hospital look at me with that familiar look, a surge of excitement comes over me.
  • Generally any time I go into the hospital is the highlight of my week. No crazy milestones to report. Well, maybe just the mini-milestone that my ECG interpretation skills have nominally improved. ST elevation and STEMI protocol are no longer just foreign acronyms.

2. The Worst of This Week:

  • After 6 weeks of following doctor’s orders I still haven’t seen any improvement in my back. I tried to go jogging for the first time and the experiment failed miserably, sending me into excruciating pain. I am too busy to actually follow-up and see what the status of my herniated disc is. I guess I was hoping it would just go away. Not being able to run is a huge disappointment and has played a large part in my brief brush with apathy.

3. Medical Breakthroughs of the Week:

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

nejmcpc0902221_f1

a) Adenoid cystic carcinoma

b) Cat scratch disease

c) Infectious mononucleosis

d)  Sclerosing sialadenitis

e)  Systemic lupus erythematosus

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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The Friday Rewind-6/7

Is it just me or are these weeks flying by faster than ever? Here’s a recap.

1. The Best of This Week

  • I survived (barely) what turned out to be my final overseas work trip. Luckily for me, things didn’t fall into place as planned and I no longer have to travel to Tanzania and Kenya in July, which is such a relief! Thank you for all the frequent flyer miles over the years, but I am happy to retire my passport–at least for a little while. My recently developed, irrational fear of flying and untimely death can have some rest.
  • Getting my Medical School Year 1 (MS1) schedule. It made me realize just how precious the next 7 weeks will be and how I will never again have this much freedom. Since my acceptance, over and over I’ve had doctors and current medical students tell me to just enjoy my summer, savor every moment, do absolutely nothing. At first I had a hard time accepting this bohemian approach. Shouldn’t I be reviewing Netter’s Illustrated Atlas of Human Anatomy? Re-studying my physiology? Once I saw the class schedule I realized that is what medical school is for and likely no amount of summer review sessions can prepare me for the fury that is about to be unleashed.
  • Being home again with my husband. Laying in bed all day watching movies. Laughing hysterically until my abs hurt. Marathon episodes of ER.

2. The Worst of This Week:

  • My husband has always joked about having to quarantine me after I returned from my work trips to God knows where–for once, he was right. I can’t believe this happened but I actually got him and myself  very sick. As a testament to how much better his immunity is than mine, he recovered from the worst of it in about 2 days, while I am still struggling 7 days later. Sigh.

3. Medical Breakthroughs of the Week:

  • Veggies Are Key to Long Life: More proof of things I’ve known for a long time–people who followed a vegetarian diet had a lower risk for death from any cause, and men in particular also saw benefits for cardiovascular mortality, a large prospective study found.
  • Short, Intense Workout Goes a Long Way: A single, short bout of high-intensity exercise three times a week led to significant health benefits in slightly overweight men, researchers reported. “We have a worldwide obesity epidemic and even though people are told they should exercise around 30 minutes a day at least five times a week, only about 15% to 30% of people do this,” Tjonna told MedPage Today. “Our study suggests that around 15 minutes of exercise, three times a week may have significant benefits as long as just a few minutes include intensive endurance training.”

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

Picture1

a) Atherosclerosis

b) Fabry’s disease

c)  Gout

d)  Hashimoto’s disease

e)  Ulcerative colitis

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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The Friday Rewind 5/24

Slightly belated since it is already Saturday morning here, but alas, here are some highlights from what the week offered.

1. The Best of This Week

  •  Sitting at an outdoor cafe with a cool breeze blowing, sipping fresh squeezed mango juice. Can you say refreshing! Although it’s the weekend and I am stuck working, it’s somehow not as bad when I can do it outdoors at a cafe.

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  •  Spending my perdiem on a super cute computer/work bag, which was hand-made by local Cambodian artisans. I am all about supporting the local economy.
  • Work meetings that led to some very creative ideas and reminded me why I do my job–helping people build their capacity to improve health outcomes and rise out of poverty. Some pretty exciting things are in the works–including a possible partnership with this group. See video below:

  • Getting an unexpected small scholarship for medical school! Woo hoo. Every little bit helps.

