Friday, April 29, 2011

Part IV Mock Exam -

[Holding at Day 458]

" 3 more tri's and you can move on with how you want to live your life!"

I've got to remind myself of the comment left yesterday - 3 more tri's. I can't honestly say with a ton of certainty that I'll graduate after 3 Tri's but, that is the current course I am on.

I know I don't ever want to spend any more of my life doing all the driving I'm doing now.

From 10 a.m. to 12:30 p.m. we had Mock Exams which simulated Part IV National Boards. I think it was a very valuable experience. I had about seven stations to go through which included two orthopedic/neurologic examinations, case history, two adjusting stations, one abdominal exam and one heart/lung station.
As usual we had another Gonstead Exam this morning and I think I got a 100% on this one.

Part II National Board scores came back and I was a bit stunned to find that I passed 5 out of the 6 sections. It looks like I missed passing Chiropractic Practices by about two questions but, if it was that close then I really need to learn that stuff better anyway. I'm totally relieved I don't have to take all 6 sections again which is what happens if you fail two or more sections.

I've been listening to a lot of neurology on my commutes lately since I'm sick of listening to lectures so, I got a completely unabridged copy of a book called The Changing Brain which deals a lot with neural plasticity. I think this is going to be my topic for my Senior Research Project.

Now that this day is behind me it looks like I will be going to Minnesota tomorrow. It's a nutty schedule since I'll be arriving at 12:45 p.m. saturday and leaving at 1:55 on Sunday - a quick 25 hour & 10 minute stay.

Monday is the final day for the Part IV board reviews as well as the morning Gonstead class which will be meeting every day from Monday through & including Saturday the 7th.

Outpatient clinic starts this coming Tuesday ...I *think* at 11:30 a.m. then also on Wednesday and Friday evenings which means I'll be finishing up Gonstead at 10 a.m. then have a 5 1/2 hour gap until I start clinic in St Peters ... ...yes, I still think there's some A-holes who have found it necessary to implement a "new" no exception rule to changing clinics.
Hell, we had one guy assigned to a clinic who dropped out of HCP so what about that spot?

Oops - Dang, am I still pissed about that drive? yeah, guess I am.

not really focused here & need to get moving.

Today's picture is of one excessively cute little girl named Snow who reminds me that some things are worth living for.

Thursday, April 28, 2011

?!*$$!!***!I(#)$(%!)@(#$%&$*#(@)!@_%!

(Holding at Day 458)

EX - IN - AS - PI - these are different ways an Ilium can move or subluxate. Dr. Perillat told us an amazing story yesterday about a 15 month old girl who had a bowing leg that doctors wanted to do surgery on by breaking the leg then trying to set it straight. Dr. Perillat was able to see the infant in a somewhat desperate last minute attempt by the little girls mother to put off surgery and Dr. P was able to determine the baby had an EXternally rotated ilium (rotated away or lateral to the sacrum) which caused the misalignment of the femur and distorted growth of the bone which was simply trying it's best to adapt to the stress placed upon it.
Dr P adjusted the ilium back in place - bone breaking surgery was AVOIDED and four months later, the femur bone had straightened out.
Which, once again reminds me of that plaque I saw in the chiropractors office back when I was in 8th grade ... "If yours is NOT a chiropractic problem then chiropractic will not help but, if yours IS a chiropractic problem then nothing else will help."

Today's picture shows the ilium and the arrow pointing to the word ilium also happens to be the general direction of an EX subluxated ilium. The bone in between the right & left ilium is the sacrum.

(the above paragraph was written last in this blog but, it's about the only worthwhile thing here to read so I moved it to the top ....the remaining rant may be omitted without consequence) ;)

I'm not sure I have the words to express how excited I am to soon be driving home 50 miles each day from my new clinic in St Peters, MO. Even if Gas Prices hold at $4 per gallon and I could theoretically get a whopping 40 miles to the gallon I'm still looking at $12 bucks a day in gas and, the reality will be more like $15 per day.
How did the last guy I talked with get his 200 adjustments in at St. Peters? Well, he went there every single day during Tri-10 or ...$75/week - $300/month. I guess that's do-able ...why not?

But really, i'm looking forward to all the time spent in my car. With the main highway opened back up I'm a scant 40 miles from Logan and yet it took be a full 90 minutes to get home yesterday. I didn't really dwell on that fact yesterday but, when I saw rain coming down today, I immediately got a sick feeling and just wanted to jet out of school before rush hour kicked in.

