T6, Wk8, Day 371, Friday

PT was pretty cool on Friday. We have a teacher named Dr. Zilke who graduated with my brother and was a physical therapist before he became a chiropractor. This past Friday was slightly better than the previous Friday because I only crashed & fell asleep for 12 hours instead of 14 the week before. Took a nap Sat afternoon then ended up skipping a Halloween party that night and couldn't much stay up past 8:30 - tack on another 10 hours of sleep. Good thing too, because it looks like I'll be getting up around 3 a.m. or so on Monday Morning.

The Jurisprudence take home portion of our midterm is turning out to be quite a bear. It's a little difficult to do it on your own and I've gotten plenty of messages tonight from other people equally confused and frustrated. If I can get to school around 5 a.m. tomorrow and share with some other people, as the assignment suggested then I should be able to get it turned in by the end of 2nd hour when it's due.

We also have our HCP II midterm tomorrow. I'll be studying that during lunch.

Then - two whole evenings of Diagnostic Imaging!!! I'm actually looking forward to a couple nights with just one exam to worry about. I'd like to video Tuesday's tutoring session since we'll be looking at a lot of x-rays.

This whole thing with the DC program is like a 10 round Rocky fight. You kind of get the crap beat out of you time and time again but have to keep going. When you've passed a semester you know you've made it through that round and, I suppose, when I'm walking across the stage and get my diploma I'll be able to claim victory! In the meantime ...it's just one bloody nose after another. It's not necessarily elegant or refined from my vantage point. It's more brutal and just having to keep going on no matter what.

I guess midterms will do that to ya - it's the time when Logan gets in their best punches and you just have to take it and move on the best you can. Speaking of which, I better get to bed ASAP or school is going to really knock me on my butt tomorrow.

T6, Wk8, Day 370, Thursday - Ferrets, +2!

Yesterday I got to see a live baby still inside a classmates stomach and today I got to hold a ferret for the first time! Ya just gotta love school! :)

We had a quick quiz at the end of EENT today. The teacher used it with a dual purpose agenda with one reason being to account for attendance during the second hour and the 2nd reason was to give everybody that turned it in an extra credit point! Those extra credit points don't come around to often so it was a nice surprise and the kid here got TWO extra credit points because I got all the answers correct!!! :D

I tried laying down for a nap but kept getting phone calls & text messages so it looks like I'm maybe up for the duration now. I've got 12 hours before class starts again tomorrow at 7:20 so, a good 10 hours to be able to study for my Phys Dx midterm. I'll have to pick up some soda from QT and get some coffee brewing to pull this off.

Geez ...some of the text I was getting was from a classmate who wanted my class notes for EENT. We just started new material last week ... I'm not naming names or anything but this is the person who tutored me prior to our last test and I ended up with a B+ with her help but she just told me she failed it?!

Well, I need to learn some heart sounds and finally embrace a sheet of paper the teacher wrote out by hand then made copies of for everyone in the class. The heart has probably been one of my favorite body parts for as long as I can remember. I remember looking at the heart in the World Book encyclopedias my parents first bought way back in the 70s so you'd think I'd be diving into this stuff like it's nobody's business. I'm going to finally look at that sheet and try typing it out here as a first exposure. Then I'll probably copy it long hand as well as read through the book to help gain a greater appreciation for what I'm looking at.

S1 ------systole--->S2 --------diastole----->S1

McTc<-(regurge)->AcPc

AoPo<-(stenosis)->MoTo

OK, well that first line shows S1 then S2, then S1 again. dang....I'm thinking I used to integrate the Gaussian curve to one just for the fun of it on the back of placemats at I-Hop so I can certainly figure this out. The Gaussian curve was an indefinite integral that needed to be broken up into two integrals both with limits approaching negative and positive infinity then it took two substitutions as well as knowledge about the gamma function......

Anyway...S1 and S2 represent the "lub dub" sounds the heart makes. No, it doesn't ever sound like lub dub but that's how it's expressed. The lub and dub sounds are fairly close together then there's a slight pause and then we hear the lub dub sound again and hopefully it keeps doing that for a very long time. The time gap between the lub and dub, (S1 and S2) is when the heart is contracting and that's known as systole. The longer time gap between S2 and the next S2 is when the heart is relaxed and refilling with blood. Much of that refilling is done passively, that is, the heart is just chillin and letting blood fill it's chambers whereas the systolic phase of the heart beat is active contraction and squeezing the blood out to our lungs and the rest of our body.

Underneath S1 we have McTc. The little 'c' stands for close or closing. The M stands for Mitral and the T stands for Tricuspid. Thus, S1 is the sound made when the mitral valve and tricuspid valve close. Those valves close when the ventricles start to contract to push blood out of the semilunar vavles (both the aortic and pulmonary semilunar valves)

If you've ever had a door open on a windy day and you all of a sudden hear it slam shut, it's because of a pressure difference and kind of the same principle.

After a good majority of the blood has been squeezed out of the aortic and pulmonary valves then the pressure in the ventricals becomes lower than the pressure in the arteries the blood has just been pushed into and the semilunar valves close and that's represented by AcPc (aortic close, pulmonary close)

....I've been looking through a couple books & study guides... I do believe my butt is about to be kicked. Which reminds me, I had my neurology midterm this morning. I had a pretty nice start to the day and headed out at 4:15 a.m. and, after failing to find a gas station or McDonald's open that early to get coffee still managed to stroll into school at 5 a.m.

Got some worthwhile studying in and there were about 10 of us down in the cafeteria to bounce questions off each other which always helps accelerate the learning process.

Gotta focus and learn specifically about ....

D - Diaphragm side of the stethoscope - better for picking up the relatively high-pitched sounds of S1 and S2, the murmurs of aortic and mitral regurgitation and pericardial friction rubs.

B - The bell side of the stethoscope - more sensitive to the low-pitched sounds of S3 and S4 and the murmur of mitral stenosis. The bell needs to be applied lightly to the patient or sounds may be lost.

