Tri-10 Wk10 Day? - Friday 3/15/12 - 2 days away...

2 days, 0 hours, 0 minutes until Part III.

9:54 a.m. - 1 day, 22 hours, 5 minutes until Part III....

I think I need to go for quantity over quality. I very much like going in depth with things... diseases, etiologies and so forth but I can probably be better served with simple associations.

Quick review - DR CUMA

Drop Wrist - Radial Nerve

Claw Hand - Ulnar Nerve

Median Nerve - Ape Hand

for shoulder orthopedic test: CAADDYS

Codman's - rotator cuff

Apley's - ROM

Apprehension - Chronic Disclocation

Dugas' - Dislocation (Kocker's maneuver)

Dawbarn's - Bursitis

Yerguson's - Bicipital tendon instability (transverse humeral ligament)

Speed's - Tendonitis

Cervical Orthopedic Test

Compression, Jackson's, Maximal - IVF encroachment

Spurling's - disc & IVF encroachment

Bakody's - (Xu pain) nerve root syndrome

Shoulder depressor - nerve root adhesions

distraction - nerve root v. musculoskeletal

O'Donohue - Sprain v sprain

Soto Hall's - General

Lhermitte's - Cord degeneration (MS)

Tri-10 Wk10 Day? - Wednesday, March 14, 2012

3 days, 20 hours, 18 minutes until Part III - interspersed focused study needed.

I'll be using the Part III Study Prep guide obtained from NBS to help with the focus.

NMS Exam consist of 13% of our exam

1. Posture & Gait knowledge

2. Ortho & Neuro Test purposes

3. Peripheral vascular conditions especially TOS, claudication and RSDS.

RSDS is kind of a favorite of mine.

DR CUMA

Drop Wrist - Radial Nerve

Claw Hand - Ulnar Nerve

Median Nerve - Ape Hand

I remember there is a ddx on the Claw Hand -

Claw Hand, Ulnar nerve, Tunnel of Guyon

Dupuytren's - flexed 4th & 5th digit - Hereditary, red ropey fascia

Volkmann's - flexed 4th & 5th digit - Post Trauma

Parkinson's - Parkinsonian Gait - Seen in the basal-ganglia defects of Parkinson disease. Posture is stopped, with flexion of head, arms, hips and knees. Patients are slow getting started. Steps are short & shuffling with involuntary hastening (festination). Arm swings are decreased and patients turn around stiffly (all in one piece). Postural control is poor (retropulsion)

Key Words: Propulsion / Festinating / Shuffling / Mincing, Rigid, subthalamic, forward leaning posture w/ small shuffling steps.

Scissors Gait - Seein in spinal cord disease cuasing bilateral lower extremity spasticity including adductor spasm and abnormal proprioception. Gait is stiff. Patients advance each leg slowly and the thighs tend to cross forward on each other at each step. Steps are short. Patients appear to be walking through water.

ddx - Cerebral Palsy / adductor spasm, Knees together (ddx from waddling (MD) in which knees are apart)

Waddling (hip flexors) - Muscular Dystrophy -

L4 - Steppage Gait - Seen in food drop, usually secondary to peripheral motor unit disease. Patients either drag the feet or lift them high with knees flexed and bring them down with a slap onto the floor thus appearing to be walking up stiars. They cannot walk on their heels. The steppage giat may involve one or both legs Tibialis anterior and toe extensors are weak.

Key Words/ ddx - L4, Anterior Compartment Syndrome (ACS), foot drop, L4 Lesion / paresis of tibialis anterior

L5 - Gluteus Medius Lurch - Lateral sway over the weight bearing leg

S1 - Glueteus Maximus Lurch - AP sway (leans back during mid stance)

Spastic Hemiparesis - Seen in corticospinal tract lesion in stroke, causing poor control of flexor muscles during swing phase. Affected arm is flexed, immobile and held close to the side, with elbow, wrists and interphalangeal joints flexed. Affected leg extensors spastic; ankle plantar-flexed and inverted. Patients may drag toe, circle leg stiffly outward and forward (circumduction) or lean trunk to contralateral side to clear affected leg during walking.

Slappage gait - Sensory Ataxia - posterior column disease; sensory ataxia (difficulty walking in the dark) gait is unsteady with a wide base (feet wide apart) patients throw their feet forward and outward adn bring them down, first on the heels and ten on hte toes with a double tapping sound. They watch the ground for guidance when walking. With eyes closed, they cannotstand steadily with their feet together (positive Romberg sign) and the staggering gait worsens.