Such understanding people at Logan. "Yeah, we understand it sucks that you live 50 miles away from the office and you own your own home so it's not like you can pack up and move in a weekend but there's nothing we can do about it"
The *majority* of the people will be pleased with their clinic selection and we never have to worry about any minority of people that may be having to take it up the derrière.

I did like the comment during this past Saturdays graduation when the class Valedictorian mentioned that they were going to walk across the stage soon, ...that is, if the graduation requirements didn't change between now and that time.
I'm not sure if I can think of any school I've ever been involved with or even heard of that changes requirements midstream. If it's some kind of accreditation issue or something like that well, that's one thing but, to change parameters midstream just because someone *thinks* it might be best could be construed by some as just plain mean, unthoughtful and inconsiderate.

From an academia point of view I wonder if this type of construct is common place given a situation where the people in charge of making the rules are so far removed from the time when they actually had to play the game themselves that they have no idea what it's like to be on the receiving end which, they obviously don't and never will know.

I wonder what kind of increase in heart attack risk factor is associated with sitting in my car an extra 2.5 hours a day. I know the 100 miles per day driving put me hypertensive for the first time in my life so, I just can't wait for the 120 miles per day of driving.

It's kind of ironic that we're being "taught" to eventually care for other people when the same caring we're being taught isn't exactly extended our way. I guess it's no different than hearing about how bad it is for us to be sitting all day without adequate breaks and then having teachers ignore our breaks so we can sit for extended periods of time regardless of the discomfort or real need to move around. I always LOVED when the last class of the day that gets out at 4:35 p.m. skipped our break so we could get out ot 4:25 especially after being in classes from 7:20 a.m.

Way back in Tri-1 we learned from Dr. H that "matter has limitations" I really wonder how well my body is going to fare with 120 mile driving days in addition to the demands of school. Oh, let's not forget our marketing events. I suppose I *should* be picking events over in St. Peters since that's where my clinic is located but wtf wants to drive 50 miles minimum on a Sat morning for something like that when there's so many events so much closer to home.

The pitch with St Peters is that they want you to be able to open up and run your own office by the time you're finished w/ clinic there. That really does sound great and I'm sure I'm going to learn a great deal but ....then I'm talking with graduates and, in particular, graduates who were out at the St. Peters office only to hear them say that out in "the real world" you just can't do anything like what was required of working the clinic in St Peters or, probably any of the clinics. Maybe I'll have a chance to find out for myself some day because, I really don't know.

Crazy is as crazy does and, maybe I'll attain that stature given enough time at Logan.

it's getting hard to tell when the nights end and the days begin.

better study - yeah, i know it's my break but, a test a day w/ the Gonstead class which, by itself, would be pretty tolerable. The Part IV board reviews are also very good (by themselves) and ...squeezing in the extra adjustments would be OK (by themselves - oh, up to 45 now) and the Senior Project thing would be fine (by itself) ...i literally can't think of everything that needs to be done. I suppose the wedding reception up in Minnesota this weekend would be a blast - BY ITSELF -
outpatient clinic ....
perception is not so hot at this time.


Wednesday, April 27, 2011

Gonstead, Part IV Board Reviews, Tri-8 Books! :)





(Holding at Day 458)

Every day starts with a test in Gonstead - heck of a way to keep us on our toes and to make sure we learn the material! :)

Part IV Board Reviews were pretty interesting today. Dr. James & Dr. Laura who teach this stuff are pretty much amazing. I like being there. My alternative of heading home just to be alone isn't all that appealing so, it works out well. Puts me in a bit of a time crunch but nothing I can't handle.
Oh, I did one of my favorite things today and that was getting some new books for a few of my Tri-8 classes! I was able to find four used books that I needed for my classes so I got them all today and saved $90 over the cost of buying them all new :)

Just went to Amazon to get today's pics and might have to check there to see if I can get the rest of my books online and save some $$$$ :)

Tuesday, April 26, 2011

Gonstead & Part IV Board Reviews

(Holding at Day 458)

Pretty wiped out today. I was up kind of late last night and am still running on four hours sleep. The Gonstead class seemed pretty cool. We're meeting in one of our radiology rooms which has a good sized conference table. There's about a dozen of us retaking the class but most of the people from my class are waiting to take it over. We're going to be meeting four days this week and then 6 days straight next week.