S3 - third heart sound - occasionally this sound is heard at the beginning of the middle third of diastole... Use the bell side. With the right ventricle the sound is increased with inspiration. With the left ventricle, S3 is heart best with the patient laying on their left side (affectionately referred to as the Left lateral decubitus position)

S4 - fourth heart sound aka atrial heart sound - normally only heard with a phonocardiogram and occurs around the beginning of the last third of diastole

WOW! ...I just posted a link for heart sounds up on facebook and have been following a conversation between a fellow student and a person who will become a nurse early next year ...

fellow student - mentions learning about heart sounds

nurse 2 be - oh yeah, a lady is coming in next week for an hour an a half to teach us all about that and how to read EKGs!

I've been learning about the heart every semester since May of 2008 and I'd hardly consider myself an expert.

I think I'm starting to understand the attitude of doctors, some doctors anyway and maybe why I've have been a possible annoyance to them in the past due to thinking I knew something when I didn't really know much of anything. I'm noticing the differences more and more everyday between my knowledge base and that of the lay person. This is probably the perfect semester for us to be having patient communication...

Let's see, for classes we've had which have pertained to the heart we've got prerequisite anatomy & physiology classes, biochemistry, gross anatomy, histology and cell biology, microbiology, Neuroanatomy, physiology, pathology, embryology, neuromusculoskeletal diagnosis, nutrition, cardiorespiratory diagnosis, laboratory diagnosis, toxicology, physical diagnosis, neurology, diagnostic imaging, clinical reasoning and pediatrics.

There's been a relationship to the heart in every single one of those classes, all from different angles, perspectives and depths and I'm sure we'll be learning more pertaining to the heart, as well as all major systems in upcoming classes as well.

anyway ...i wish i could learn about all these sounds in an hour an a half and even with all this study, we're still just scratching the surface, just enough to be in awe of a cardiologist.

EC - Ejection clicks, happen when semilunar valves open

OS - Opening Snaps, happen when AV valves open

an AV valve (S1) will close in about 0.14 second while the semilunar valves (S2) close in about 0.11 seconds. The semilunar valves are more taut than the AV valves hence, the faster closure.

The mitral valve is louder than the tricuspid valve due to the higher pressure on the left side of the heart

Geezzzzz.... According to Bates (our Phys Dx textbook) the splitting of S1 does not vary with respiration. Accroding to the paper our teacher handed out, the splitting of S1 is associated with expiration but according to two different websites the split S1 is more greatly appreciated during inspiration because inspiration delays the closure of the tricuspid vavle due to increased venous return (in a normal person anyway) I guess I'll go with the teachers handout even though the website explanation makes sense.

I've got a boatload of other sounds to get through ...thinking I might take a shower to help change my state of mind then get back to it. Fridays are always my toughest days. My eyes seem to be shaking as I'm reading.

T6, Wk8, Day 369, 370, Tue & Wed

I completely forgot about blogging yesterday. Midterms, ya know? :)

Today was a pretty darned fun academic day at Logan. We had two hours of Phys Dx, two hours of Dx Imag and two hours of Phys Dx Lab ...doesn't seem like much but still pretty fun. :)

Phys Dx - We concluded material that we're going to be tested on Friday ...geez, what is that material??? I know we started the abdominal region and I remember some stuff about that... I think I haven't been getting enough sleep. I had a hard time today remembering some classmates names - people that sit close by and now this ...let's see ...oh yeah! Cardio stuff, heart sounds, and Peripheral Vascular stuff :)
We hit on Cirrhosis a bit in the abdominal lecture and it was interesting to note that the number one cause of Cirrhosis has traditionally been chronic alcohol abuse but vying for that number one position, according to our teacher, would be prescription medication because Americans consume so much. She also pointed out medication like Crestor as being a leader in the pack since it's so widely prescribed but, eventually, people have to give their liver a break and get off the medication. In another class I heard about the rebound effects of going off Crestor in that the levels of Co-Q10 get depleted. I guess it's something to keep in mind.

Diverticulitis is something else I finally got straight. I've probably heard that word 50 times since I've been in school but never really knew what it meant (maybe I just forgot). Anyway, thanks to the internet I know it's an outpouching of weak spots in the intestines ...colon or large intestines specifically. About 10% of people older than 40 have diverticulosis. The conditoin becomes more comon as people age and about 1/2 people above age 60 have diverticulosis.

DX IMAGING - Always a fun and informative class. Dr Kuhn's classes seem to be the best to listen to via recording while commuting back and forth to school because they're so packed full of information. It can be a bit exhausting in class to catch everything he's going over. I probably just need to be better prepared so it's not like so much new stuff is coming at me. I've noticed he's extremely clear with pretty much everything he conveys. I can be clear in my head but when I articulate sometimes it's like my first day with new feet and I trip over my words and thoughts ...stumble, then try to regroup then forget what the clear thought was I had in the first place.

I read a bit more about those Human leukocyte antigens (HLA) which is a pretty fascinating topic. The list of HLAs began as a result of transplant rejections. I think most people are aware that we have different blood types such as A, B and O and a body with type A blood doesn't really like getting B type blood. With procedures such as transplants we consider things a little more detailed than blood type with something called the Major Histocompatibility Complex (MHC) which plays a role in the bodies immune system. With transplants, we need to be concerned with autoimmunity which is when the body doesn't recognize parts of itself and tries to destroy those parts it doesn't recognize.

I'm really starting to go off on a tangent here ...I just hit the HLA stuff again because I noticed HLA-8 was associated with DISH (diffuse idiopathic skeletal hyperostosis) but, according to Dr. Kuhn, it's not a major association or one that's been very well verified.

He did point out a nice table today which showed HLA-B27 and it's relationship to diseases such as AS, Reactive syndrome and Psoriasis. The percentage of time we'll find HLA-B27 with each dz is as follows

95% - Ankylosing Spondylosis (AS)

75% - Reactive Syndrome

60% - Psoriasis

I keep thinking that the thing *most* related to HLA-B27 is Sacroiliac (SI) joint disease but, I'm wondering exactly what disease they're talking about or if that isn't in fact AS that's being talked about.

PHYS DX LAB - We're spending more time on heart auscultations and I'll need to get plenty of practice and memorization in to do well on our next practical.

