Chiropractic Student

Tri-10, Wk03 - Day ???, Monday January 23rd, 2012

2012-01-23T22:41:00.002-06:00

It will take some catching up to figure out what day we're on right now since it's been so long since my last blog (11/8/11) I've had some request from others who have read my blog prior to becoming chiropractic students themselves, some are at Logan and other's are elsewhere across the country. There's also been a few local request to get back to blogging. Some have said it's inspirational but, I'm not quite sure how.

My current favorite class is Differential Diagnosis which is taught by Dr. Kettner. We've been going over chronic pain and it is a fascinating subject. The most recent research would indicate that a main culprit in the chronic pain syndrome is not so much by the stimulus of pain but rather by a lack of inhibition of that pain. A part of the anatomical basis for the inhibition of pain would have to do with descending inhibitory pathways from the brain.

What's really fascinating is something new I learned today called Nocebo - this is the counterpart to the much more well known "Placebo" which most people have heard of with reference to the Placebo effect, when a patient may be given something like a sugar pill but upon believing it is something beneficial will manifest positive outcomes as a result of their beliefs.
Nocebo is the opposite of the Placebo effect - this is based upon a patients pessimistic attitude or even a lack of trust or understanding and can result in increased pain.
But - there are real chemicals at work and real pathways in the Central Nervous System (CNS) which conduct and manifest these beliefs.
On one hand we may have descending inhibitory pathways but those pathways may also be descending fascilitating pathways.
with an emphasis on fascilitation, we may have a lack of inhibition. Substances associated with pain would be on the order of NMDA or Substance P while those substances which help inhibit pain would be things like enkephalins and endorphins.

I've left and gone off on a tangent - I'm reading about GABA-A alpha 2 receptors and their contribution to binge drinking and their association with a persons vulnerability to engage in binge drinking.

from an article in PNAS - Neuroscience, received for review January 6, 2011 we read that Binge drinking was inhibited by GABAa alpha 1 siRNA vactor infused into the ventral pallidum, unrelated to TLR4....

The data indicate that GABA a alpha2-regulated TLR4 expression in the CeA contributes to binge drinking and may be a key early neuroadaptation in excessive drinking...

That GABA is what we've talked about earlier in this blog, I believe it's Gamma Amino butyric Acid.
The TLR4 is Toll-like receptor 4.
CeA is the Central Nucleus of the Amygdala
siRNA is small interfering RNA

The earlier reference to the amygdala is how I got on this tangent to begin with...not sure if I mentioned it specifically before but it's one of the pieces when talking about pain processing pathways.

Tri-9, Wk10 - Day 569, Tuesday 11/8/11

2011-11-09T08:18:00.002-06:00

started this blog last night (tuesday) I was chatting with an old high school class mate - we're putting together a night out for another high school friend who has terminal brain cancer

and the friend i was talking with is dealing with neurological issues of her own.

then I wake this morning to find another in our group has passed away - no older then me and died of a heart attack

damn - gotta get to school.. heart disease - even for women it leaves things like breast cancer in the dust as far as morbidity is concerned.

RIP Thomas.

Tri-9, Wk10 Catch-up, Days R,F, M,T,W,R,F, M - Days 561 to 568

2011-11-07T19:41:00.005-06:00

Tri-9:

Week 8

Thur - 10/27, Day 561

Fri - 10/28, Day 562

Week 9

Mon - 10/31, Day 563

Tue - 11/1, Day 564

Wed - 11/2, Day 565

Thur - 11/3, Day 566

Fri - 11/4, Day 567

Week 10

Mon - 11/7, Day 568

There is a lot to say, if I were so inclined but, for now I'm looking over what needs to be done this week for my classes. Tomorrow is Clinical Nutrition and Clinical Psychology - 2 hours of each.

Clinical Nutrition - Week 10 - Covering nutritional and dietary management of functional endocrine disorders, metabolic syndrome and carbohydrate handling w/ the following reading assignments;

Female Complaints

Cervical Dysplasia - pgs 152-160
Fibrocystic Breast Disease - 249-254
Menopause - 476-491
Menorrhagia - 492-501
Nausea & Vomiting of pregnancy (perhaps that should say "due to" instead of "of") - 533-537
Pelvic Inflammatory disease - 605-617
Premenstrual Syndrome - 650-663
Hormonal Balancing with nutrition - haven't found yet

Male Complaints

Benign prostatic hyperplasia (BPH) - 112-118

BHP - One of the more interesting parts of the BPH reading was self learning Rx abbreviations. The abbreviations are from Latin and are as follows

q.d. = quaque die = once a day
b.i.d. = bis in die = twice a day
t.i.d. = ter in die = three times a day
q.i.d. = qaurter in die = four times a day
p.o. = per os = by mouth - I remembered this one from pharmacology class
gt = gutta = drop - this one I ran across last night when studying a specific type of psoriatic arthritis called Guttate Psoriasis where the skin produces small, red & scaly teardrop-shaped spots.

Cervical Dysplasia - more acronyms... the ones below refer to possible results from an abnormal Pap smear.

ASC = atypial squamous cells
ASC-US = ASC with "Uncertain significance" (some of your cervical cells are abnormal but, we don't really know why)
ASC-H = ASC with possible HSIL which, begs the question, what's HSIL stand for...
HSIL or HGSIL = high-grade squamous intraepithelial lesion. high-grade means the cells are very different
AGC = atypical glandular cells. Glandular cells are cells that produce mucus and are located in the cervix or uterus. Again, this means that some of the glandular cells are not normal and we don't really know why.
LSIL or LGSIL = low-grade squamous intraepithelial lesions. Here, low-grade means early changes in the size and shape of the cells.

Fibrocystic Breast Disease -

excisional biopsy = removing all or part of abnormal tissue for examination under a miroscope
needle aspiration biopsy = when a pt sample is removed without preserving histological architecture of the tissue cells.
fine-needle biopsy = i'm guessing it's similar to the needle aspiration biopsy but with less histological architecture disturbance...

I suppose my focus should be more on the nutritional aspects of these reading assignments since these are for my Clinical Nutrition class. There were some interesting points I highlighted in this chapter. These points are as follows:

- Limiting dietary methylxanthines (coffee, tea, cola, chocolate, caffeinated medicines) improved 97.5% of 45 women who completely abstained and 75% of 28 women who limited consumption

- women having fewer than three bowel movements (BMs) per week have a 4.5-fold greater risk of FBD compared with women having one or more BMs every day.

Menopause - Wow - with regards to things such as hot flashes or any other symptoms ... A study of Mayan Indians showed NONE of those women experiencing any of those symptoms as well as no evidence of osteoporosis despite hormonal patterns identical to postmenopausal women in the United States. Mayan women saw menopause as a positive event, providing acceptance as a respected elder as well as relief from childbearing

As such, we could say the cultural view of menopause is directly related to symptoms of menopause. If the cultural view is negative, symptoms are common; if menopause is viewed in a positive light, symptoms are less frequent.