Tri-10 Wk10 Day? Tuesday, March 13, 2012

Tri-10 Wk10 Day ? Monday, March 12th, 2012

...up late last night reading a bunch of stuff for my Senior Research Project (SRP). Very interesting material though and quite engaging. My head was swimming with new information yesterday. I remember some of the studies we went through in advanced Basic which included one on the decrease of melatonin production for kids who sleep with nightlights. Another study was the correlation between platelet calmodulin levels and predictability in scoliosis patients.

Today my mind got put through the grinder with Dr. Ketner in our differential diagnosis class. I think it's going to take me four days of study and review to even start to fully appreciate & digest everything he told us today.

Super nice outside ...I do believe I'll be going for a walk :)

Tri-10 Wk09/10 Day ? Sunday, March 11th, 2012

4:34 a.m. - ....NOPE ...it's actually 5:34 a.m. - I think I'm missing that extra hour of sleep already but, on the positive side, my wrist watch is finally correct after 4+ months of being an hour ahead :)

Pretty much same agenda today as yesterday, just not quite as long. I still have to get an article read for Advanced Basic.

2:57 p.m. - Home by 3, very nice :)

I'll need to sign up for comp board exams on Tuesday, March 20th - had a couple other things in my head this morning I needed to add to my list but can't think of them right now. I'm sure they'll come to me eventually. Tons of new information this morning - thinking a nap might be in order to let this new info gel.

9:11 p.m. - good number, 911, just like the Porsche :)

definitely a good & much needed nap.

This is kind of interesting. I was scrolling back through my blog looking for my list of things I need to be focused on and came across my Blog Archive which shows the number of times I've blogged each year. Here is the breakdown of years w/ number of blog entries.

2009 - 196 entries

2010 - 177 entries

2011 - 135 entries

2012 - 11 entries so far

looking at the monthly breakdown it looks like 2011 was on a normal pace until August when things started to drop off drastically. I went from an average of 17 post per month from January to July then from August to December the average dropped to 3.2 post per month ...and that's in spite of the fact I dropped clinic about a month into my Fall trimester. Not good.

Tri-10 Wk09 Day ? - Saturday, March 10th, 2012

Super fascinating day! :)

Darn long day as well. I had to be up by six - hit the road at 7 and didn't get back until just a few minutes ago at 8 p.m.

This weekend I have two things overlapping a bit - it's my last weekend of Advanced Basic - a specialized technique and another session of my Internal Health Specialist program. Both are rather fascinating.

We had a pretty cool display this morning of having people march in place with eyes closed and no sound - this took vestibularcochlear aspects out of play and forced us to rely solely on proprioception. We had four students at a time do this and people would either end up rotating to the right or left, veering forwards or backwards and we could get a darn good idea of what was going on with their spines and where scoliotic type curves were present - Our teacher - Dr. Montgomery, is just brilliant - so much to share. His Advanced Basic class really should be a staple of the curriculum.

On another exam, we went to the cranial nerves and had specific things we were looking for when we did simply test like checking a patients cardinal fields of gaze. These abnormalities were able to indicate atlas and sometimes axis (C1 & C2) subluxations. The really cool part was we could see these anomalies, then adjust the patients atlas then check again and see the anomalies were gone.

Find a drug that's going to instantly change the neurology of a person with zero side effects! Good luck - ain't going to happen. :)

We also got into acupuncture for scoliosis. Just 8 needles. They ranged from the very top of the head to the lateral side of the little toe. Some of the needles I had in me really elicited a different type of feeling in me. They call the energy Qi - pronounced "Chi or Chee" and, by "they" I'm referring to TCM or Traditional Chinese Medicine. Actually the specific type of acupuncture we used was Tsaoist (?) can't think of the exact spelling - it's pronounced like "Dow"

I did learn (and now use) Xu as meaning deficiency which is nice to use on a laptop since up and down arrows don't translate as nicely.

I still need to get to the DoubleTree hotel on a Friday before we have our next Internal Health classes to learn more about the specific enzymes available. There's a lot of nice perks and stuff we can get our hands on even as a student in that IHS class, same for the acupuncture.

Our acupuncture teacher previously only taught advanced acupuncture and we're the first to get him for the 100 hour acupuncture course.

My head is pretty much swimming in new material. I really enjoyed the basic today.

OMG! I *finally* learned the Spears Painless technique for cervical adjustments - *very* cool - very specific. I like it MUCH better than the rotatory break / diversified method.

Heck - I gotta get going here. Tonight is a very special night for two wonderful people. It's their 50th wedding anniversary and I get to help partake in the festivities. :)

What a feat. I just need to get married before I'm 50 then live to be 100 ...well, I guess my wife would need to be able to live another 50 years as well. but, what a trip. What great things could be done.