The REALLY cool part about todays lab was the last part when Dr. Haun came in with his ultrasound equipment to show us various arteries, the heart, liver, spleen and a few other goodies but then - we got a HUGE bonus at the end of class when he asked if there was anything else we'd like to see and I just had to shout out (as loud as I shout anyway) the name of a classmate who happens to be about eight months pregnant. I've never seen a baby via ultrasound before. And, lucky for us, we did get to see the baby which was amazingly fascinating and interesting. Dr. Haun was quick to point out that we don't practice obstetrics but, I was thinking we do have a heck of a lot of embryology and chiros can deliver babies in some states.

The baby's face was turned away but, by varying the magnitude of the US, we were able to see various parts of the brain, the pons, the falx cerebri, the beating heart, entire vertebrae and even the spinal cord! It was really amazing. It's hard for me to imagine what it must be like if it was my own kid we were looking at since this was so remarkable.

OK, well, I've got a Neuro midterm tomorrow and I haven't exactly gotten the sleep I've needed in the preceding days so I'm going to have to do the best I can tonight. I need at least a little bit of sleep but certainly not too much. I'm planning on maybe taking a nap tomorrow after school then just staying up all night to help do the best I can do on our Phys Dx exam on Friday.

Next Wednesday is our Dx Imaging II midterm and I'd *really* like to do well on that exam. I wonder if Friday will be another day of crashing at 3 p.m. and not waking up until the next morning like last week .....

I'd love more time to study and sleep. However, I am certain I can continue to make headway in simply using the time I have more efficiently and effectively.

I've looked over some previous exams given in Neurology to help get an idea of what to study and it looks like the test have four sections worth of topics.

1. Locations of Lesions - given a set of symptoms, where is the lesion. I made up flashcards last night (two sets of the same thing, actually) to help cover this. Memorize 25 flashcards and I should nail 10 questions on the exam.
2. Arteries in the head - arteries along w/ a little bit of knowledge about CSF should give me the bulk of another 10 questions.
3. Neuromuscular diseases - Looks like another 10 could come from this area.
4. Cranial nerves & some spinal cord basics - final 10 questions.

As best as I can tell, those are the areas I need to focus on. I should be able to get a solid grade on tomorrow's exam with enough work tonight and tomorrow morning.

Almost forgot - for reference, here are a few of the things I looked up today in Dx Imaging

Primary and secondary synovial chondrometaplasia - This is actually a link to
PubMed.gov which I know, as students, we've always been encouraged to use but, until I had the internet available to me in class I've not made much use of the site. Since I got my mobile wifi unit, I think this is the 5th article I've referenced from PubMed :)

synovial chondrometaplasia - just a Google link to a bunch of images ...I'm always on the lookout for similar images to what we're shown in class.

Synovial osteochondromatosis (SOC) - is a benign condition characterized by synovial membrane proliferation. This link is from emedicine (from WebMD) I like that site as well as the MayoClinic website for nice definitions.

Today's picture is a lateral radiograph of a patient with synovial osteochondromatosis of the knee joint.

T6, Wk8, Day 368, Monday

Almost 8:30 p.m. and I'm ready for bed and don't really feel much like blogging or working out ...studying doesn't sound too bad ...maybe not the blog to read if one is trying to get inspired ;)

We had our Jurisprudence exam this morning ...it was a bit different than most test we take at Logan and that's about all I'm going to say about it for now.

I was kind of excited this morning when I heard our Diagnostic Imaging teacher, Dr. Kuhn, mention syringomyelia! This was one of the words I looked up last week and learned about in our Neurology class.

Wow - it's after 9 now ...here's what i got from Dx Imaging today. I'm ending this blog w/ some of the words I looked up during class today. It was nice to already have the link for syringomyelia already bookmarked! :) (doesn't take much to make me happy)

Let's not forget, HLA-B27 (Human Leukocyte antigen B27) is associated with ankylosing spondylitis (AS) and Reactive arthritis. It is even more strongly associated with SI joint disease.

The HLA-B27 would be found on the surface of your cells. it helps assess the likelihood that you have an autoimmune disorder.

Here's the other part I keep forgetting HLA is Human Leukocyte Antigen which is encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6. OK, the words in bold were all I needed. ;)

• Homogentisic Acid - hmmm, it's associated with alkaptonuria which is also known as Ochronosis, the acid in question here turns black when it's oxidized and I need to remember that Ochronosis kind of sounds like Okra which also turns black(brown) when it is cooked and oxidized.
• 
  
• hypertrophic pulmonary osteoarthropathy - HPOA. if there is no lung disease present then we'll remove the letter P and have HOA. this is a miscellaneous arthritide

• Hypertrophic Osteoarthropathy - HOA :)

• Gout & Pseudogout - Gout and pseudogout are the 2 most common crystal-induced arthropathies. They are debilitating illnesses in which pain and joint inflammation are caused by the formation of crystals within the joint space.

  Gout is inflammation caused by monosodium urate monohydrate (MSU) crystals.

  Pseudogout is inflammation caused by calcium pyrophosphate (CPP) crystals and is sometimes referred to as calcium pyrophosphate disease (CPPD).
  

  
  

  
  
  

T6, Wk7, Day 367, Friday ....yuck!

Friday kind of sucked. I stayed up late enough to copy a ton of questions and answers from the book, finally crashed then slept until 6:38 a.m.!!! not good. Even without any rush hour traffic I still need 45 minutes to get to school.

I was out the door at 7:45! and got to school about an hour later, learned everybody had already finished the test so I high tailed it to my teacher's office and she was kind enough to let me take the test right then and there. Even let me sit at her desk. I took it as quickly as I could and still ended up finishing it before the first hour was over but I took the darn thing cold - zero studying which is never a good thing to do.

Fortunately, the second half of PT (which is taught by a different instructor) will get averaged into the mix so I still should be able to get through the class .....should be able to anyway ....

When I got home Friday I ended up crashing again at 3 in the afternoon ...I didn't wake up until 5:30 a.m. the NEXT MORNING!!!

I'm not sure when I've ever slept over 14 hours before. ...anyway - on to Mondays post ;)

T6, Wk7, Day 366, Thursday - 2 More Boards!