Menorrhagia - general def - excessive menstrual bleeding (blood loss > 80mL)

this chapter is reminding me of a few things I need to keep straight -

Graves - hyperthyroidism

Hashimoto - hypothyroidism (aka autoimmune thyroiditis)

Cushing's dz - hyperadrenocoricism, too much ACTH (adrenocorticotropic hormone) released by the pituitary

Addison's dz - hypocortisolism or chronic adrenal insufficiency or hypoadrenalism

DUB - dysfunctional uterine bleeding
Metrorrhagia - spotting, uterine bleeding at irregular intervals, esp btw expected periods.
menometrorrhagia - excessive and prolonged uterine bleeding occuring at irregular, frequent intervals.
polymenorrhea - menstrual periods that are abnormally frequent, say w/ intervals of 21 days or fewer.
CEE - conjugated equine estrogens

Nausea and Vomiting of Pregnancy (NVP) -

Hyperemesis gravidarum (HG) = extreme, persistent nausea & vomiting during pregnancy that may lead to dehydration.
.

This is interesting. HG, postpartum depression and lactation failure are linked to deficiencies of zinc, magnesium, vitamin B6 and essential fatty acids.

Pelvic Inflammatory Disease -

dyspareunia - painful intercourse (part of dx summary)
adnexal (L. plural of adnexus) - accessory or adjoining anatomical parts as ovaries and oviducts in relation to the uterus.
Porphyrias - a buildup of porphrins in the body. porphrins are a heme precursor in the porphyrogenic pathway and porphrins are toxic to tissue in high concentrations.

Premenstrual Syndrome (PMS) -

PMDD - Premenstrual dysphoric disorder
Xenoestrogens - environmental estrogens

Dietary Considerations - Guy Abraham, MD, stated that compared with symptom-free women, PMS patients consume:

62% more refined carbohydrates
275% more refined sugar
79% more dairy products
78% more sodium
53% less iron
77% less manganese

Primary Causes of Premenstrual Syndrome -

estrogen excess
progesterone deficiency
elevated prolactin levels
hypothyroidism
stress, endogenous opioid deficiency and adrenal dysfunction
depression
nutritional abnormalities
macronutrient disturbances or exesses
micronutrient deficiency

Physiologic Effects of an Increased Estrogen to Progesterone Ratio

impaired liver function
reduced manufacture of serotonin
decreased action of vitamin B6
increased aldosterone secretion
increased prolactin secretion.

Hormonal balancing with nutrition -

Hmmm - it's after 3 a.m. and I just finished the reading assignments for Clinical Nutrition ...almost to the point where I'd be better off just staying awake and knocking out the psych reading...

Tri-9, Week 8 Catch-up, Days 558, 559, 560, Mon Tue Wed, 10/24, 25, 26th

2011-10-27T04:36:00.002-05:00

Week 8

Mon - 10/24, Day 558

Tue - 10/25, Day 559

Wed - 10/26, Day 560

In the midst of midterms right now. got more to do then can fit in the front of my brain. Clinical Psychology midterm is today.

Tri-9, Wk7 Day 557 - Friday - 10/21/11

2011-10-21T13:25:00.003-05:00

Tri-9

Week 6

10-12, Wed - field day - no classes

10-13, Thur - Day 551

10-14, Fri - Day 552

Week 7

10-17, Mon - Day 553

10-18, Tue - Day 554

10-19, Wed - Day 555

10-20, Thur - Day 556

10-21, Fri - Day 557

This Trimester started out with concerns for a an old high school classmate of mine who had a sick daughter. ...mulling

anyway, my friends 27 year old daughter died of a heart attack after the first week of the tri

This same friend had a son who she had been fighting to get through high school and she was successful at that and last night a friend of her son's hung himself and is also now dead.

I'm getting more and more friends on facebook that are no longer alive. it's a curious situation.

Imagine an article written with the title "What if Jesus had Facebook?"

Facebook is kind of a life diary like non other in existence. Imagine being able to pull up a facebook page of Benjamin Franklin or George Washington - eventually we may get to that point.

The kid who hung himself had been kicked out of his house while still in high school. My high school friend and their family had taken him in a number of times while he tried to find a place to live.

This makes me think that no matter how crappy of a parent you might be, if you are at least there for your kids that could literally be the difference between life and death. It certainly seems that way for this kid.

I looked over his facebook page. He graduated in 2011 - he left behind 4 brothers and a sister. oh, and his best friend who was my friends son.

I'm working on a couple of CBI's, Northwestern is still in my head and after 5 weeks in the Lose to Win STL Challenge I'm down 38.2 pounds - better then a pound a day and walked a little over 100 miles in those past 5 weeks.

i also dropped clinic this past week.

it is what it is...

Tri-9, Wk6 Day 550 - Tuesday 10/11/11

2011-10-12T10:18:00.003-05:00

Tri-9 Monday - Oct 3, Wk 5, Day 544

10-4, Tue - Day 545

10-5, Wed - Day 546

10-6, Thur - Day 547

10-7, Fri - Day 548

Tri-9, Week 6

10-10, Monday - Day 549

10-22, Tuesday - Day 550

I'm not sure what blogs I'll be keeping up with from here on out. It's very difficult to care anymore. Logan has a way of doing that to you.

I heard a comment from Dr. Christy the other day who said he likes teaching the younger Trimester students because they're happier. That's a pretty accurate assessment.

Logan may have a lot of things going for it but, generally speaking, instilling enthusiasm in it's students for chiropractic is definitely not one of them.

The one thing they do engender in the last few trimesters is an overwhelming desire to get the hell out and be finished with Logan once and for all.

We've still got some great teachers in the classroom and I don't mind heavy work loads but, I'd have to classify my own exposure to the program, especially in these last few tri's as abusive and, as far as clinic goes, I'm tired of being treated like shit.

Tri-9 Wk5 Day 544 - Monday, Homage to Dr. Sanders

2011-10-03T21:06:00.007-05:00

First, to pay my respects to a Great teacher who passed away this past Friday, Dr. Gary Sanders

Mourning the loss of Dr. Gary Sanders, PhD at Logan University. Thanks for sharing your knowledge, contribution to science and strong commitment to helping students like myself. Dr. Sanders has published research in JNMS: The Journal of the Neuromusculoskeletal System, JMPT: Journal of Manipulative and Physiological Therapeutics, Chiropractic Technique, The New England Journal of Medicine, the Journal of Clinical and Laboratory Immunology, and others.

Dr. Sanders is on the right in the picture below. As a Pathologist Dr. Sanders once comment that they (pathologist) were often thought of as the Doctor's Dr. Huge loss. I used to talk with him on a pretty regular basis, at least 4 or 5 times a week. His funeral and visitation is tomorrow from noon to 1. I've got clinic. :(

I'm getting stuck here. Here is a public link to my Logan Family album on facebook. http://www.facebook.com/media/set/?set=a.1820711920619.106170.1324821250&l=408738468b&type=1

the 41st picture is of Dr. Sanders along w/ my homage to him.

