In the driver's seat

Yesterday in our clinical skills lab, they actually brought in real people with real problems to interview. For our entire clinical skills course, our lab sessions have involved examining each other. Even though we had local people to do our examinations on for our midterm, we still had to do a lot of pretending. For example, my practical scenario basically read that the guy had varicosities on his legs, an an ulcer on his ankle. So when I went to see the patient there were no veins or ulcers, and I had to proceed to examine as if they were there (its kind of hard to map out a non existent varicose vein).

So yesterday, we when saw a patient with actual complaints, it was almost surreal for a moment. In addition to the patient’s chief complaints, we went through some basic physical signs. When I took the blood pressure, and found that the person nearly had malignant hypertension I sort of had an “Omigod – this person has a real problem” moment. I think I had that flash of reflective thought given the situation it was in. I’ve done health fairs here, and I’ve worked in a clinic at home, so it was not as though it was the first time I encountered a stranger with a real health problem. I think it was the fact that for the first time in this course, we were given something real, something tangible to observe and investigate for ourselves. Other than some fungus-y looking toenails, the patient appeared completely fine, when in actuality they were a ticking time bomb to a number of other problems (and that wasn't even what they were coming in for!).

So I guess what I’m trying to say, is that I’m excited to do some more of this stuff (sort the same feeling you get when you’re 10 16, and your dad lets you try driving for the first time).

For the busy med student in you.

With finals coming up around the corner, and a semester of eating chicken twice a day, it was time for a little change (and not with tuna fish). These are quick and easy to make, and offer a great workout for your masseter and temporalis muscles.

8 scoops chocolate protein powder
5 Tbsp. Unsweetened Cocoa powder
1.5. c uncooked rolled oats
1/2 c. peanut butter
3 eggs whites
1 whole egg

Tinfoil and spray 6x9 baking pan. Mix ingredients together, and press into pan. Bake at 300 F for 15-20 min.

Makes 8 bars. Nutrition per bar:
Cal – 295 Carb – 18 g Protein – 33g Fat - 11g Fibre – 3.6g

They’re a little low on the fibre, but if you’re living by a grocery store that sells flaxseed (that hasn't been on the shelf for 2 years), substitute 1/2 cup of the oatmeal for 1/2 cup flaxseed, and only put in 1/3 cup peanut butter, then throw in 1 more egg white. This will give you roughly the same macros, but with 6g of fibre per serving, and some really healthy fats!

As you can tell, I like to cook when things start to get a little stressing - it helps procrastinate from studying, and I don't have to think about anything.

A manicotti creation and mint blessings

I got a creative hankering this morning at the grocery store....and so this is what happened (not really sure what I should call it).

Fills 2 Manicotti noodles
¼ cup cooked lean ground turkey
½ tsp cinnamon
Pinch salt to taste
½ tsp cayenne pepper
½ cup chopped eggplant
1 small chopped onion
¼ cup chopped mushrooms
3 cloves garlic, chopped
1 small egg
2 tbsp fat free cream cheese
¾ cup tomato sauce
½ oz skim mozzarella

Boil manicotti's and set aside. Brown turkey with salt, cinnamon, and cayenne, set aside. Saute eggplant, garlic, onion, and mushroom (use cooking spray). Mix together turkey with veggies, add egg and cream cheese. Stuff manicotti's and pour tomato sauce, and any extra stuffing over the noodles. Cover and bake at 400 F for ½ hr. Uncover for last 5 min, and add mozzarella.

Nutrition per serving (1 stuffed manicotti with sauce):
Cal – 264 Fat – 6.5g Carbs – 19g Protein – 21.5g

I would’ve preferred to use ricotta or cottage cheese, but the grocery store was out of both items, and ff cream cheese has a pretty decent amount of protein per serving. To cut the carbs and calories, stuff a pepper instead of the manicotti's. If you’re a vegetarian, substitute soy pellets for the turkey.