With yesterday making a full year of classes, I divided our total class hours (around 2700) by 365 and figured we've spent about 7 1/2 hours a day, every day for an entire year so far, and we just broached the 1/2 way mark! Awesome! :)

Today was solid. I believe I scored perfect on both of my competency exams. I had to get in line for the breast exam first so I only had about 18 minutes to memorize the sheet relating to what we had to know and I'll be darned if I didn't get it all. I should be able to learn something there regarding learning and memorization. Stress seems to inhibit my learning but pressure seems to enhance it. I'll work at putting more pressure on myself and maybe I'll get away with less stress in the long run. I also rocked the venipuncture (blood draw) practical with time to spare!

The CCR exam was solid but not spectacular. I did remember every portion of the Cervical Regional Exam sheet and ran a little short on time and missed the very last part. I was happy to have at least hit all the other parts. The teacher said I just missed some little things here and there. I know I can do better. I hope my parents will be around for the next one. I only got one evening of practice in with them. I'll have to check with them ahead of time and make some kind of arrangements to practice with someone from school otherwise.

OK, enough of the past. I need to get focused on what needs to be done next. There are specific things I know I should do for each of my classes (or, for most of them anyway) so, I've thought to assign myself a little homework.

Also, we do have a PT written midterm tomorrow and ample time will need to be spent on that but I can't and don't want to get behind in any of my other classes.

Dx Imaging
I've got four tutoring handouts and I still need to finish typing the fourth one into the computer.
An Arthratide album has been added to my fb account and will need to upload samples as I come across them. Other than that I just need to read the book more/again.

Diversified V
I've got some good notes started for our next exam but they're on a scratch piece of paper and should copy those over, outline the related section from my diversified DVD and make up a couple flashcards with the moves on them so I can glance at the cards and do the moves in my head on a regular basis.

Neurology
Dr Bub - aka Dr. Neurology Extraordinaire ... I have a lot of work to do especially since we have our midterm next week. He gave a lot of definitions today so it's clear I need to know and own those words - Flashcards, Reading and Time are needed.

Dx Imaging II
Another exam we have next week. She gave us a sheet of paper and I think I should know & own what's on that piece of paper as well. All about heart sounds ...S1, S2, S3, S4, murmers, clicks, snaps, regurgitation and all the variations in between. There is a tutoring session tomorrow from 11 to 12 that I'll miss but, I'm hoping to hook up with some of the students that go, maybe over the weekend, to have them tutor me second-hand! :)

Jurisprudence
oh heck! I forgot about this one - our midterm (MT) is this Monday! OK, that's one thing I'll need to get lined up and looked at over the weekend.

SHC Practicum
Our teacher wants us to take practice histories. I'm going to take some of my parents ...and I still miss Scott, my neighbor, who would have been the other person to partake ...
I'll need to schedule this in and get it done. If I have two done by Monday, she said she would look any over that we have and help us improve. Sounds good to me! :)

Pediatrics
Huh? I'm not sure what we're currently doing ...we just had an exam this week.
I need to print out whatever is necessary for the next exam.
Get my reading assignments figured out, then read & learn!

Patient Communication
I just need to remember to dress up in clinic attire for Tuesday so I'll need to get my clothes cleaned again ...which reminds me, I'm planning on going to the gym tonight with some PT flashcards in tow so after my workout I'll spend some time on a nice recumbent bike and look over those cards.

Phys Dx II Lab
We are going over all those heart sounds as well as Jugular Venous Pressure. I need to learn more about this stuff. I need to read what's been assigned.

EENT
Dr. De Geer's class! I sure do like him and wish I could have a major chunk of his brain transplanted directly into my head. This is a new section we started today. GABHS is one acronym I learned today which stands for Group A Beta Hemolytic Streptococcus. So, we must have been talking about sore throats & stuff. Wait! I'm supposed to be a doctor someday ...how do doctors refer to a sore throat? They refer to it as odynophagia! (that's another word I need to know and not have to look up!) ;)
I've got some great notes today from that class ...once again THANKS TO THE INTERNET!!!!!
I was able to download the most recent powerpoints from our school website for this class then copy and paste pictures and verbage from the powerpoint directly into a word document.
Without the internet the notes would not have been possible because I wouldn't have had access to the powerpoints.
I also got to look up, learn and elaborate on some new words today! Maybe I'll summarize those at the end.

CCR - Chiropractic Clinical Reasoning
OK, this is a challenging class for me. I am passing but I want a better grade. I had a thought of talking with Dr. Manello to maybe get some tips. If nothing else, simply meeting with her would help to focus me in on the class more. I should do this and I'll add it to my notecard.

PT - Physical Therapy
Our midterm is tomorrow! That's what I'll be doing much of tonight and as early as possible tomorrow morning. A fellow classmate named Lauren also gets to the cafeteria to study bright and early, often times she's there before me. We generally sit at separate tables but next to one another so we can bounce questions off one another. The coolest thing is that her husband, Steve, just started this semester as a Tri-1! I think he's going to make a great chiropractor.

Pro-D, Professional Development
I still need to get another hour (or two) of volunteer work in at the local Humane Society and was thinking about knocking that out this Sunday. I'll need to schedule this and make sure to bring in my sheet to get signed then I'll be done with that requirement.

Well, that's all 13 classes. We only have one more competency board exam to complete and that's for a prostate exam.