What else is going on....

I did get a very nice comment on my last post from a DO student. He sent me a message that he thought I was an instructor at a med school! That was nice to hear. :)

I've really gotta get more videos up ...especially while I still remember a few things. I know I wanted to do a video on the malate shuffle back from my biochemistry days but I don't quite remember it enough right now to knock out a video. I still retain the gist of that concept :)

Week 2 results came out today in the 1,000 person Lose to Win weight loss contest being held here in St Louis and I moved from 9th to 3rd place which is kinda cool. Online results are here - http://www.ssmhealth.com/depaul/losetowinstl/pages/results.aspx

The people who were in the top two spots last week aren't even in the top 10 anymore and if either of them would have just maintained their weight loss they would have still been in the top 10 so ....logic dictates that those two had to have gained weight.

Test coming up Friday - another dozen or so classes to look over.

two hours of clinical nutrition and two hours of clinical psychology tomorrow - clinic attire is in the washer & dryer right now -

Got another 6 miles in tonight after school - just walking but, it was on a new path which was nice. Fri, Sat & Sun was pretty much a bust - fell asleep early friday after i got home from clinic and had class all day Sat followed quickly by a super nice dinner then out to some club in St. Louis that was supposed to be all swanky & stuff. Didn't seem like anything all that amazing but, maybe that's just my age talking. Club stuff was quickly followed by Sunday class at Logan.... (yeah, it was a long Sat night...) and getting done with my class on Sunday was quickly followed by more much needed sleep but, I did wake up for an hour around 9 p.m. Sun night then fell asleep until my classes today.

Tri-9 Wk4 Days 540, 541, 542, 543 - Tue, Wed, Thur, Fri

2011-09-30T08:47:00.002-05:00

trying to remember what the heck i did this week regarding school....

I don't remember the classes so much but I record my classes and listen to them while I'm out walking & jogging at the park. I remember my park lectures :)

I'm liking Advanced biomechanics. We've got a couple younger guys teaching that class, I think they've been out of Logan for about 10 years now. They have some supurlative analogies they give in class.

Rheumatology is taught by Dr. Guebert who is a DACBR and that's always a positive thing. DACBR lectures tend to be fraught with useful information, plenty of meat to those classes as opposed to some other classes where a teacher may be groping to trying and find enough material to talk about to fill their hour of class time which makes me wonder why such a teacher would skip over reading the slides and flipping through things so fast. I guess if I ever teach a class I'll have to remember that.

I did some pretty good work for Nutrition and our Capstone class. Still getting into the groove and handed in a substandard piece of work in week two for Capstone but, had a nice 4 page write up for our week 3 assignment. Also had four pages written up for Nutrition.

The amazing thing about having days off from clinic is that after my shift tonight, i'll actually have 3 days off from clinic!!! YeeHaw!

I do have my specialized technique class this weekend but that still doesn't take away from my day off on Monday! :)

I sent my brother an email asking about the whole CBI thing and if he might be able to inquire at one of his EPOC meetings if anyone was interested in a free intern :)

My training has been going well and it's one thing I can totally count on because it's simply up to me to make happen. My involvement with the Lose to Win competition has been invaluable. There isn't anything too difficult about the working out and dropping weight, in the past few years I just haven't had much focused awareness of the working out because my attention has been so imbued with school stuff. I'm at 60.1 miles total in the last 2 weeks & 4 days and 20 of those miles have come from the last four days :)

I need to get riding my bike since I signed up for a 50 mile bike ride which is in two weeks and I haven't ridden my bike in at least a year!

Tri-9...Week ????, OK, Wk4, Day 539 - Monday

2011-09-26T22:27:00.002-05:00

it's taking me a while to figure this out...

days from week 1

528 - 9/7 - wed

529 - 9/8 - thur ...already got those days logged

530 - 9/9 - Friday

yeah - on 9/10, a friend i went to high school with had a sick daughter and she died this day.

Miranda Bell, only 27 years old. Rest in Peace.

531 - 9/12 - Monday

532 - 9/13 - Tuesday - funeral

533 - 9/14 - Wednesday - Here is the tribute that was done for Miranda via YouTube... might need to have some Kleenex handy for this one... http://www.youtube.com/watch?v=GMD_vXNzPTk&feature=youtu.be took a vacation day from clinic on this day.

### - 9/15 - Thursday - no school so we can study for boards

### - 9/16 - Friday - Physiotherapy Boards - idk - some 160 questions or so about PT stuff. fairly good chance I passed this exam

### - 9/17 - Saturday - Part III National Boards - just another couple hundred questions on diagnosis & other fun stuff like that. not sure about this one, maybe a 50/50 chance of passing it.

### - 9/18 - Sunday - retook Chiropractic Practices of Part II.

If I passed all those test over the weekend then, along with a DC degree, I'll be legal to practice in the state of Illinois. Most states also require Part IV. I don't think I ever counted boards as class days or anything (hence the ###) - not sure...

Week 3

534 - 9/19 - Monday -

535 - 9/20 - Tuesday -

536 - 9/21 - Wednesday -

537 - 9/22 - Thursday -

538 - 9/23 - Friday -

9/24 - Saturday

9/25 - Sunday

Week 4

539 - 9/26 - Monday

I've got days off & away from clinic this trimester - makes a BIG difference!

started hitting the park again to get back into jogging. I think I've got around 45 miles in over the past two weeks.

entered a LoseToWinSTL.com contest consisting of 1,000 people in the St Louis area. For week 1 I took top honors from all the contestants weight in at the Fleet Feet stores and also made the top 10 overall for all contestants.

honestly, i think the only reason I signed up for this current semester was for the student loan money so i could continue to pay my bills.

sort of a bit apathetic towards it all.

Tomorrow is two hours of clinical nutrition, two hours of clinical psychology then four hours of clinic. I'll need to get straight to the park after clinic then home to knock out a Business type assignment due on Wednesday.

I *really* need to find a CBI - Community Based Internship so I can get out of the St. Peters clinic. One of our teachers was telling us today about a former student who was maybe 5 years older than me and ended up having a heart attack at school. HTN & stuff. I can relate.

Tri-9 Wk 1 - Days 528, 529 - Wed & Thur, 9/7, 9/8

2011-09-08T22:48:00.003-05:00

I think I have the numbers portion of this blog all caught up. I sort of shut down a few days prior to last semester ending. kind of stayed shut down. and...I don't usually blog between semesters and have far less enthusiasm for school here then when I started.

Let's see... what's going on? I was able to make a deal with my dxi teacher to attend an extra 10 hours worth of radiology conferences in exchange for being able to take the final exam in spite of my absences. I had to give Dr. Kettner the 10 hours regardless of whether I passed his final or not. I thought it was a pretty cool deal. I accepted the deal and did pass the final and the class. kind of impressive when you consider i wasn't in class the last few weeks and took the final cold without any studying.