Gotta Run!

Tri-10 Wk09 Day ? - Wednesday, March 7th, 2012

Tri-10 Wk09 Day ? - Wednesday, March 7th, 2012

6:09 a.m. - I don't have classes on Tuesdays anymore.

Differential Diagnosis (ddx) Midterm exam tomorrow and some poster type project is due this Friday for Office Management. I think I might have something going this weekend, maybe Advanced Basic. ...confirmed - last Advanced Basic class is this weekend.

Tomorrow at 11 I have ddx midterm - 25 hours from now - definitely a day to study which generally means my home should end up getting cleaned up nicely since things like doing dishes, laundry and general house cleaning seem to not be such daunting task when studying is afoot.

But - as long as I'm doing the studying throughout the day, an occasional cleaning break won't be so bad. I have a host of old ponies to work through and I was also thinking of hitting things on a neurologic level with a laminated sheet I have from neurology class which pertains to localizing lesions in the nervous system.

...calendar updated w/ Acupuncture, Advanced Basic & Part III NB Exam dates....

10:47 a.m. ...reading about neurology - kind of expansive topic, not focused enough - thinking of heading to ponies to get a better idea of what I should be reading. probably the most interesting bit of reading that I did was learning that a 1500 gram brain only weighs about 50 grams when suspended in CSF (cerebral spinal fluid).

3:20 p.m. - kind of a strange visit I just had - quite out of the ordinary and definitely a first for my particular visitor. I got a feeling someones 1500 gram brain is shifting and probably not for the better...

3:25 p.m. back to HA & diff dx ponies - much to cover between now and tomorrow at 11 a.m. I'm certainly up for a change of venue - especially now. Maybe flashcards at my table by the window at a local pub, I certainly have enough of them to go through. I definitely need to change my location

Tri-10 Wk09 Day ? - Monday, March 5, 2012

Tri-10 Wk09 Day ? - March 5, 2012

5:08 a.m. No shortage of sleep lately, that's for sure.

...7:27 a.m. ... unexpectedly sidetracked. can't say it was good or bad, just was.

8:12 a.m. - off to school.

2:41 p.m. - leftover pizza for lunch.

I was surprised in Office Management when Dr. Hillgartner told us about insurance companies that offer "expedited service" with regards to paying their claims in exchange for something like a 30% reduction in what they owe to a doctor for services rendered.

So, if an insurance company owes a doctor $230 then the insurance company would be willing to pay $160 in a timely manner as long as the doctor takes a cut in what's due them otherwise the doc has to wait .... It's pretty ridiculous but, seems like standard practice according to Dr. H.

Case STudy in ddx today consisted of a 20 yom, collegiate athlete two experienced right sided parasthesia & weakness with a sudden onset while squatting w/ 325 lbs.

With the sudden onset and lifting, I initially thought musculoskeletal system and it reminded me of a pt I had in clinic.

Tri-10, Wk08 - Day ??? Sunday, March 4th, 2012

Today is my Dad's birthday! YeeHaw! :)
I've noticed the older I get the more people tell me to appreciate my Dad and they wish theirs was still around. That will be a very sad day, should I live to see it but, hopefully he'll be around for at least another 20 or 30 years. I think his goal is to live to be 100 which is fine by me :)

Of course, I should be able to procure some type of progeny by then ...God willing...

Module 1 of 6 for Acupuncture is now complete and HOLY COW and OMG!!! That was a butt kicking weekend I just went through. Our teacher, Dr. Zeb asked us if we felt like our head was going to explode and if we felt like we were totally lost. I sure did and he said if that was the case then he did his job.

It is a fascinating field. It's an elegant, artistic and even poetic way of viewing the body which is pretty cool and kind of a refreshing change of pace.

Ugh - horrible time focusing here.

oh well. i've done my class today, lunch & dinner w/ the family to help celebrate dad's birthday - what next.....

I remember I had bills listed yesterday and I could probably kill some time at the gym :)

I wish my dog could talk. I could use the company.

I did like seeing all the nice cars from all the docs that are taking the post grad courses at Logan. I remember at all of Troy's parties everyone that showed up had nice cars and any that I visited had nice houses and nice gf's or wives.

I guess gf/wife, house then car would be my order and finishing up school needs to happen along the way.

I did run by SAMs after class to get some gas and smokes. Cigs were only $20 & change for a carton! damn - way overpriced in Illinois. I missed my 141 south exit and had to take Weidman down to Manchester road but, that reminded me of Queeny park where I spent a lot of time walking, jogging and biking last trimester. I got some really good physical results last trimester. I'll have to do that again. Last trimester I snuck in the walks & stuff right after class and it was still pushing it to get done before rush hour started. I don't have that problem this tri so much because of so many fewer classes. I think I have two or three days in a row in at the gym so I can easily keep up that effort and the extra physical involvement should help with my mental state as well as my memory for school.