Here's some of the stuff I found on the internet today. Most of it I could only look up, get correct spelling but not spend too much time on the site because I had to keep paying attention in class. You know, I just realized that I haven't fallen asleep in any class where I've been able to stay involved and look things up or download necessary class materials. Actually, it's helped to improve some of my personal relationships by helping me keep in touch with friends. I know I was able to share the word odynophagia right when I first learned about it with a very special friend of mine J

Internet Gems I Found Today –
Charles-Édouard Brown-Séquard. This person lived from 1817 to 1894, he was a physiologist and neurologist who, in 1850, became the first to describe what is now called the Brown-Séquard syndrome. OK, so what is that?!
Brown-Séquard syndrome (BSS) – From the National Institute of Neurological Disorders and Stroke we have the following definition. BSS is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. BSS may be caused by a spinal cord tumor, trauma (such as a puncture would to the neck or back), ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis. Cool! Someone else in class knew about this and it's about the spine so I should know about it also.
Spinal Cords Gone Wild! - What a great title! LOL. This is a blog I found (also on blogspot.com called syringo.blogspot.com) I think the word Dr. Bub used was "syrinx" I need to find out what this means. Hmmm, the site talks about Chiari Malformation (which I have heard of) and Syringomyelia. Found it! (straight from MayoClinic.com)
Syringomyelia – (sih-ring-go-my-E-lee-uh) is the development of a fluid-filled cyst (syrinx) within your spinal cord. Over time, the cyst may enlarge, damaging your spinal cord and causing pain, weakness and stiffness, among other symptoms. If left untreated, syringomyelia symptoms may worsen, in some cases requiring surgery.
Syringomyelia has several possible causes. The majority of syringomyelia cases are associated with Chiari malformation, a condition in which brain tissue protrudes into your spinal canal. Other causes of syringomyelia include spinal cord tumors, spinal cord injuries and damage caused by inflammation around your spinal cord. (BONUS! Now I know what Chiari malformation is also!!!)
What's that saying? "I LOVE to learn, I just don't always like being taught" ;)

Today's picture is of lymphangitis which is an infection of a lymph vessel.

And ....I found one more word I need to look up which I saw on a test and knew at one time ....
Coryza - Dang! I knew this and forgot about it, i think I even had the word in a blog not too long ago ...Here's the definition from MedicineNet.com;

A cold in the head. The word "coryza" came from the Greek "koryza" which is thought to have been compounded from "kara", head + "zeein", to boil. The "boiling over from the head" refers to the runny nose, an all-too-familiar feature of a head cold.

T6, Wk7, Day 365! Wednesday

1 full year of classes!

one cup of coffee while I blog this then head to school. Not up quite as early as anticipated but will still be leaving circa 5 a.m.

Today -

CCR Practical Midterm

Breast Exam Competency Board Exam

Venipuncture Competency Board Exam

Tomorrow -

PT written Midterm Exam

Looks like midterms rank 2nd in stress levels only to Finals.

Gotta run!

T6, Wk7, Day 364, Tuesday

Wow! Tomorrow will be our 365th day in class. One entire year of nothing but classes! Cool! :)

What did I learn (memorize) on the way home from school today? Good question, let's see if I can recall it ....

The differential diagnosis for Acroosteolytis is threefold, namely;

1. Scleroderma

2. Pyncnodystosis

3. Hyperparathyroidism

OK, now, let me check my notes and see how much i butchered the spelling ....

it's Acroosteolysis and the differential (diff dx or ddx) is

1. scleroderma (got that one right!)

2. pinctodysostosis ...not right but that darn word is even hard to copy correctly!

3. hyperparathyroidism (we've had this word before so it was easy)

Acroosteolysis is an interesting if not odd little bugger - the distal tips of your finger bones get reabsorbed! When I saw the x-ray, I first thought the picture just cut off the ends of the fingers but that wasn't the case, they were just missing! This would be a good thing to find a picture of for today's blog :)

The x-ray pic I uploaded shows some tissue so it's not quite as confusing as what I saw in tutoring today. I'll have to get another facebook album put together for arthratides ....

maybe i'm thinking of that because what i really need to do is get cracking with some CCR study, like PRONTO!

T6, Wk7, Day 363, Monday - Whew!

May fortune favor the foolish ....

That's all I could think after seeing my EENT grade. I do my best to pay attention in class but my study was weak for that midterm. Non-the-less, I got an 87% for my EENT midterm grade!

still ...w/ Dr. DeGeer, I had over a 100% average in toxicology ...just seems like so much to deal with this tri mentally.

and this is nothing compared to what's ahead.

btw - I Tri-10 posted a comment yesterday and I learned Comp boards stands for Competency boards! :)

first time I ever heard that and I'm glad I finally did.

gotta get to sleep but not too much - got Pediatrics at 8 a.m.! (another class taught by Dr. DeGeer) :)

T6, Wk6, Days 360, 361, 362, Tue, Thur, Fri

We had off school Wednesday for field day. Midterms have started but, that really isn't a very good excuse for missing the last few days of blogging. I don't remember offhand all the exams we had last week, I know EENT was in there and we did two stations for our Comp Boards. I think Comp is short for Comprehensive. We have either 20 or 25 stations in comprehensive boards that all need to be passed before we can start our clinic rotation in Tri-7. This last Thursday we did History taking and a Cranial Nerve exam.

I didn't realize that the Comp Board test we were taking now were real, I thought it was practice so we wouldn't be so nervous when we took them at the beginning of Tri-7 but, about 10 minutes before heading to testing I learned we knock out 5 or 6 of the comp board stations during Tri-6 then complete the remaining comp board stations a the beginning of Tri-7. Should make for a fun break of studying! :)

There's quite a bit coming up for Week 7. Let's see ...I need to complete my portion of a presentation due Wednesday by tomorrow, Monday is our CCR written exam, Tuesday is Pediatrics, Thursday is our CCR Practical along with comp board testing covering Venipuncture and Breast exams then Thursday is our PT written examination. Just enough to make for a fun weekend of studying.

I went to the gym last night and have planned to go in the a.m. and p.m. over this weekend, nothing huge in terms of workouts and probably just light cardio for 1/2 hour or so but that should help me to maintain my sanity and offset all the sitting I'll be doing. My brain just seems to work better with a little activity thrown in the mix.

Oh yeah - I signed up for the Internal Health Specialist program which runs next year from March through September. It's a post graduate class that meets once a weekend each month for 16-20 hours a weekend. I think I can handle it since it's just one weekend a month. As a student it's much cheaper to take now then after I graduate. I don't really know what the program entails other than the obvious, that it deals with our internal health, so I'm thinking all those nifty organs in our thoracic region. The course is taught by Dr. Loomis and I know part of our Auditorium is named after Dr. Loomis. Anyway, I'm looking forward to it.