This is the kind of deal that Dr. K has made with students in the past and I know there was one other student in our class that made the same deal with him. It makes sense since those Rad Conferences are every bit as educational as the classroom atmosphere would be.

But .... the powers to be who make decisions about the school .... and, why is it the people most removed from the classrooms are butting in to things they know less about then the teachers?

anyway - they haven't let Dr K change my grade from an AF (attendance fail) to a passing grade. so...that means I can't officially sign up for my classes, can't get any of the sylabus' or class materials and don't really know what my classes will end up being. Can't get my student loan check either.

As is, I just have to retake Rheumatology which, I had a B or B+ in (depending on how much the extra credit I did helped) due to an AF I got in that class. Rheum is just a two hour class held on Mondays so, the rest of the week I would just take courses with my regular class. It's kind of a nice situation since I get to end taking classes with my original class then get to see all the rest of my classmates who are in the current Tri-8 class.

anyway, essentially we have yet another in a LOOOOONG list of impromptu changes by people who have no actual experience with the current program and have no idea what things are like as is.

Oh well, my primary focus right now has to be for the National Boards, Part III & PT coming up in about a week - next Friday, Sat & Sun. I'll just keep showing up for my classes as best as I can figure them out.

Today's pic will be my second completed painting, it's another guitar and this one is called the Electric Leah. Next painting will be done on Thursday, Sept 22nd. It's going to be Grapes! and it's pretty cool ;)

Tri-8 Wk15 - Days 524, 525, 526, 527 - Mon, Tue, Wed, Thur

2011-09-08T22:43:00.000-05:00

Tri-8 Wk15 - Days 524, 525, 526, 527 - Mon, Tue, Wed, Thur

Tri-8 Wk 14, Days 521, 522, 523, 523 - Tue, Wed, Thur, Fri - 8/9, 8/10, 8/11, 8/12

2011-09-08T22:40:00.001-05:00

Tri-8 Wk 14, Days 521, 522, 523, 523 - Tue, Wed, Thur, Fri - 8/9, 8/10, 8/11, 8/12

Tri-8 Wk14, Day 520 - Monday, 8/8

2011-08-09T06:00:00.003-05:00

Over the weekend I received a letter from Logan stating I had AF'd Dx Imaging. AF stands for Attendance Failure and means I have to take the class over. I didn't make it in time for Rheumatology this morning so I also have AF'd that class as well. I love the trite, arrogant advice that gets tossed my way sometimes such as the brilliant Tx of "you need to get more sleep". No shit Sherlock, I think to myself. As Dr. Kuhn had pointed out in class one time, "it's not as simply as turning a page in a book" which, is pretty much my situation. If any of my unsolicited advisors had any clue what they were talking about they would know there's a bit more to the story and Tx then just "get more sleep".

Varieties of the "Walk in my Shoes" is a is a status post I've seen a lot on Facebook lately and that's kind of what I think when I hear such flippant advise. Try waking up with 30% less oxygen then you went to bed with, see how that feels and how well you can function. Try driving an average of over 650 miles per week for school and spending about as much time sitting in your car as you do in class and try doing all this when you're 45 as opposed to being in your 20s.

...insert a couple hour time gap here...

looks like this gets finished later...

Tri-8 Wk13, Day 519 - Friday, 8/5

2011-08-09T05:57:00.003-05:00

I had this day off from clinic, for which I am extremely grateful.

I painted a picture the night before in honor of my new nephew. I called the painting The Wyatt Gibson. I'll toss up a picture of this and keep catching up with my blog entries. :) The painting is acrylic on canvas.

New Baby!

2011-08-09T05:52:00.003-05:00

Tri-8 Wk13 Day 518, Thursday 8/4

My brother and his wife had a new baby boy this morning at 7:01 a.m. and named him Wyatt John Dukowitz!

I'll toss up a picture of the lil critter and move on to catch up on my Friday blog ;)

The vacation day that never was ....

2011-08-04T00:09:00.004-05:00

Tri-8 Wk14, Day 517, Wed, 8/3

I was hoping to take off tonight so I could more adequatly study for my PT III practical tomorrow but, after a couple members of the "staff" expressed concerns over my vacation request I acquiesced and withdrew the request. Guess what? The patient never showed up anyway. It's sort of an every other type even with that person ...

grrrrrr .... is about all i can say.

so, i will end this tri with more than enough clinic hours and two unused vacation days.

Those vacation days have gone way down.

Based on once a week clinic duty and three days off and a 15 week semester - 3/15 = 0.20 or 20% vacation rate.

at three days a week for 15 weeks with 6 vacation days ... 6/(15x3) = 6/45 = 0.13 or 13%

at 5 days per week for 15 weeks with 6 vacation days... 6/(15x5) = 6/75 = 0.08 or 8%

and ..5 days per week for 15 weeks with 4 vacation days = 4/75 = 0.05 or 5%

so, we slaves have the vacation days cut from 20% to 13% to 8% to 5%

anyway - it was kind of bullshit for me to give in - guess it's my fault but WTF. just give us our f*cking vacation days without any hassle.

whatever.

Tri-8 Wk13, Days 515 & 516, Mon & Tue, 8/1 & 8/2

2011-08-03T00:28:00.002-05:00

shit ....

I've got a PT III final practical on Thursday and tried taking tomorrow off so I could study for the class which I've scarcely been to but, after submitting my vacation request I found out I have a patient scheduled ...I didn't actually schedule them, it's something the front desk took care of which is fine ....

As is kind of customary these days, I fell asleep soon after I got home tonight which means, by 5:30 p.m. since I actually got off work at 3:30 today and got up about an hour ago (11:30 p.m.) but, not I'm not exactly sure when I'm going to be able to get enough study time in for this exam on Thursday. Since I just got up I could maybe stay up but once tomorrow starts it won't end until I get home at 8 p.m. which means it will be *really* hard to continue to stay up to study for that exam.

Hell, i could fall back asleep now. Maybe not. I'm just pissed off.

idk- i'm tired - going back to bed - looked over some PT stuff but not really sure exactly what to study ...hence the need for extra time to have any chance of getting through that final.

Tri-8 Wk12, Days 513 & 514, Thur & Fri, 7/28 & 7/29

2011-07-30T00:05:00.003-05:00

I survived. Two solid months of mandatory 5 day per week clinic is FINALLY over. Like a lot of people I was saving the gist of my vacation days for finals but it looks like the start of the next semester is our first day of finals for the current semester. I'm not sure I quite understand that because you don't actually move on to the next semester until you've passed all your classes. oh well.

I put in vacation request for 8/5 and 8/12, two Fridays in a row and now that I'm back to a normal clinic schedule that means I'm already off on Thursday and now on Friday and Saturday and Sunday and Monday!!! - Five Days in a ROW! YeeHaw!

I'm not exactly sure what's going on in school.