I went to the Part IV Board Reviews after my Gonstead class. There were a lot of people in there who had already graduated and still needed to get through Part IV in order to get licensed in the state they wanted to practice in. Part IV is definitely going to take some work. I only stayed through the lunch break because I was so wiped out (kind of wondering what I'm still doing up)

I only saw two other people from my class taking this round of Part IV reviews. I was happy that everything we covered I was already familiar with ...well, almost. We need to know what test to order for each malady we come across.
We covered Cullen's sign (bluing around the umbilicus), Caput medusa (portal hypertension) and Grey Turner's sign (ecchymosis of flanks) but didn't mention Sister Mary Joseph nodule which was one of my favorites ;) but ...probably not to the person who has SMJN since it refers to a metastasis of a malignant cancer. I guess it would be more accurate to say, it's one I remembered well from our Physical Diagnosis class and ...I'm just happy about remembering anything!

For the stomach, test may include Barium, GUAIAC, Stool culture, endoscopy and biopsy. The Pancreas is divided up into the head and the tail with DX US, amylase/lipase, biopsy, stool, UE and CT for the head and FBS, US, dipstick, ghycosylated Hb, GTT and AIC test for the tail. With the tail we're thinking more along the lines of Diabetes and with the head leaning more towards infections & cancer. Pain from pancreatic cancer or pancreatitis can manifest in hte T-10 vertebrae and other s/s include Grey Turner sign, fetal position, steatorrhea and jaundice. That fetal position is one of the first examples I ran across of muscle splinting.

With the Gall Bladder and ...I'm thinking a positive Murphy's sign we'll order a CBC w/ diff, bilirubin, UA, Cholecystogram, dx US and cystography. Basics were mentioned such as cholecystitis (aka cholangitis) or dochoangitis but left out another favorite of mine which is choledochocystitis. But, they did mentione cholelithiasis which, is just kind of fun to say.
The s/s for cholelithiasis (gallstones) are a bit irreverent with reference to females but, just remember the F's - Fat, female, 40's, flatulance and pretty much any other F thing you want to put in there ...along w/ multiparous, pain in the inferior right scapula, statorrhea (fatty stools) and jaundice.

Pale - clay - gray - poop ...what you get without bilirubin.

and ...once again we get another look at Nephritic vs Nephrotic - same word except for the I and the O. I know I've mentioned these two cuties in a previous post. We'll associate infection with Nephritic and Death with Nephrotic.
I like the s/s w/ nephrotic because they all go together quite nicely and make sence. HTN, Edema, protenuria, etc.

Let's call the bladder a cyst then it makes more sense to talk about Cystitis. We'll see this in older males due to the prostate and in younger females due to sex.

I'm wondering now if rigid abdomen w/ appendicitis was my first exposure to muscle splinting.

I'm kind of all over the place tonight. I have a Gonstead quiz tomorrow morning and would like to get to school early enough to study over the material.
One big benefit of having to get up early all these days over break is that I'll already be in the groove when Tri-8 starts.

still have a ton to take care of. Need to see what the clinic hours are during break then get some people in to still hit my 50 adjustments. Need to find an advisor/teacher to sign my blue sheet for my senior project ....and maybe also figure out what the heck I'll be doing the senior project on.

I also have to figure out what the heck I'm going to do about this weekend and going to Minnesota for my brother's 4th wedding reception ....

Radiology is this weekends review and we've got a board certified radiologist giving the lecture. I'm sure i'd have more fun at the reception but a weekend of radiology could go a long way in helping me through my 4th Diagnostic Imaging class coming up ....and those Dx Imag classes always test cumulatively so, anything we've seen over the past two years is fair game ...so much to remember ...

Monday, April 25, 2011

Thyroid Comment & What's going on?

(Holding at Day 458)

[8 a.m.]
I just had a comment posted on a blog recommending for people with hypothyroidism to take a natural thyroid hormone replacement and also provided links to the webpage to buy the natural hormone replacement.

The recommendation by that comment is NOT what we are taught at school. The recommendation would be a referral to an MD and, ideally, an endocrinologist.