I'm also wanting to sign up for Dr. Montgomery's Advanced Basic Class which is also a weekend class so I'm hoping the two don't conflict.

Better get moving, lots to do! :)

T6, Wk6, Day 359, Monday

Midterms are starting this week and we'll be having exams and/or practicals in all our classes over the next 2 to 3 weeks. Today starts our Diversified V practicals. Which reminds me, I did my first vertical A to P adjustment yesterday and got great results with it. It's a standard "hug" type of adjustment usually performed with the patient laying on their back but, when done vertically, you can put the pt up against a wall which provides for excellent support.

I was considering skipping my Patient Communication class today in order to get some extra studying in for my practical. I've got 5 absences this semester which isn't too awful considering we've had 174 classes so far. It's no surprise that those 5 I missed where morning classes.

The other day when I blogged about Craig's list and the Internet being held responsible for illicit activities I may have skipped a bit of my train of thought. The rationale for the post was because one of the reasons I've heard about Logan being reticent on providing internet in the classroom is because of concerns about it being a distraction. For example, students might play games or otherwise not pay attention. My point is that you have to hold people accountable for their actions and not the mediums at their disposal. Besides, everyone with an i-phone already has the options of playing games. Some classes though, it's been very useful for me. When I'm able to look things up I do feel more connected with the class and feel like more of an active participant.

I am glad we're off school tomorrow for field day. I was thinking of participating in the tug-o-war competition but didn't see a time on the sign up sheet which is kind of like the comp-board sign up sheets that didn't have times ....

I need to get moving, it's already after 5 a.m. I should be able to head out by 5:30 this morning and get a little extra time looking over diversified. I'm not sure how I'll do on the practical, I'm not really sure what to expect which is kind of pathetic considering this is my 5th semester of diversified but, it all depends on the teacher and whoever I get to test me. It's definitely the least objective type of testing that goes on and still kills me to hear how arrogant this particular teacher can be to think it's totally fair and equitable. I'm sure it's better than nothing and a necessary component to the process but it could also be improved on many levels.

Today's picture is of a cervical adjustment.

T6, Wk5, Day 358 cont. - My Take on Diabetes, Type II

The following is copied from an email I sent to my family regarding diabetes.

I don't necessarily think diabetes is caused from obesity per se but perhaps rather what obesity or being overweight may represent, as in a lack of physical activity. In the 2,700 or so hours of classes I've had so far in the DC program at Logan a couple truths keep ringing loud and clear. One is movement and motion are vitally important to our health and well being and Two, Use it or Lose It.

With Type II diabetes I'm thinking about the Use It or Lose It concept and it's relationship to insulin receptors on our cells. So, if we don't make sufficient use of the insulin receptors on our cells then we'll start to lose them.

Secondly, is a simple concept of osmosis - this is when things move from an area of greater concentration to an area of lesser concentration. If I fart in the left corner of a room, that smell will not stay in the left corner of the room (area of greater concentration) it will spread throughout the rest of the room (area of lesser concentration) so everyone may enjoy the scent.

The sugar that floats around in our blood stream is called glucose, the bloodstream is the area of high concentration of glucose. The cells throughout our body are the areas of lesser concentration.

This is where the body is really clever! The glucose will go from the area of higher concentration (the bloodstream) to the area of lesser concentration (the cells) and once the glucose gets inside the cell, it's immediately changed into something else (glucose-6-phosphate) so the area of higher concentration is always in the bloodstream since plain old glucose doesn't exist inside the cell! :)

Insulin helps regulate uptake of glucose into the cell and those cells need insulin receptors to help get the message across to our cells that we've got increased blood sugar levels in the first place.

Here's my thinking, the less of a demand we put on our cells to produce energy, the less likely they're going to be set up to produce energy and, if all we're doing is sitting then how many insulin receptors do our cells need?

So ...what happens when we have excess sugar floating around in our bloodstream? I'm not much of a cook but, I'm pretty sure when you add sugar to a mixture it ends up getting thicker. With the blood, I'm quite certain from what I've been taught that your blood does get thicker. Arteries have several layers to them and the middle, muscular layer is known as the tunica medium. Just like skeletal muscles get bigger and stronger with extra resistance, the muscles in the middle layer of our arteries also get bigger. Now, when the muscles in the arteries get bigger, that means the the opening (lumen) blood travels through is getting smaller so, we've got thicker blood and a smaller hose for the blood to travel through. This is hardly an ideal situation.

Vaso-vasorum - this is Latin for "vessels of the vessels" which, in our bodies mean that large blood vessels actually need their own blood supply hence, vaso vasorum.

vaso nervorum - (vessels of nerves) - Nerves also have their own blood supply and are called vaso nervorum.

As you can imagine, the blood supply to other blood vessels and nerves are quite small, delicate and fragile. The blood supply is the source of nutrients for blood vessels and nerves. What do you think happens when we cut off or diminish the blood supply to a nerve? Well, it gets starved of nutrients and doesn't function so well and we may start seeing signs of neuropathy (damage to the nerves).

TAKING ACTION

Now, I'm thinking of the 2nd line of Hamlet's "To be or Not to Be" soliloquy

"Whether 'tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles and by opposing, end them."

Type two diabetes is an outrageous fortune -

We can take arms against it's sea of troubles - we can oppose them and we can end them.

However, with chiropractic principles, the propensity is to be Pro-Active instead of Re-Active (as tends to be the case with allopathic medicine)

The proactive move would be to keep the serfs at bay before they ever even begin to think of revolting! :)

The action I would advocate is simply ...Move After Eating.

This is a little bit different than a regular exercise program one might do three times a week as the action is specifically prompted due to a recent ingestion of food.

For example, walk for 10, 15 or 20 minutes after a meal - even 5 minutes of walking after a meal would be preferable to sitting on a couch. After eating might be a good time to run to Target to get some shopping done.

I'm thinking of the biochemical processes that go on - you might have potential energy go into the mitochondria of your cells but, if the demand for energy isn't there, then that energy will get kicked out and stored as fat.