2. The Worst of This Week:

  • Arranging my work trip to include a weekend and Memorial Day so that I can overlap with a new hire that I was going to train–only to get an email one day before her arrival that she accepted another offer and is not coming! This was frustrating on so many levels–but mainly because I don’t get to spend the 3-day weekend with my husband. He typically works way too much and it was a rare occurrence that he is actually home for Memorial Day. I am very bummed as this was totally avoidable.

3. Medical Breakthroughs of the Week:

  • Teen Smartphone ‘Addicts’ Also Have Other Ills: Not a breakthrough but certainly an interesting read in any case- teenagers who spent enough time on their smartphones to be called “addicted” also tended to show signs of other psychological problems, according to a small study reported here.
  • Vitamin C May Be Key to New TB Treatments: In a serendipitous discovery, researchers said they killed cultured strains of drug-resistant tuberculosis bacteria with vitamin C. My mom, who is a cancer researcher has her own theories about Vitamin C’s potential therapeutical potential in oncology–here is proof of it’s benefit as related to TB.

4. Just for Fun-The Friday Rewind Image Challenge 

What’s the diagnosis?

a) Familial hypertriglyceridemia

b) Injection-drug abuse

c) Sarcoidosis

d) Systemic sclerosis

e) Takayasu’s arteritis

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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The Friday Rewind 5/10

Another week has come and gone–here are some highlights from what the week offered.

1. The Best of This Week

  • The 2nd Annual L.A. Gang Violence Prevention & Intervention Conference: It was great seeing the trauma team from my hospital out of their scrubs. At first I kept looking at them, thinking where do I know these people from?– only to realize, they clean up well! The conference brought to light, in very real terms, the epidemic that is youth gun violence. It was inspiring to meet former gang members who are playing such a big part in helping disadvantaged youth. I don’t know what this says about me, but I recognized at least two from the documentary series Gangland. To learn more about the conference, see my post Issues Closer to Home.
  • Since posting the “Dr. Carson Challenge“, I finished reading my sixth book this week. Although this in no way meets the challenge (two books a week),  I have successfully retrained my brain to remember (and enjoy!) the lost art of reading for pleasure. I now find myself  voluntarily turning off the TV and looking forward to the moment I can pick up my NOOK again. I just started reading the 1925 Pulitzer prize winning novel, “Arrowsmith” by Sinclair Lewis. Below is a list (in no particular order) of the books I recently completed:
  • “Gifted Hands”-Ben Carson
  • “On the Road”-Jack Keruac
  • “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America”-Dr. Ottis Webb Brawley
  • “Not Entirely Benign Procedure: Four Years as a Medical Student”
  • “The Emperor of All Maladies”-Sidhartha Mukherjee  (592 pages)
  • “Complications”-Atul Gawande
  • Only 11 weeks to go before my last day at work!
  • Only 5 weeks to go before our belated honeymoon and 11 blissful days on the beach!

2. The Worst of This Week:

  • It is 4:36 pm and I am staring at a dead body. Just one day after attending the LA Gang Violence Prevention and Intervention Conference, another senseless act of violence has brought in a young gun shot victim through the doors of our Emergency Department. I am struck by how white his feet are. The rest of him doesn’t look particularly dead. He looks like he’s sleeping–ready to wake up from his nightmare. I wonder if the shock of seeing a young person die will ever wear off. A deep sinking feeling hangs over me.

3. Medical Breakthroughs of the Week:

Below are links to some of the more interesting health discoveries from this week.