Tri-10, Wk08 - Day ??? Fri/Sat, Feb 2&3, 2012

Finishing up my Saturday here (2/3) I think I did pretty well today or at least as well as I could possibly do. I made it to school on time, spent all day in my new Acupuncture class, went to the gym after school then studied my flashcards for Part III boards and now ...it's about time for bed. I just need to keep my head in the game and keep forging forward with school and hope & pray that the rest of my life will turn out well if I just keep on the straight & narrow.

I'm still getting cable even though it's been cancelled for a few days now. I used to work disconnect orders when I first started with SAVVIS so, I know it can take a few days for all the disco orders to get pushed through.

I still need to cancel my Netflix subscription and go through all my bills tomorrow.

Today was a little odd in that someone pretty close to me texted me this afternoon and said they wanted to pay for my Acupuncture class then proceeded to text me all their credit card information so I could pay for my remaining classes. It was a nice gesture but not one I could put a lot of stock into.

I didn't hear anymore from that person and after I got home I learned they unfriended me on facebook. Other than that bizarre episode I'd say the day went pretty well. I need to be back up at 6 tomorrow and heading out at 7 to get to class by 8.

We did practice "needling" today. That was a bit interesting ....

I did learn that in 1997 the NIH (National Institute of Health) recognized Acupuncture as a legitimate and viable means of health care. Also learned the World Health Organization (WHO) recognized Acupuncture as being a valuable adjunct to about 2,000 ailments.

Our instructor actually used acupuncture on his son who had suffered from testicular cancer. His son received chemotherapy but, instead of taking a slew of drugs to help offset the side effects of the chemo, he received acupuncture instead and the kids blood labs actually maintained normal levels. The teacher and his son were told 5 years ago that his son was going to die. No probability or anything, just that his son was going to die. That was 5 years ago and his son is still alive.

There is also an herb we learned about - actually an extract from an herb. Some company noticed the great results from an herb that was already on the market and was able to isolate the molecule which was responsible for providing the great results. It's rather expensive but, for people taking the supplement and who have had cancer, they've never had a relapse and apparently it's supposed to help people who are currently battling cancer.

The teacher and his son both take the supplement at a cost of $12,000 per year so, for one person I'm figuring about $500 per month. I can't say I would push a family member to take the supplement at this point but, if they ever had a relapsing course of cancer then I definitely would recommend and do what i could to help pay for it.

The guy teaching the class said he works a lot with supplements - herbal supplements and takes in about 2-$3,000 per week extra income from it. and that's profit ...and only a small part of their practice.

Tri-10, Wk08 - Day ???, Thursday, March 1st, 2012

Note to self: do not set calendar on keyboard or you will lose everything you typed....

Basically I screwed up and overlooked my 3rd and 4th competency board exams which means I get no credit for them but still need to pass comp boards to get back into clinic. I had Feb 14, 21 & 28 to choose from. I was going to go with the 28th but ...lost focus :(

Where's that list again?...

1. Senior Research Project - waiting for approval in the mail from IRB, Internal Review Board
2. Loomis, Internal Health Specialist program - next meeting is Sat 1-7 & Sun 8-2
3. Acupuncture - First weekend is coming up! March 4th & 5th. I think I might need a book and maybe $79 or so for needles??? not sure
4. Competency Boards - already screwed this up. Might want to shoot for the 13th or 20th.
5. Part III National Boards - March 25th!!! Keep working through the books, making flashcards and studying whenever possible. The matching feature on studystack.com is really nice when first learning a set of cards and I have an app on my phone to look at flashcards any other time.
6. Advanced Basic - I think I'm sitting pretty good right now. Just took the midterm
7. Differential Diagnosis - I have a midterm next Thursday in this class. Studying for this class will probably do the most with helping me out on Part III Boards
8. Office Management - we have some poster due next week. I have to find out more information about this.
9. Clinic - I guess this could start with an email
10. Marketing - this hinges on Clinic but, i've already talked w/ the Marketing director and met her temporary replacement.

Just remembered that I'm also signed up for a half marathon on April 15th... I should probably start running for that

AND...I'm still in that Lose to Win contest. not sure how much time has passed on that.

w/ the money thing I can still cancel Netflix since, it's not much good w/o the internet and was looking into Centero Research to participate in an upcoming study to earn some extra cash :)