Walk, move, swing your arms in the air, - give your insulin receptors a reason for being! :)

The notion of moving around after you get done eating is pretty basic advice and something my gramdma has told me and understood even with zero hours of advanced education but, as I've learned and tried to share, there's good reasons for it.

What's the Benefit?

Oh, you're wondering what's in it for you? OK. Here's three big scoundrels you'll be able to help keep at bay

1. Renal Complications - kidney failure - you can't live without our kidney shaped super-filtering friends down there.

2. Eye Complications - Diabetic retinopathy is one of the leading causes of irreversible blindness in the United States.

3. Atherosclerosis - Arteries clog up. Not good. The most common cause of death with diabetes is myocardial infarction. In fact, for diabetics above 60 years of age, 75% of them die due to cardiovascular disease.

The life span for a diabetic patient is about one-third less than that of a person without diabetes.

This is Interesting ....

I consulted that Family Medicine book I recently sent out and here is what it mentioned regarding guidelines for planning an exercise program with respect to diabetes.

1. moderate aerobic activity 3 to 5 times per week along with resistance training 3 times per week.

2. Exercise after meals to reduce postprandial hyperglycemia.

Huh, I guess all one had to do was read point number two in the book to know to exercise after meals but, all the classes kind of are starting to come together and make sense so I was able to figure number 2 out on my own and wanted to share it with loved ones. At least my reasoning is sound. :)

By the Way -

I spent a few years of my life driving for EMT and had one patient in Illinois I picked up three times a week for dialysis. He was diabetic and his kidneys had shut down, hence, the need for dialysis. When I started picking him up he would walk to the car, then due to complications of the diabetes he kept losing body parts - rather important ones too. Over the span of just a couple years he lost his toes, then feet, fingers, and legs ...by the time I finished up my stint with EMT he was in a wheel chair pushing a joystick to move around and stay mobile.

Much love,

Scott :)

p.s. keep in mind this thinking is for type 2 diabetes which results from an insulin resistance. Type 1 diabetes usually presents in younger patients and results from beta cells in the pancreas not being able to produce enough insulin in the first place.

T6, Wk5, Day 358, Friday

Getting a jump on my blog before heading to school today. Our first class is physical therapy followed by Professional Development and then Physical Diagnosis II. Off at 11 o'clock today!!!

almost 6 now - gotta run!

[update] - not quite 7 a.m. and already at school. Have I mentioned how much I love the Internet? How much I love not being beholden to someone elses rules and restrictions regarding the Internet?

I read an article not too long ago about how certain government agencies were trying to hold the Internet and certain websites such as Craig's List responsible for things like prostitution and I'm thinking these people just don't get it. Why not hold car manufacturers responsible or telephone companies since those aspects almost always play a role in prostitution. It seems like, the less we understand something, the easier it is to blame that something for our shortcomings. Maybe we should hold concrete manufacturers responsible for our behavior since many prostitutes stand on sidewalks and street corners that are made of concrete. It's pretty easy to see the folly of holding General Motors, AT&T or the local Masonary Union responsible so, why is it so difficult to see the folly in holding the Internet or certain sites responsible.

Anyway, better prep for the day - on my FAST, Unfettered and Ubiquitous Internet! :)

T6, Wk5, Day 357, Thursday - Lovin the 'Net!

I *really* love having the internet in class. I've got folders for each class to save my websites in that have to do with various things mentioned in class.

Here are six things I looked up while in Neurology today.

1. Meralgia Paresthetica - a condition characterized by tingling, numbness and burning pain in the outer part of your thigh. The cause of meralgia paresthetica is compression of the nerve that supplies sensation to the skin surface of your upper leg.
2. Shimizu Reflex - a muscle stretch reflex (MSR) discovered in 1993 while researching MSR’s innervated by the higher cervical cord. It was known prior to this research that precise information regarding C0-C4 spinal cord segments represented a blind spot in exam procedures.

3. Hilton's Law - expoused by John Hilton in a series of medical lectures given in 1860-1862, is the observation that in the study of anatomy, one often finds that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles^[1].

4. Porphyrias - a group of rare disorders passed down through families, in which an important part of hemoglobin, called heme, is not made properly. Heme is also found in myoglobin, a protein found in certain muscles.

5. Paraneoplastic Diseases (or syndrome) - this is kind of a tough one to nail down but, here is what I got from Wikipedia... - A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.

6. Rhabdomyolysis - Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) into the bloodstream. Some of these are harmful to the kidney and frequently result in kidney damage.

From EENT, I got three new look-ups

1. Coryza – the interesting thing with this word was how much Dr. DeGeer knows about the origins of so many words and this word was no exception. It comes from the Greek word “koryza” which means “head” + “to boil”. and refers to a head cold.

2. Dangerous Triangle – this is an area of the face that runs from the upper bridge of the nose down to the corners of the mouth. there is a cavernous sinus behind the face in that area that can become infected and cause much malaise with the brain. What’s really cool is that I was able to look up Dangerous Triangle on Google and I came across a site with a picture in it that Dr. DeGeer had also used in his power point presentation just a few slides later! But, I already had the scoop. I’ll use the picture as today pic of the day. The picture is of a patient who had an abscess of an upper front tooth which is in the area of the Dangerous Triangle. The patient ended up getting Cavernous Sinus Thrombosis.

3. The third lookup was a software download from http://www.mobipocket.com/en/DownloadSoft/ProductDetailsReader.asp

that link and the software I got from it enabled me to download the entire text to a book called Family Medicine: Ambulatory Care & Prevention, Fifth Edition which, is a book we use for our EENT class. It's really a great little book. Well, close to a thousand pages little but, it is paperback and fits nicely in my bag. Of course ...now that it's on my laptop I don't *have* to bring it with and if I forget it, I've still got it online :)

T6, Wk5, Day 356, Wednesday

Had Phys Dx II, Dx Imag II and our Phys Dx II Lab Practical today. I was really hoping to get testing on the posterior lung examination but got hit with the breast exam instead. I muddled through alright but didn't have near as much practice with the breast exams as I did with the lung exams.