I really had no solution for effectively dealing w/ the abhorrent schedule I was subjected to over the past couple months. About all I can say is that it's a good thing I don't own a shotgun. I have been learning quite a bit but, not necessarily anything specific to any current classes. This reminds me of the special class I was put in during grade school where us higher motivated types of students wrote out on a contract what we wanted to work on during the week.

One interesting thing I studies was the primary and secondary ossification centers in the metacarpals and the phalanges. Both metacarpals and phalanges have primary ossification centers centrally located along their shafts but the phalanges have secondary ossification centers proximally, at their bases while the metacarpals have their secondary ossification center distally located. BUT WAIT - only metacarpals 2, 3, 4 and 5 have secondary ossification distally and metacarpal #1 (the one attached to the thumb) has a PROXIMAL secondary ossification center which means in terms of ossification the first metacarpal is more like a phalanx. Makes me wonder if things were misnamed originally... this same phenomenon occurs in the foot.

with the carpal bones, ossification starts at the capitate and kind of spirals around in a counter-clockwise direction but, the age at which these carpals ossify isn't exactly one per year but more like 2-3 months for the first two then age 3,4 and 5 for the 3rd 4th and 5th but, also year five for the 6th and 7th. then the pisiform which is just a nifty little sesamoid bone finally ossifies between the ages of 9 to 12.

I've also been going over some of the neural pathways, specifically w/ the eyes and the various reflexes. Unilateral cranial nerve palsy has also become an interest mainly because it's now clinically relevant and we've got real people involved. Of course ...I'd say about 1/2 the people I'm working with and trying to learn things for aren't even official patients from my clinic but still people that come to me with issues so I do the best I can.

...got severely sidetracked here - oh well, that's it for now :)

Tri-8 Wk12, Days 511 & 512 - Tue & Wed, 7/26 & 7/27

2011-07-27T09:08:00.002-05:00

I'M DRIVING LESS THAN 40 MILES TODAY! I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!
I'M DRIVING LESS THAN 40 MILES TODAY!
I'M DRIVING LESS THAN 40 MILES TODAY!

That's 40 miles TOTAL. I've had enough - quite enough. I'm going to the St Patricks Center in downtown St Louis for my clinic shift today. there's only so many days the 5 a.m. alarm can go off with me waking up as if I've been run over by a truck.

Next week - week 13 will be my first opportunity to get out of this mandatory 5 day per week rat race. I think I summed it up best in an email I had to send one of the teachers whose class I'd already screwed up in when I said, "If everyone in Tri-8 has the same requirements then we should all have the same demands."

Amazingly enough, I got home at 5 p.m. yesterday! It was fantastic. I was also asleep by 5:30

I know Dr. Guebert has talked about his father and the pain that man has been going through. It makes me very sad. I know there has been reference to him maybe "checking out" voluntarily.

I know we've talked about the mortality rate with reflex sympathetic dystrophy and the number one cause of death with that disease being suicide.

I know my pains probably aren't as bad as others but, dropping a third of your O2 saturation levels over night doesn't feel very good either. I've read the mechanism behind it is equivalent to a severe stroke or dying.

I've come to believe that things like a person drinking soda or ingesting Splenda are probably far less detrimental to health then losing the will to live.

I've read about cultures in Africa where capital punishment consisted of ignoring the offending party until they eventually wandered off into the mountains and died.

I never was able to come up with a solution to my situation which would allow me to effectively continue to get up at 5 a.m. every day then go to all my classes then go to clinic every day as well as attend all of my weekend obligations such as Loomis, SOT or Irene Gold board reviews.

I no longer think sleep is the answer but maybe just a beginning of a solution. The weekends I did have off, especially the last weekend when I missed my final SOT classes I was in and out of bed constantly and never up for more than two hours at a time and that still didn't help the exhaustion.

Moving, being healthier and being younger were the only answers I could come up with. The idea of putting my home on the market and moving seemed too huge an endeavor to pull off with all the school demands. Healthier is an option. I know I started training for my St. Peters shift back in Tri-7 and was going to the gym quite often. Of course, at that time, I was only aware of the distance I'd have to be traveling and not the 5 day per week shifts. Younger ...nothing I can do about that and, quite frankly, .....yeah .....what is, is.

I am going back to sleep now. That's pretty much where I live if I'm not in a class or clinic.

Tri-8 Wk12 Day 510 - Monday, 7/25

2011-07-25T22:22:00.002-05:00

5 months until Christmas -

maybe 2 weeks or so until I get a new niece or nephew - that will be pretty nice :)

not really much sure about anything else.

Got my last Case Report in today but wasnt able to listen to my 20th case report due to patient duties.

It does seem like week 12 will be my final week of mandatory 5 day per week clinic.

Dr. Hogarth, my clinician, is really pretty good at overseeing the case reports. I've never seen him in a classroom situation but he definitely seems to have a talent for teaching.

The case report I gave tonight didn't have a clear cut resolution due to non-compliance by the patient but, it did involve a pretty serious auto accident and I was really curious what Dr Hogarth had to say about it. He did not disappoint. A class might be good but that could be slow going. Hogarth would probably make a great teacher for that class but I have no idea if he'd want to leave clinic.

My favorite scenario is what a clinic pulled off last Friday by knocking out 16 case reports in a single evening. That's what a fellow intern told me anyway. All I can think is that represents 8 days I could have been off from clinic.

Dr. Guebert had a pretty good class today. We got to see a CT with contrast and it was a really nice picture showing the relationship between a vertebrae, the psoas muscles and the ureters. I think most everyone knew the roundish images on the CT were ureters but seeing the relationship to other structures was pretty cool.

That's about it.

Oh, my radiator went out and I got a letter from the IRS. Car is at the shop to get the radiator fixed and ....i guess the IRS really did want me to file last year even though I didn't work or sell any securities.

Tri-8 Wk11 Days 508, 509 - Thur, Fri 7/21, 7/22

2011-07-24T09:25:00.004-05:00

I took a vacation day Friday from clinic and it was the first day since May that I've been able to go straight home from school instead of dealing with clinic. I did take one other vacation day on a Friday but ended up staying at school until 6 p.m. so I could finish up various requirements that I just haven't had time to finish up, most notable my radiology conferences.

Originally, I thought the vacation day would also let me stay up late to study for my derm exam on Friday but I was way too tired to fall asleep. I made good use of my time on Friday - got to have a quick lunch with my parents then got my tires rotated and oil changed at Valvoline. I wasn't able to stay awake much past 5 p.m. and fell asleep. I woke up a bit after midnight and watched some of the horrific tragedy that took place over in Norway where 92 people have now been declared dead due to the messed up actions of one person. I fell back asleep after that and slept until 10 p.m.