I found a bundle of fresh mint leaves at the grocery store this week (I've never bought fresh mint before). But when I brought it home, I didn’t really know what to do with the bundle other than to pretend I was a priest and bless the dorm room (it was to shake out the water of course). Now they’re drying out, and hanging next to the icon over my bed. It smells nice, and I figure it could be convenient for morning breath (not like I ever have that).

Complaining.....again

The end is finally in sight, and I feel like a 20 year old car that just may die at any moment. I have no acceleration, some days I pray that I’ll even start, and even the high octane fuel (extra strong coffee) has no kick whatsoever. The Emperor (Star Wars) has been teaching us neuropathology for the past week. I listen to him talk for 4 hours of the day (yes he talks for 2 straight hours during class, then 2 full hours during lab – how is this possible? The man is like 206 years old). Even the gym has become uninspiring, and it really sucks to mentally push myself through every set and rep. I’m sick of eating the same food I’ve been eating all semester, and uninspired to try and cook anything new. If I found a study stating all my nutrients could be assimilated from 6 servings of oatmeal a day, I would subside off of that. As it is, I’ve discovered that refried beans straight out of the can, can be a very satisfying meal (reminds me of posno pasulj).

The nutrition course we’ve been taking these last three weeks have been a complete and utter sham. I am seriously considering writing a letter to the dean, asking for a refund of the credit hours (at this point, its just waaaay too much effort and I have no motivation)! Not only was the required textbook not used or referenced by any of our professors, that last packet of lecture material was thrown out due to poor time management and lack of screeing the lecture material presented by the visiting professors.

On the topic of nutrition – I highly recommend taking a read through an excellent article about Type II Diabetes and its disease like spread along with the American Heart Association’s endorsement of their high carb, low fat food pyramid.

It is so enraging to both read and watch how society has become so dependent on medicines and pills to correct their health problems, when a proper nutritional regiment could absolve 90% of the problems. Medicine should be a last resort! This is why I plan on practicing more as a preventative doctor, encouraging my patients to come in during times of both sickness, and health - while they still have some so we can figure out ways to maximize, and keep it! I haven’t quite figured out the logistics of how I’ll get that type of relationship to work, but it’s something to aim for.

Plastic pelvic exams

So today was the day in our Clinical Skills class that we kind of learned how to perform pelvic exams. It began by watching outdated videos showing an exam of a ‘normal’ healthy patient, then we lined up to go feel around in some plastic models……and so let my griping begin.
Firstly, they really need a new video for the pelvic exam of the female patient – was it really necessary to find the hairiest woman possible for the exam? Yes I know I’ll be seeing patients in all shapes, forms, and sizes, but comon’, this woman quite possibly had hirsuitism. Secondly – my God! I never knew that as part of the complete genital examination a combined bimanual rectovaginal exam was done (yes one finger in each at the same time)…..I’m glad my physician has good judgement about skipping that part of the exam. Also, during the breast exam of the female patient I could literally count all of her ribs coming off her sternum – is this normal/healthy? I’d like to know her BMI to use that statement (maybe all that excess hair was lanugo…..). So that was my review of the instructional video we were shown.

The plastic models were just plain silly – they should upgrade those too – these things were made out of pliable plastic, and I could see the cervix without even inserting the speculum (kills the whole joy of discovery). At least fill the inside with some sort of foamy/spongy stuff - heck, just buy some apple preserves and heat ‘em up for good measure (the movie ‘American Pie’…..). There wasn’t really an anus on the model either, unless you count the puncture marks in the rectal area.

Lastly, I was disappointed that they didn’t have any male plastics so I could pretend to palpate inguinal/femoral hernias, scrotal masses, or enlarged prostates. A little one-sided, and I will not think about it much longer because it will inevitably lead me to write about the iniquities of being a female in this world – and I’ve got studying to do.

The next gene to be discovered....