[9:50 a.m.]
I need to get my head wrapped around everything that's pending in my life. The Part IV Board Reviews started this morning at 8 a.m. and, if my information is correct, the Gonstead class retake starts tomorrow at 7:30 a.m.
My brother advised me taking the Gonstead class and forgetting about the Board Reviews.
My parents also recommended taking the Gonstead class. Both my parents & brother had similar reasoning regarding taking the Gonstead class over now instead of waiting and that was to just get it out of the way and not hanging over my head. I'd have to say I agree. I've not had good results from waiting and putting things off. It always looks good on paper ...when I rationalize... but, there's no telling what the future holds and how busy I might be in the future. There's way too many unknown variables. I have a ton of work to do and many, many things to catch up on. In some ways ...

[12:50 p.m.]
...not exactly setting the world on fire today. I still have an opportunity to head to school and get in a few hours of Part IV Board Reviews ....OR, just take my brother's advice and focus on the Gonstead class. I kind of think heading out to school might help me get back in the groove (since I've been away a whole 3 days!)
I've been thinking about my attitude which hasn't always been the greatest especially with this recent semester. I have noticed my physical cues seem to come in two forms. One is, metaphorically speaking, the screaming in my head and the other is the physical shakiness which seems to be solely due to stress.
I was thinking of trying to view the mental dissonance differently and maybe remind myself that when my mind is screaming over all the things that need to be done that this is really a cue that I'm heading in the right direction. I have to change my perspective regarding the mental anguish which presents itself from time to time.

I know I've tried the increased physical activity to help cope with all the stress and, maybe that helped, it's hard to critically evaluate. I definitely know I need to eat more often and on a consistent basis. Too often, 12, 18 or even 24 hours can slip by without eating a meal and then I'm starving and eat a huge meal. This probably doesn't bode well for maintaining consistent blood sugar levels which probably affect my attitude as well.

Taking a page from Dr. Kuhn's teaching, I'm thinking about my e-cigarettes and how they are kind of a hassle to use but, with his teaching, I can also ask myself how much of a hassle would it be to get lung cancer or emphysema or COPD. Even if I would never get those diseases, there is still a sapping of energy that's probably taking place from forcing my body to have to deal w/ the toxins from smoking.

As I started to say at the end of my 9:50 a.m. entry, all these challenges I'm being faced with could be a very good thing since I'm being forced to deal with life at it's most interesting & challenging levels.

I really do want to graduate like the people I saw on this past Saturdays webcast. It's about the most amazing thing ever. When my brother graduated in 1996 I thought it was the greatest thing ever and when his wife graduated in 2007 I thought the same thing and when I saw graduation again two days ago I got those same feelings again. It's just an amazing accomplishment.

I've still got some notecards in front of me. I was trying to disseminate everything I need to get done in my life. "Plan your work, then work your plan" is something I learned my Dad used to do with regards to work. It's sound advice. I just need to apply it.

For right now, I'm going to meld back into some good habits. Namely heading to school, checking out the Part IV Board Reviews then stopping at the gym on my way back home. Gonstead starts tomorrow and I need to get my mobile internet working again. I don't know where the class meets or how the payment will work since the school doesn't open up again until Wednesday, not sure why the mobile internet isn't working. Not sure of a lot of things and I'm just going to have to deal with them all one thing at a time.

Boot Camp from 5 a.m. to 6 a.m. is the only other thing I've thought of adding to my life over these next couple of weeks.

Saturday, April 23, 2011

Tri-7/8 Wk15 Day 458 5th & Last Day of Written Finals

quick edit -

Day 458 was my last day of Tri-7 BUT this morning (Saturday, April 23rd, 2011) we have a live graduation ceremony going on from 10 a.m. to noon.

Wednesday, April 20, 2011

Tri-7/8 Wk15 Day 457 - Wednesday, 4th Dday of Written Finals

I'm not sure I've slept much more than 3 or 4 hours a night this week ...going to catch up on that tonight.
Most all grades are in but we still have Research Methods to take tomorrow and need the grade for the Diagnostic Imaging III final we took today.

"Break" is looking interesting ...
Gonstead will meet from April 26th to May 6th from 7:30 a.m. to 10 a.m.
Part IV Board Reviews from April 25 to May 2nd from 8 a.m. to 5 p.m.
Outpatient Clinic Starts May 3rd
from emails ....
This Friday morning at 7:30 a.m. (our first day of "break") we need to be at school to sign up for a Marketing event
and ...I got an email stating I only had 43 adjustments and still needed 7 more.... Even with all the time off I had, if all my patients would have just shown up the last three weeks this wouldn't be an issue ...
oh well.