There just doesn't seem to be any catching up on sleep anymore. i'm flat out chronically exhausted. I've scarcely anything new to say. I did read a few weeks ago about a very young administrator that was once hired on to the faculty at Harvard University and the one thing he immediately implemented was that if any department head wanted to add anything to their program then they had to take something else away. Kind of reminds me of the PAYGO plan signed by President Bush that forced Clinton to only spend what monies were available or to eliminate existing expenditures to offset any new spending. At least those are the charts I see most often. I'm sure 101 different views and opinions exist but ....I'm no expert in the field ...

I guess I need to get an application in to Northwestern University (NW) I need more information. There may be a CBI or Community Based Internship available which may suit me but, honestly, I don't feel fit to run a cash register at Dairy Queen right now.

I thought the process of becoming a chiropractor at Logan would help me become a better person but it's doing nothing but destroying me. NOBODY should have to drive 4,000 miles in their first 6 weeks of classes - that comes out to over 650 miles a week. The one individual week I checked w/ my car's odometer put me at 718 miles for the week.

In the few trimesters before becoming a Tri-8, the most common comment I heard from upperclassmen was that they wanted to burn down the school. I never gained full insight as to why they were disgruntled but I'm sure part of it had to do with the switch from 1 to 3 days per week mandatory clinic. I also know the valedictorian of the last graduating class made a comment in his speech that his class was about to step across the stage to get their diploma "as long as there were no more graduation requirement changes".

I wonder how students who transferred to Logan were so enthusiastic about chiropractic. I don't remember exactly which college it was but I think one of them lost their accreditation which caused the influx.

I just don't know .... I love my patients and I love being able to actually help make people feel better and help alleviate them of pain & suffering ....

I really can't stand the end game of this DC program at Logan.

I do know that last Friday, one of the clinics was scheduled to knock out 16 Case Reports! 16 in one day!

I know that the person behind scheduling our case reports NEVER had to come in on his day off for a case report. I know out clinician simply backed him up instead of ever once bothering to look into any reason why anybody would be disgruntled about the schedule. I know my name has come up a lot with my clinician (he told me it did) but, I have no idea exactly what was said because he had nothing further to say to me other than my name had come up a lot. who knows.

I detest their newly implemented No Tolerance policy with regards to switching clinics. Seems like they're doing everything under the sun so as not to ever have to deal with any student concerns regardless of the circumstances. I'd like to see those who implement the policy drive 4,000 miles over the next 6 weeks. I dare any of them to try and get through the Tri-8 program under the same circumstances as me.

probably a waste of time to write about any of this. I still have work to do. and, either i'm staying or i'm going.

Recommendation to any students considering chiropractic school .....LOOK AROUND - see what their programs are like - LOOK at the end game - COMPARE - right now, all Logan knows is to add, add, add without having a clue of all the consequences they're having on their students.

Tri-8 Wk11 Days 505, 506, 507 - Mon, Tue, Wed 7/18, 7/19, 7/20

2011-07-21T08:28:00.002-05:00

*If* I take a vacation day from clinic tomorrow then I can pull an all-nighter for my derm exam.

I had my transcript sent to Northwestern on Monday and joined an Online Chat with a few students Tuesday night. I know they might start taking grades into consideration when determining their outpatient clinic assignments. I wonder why it never occurs to anybody to take into consideration proximity & preferences.

I keep thinking of Shakespeare and the line that we'd "rather bear those ills we have then to run off to others we do not know"

NW claims to average about 650 adjustments per student and they don't have to go out to find their own patients. It would take a minimum of 5 trimesters to graduate from NW ...that's the kicker part. I'm kind of on the fence. I do like the idea of dropping HCP here at Logan and not having to drive so much. The only way I'm really making it is by missing tons of classes which makes me wonder what the hell I'm paying so much money for.

Tri-8 Wk10 Days 503 & 504 - Thur & Fri - 7/14, 7/15

2011-07-16T10:29:00.004-05:00

hard time moving this morning ....

Rheumatology exam is Monday, Case Report is due Monday, Report of Findings for a new patient is due Monday, Final Exam in SOT is due tomorrow (Sunday) and ...I should be in SOT class right now ....

it's still in the a.m. and I'm finally dressed and pretty much ready to go. I'll probably end up at school after the lunch break.

The people at Logan are pretty much great. The instructors are probably among the best of any chiro college in the world. Is it the institution I hate or maybe the DC program. I was at a table with some Tri-9's yesterday and even more changes are being implemented for the first time for them in Tri-10. Something about having to be at school on Fridays ...things have changed so much and I'm not sure exactly how the changes are supposed to make better doctors of anyone.

Tri-10 is kind of the 5 day a week clinic schedule, if needed. I know one guy who did that in order to graduate on time. He got the last adjustment in he needed just 4 days before graduation!

oh hell, ...things could certainly be worse. I could have lost my spouse and job in the same week then be forced to move as my neighbor is dealing with right now. Doesn't really make my current situation any easier to deal with ...just perspective.

Of course, I lost a good friend in that process as well. Probably the one human being I spent more time talking with than anyone else. I still have my dog ...she's just not much of a conversationalist.

Being at the most distal clinic possible is one thing but, having to be there five days a week is quite another.

I need to have my Case Report done before Monday - have to prep for ROF on Monday before patient arrives at 4 p.m. I give my case report at 3.

RADIOLOGY! damn! how could I have forgotten about that! ...those reports are due by 9 a.m. Monday ...

Gezzus ....let's get this straight ...

SOT - Classes Sat

SOT - Classes & Final Exam Sunday

Radiology - 10 Case Reports due Monday morning

Clinic - ROF etc., with new patient at 4

Clinic - Case Report due at 3

Rheumatology Midterm Monday morning

that's gotta be close to it ...just mix in over 200 miles of driving and you have my current life for the next couple days.

Tri-8 Wk10 Day 502 - Wednesday

2011-07-14T07:11:00.002-05:00

Ridiculous is a word I often hear used to describe the later trimesters at Logan. I use that word too, along with the word INSANE.

I'm looking at other chiropractic colleges and notice that up at Northwestern University their Tri-8 schedule consist of 18 hours worth of classes - Those classes meet 9 hours a week on two days per week. When I look at Parker college I don't see any classes in 8, 9 or 10 - just Internship.

When I look at my classes for Tri-8, I'm seeing 38 hours of classes - 5 days per week and sometimes on the weekend. I see clinic 5 days a week, I see my 650+ miles I drive per week and I just have to wonder why.

ok - i've got an email out to Northwestern - just looking into the possibility of transferring. If I need to sell my home and move in order to make it through the program I might as well consider all possibilities of where to finish up my education.

Gotta run ...school beckons.

Tri-8 Wk10 Day 501 - Tuesday

2011-07-12T20:45:00.006-05:00

Today we had a presentation by the NCMIC which is an agency which provides malpractice insurance for a majority of chiropractors. They have a pretty cool website called startingintopractice.com that looks like it could be pretty useful someday. That presentation lasted from 8 to 11 then I had to head to clinic for a 12 o'clock appt.

I have another new patient on the books for tomorrow. Not sure exactly what time but I'll figure it out.