Ever find yourself wondering if some people are conscious of the noise they make? When I lived at home, and would come home during the early hours of the morning, I would attempt to be as discrete as possible (and not because I was scared Tata would beat me). This meant extra care in opening and shutting of doors, stepping on the least creaky parts of the staircase, and not turning on lights, until doors were shut. I did notice that both of my brothers were completely unaware of doing any of these things.
Other house activities that make an immense amount of noise are in the kitchen. I don’t know if it’s just me, but when I hear the slamming of cupboards, refrigerator and microwave doors, the banging of pots and pans or dishes being put away – I seriously wonder where the consideration is. And secondly, if they have none, why do I make such an effort to be polite at 5:30am if they can’t do so at 12:00 am? Perhaps its just habit to be naturally loud at some things without even realizing it – every now and then I find myself giving people the ‘lets lower our voices' sign (really meaning lower your own voice).
I know we are all missing genes of some sort, so I’ll call this one the SSC gene – Self Sound Consciousness gene. And of course the scientists will discover different variants of it with mice knockout models: SSC-1, 2, 3, 4, and 5.
1 – sound modulation while on the phone
2 – sound modulation while entering a room
3 – sound control while performing kitchen tasks
4 – sound control while closing/opening doors of any sort
5 – sound control while using devices (ie tv’s, mp3 players etc)
Most people I know have mutations in one or more of their SSC genes (heck, I’m sure my SSC-5 is under regulated at times). Either that or some of us have selective hearing damage and cerebellar brain damage modulating fine motor control.

Lose money lectures

Every Monday morning, I get up between 5-5:30 so I can make it to the gym, and attend the 8am lecture. On Monday’s I gage whether the 8:00 lectures are worth attending for the week because generally, it’s the same professor lecturing on their prospective material. Last week we began our nutrition course. Before the course began I was excited to expand upon what I believe to be a decent foundation in nutrition. Considering I have spent a lot of time reading about this stuff during my leisure, and growing up in a slightly orthorexic household with a mother who was a former childbirth educator (I've been lectured on breast feeding since I was 5), I've already been exposed to a large amount of the material. After last Monday’s assessment of the lecture material and presentation I decided to forgo the 8am lecture as it was an introduction to the material, and more or less common sense, and a lot of material I had already learned either individually or through other courses. This morning’s lecture was utterly unbearable. The professor showed up 10 min. late, and clearly unprepared to deliver his material. I often become annoyed when nothing can be added to the material being presented from the slides – what is the point of lecture then? This is not a subject that requires clarification, or attention to visual details – it’s based on experimentation and facts. I appreciate when a professor can infuse humor into a lecture when it is pertinent to the material, otherwise I don’t want to hear it. If I leave a lecture feeling that I could’ve presented the material better than the professor did, then yes, I’m pissed off because 50 min of my time was just wasted. This is a very expensive professional school, and with it I demand professionalism and excellence from my educators - is that so much to ask?

Sorry, I've been playing around with my template, eventually I'll find something I like. Plus, I don't speak XML so it takes me forever to modify things.

For kicks

Every now and then I see these things posted up on someone's blog or website (thanks Aziza). Its a great way to kill time - this one was actually pretty accurate (or so I'd like to think).

Your Five Factor Personality Profile

Extroversion: You have low extroversion. You are quiet and reserved in most social situations.A low key, laid back lifestyle is important to you.You tend to bond slowly, over time, with one or two people. Conscientiousness: You have medium conscientiousness.You're generally good at balancing work and play.When you need to buckle down, you can usually get tasks done.But you've been known to goof off when you know you can get away with it. Agreeableness: You have high agreeableness.You are easy to get along with, and you value harmony highly.Helpful and generous, you are willing to compromise with almost anyone.You give people the benefit of the doubt and don't mind giving someone a second chance. Neuroticism: You have low neuroticism.You are very emotionally stable and mentally together.Only the greatest setbacks upset you, and you bounce back quickly.Overall, you are typically calm and relaxed - making others feel secure. Openness to experience: Your openness to new experiences is high.In life, you tend to be an early adopter of all new things and ideas.You'll try almost anything interesting, and you're constantly pushing your own limits.A great connoisseir of art and beauty, you can find the positive side of almost anything.