Tri 7/8 Wk15 Day 456 - Tuesday, 3rd Day of Written Finals

Gonstead and Geriatrics were on the menu for Tuesday.

It's about 3:45 a.m. on Wednesday, April 20th. I should get to school around 5-something a.m., study Dx Imag for 3 hours then 1 hour on Soft Tissue, take the 9 a.m. ST final then study Dx Imag more until our 2 p.m. final ....

Got an email from school regarding the remaining National Boards Part III, IV & PT testing and based on last year's prices we'll need to pay $2,015.00 to take those remaining exams to get our license. Part IV alone is $1,235.00

from text I got last night, I learned 3 of 4 people who did not pass Gonstead.

Yesterday, I learned of a second person who has been kicked out of Logan in the past month. It is a pressure cooker of a place.

The last final from Tri-7 is this Thursday and another email informed us of a Marketing Event this Friday at 7 a.m.

After Thursday, I have 3 days off then 8 straight days of board reviews then start outpatient clinic.

I was looking over the outline for these Part IV board reviews coming up and they look extremely valuable since most all of it appears to be related to what we'll be doing in clinic.

I think we have around 13 more classes in Tri-8 but one of those classes is like 6 classes in one in that it contains 6 different modules of activities that need to be accomplished. I know one of those modules pertains to the different marketing events we need to attend and another one has to do with x-raying phantoms for practice.

Monday, April 18, 2011

Tri-7/8 Wk15 Day 455 - Monday, 2nd Day of Finals

2nd day of written finals that is.

Early on in this semester I was using YouTube to help me cope by looking up songs we used to sing in church when I was younger. I remember looking up Make Me A Channel of Your Peace which is also known as the Prayer of St Francis. I was never sucessful in finding a version of the song which was as fast paced and upbeat as we used to sing in church but, the words were still helpful.

From those searches and, as the semester wore on, I sought out a slew of inspirational type videos. Recently, I've gravitated towards groups like the Bee Gees & Three Dog Night and enjoy seeing the live concerts, the dress, apparel and ambiance of the 70s which, also lead my mind back to simpler times.

Speaking of simplicity, there's the hauntingly beautiful, Non nobis Domine song from Henry V which consist of 8 Latin words sung over and over.
Non nobis, Domine (Not unto us Lord)
Sed nomini tuo da gloriam (But to Thy name give the glory).

It's after 2 a.m. and I've got my first final of the week in 7 hours.

Saturday, April 16, 2011

Tri-7/8 Wk 14 Day 454 - Friday, 1st Day of Finals


[1 p.m. -ish] We had our GIUG and PT written finals on Friday and next on the list is AK & Endocrinology on Monday at 9 a.m. and 2 p.m. respectively. Nothing has been posted yet for either of Friday's finals. I did get a 92% on this past Thursday's Activator practical.

We sure learned a lot in GUIG, that's definitely a staple class. It's changed my views and perspectives of the entire GI system for the better.

My writing mind is kind of cold today but I know I've had a plethora of topics ruminating through my head over the past few days. Guess I'll focus on the immediate future for now. It seems a little odd but, I believe I'm actually off today & tomorrow ...no extra classes, no board reviews, no clinic, nothing. Speaking of clinic, a lot of my patients never showed up the past 2-3 weeks so that kind of put me in a bind w/ my numbers and I ended with 43 adjustments.

For AK, I'll just need to memorize a table or two worth of material then I should have no problems getting through that class. Endocrinology is over diabetes mellitis and will take a bit more conceptual understanding as well as memorizing.

Tuesday is Gonstead & Geriatrics.

[4 p.m. -ish] ok, 5ish now ....
and the cortex needs to be stimulated to a degree sufficient enough to induce proteins to form memory ... I'm thinking now that I've ate some things are easier to remember. As I've been thinking, sometimes we'll do things like exercise or improve our diet to help improve ourselves but, sometimes we need to do those things in order to simply slow the progression of degenerative processes. In a way, healthy living can act as a parachute to help stave off the entropy inherent with life.

I think there is value in this type of thinking. For the past two months or so I've been exercising pretty diligently but I still haven't noticed a huge surge in energy or a 32 inch waistline or anything like that which would indicate obvious improvement but, then I think, how would things be if I hadn't been exercising? How much of a parachute did that exercise act like and how much worse off would I be if I hadn't been exercising. With that type of thinking, a person can always rationalize benefit then, maybe over time, the more obvious types of benefits will present themselves.