Tomorrow we've got two hours of Neurology followed by two hours of EENT then 3 hours of Chiropractic Clinical Reasoning (CCR). In CCR we start by giving a regional exam to our patient and we've got 20 minutes to complete it then switch Dr. / patient roles. After the first 40 minutes we're given a case study to evaluate. The case evaluation part is kind of like the TV show House MD. The neat part is these are actual cases from one of our teachers. The first week kind of sucked because we had a patient w/ a metastatic cancer but, last week it was a much nicer (and easier to evaluate) muscle strain.

Neurology is all case based also. The first hour of that class starts out by going over a couple cases and we have to figure out where the neurological lesion is located. That might not be a bad thing to review right now. We start at the top of the head, with the cerebral cortex and work our way down. For each segment of the neurological system we may have sensory and motor symptoms.

A quick look at todays pic may help when going through this neurological list. We're basically starting at the top of the head. Numbers 1 to 4 deal with things in the head and upper neck region. #5 is the Spinal cord, then we have the roots (#6) of the nerves that project from the spinal cord. Those nerves that spread out to all areas of the body are known as the peripheral nerves (#7). The neuromuscular junction (#8) is simply where a nerve attaches to a muscle and #9, myopathy refers to the muscle itself.

1. Cortex - complex sensory loss, asterognosis/agraphesthesia, visual spatial loss (neglect) difficulty localizing - motor loss involves weakness or paralysis, spasticity with increased tendon reflexes and little, if any muscular atrophy.
2. Subcortical (thalamus or Basal Ganglion) - thalamus deficits include sensory losses of primary sensory modalities, possible visual disturbances, spontaneous painful sensations. Motor loses involve the basal ganglion and include dyskinesias, abnormal posturing (dystonia) possible hemiparesis.
3. Cerebellum - sensory losses include clumsiness and incoordination. Motor signs & symptoms include ataxia, intention tremors, dysmetria, hypotonia, dysdiadochokinesia ...
4. Brainstem - sensory changes seen in cranial nerves and long tracts. Motor changes seen in cranial nerve territories and may be LMN or UMN signs. Long tracts involvementwith UMN signs.
5. Spinal Cord - well demarcated level below which there is decreased sensory perception. Sensory signs include spastic weakness with increased DTR's and dysautonomia. Acute injury has flaccid paralysis with decreased DTR's.
6. Nerve Root (radiculopathy) - sensory = dermatomal loss of sensation, asymmetric distribution that may be distal or proximal. Motor = flaccid weakness, decreased DTR's, presence of fasciculations.
7. Peripheral Nerve - Sensory = territorial distribution of sensory loss, usually distal asymmetric loss. Motor = flaccid weakness, decreased DTR's presence of fasciculations
8. Neuromuscular junction - absence of sensory changes. Motor signs include weakness that may be patchy in distribution, weakness noticed worse with exercise or later in the day, normal or reduced tone and DTR's
9. Myopathy - absence of sensory changes. Motor signs include proximal weakness, usually symmetric, absence of atrophy or fasciculations, normal DTRs and mass until late in disease, absence of sphincter disturbances.

DTR stands for Deep Tendon Reflex.

T6, Wk5, Day 355, Tuesday - INTERNET

Since the school doesn't provide internet in the classrooms, I took matter into my own hands and got myself a Virgin Mobile Hotspot! So far, it's been working fantastic! Now those words that would otherwise pass me by I'm able to grab hold of and learn something about them.

Here are the 6 extra things I was able to get from Pediatrics class today.

1. plagiocephaly - a malformation of the head marked by an oblique slant to the main axis of the skull.
2. preeclampsia - a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine.
3. Craniosynostosis is a congenital (present at birth) defect that causes one or more sutures on a baby's head to close earlier than normal.
4. KISS Syndrome - Kinematic imbalances due to suboccipital strain.
5. Opisthotonus - a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position.
6. Macrosomia - a newborn with an excessive birth weight.

With the internet, I'm able to write these words down as best as I can spell them, pop them into Google, the viola!, I get the correct spelling and all the links I can handle to learn more about these topics.

I doubt if any of those six things are going to be on any test but, that's besides the point, I'm there to learn and that's what I'm doing.

Today's picture is a depiction of opisthotonus by Sir Charles Bell from 1809. I also have access to a couple dozen class books which are available online. It was really nice, I even got to download any and all powerpoints I needed to follow along in class.

Another big plus - NO RESTRICTIONS on what I look at and where I go on the internet. We has some great Google Groups we made up back in ASP and for all the Trimesters but, after Tri-1, they got blocked and nobody could access them in the library anymore ...at home, yes but, not at school. Then, for some reason, there was a block on Google documents ...why in the world would anybody block that? A classmate and I had spent quite a bit of time simultaneously working on a spreadsheet last trimester which listed every day of class and every assignment we had due for each class but, when we went to the library to bring it up to print, we couldn't access that portion of Google.

You Tube seems to have some limitations as well. Where do these people in charge come from? YouTube is one of the best learning aids out there. We've got students trying to help other students. And, as I never get tired of pointing out, MY OWN You Tube video on the brachial plexus was used by an Anesthesiologist working at a hospital in Munich, Germany to help train other doctors at the hospital.

As long as I'm on a roll here, I guess not having my internet access turned OFF, as has been the case during three different trimesters DURING FINALS will be a MAJOR plus!

It's kind of ironic for a school that professes to be so big on technology to not have fast, unfettered and ubiquitous internet service at the school.

T6, Wk5, Day354, Monday

There's a pervasive feeling of sadness, tears seem closer than I'm used to and there's been a knot like, nauseated feeling in my stomach for the last few days now.

I write this blog and sometimes share information, things I've learned ...

Scott was kind of like a verbal blog since I'd always be sharing the new things I've learned.

Just need some time to pass. Still don't have a cause of death.

Massive heart attack - cause of death for my 45 year old friend was a massive heart attack ...

went to Jurisprudence this morning followed by Phys Dx II, Dx Imag II, CCR then four hours of HCP II.

I did rock my first double cervical adjustment. Pt said she felt great after the adjustment and the instructor complimented me with a couple "excellents!"

T6, Wk4, Day 353, Friday

Had the Phys Dx II exam today. had PT, had a Professional Development class. Came home.