For as sick as I felt yesterday it was GREAT to be able to come straight home after classes. It was nice to come home today and not want to look up guillotine's on eBay. ;)

Still blogging from my iPad. Have a case report due Thursday so I better get a template together to get that taken care of ASAP.

I think after next Thursday... At the end of week 11 I will no longer have a mandatory 5 day per week clinic shift and will just have to try and get my patients in when I'm actually scheduled to be in clinic. Even if I can just get one day a week away from clinic then I might have enough time to pull out the senior project that's due this Tri.

Tri-8 Wk10 Day 500 - Monday - 7/11/11

2011-07-12T01:26:00.004-05:00

Laptop is down, won't recharge. Hoping it's a bad plug or, at worst, needing a new battery. Today was Bootcamp from 1-5:30 pm which replaced our clinic shifts. We just found out that tomorrow we have meetings with one of the main insurance companies for chiropractic which is supposed to be mandatory and last from 8 to 11:30 am. Unfortunately the people who schedule such things are unaware of our other obligations such as clinic duty which starts at 11:30 am. For me that means I need at least 40 min commute time as well as time to gather xrays and mail to deliver to our clinic tomorrow.

It seems as though I've passed being chronically exhausted and moved on to just being sick. I left Bootcamp as early as possible, got home, threw up, put an icepack on my head and went to bed.
I read a lot over the weekend and downloaded a bunch of apps to my iPad pertaining to orthopedics, skeletal anatomy and radiology. This iPad I'm using now may be a huge key in helping me finish out school.
Next Monday is our first rheumatology exam. Hmmm, just checked the midterm grades posted to date ... Everything is well above passing and there's even three A's and a B so far in the mix. Of course, that may all get evened out after finals when extra effort gets put into the lower grades thereby ignoring the classes with the higher grades. There's only so much time to divvy up between things.

Thinking about classes... There's still a senior research class that I haven't progressed in beyond reading a book before Dr. Bub got fired so, I still need an advisor and god knows what else for that requirement.
I really detest that ride to & from St Peter's. My average weekly mileage for the past 6 weeks has been 652 miles per week ... Per mon through Friday and that's with skipping as much weekend BS as possible and riding my motorcycle locally.

A bit after 3 am, need to get some laundry done and half considering heading to the gym.

Tri-8 Wk9 Day 499 - Friday - 7/8/11

2011-07-10T11:32:00.003-05:00

What happened this day???? I think our Dx Imag IV grades were posted and, in spite of meager preparation on my part - actually none, I still did fine and will get through that class as long as I don't Attendance Fail (AF).

I had clinic Friday. No patients, not on any list to take walk-ins, just needed to be there. I did get to talk to a classmate at lunch who was loving this semester so I asked him how many clinic days he had per week. He seemed a bit perplexed by the question and answered 'three' then was surprised to learn I've had mandatory 5 day per week clinic since the beginning of last month.

Monday is going to be our 500th day of class. Amazing. 500th day in the DC program which correlates to about 3,500 hours worth of classes. I've got so much to do.

I did skip the Loomis Internal Health Specialist (IHS) program this weekend. I guess I'm starting to have a psychosomatic effect with regards to driving. The thought of getting into my car for another jaunt to Logan literally made me queasy. I've definitely felt like throwing up more times this semester than any other time in my life.

I checked my mileage from the last time I got my oil changed and was a bit stunned to learn I've put in 4,000 miles of driving in the past 6 weeks - that's over 650 miles per week and I tend to ride my motorcycle locally so the vast majority of those miles are nothing but school related. It's just insane.

I just need to get to work. Unfortunately, the first thing on my agenda today is to get my car in to have my tires rotated and hope to god that has a positive effect on driving performance. It should help but I really thing my ball bearings are going out.

Tri-8 Wk9 Day 498 - Thursday - 7/7/11

2011-07-10T11:19:00.002-05:00

This was my birthday and the day my clinician was accusing me of being a cause of changes in the office such as the clinic having to hold meetings twice a week and allowing interns to attend the meeting of their choice. I know other students that are happy about it but it doesn't affect me in the least because I already had a clinic shift on our meeting day.

What was his line ...oh yeah, "I've been hearing your name a lot" I think he said that at least a half a dozen times while telling me how some students have really learned how to play the game and if one student isn't happy blah, blah, blah ....

There wasn't any actual conversation, just someone that needed to off on a little rant and assign blame to someone. I can think of several people who may have complained specifically about the meeting days because it caused them to have to be in clinic 4 days a week but that certainly wasn't me.

This reminds me of an old job where a female friend of mine was having an affair with another guy at work. The husband kept suspecting me which was never the case but, as long as he was focused on me he never saw the reality of the situation. Similarly, he just needed someone to blame.

Tri-8 Wk9 Day 497 - Wednesday - 7/6/11

2011-07-06T21:35:00.002-05:00

same crap, different day - dxi4 midterm today - didn't study a lick but passed it with a bit of a cushion to spare. got caught up on all of this weeks dxi/radiology module and will turn in the remainder of that tomorrow.

my 45th birthday is tomorrow and I can't really recall any time in my life when I've been less enthused. I'm just beat. dead tired beat.

I slept and napped more over this break than any other time in my life but it didn't seem to add up and help like times in the past. I'm just beat.

Almost bought the farm tonight on my drive over to clinic. Honestly, I was too damn tired to be driving. The second close call kept me awake for the last 5 miles of my trip to clinic.

I've got joints hurting that have never hurt before in my entire life - seems to be a theme - which joints? pretty much all of them.

Thanks Logan.

Tri-8 Wk9 Day 496 - Tuesday - 7/5/11

2011-07-06T21:34:00.001-05:00

I don't really remember anything that happened this day ...clinic, patient ....

Tri-8 Wk8 Day 495 - Friday - 7/1/11

2011-07-06T21:32:00.002-05:00

took a vacation day from clinic today ....wanted something to look forward to ....a jump to the 3 day holiday weekend ...ended up catching up on school stuff until 6 p.m. ...about the same time I would have gotten off clinic but, at least I was closer to home

Tri-8 Wk8 Day 494 - Thursday - 6/30/11

2011-07-06T21:31:00.002-05:00

kinda envy those students who can run home at 11 a.m. ....instead of dredging through until 8:30 p.m. to get home ....

Tri-8 Wk8 Day 493 - Wednesday - 6/29/11

2011-07-06T21:29:00.001-05:00

I drive enough to get my CDL ...

Tri-8 Wk8 Day 492 - Tuesday

2011-07-06T21:28:00.000-05:00

Walking Zombie ....

Tri-8 Wk8 Day 491 - Monday

2011-06-27T23:35:00.002-05:00

I'm thinking of those paint can shakers you see in hardware stores. I feel like my nervous system has been removed, put in one of those shakers for 20 minutes and then reinserted back into my body. I feel like my muscles have been put in a punching bag and gone over by Muhammad Ali. My neck feels like someone decided to play a joke on me and squirted super glue in my joints. My left elbow still has the olecronon bursitis but it's my right elbow and shoulder that are hurting. When do they hurt? They hurt when I move! I'm wearing compression socks to help combat all the time I'm sitting, but getting pains deep in my thighs which, I can only correlate to arteries deep in the leg.