Anyway, I need to start hitting the books - AK is on the menu for tonight, at least a few hours of it.

Today's picture is of Reflex Sympathetic Dystrophy. That's the name I first learned it as. Now-a-days I think the updated terminology is CRPD, Complex Regional Pain Syndrome. As this x-ray image demonstrates, bone is washed away. There is a mortality rate associated with CRPD which is usually due to suicide which tends to be secondary to physicians being unable to diagnose this disease. It can be self limiting and correct within a decade or so. Trauma can be an etiology to this disease, such as a post surgical incidence.

Thursday, April 14, 2011

Tri-7 Wk14 Days Wed/Thur, 452 & 453

Still, not a ton of time to blog here but I did find out something interesting. I knew I had a paycheck coming from YouTube & Google for the brachial plexus video I posted because I'd reached some sort of threshold but, what I just found out is that threshold is $100! :)

YeeHaw! I've got $123 coming from Google now :)

Anyway - GIUG exam tomorrow at 7:30 and PT exam t 11:30

Gotta get to bed, get up early and rock these two out!

Tuesday, April 12, 2011

Tri-7 Wk14, Days 450 451, Mon & Tue

just going to be a placeholder here today - not enough time to blog -

Sunday, April 10, 2011

Tri-7 Wk13 Day 449 - Friday

late Sunday night ...too late ...I always seem to want to milk the weekend for all it's worth and not go to bed as early as I should on Sunday nights. This makes for a most difficult start on Monday. I'm going to try something new & different tomorrow morning. We'll see how it plays out and I'll update in tomorrows blog ...day 450! :)

Four days left of classes then it looks like only 4 days of finals because the last day of finals is just a research project that's due. It looks like I have a reasonable chance of getting through everything except for Gonstead which, I'll probably have to take over the break. That's only a two hour class so I should still be able to get to many of the Part IV board reviews over break - those go on for 8 days straight, 8 a.m. to 5 p.m. but, I'll be jetting off to Minnesota during a weekend and missing two days of board reviews.

AK quiz due this Wednesday -
Activator Practical this Thursday -
then finals ...
Friday - GIUG @ 7:30 and PT II @ 11:30
Monday - AK @ 9 and Endo at 2
Tuesday - Gonstead at 7:30 and Geriatrics at 11:30
Wednesday - Soft Tissue @ 9 and Diagnostic Imaging III @ 2
Thursday - Research Methods project due @ 7:30

Pretty darn light schedule as far as final testing is concerned ...
I've got 41 patients seen now and *should* be able to get that at least to 45 by Thursday
Still got one CMR to finish.

It's going to be amazing to get down to just the two exams per day ...and ...I *think* a whole weekend off! just amazing.
I do wonder what the Gonstead final will be like. The midterm was a bunch of fill in the blanks

Thursday, April 7, 2011

Tri-7 Wk13, Days 447 & 448, Wednesday & Thursday

hmmmm .... long day. I caught a post from a classmate yesterday who had to get up at 5 a.m. and I'm thinking I've been getting up on average at 4:30 a.m. or earlier for the past three years but, I guess things are always more noteworthy when they're happening to you.

This morning was a 3 a.m. start to the day and I just got home at 9:30 p.m.

We had our Activator written final exam this morning and ...I did pass. I'm having a heck of a time remembering the simplest of things. The toughest part of this morning's exam was filling in the date correctly on my scantron. I knew it was 4-7-11 but had trouble getting it out. First, I put down the 11, then a 7, and finally the 4 ....
AK class wasn't any better ...class had started and I was struggling to pull up my word document I use to take notes for that class, I finally admitted defeat and asked my neighbor what class we were in - for the life of me I just couldn't remember. But, I'd had to ask neighbors before what class we were in so, maybe they're getting used to it by now.

I ended up seeing my 39th patient today which, was my room partner. She got bogged down in a diagnostic ultrasound and we only had 15 minutes before the clinic closed to get her exam in plus, we had two lower tri's join the fun by observing as part of a requirement for a class they were in.

Her adjustment went pretty well.

A semester or two ago, I remembered seeing a section of our exam sheets that referred to tone, symmetry, tenderness, temperature and things like that. I wasn't sure (at the time) about temperature but, in the last month or so, I've been able to notice temperature differences along my patients spines and, when I palpate those areas or challenge the joints I inevitably end up hearing a squelch from my patients because those are sore and tender areas along their spines.