http://www.blogthings.com/thefivefactorpersonalitytest

Cheaters 1, Hard-workers 0

This last month or so has been very destructive. We’ve had midterms, quizzes, assignments, a final, and a nice big cheating scandal resulting in nothing. Needless to say, I’m trying to reconstruct myself, and drinking on a Monday night really wasn’t the best way to start things off. But, what’s done is done and I always like to find the positive side of any situation.
To begin with, I had my microbiology final last Friday. I am never one to stay after a test to find out my mark (although in retrospect I should’ve for this one). Normally, after I’m finished a test I relish in packing up course notes, taking down all the post-its or charts I hung on my wall, and just putting everything away. Oddly though, after this final, I couldn’t bring myself to take any of the notes or charts off my walls – for some reason it just didn’t feel right (at times I get eerie bouts of clairvoyance). Low and behold, Monday we found out that cheat sheets were discovered in the washrooms used during the test, and we were informed that all 350 students (regardless of whether they used the bathroom or not) may have to re-write the final, as a consequence for the few. The rest of the week was a huge hoopla regarding the issue. The course of this semester has gotten worse as the weeks have gone by, so when I heard we may have to re-write the test I had no feelings at all. I've been so numbed out by all the other work we have, I couldn’t have cared one way or another (its like being $100 000 in debt – what’s another $10 000).
I am disgusted by the fact that there are people that may have cheated on our test. It reminds me of undergrad. There were some students that spent so much time figuring out how they could scam the system when it would’ve made more sense to just use that time to study. Well, it seems that the cheaters won again this time. After a week of noise making, no action was taken and our grades were finally released yesterday.
So when do the cheaters stop winning? Is it only about feeling good on the inside, and taking pride and satisfaction in my own hard work? It’s so infuriating – I cannot wish misfortune and bad luck on people, but I do believe in karma. Those who have cheated may have passed their microbiology final now, but in the grand scheme of things, maybe they will be cheated out something much larger in the future. Also, this group of cheater’s are particularly stupid – if you’re gonna cheat in the bathroom – flush your damn cheat sheet down the toilet when you’re done dumbass. I have so much more I would love to say regarding the situation, but frankly it's all talk, and nothing will come of it – so why waste precious study time?

What doesn't kill us now will do so later.

Med school is paradoxical, and at the crux of it all we’re studying all the things that can destroy a person’s health. It would be a correct assumption to believe we are all well versed in risk factors, predispositions, and predilections for certain diseases. And yet in trying to attain our ultimate goal, we do so by sacrificing so many facets of our own health.

I took my second pathology midterm last Tuesday. This was promptly followed by the advanced clinical skills (ACS) practical on Wednesday, and topped off by a microbiology final Friday. This weekend is supposed to be leisurely in that we only have our ACS written midterm this Monday. This semester can be summed up with a mental picture of the torture we've been subjected to. It is of a huge muscular guy, with a bald head, paunch stomach, and a tattoo around his left eye. He is shirtless, wearing a spiked collar, and responds to the name Thor. For the last month Thor had been instructed by my professors to beat the $%*& out of me with his bare hands everyday, and then increase the frequency to twice a day for the last two weeks.

Well, this last day and a half I’ve been trying to recuperate. I learned a lot from the experience and thought “Okay, that hurt, I’m still alive, but I think next time I finally know how to handle Thor". Just when I thought it couldn’t possibly get any worse I checked my schedule for the following month.

Now picture Thor again, only this time my professors have given him a mace with the same instructions. I hope I make it out alive.

I think I'm gonna puke

How to get rid of restless leg syndrome from too much studying:

If you can do this circuit in under 100 seconds with proper form I give you props:

24 body weight squats
24 bw lunges (12 per leg)
24 lunge jumps
24 squat jumps

My time was 134 sec with a full belly, tight jeans, and bare feet. Do not attempt on a full stomach of food - I keep burping up little vomits in my mouth (regurgitated chicken does not taste good the second time going down), and do it in a gym or on carpeting - I only smashed my knee off the ceramic tile twice during the lunge jumps.

Thank you to Alwyn Cosgrove for the finisher.