  • Bipolar Disorder Tied to Flu Exposure in Utero: Prenatal exposure to the flu virus has previously been linked to schizophrenia, and investigators now say the same exposure may be a risk factor for bipolar disorder. In a population-based cohort of Californians born between 1959 and 1966, exposure to influenza in utero was associated with a nearly fourfold increase in the risk of bipolar disorder.
  • Study Suggests Heart Risk for Newer Oral Contraceptives: Women taking fourth-generation oral contraceptives, which use anti-androgenic progestin, had a significantly longer corrected QT interval (QTc) than women who didn’t use any oral contraceptives, but women taking earlier formulations of birth control pills had significantly shorter QTc (P<0.001 for both), researchers reported. Having a prolonged QTc interval is a marker for an increased risk of sudden cardiac death, the researchers said. It’s been shown that testosterone and progesterone shorten QTc, while estrogen lengthens it.
  • Exercise Ups ‘Good’ Estrogen, Cuts Breast Cancer Odds: Exercise changes the way the body breaks down estrogen, increasing the ratio of ‘good’ to ‘bad’ estrogen metabolites, and so may lower the risk of breast cancer, new research suggests. “We found that in healthy premenopausal women, an exercise regimen of 150 minutes of moderate-to-vigorous aerobic exercise per week for 16 weeks resulted in significant changes in estrogen metabolism in a direction consistent with reduction of breast cancer risk,” researchers said.

4. Just for Fun-The Friday Rewind Image Challenge 

What is the diagnosis?

a) Bedbug bites

b) Dermatitis herpetiformis

c) Ecthyma

d) Guttate psoriasis

e) Lichen planus

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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The Friday Rewind

Time to wrap up the work week! As a way to reflect back on the best and the worst, the new and inspiring, the mundane and the news-breaking, I am starting a weekly post simply known as– The Friday Rewind.

1. The Best of This Week:

  • Biked (and jogged) a total of 59. 7 miles, completing over 5 hours and 45 minutes of cardio-strengthening training! How do I know this? I use the convenient free ap–Map My Run–which logs all of my work-outs and  emails me a summary at the end of the week. This is a data lovers dream!

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  • After a short hiatus, my husband and I returned to our nightly ER viewing habit (the old NBC medical drama, 1994-2009). This is quality time very well spent. We are now on season 7 of 15. I love this show because they make zero attempt to explain medical terminology and expect viewers to just get it. It makes me feel good when my husband turns to me and asks, “so what is a compartment fasciotomy,” and I immediately know the answer. Finally, I know about something he doesn’t! Of course, he has a disturbingly impressive memory, and with his uncanny ability to recall medical facts like an encyclopedia is well on his way to an honorary MD. (Secretly, I think the wrong person is going to medical school–if ever given the chance, he would crush me…)
  • Only 12 weeks to go until my last day at work.
  • Only 6 weeks to go until our belated honeymoon and 11 blissful days on the beach!

2. The Worst of This Week

  • I have had an unrelenting cough for 33 days and counting. Three doctors visits, one chest x-ray, one nebulizer breathing treatment, two steroid medications, an antibiotic and an inhaler later–I am still non-the wiser to what is causing this annoyance. Coughing is one of the top five most common reasons for a doctor’s visit, with up to 40% of non-smokers having reported a chronic cough at some point in their lives. A 2006 study found that among women with an average age of 48 who had a cough lasting for six months, 39% were found to have asthma, 9% had chronic upper airway cough syndrome (commonly known as postnasal drip), and 9% had gastroesophageal reflux disease (GERD), while 11% had chronic obstructive pulmonary disease (COPD), a serious, progressive disease that includes both emphysema and bronchitis. My money is on asthma…

3. Medical Breakthrough of the Week

  • Rather than picking just one medical breakthrough of the week, I will let you in on a treasure trove of medical discoveries! The website MedPage Today (www.medpagetoday.com) is a phenomenal resource of the latest in medical developments. This is a particularly helpful tool because it summarizes medical literature into easily digestible articles–each article alerts the reader to breaking medical news, presenting that news in a context that meets their educational practice needs. Sign up for daily email alerts to stay on top of all that is new in medicine!

4. Just for Fun- The Friday Rewind Image Challenge

A 26-year-old woman presented with pain and discoloration in the fingertips of both hands on exposure to cold (Panels A and B). She had had the same symptoms every winter for the past decade. The patient’s history and physical examination revealed no signs or symptoms suggestive of systemic lupus erythematosus or scleroderma. She reported that she did not smoke. What is the diagnosis?

a) Carcinoid syndrome

b) Mastocytosis

c) Normal pregnancy

d) Radial-artery occlusion

e) Raynaud’s phenomenon

* Courtesy of The New England Journal of Medicine

The Answer: Shown in the comments section.

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