I'm having a much harder time figuring things out like spinous right or spinous left. I can usually tell a bit more from AROM or active ranges of motion. My Gonstead class (in spite of my poor performance in that class) has actually helped me to identify fixated or restricted vertebrae which, isn't exactly always the easiest thing in the world to do.

I'm not sure what's going on tomorrow ...let's see ...Activator practicals are going on first hour but my practical isn't until next Thursday. Then we have .....
Oops, my mistake - we have Geriatrics first! Good class, Dr. Bub!
Then I guess I have an hour break
Then ...well, i've got PT next but my Gonstead teacher wanted me to come see him at 9:15 so I'll probably try and let my PT teacher know what's up then see my Gonstead teacher and, hopefully, get back to my PT class.
5 days left of classes and then 5 days of final exams .....

oh, and for some reason ...my car seems to have gone from getting close to 40 miles to the gallon down to about 13 miles to the gallon. I just filled the thing up yesterday and I'm all the way down to E! I was hoping maybe someone siphoned off my gas or that my gauge is broken.

Dead tired ...gotta get to sleep :)

Tuesday, April 5, 2011

Tri-7 Wk13, Day 445 & 446, Monday & Tuesday

two days down this week - where did the time go?
I only had about an hour and a half of sleep last night due to studying for two exams I had today. One was in Endocrinology and the other in GIUG.
I think we're supposed to have some goals for HCP tomorrow pertaining to our new outpatient clinic and what we're going to do each week in order to generate business. I think it's something new they're doing starting with us. I dont' really know what to do week by week. I've thought about joining Toastmasters to help with public speaking.

I think I was a little overconfident with regards to my endo exam. I knew about diiodinase types 1,2 & 3 and where they were made and other such details that weren't asked about. But, there were some more basic type questions that I didnt' get down. Well, not basic for the general public but when I saw the questions I figured I should have known a bit more about them. I dont' know, it is tough not having notes for the class due to not being able to use my laptop.

I am pretty sure I fared a bit better with GIUG ...a class for which I have over 70 pages of class notes that never get lost or misplaced because their on my laptop :D hehehe and backed up every day automatically.

Activator written exam is this Thursday then the practical for that class will be held over the next three classes, those being Thursday, Friday and the following Thursday.

Adjustment #36 is scheduled for tomorrow - I'm hoping to come as close to 40 by the end of the week as possible. It will be exciting to start the outpatient clinic. I have no idea what to expect but I'm pretty sure there will be plenty to learn.

I've been keeping a photo journal of the new building being put up at Logan, you can see the pictures here --> http://www.facebook.com/album.php?aid=112625&id=1324821250&l=2c0f38383a

Sunday, April 3, 2011

Tri-7 Sunday - Thyroid Talk

holding at Wk12, Day 444

I'm not sure how to count these last couple days. The powers that be decided it would be a good idea to hold our Monday classes on a Saturday - I'm not sure who thinks of these things but it's not like our weekends are free - Clinic is open from 9 to 12 and post graduate classes for both Acupuncture and the Internal Health Specialist (IHS) programs were also held this weekend. The IHS program has been fantastic and I'd love to go over some of the stuff learned in this blog but I have to keep my gears and direction shifted into the Thyroid ....
Amazingly complex at this level but, I'm going to try and hit just the high points in this blog. This may not be the most readable blog but I'll be sharing this info w/ a classmate (that's what I have in mind anyway) also kind of a way to take notes

page 1699 -

T4 is 100ugm - T3 is 5umg / day
T4 is 90% of what's secreted by the thyroid - ppt

T3 is 8x more powerful than T4 per book
T3 is 4x more powerful than T4 per Dr Sanders ppt ...

80% of T3 comes from T4

T3 burns brighter and dies faster - (shorter half life)

3 types of deiodinase convert T4 to T3
Type 1 is found in the liver and kidneys
Type 2 is present in the pituitary gland and brain - can you say pi-TWO-itary?
Type 3 is present in the glial cells of the CNS

TBG - Thyroxine-binding globulin is synthesized by the liver and functions as the main trasport protein for thyroid hormones.

Thyroid Hormone Action
thyroid hormone binds receptors that are members of the nuclear receptor superfamily, regulating expressioni of thyroid hormone-responsive genes.

Isoforms of the thyroid hormone receptors (alpha1, beta1 and beta2) bind to a specific hexameric oligonucleotide sequence in the transcrptional regulatory regionof the thyroid hormone-responsive genes.

Thyroid hormone increases oxygen consumption, thermogenesis and expression of the low-density lipoprotein (LDL) receptor, resulting in accelerated LDL cholesterol degradation.

In myocardium, T3, increases myocyte contractility and relaxation by altering myosin heavy chain and sarcoplasmic reticulum adenosine triphosphatease (ATPase).

In cardiac conducting system, T3, increases the heart rate by altering sinoatrial node depolarization and repolarization.

Other physiologic effects of thyroid hormone include increased mental alertness, ventilatory drive, gastrointestinal motility and bone turnover -
from ppt - increases # of mitochondria within target cells and increases rate of intestinal glucose absorption

page 1699
DIAGNOSIS -
Physical Examination -
inspection of lower anterior portion of the neck to check for diffuse or asymmetrical gland enlargement, tracheal deviation, lymphadenopathy and jubular venous distention.

Laboratory Findings -
log linear neagative relationships btw levels of T4+T3 and TSH makes it a sensitive indicator of primary thyroid gland dysfunction.


ppt - GD is no longer thought of as an idiopathic disease but rather as an autoimmune disorder in which B lymphocytes produce immunoglobulins, some of which bind to and activate the TSH receptor, stimulating excess thyroid growth and hormone secretion.

Cecil goes with hyperthyroidism, ophthalmopathy and dermopathy
m/c onset for Graves is with women btw ages of 30-60

Pathobiology of Graves
The proximate cause of hyperthyroidism is production of thyroid stimulating immunoglobulins that bind to and activate the TSH receptors, promoting thyroid hormone secretion and growth of the thyroid gland.
Other thyroid autoantibodies also commonly identified in the setting of Graves dz include antithyroid peroxidase antibodies, antithyroglobulin antibodies and anti-TSH receptor antibodies that block TSH binding.
The fundamental pathogenesis of Graves dz remains unknown. A genetic predsposition is implicated by a higher incidence in monozygotic twins and first degree relatives of affected individuals.
Environmental factors implicated in triggering the onset of Graves dz include exposure to cigarette smoke, high dietary iodine intake, stressful life events and certain antecedent infections.

Clinical Manifestations
Affected individuals usually present with thyrotoxicosis and a thyroid gland that is diffusely enlarged with a rubbery consistency, smooth contour, definable pyramidal lobe and audible bruit or palpable thrill due to increased blood flow.
When it is clinically evident, thyroid eye disease usually presents within a few months of the onset of jyperthyroidism. In rare cases, it may develop long before, long after or without any biochemical confirmation of hhyperthyroidism.

Prognosis -
The hyperthyroidism associated withthis condition often follows a persistent and progressive course but approximately 1/4th of pts w/ Graves dz demonstrate spontaneous dz remission.

TSI - Thyroid Stimulating Immunoglobulins - THS receptor binding antibodies

Other antibodies occur in Graves and other autoimmune dz such as Hashimoto's dz. These antibodies bind to the TSH receptor but stimulate only thyroid growth without increasing thyroid hormone secretion.

GD - occur in 1.7 to 1.9% of females and 0.2 to 0.3% of males
Peak incidence of onset is 30 to 40 years old w/ strong familial component.

I've had enough thyroid for one night ....heading to the gym :)



Friday, April 1, 2011

Tri-7 Wk12 Day 444, Friday

Just a few topics that got covered in classes that I still had web pages up for. :)

Bezoar - (Trichobezoar) - these are so nasty I wont bother adding a pic. A bezoar is a ball of swallowed foreign material (usually hair or fiber) that collects in the stomach and fails to pass through the intestines.

Alpha 1-antitrypsin - (AAT) this helps keep your lungs healthy, without it elastin is broken down in the lungs and can result in complications such as emphysema or COPD. AAT deficiency is the most common inherited disorder among white people.

Bochdalek hernia - a form of congenital diaphragmatic hernia.

Postherpetic neuraliga - a painful condition affecting your nerve fibers and skin.

TRAP - an acronym used to help remember the four primary signs of Parkinson's Disease
  • T - Tremor at rest
  • R - Rigidity
  • A - Akinesia (absence or slowness of movement)
  • P - Postural instability