One of the 26 reasons I had for going to school was due to dissatisfaction at the low activity level inherent with my old job. My old job was great but before I was ensconced with that job I weighed 222 pounds and was benching a robust 515 lbs in competition. Outside of competition I was looking at benching 300 pounds over my body weight. I started with SAVVIS towards the end of 2003 and my last marathon was towards the beginning of 2004.

I'm not exactly sure what to do. I lost the two days a week I had off from clinic due to Case Reports and now I've lost the two free hours I had before going to clinic on my days off due to patients. Patients are a good reason, it is very easy for me to care about other people.

...

oh well - less than 300 days to my first potential graduation date ...August is probably going to be more likely. Already lost one class and on the verge of attendance failing another. only so much I can give ...

Tri-8 Wk7 Day 490 - Wednesday!

2011-06-22T07:17:00.002-05:00

I'm keeping this to a 12 hour day today which is an ambiguous way of saying I'm not making it to my Nutrition class this morning and will be leaving home around 8 a.m. and getting home around 8 p.m. after my clinic shift is over.

I've got a smorgasbord of thoughts & ideas, a plethora of pensive passions, and a couple of thoughts on how I'm going to spend the 4 days off I have coming up. Physically, I've turned to mush as well so, one of my first thoughts regarding the time I have off revolves around getting into the gym. Sleep is a HUGE priority and I'm pretty sure there will be a double sleep session starting tonight which means I'll be sleeping through the night, get up then probably laying back down to sleep again. This double sleep pattern is how I first dealt with the sleep apnea, before I had my bi-pap machine and was the reason I first went to see my MD because I wasn't having much of a waking, productive life anymore which was disturbing, to say the least. There is nothing more powerful I'll be able to do to reset my brain and infuse a more positive, happy outlook on life then to get rested with productive sleep.

After gym time & sleep, the third thing on my to-do list will have to concern school. Geez ...I can just feel the dissonance swell up in my brain at the mere thought of dealing with school. I noticed Dr. Shay had added this blog as one he was following and I recall when I first saw him after quitting the pledging process with his fraternity when he mentioned he noticed some kind of psychosomatic response from me when I first saw him. I sure didn't mean any personal or bad reflection on him but, he may have been correct in his assessment. I can feel that same type of response when thinking of school ...a very distinct and noticeable firing of neurons in my brain which tend to produce a not so pleasant emotional response.

As far as what I can "handle" with my current self, I can think back to those pledging days and say with a fair amount of certainty that 16 to 18 hour days were too much and these current 12 to 14 hour days are kind of on the cusp of survival and still being able to progress and move ahead with school.

Mail is a fourth consideration to deal with during this 4 day break.

Tri-8 Wk7, Days 488 & 489 - Mon & Tue

2011-06-21T17:18:00.002-05:00

The blogs have been getting more sporadic lately and all I can say is ....5 mandatory clinic days per week, 12 to 14 hour school days - everyday and 35 hours of classes. Oh, and up to 3 hours per day in my car driving. Although, there have been days with as little as 2 hours & 40 minutes :)

Beat, sore & exhausted would be the first adjectives that come to mind when describing my current state. My brain is mush and with that mush & fatigue comes a less than positive attitude and some of the crummiest thoughts I've maybe ever had.

Tri-8 Wk6 Days 485, 486, 487 - Wed, Thur, Fri

2011-06-19T01:48:00.002-05:00

It's early Sunday morning (about 1:50 a.m.)

Tri-8 Wk6 Day 484 - Tuesday

2011-06-14T21:10:00.003-05:00

I've been home for less than an hour but, it's already after 9 p.m. and I'm pretty much obliterated and could fall asleep at the drop of a hat. Let's see ...yesterdays comment asked who's Korina. As I understand things, she was the Director of Social Media at Logan. As far as specifics, one would have to ask the parties involved. To me, the situation reminds me a little of when I worked as a Realtor back in '95. I remember I wanted to bring my computer into the office but that was forbidden. In my situation, I think the technology was a bit too new for the Broker I worked for but, now-a-days that same company does have a website and everything you'd expect of a Real Estate office. Maybe there's some parallels between the two situations. Maybe not.

I had my 2nd patient today. and ....that's about all I can say about that. LOL HIPPA, ya know. My first patient was this past Friday and, looking back, I probably should have come in Saturday to get all the paper work completed. Of course, it wasn't until today that I saw, first hand, how much was involved. Plus, I already had plans to go to the Ozarks Friday night which kind of precluded going into the office on Saturday.

I did catch an email at work another intern was looking at regarding recent firings at Logan. An interesting part was that Dr. Goodman (current president of the college) starting teaching back in 1968...and he's still with the college! That's about as impressive as it gets. 43 years with the same institution.

There was talk a month or so about a letter that was going around - not an email, but an actual letter critiquing the school and top administration. I think part of the gripe was about salary but, the numbers I heard were actually a little lower than I expected.

There's two things I keep in mind regarding the upper echelons of our administration. 1) There's a chiropractic school out West that's closing it's doors after the Summer semester and 2) Logan is putting up *another* brand new building. So, the people in charge must be doing something right.

My personal gripes tend to be indigenous to my own, somewhat unique situation and most can easily be avoided by simply not living an hour away from the school and also by not waiting until you're in your 40s to go to chiro school.

It's damn hard, I can tell you that. It looks like being away from home for 12 to 14 hours a day is going to be pretty standard. I was thinking this morning, it's like with each new thing that pops up there's a feeling of dread and loathing and then you try to accept it the best you can.

The driving is pretty nuts. Without any bad traffic, I'm putting in about 2 hours and 40 minutes of driving per day. Originally, I was mostly concerned with my blood pressure going hypertensive again like it did when Hwy 40 was closed down but, in spite of my drives being longer, the traffic jams aren't near as bad as when that main highway was closed. My main issues tend to be with sleep and upper arm joints - shoulders & elbows along w/ the ever more frequent parasthesia in the arms & hands.

I sort of remember with fondness how blog entries from a year or two ago were more fraught with interesting things that I learned in class. But ...I can't really remember anything from my classes and there's too many to remember without referring to a schedule or writing them out.

hmmm, OK - I looked at the schedule and am not sure what to make of it. There's too many classes to go through at this time.

I have a PT III practical on Thursday and I've still got to get done the Dx Imag (xray) original interpretations and Lab Interpretation, Case 4 by Friday. I need to get a blue sheet for my senior project turned in ASAP. I don't think Neuroplasticity & rehabilitation as it relates to Stroke patients will be my topic anymore because that was Dr. Bub's forte. I'm not sure who I'll get.

I think part of the griping by recent graduates may have had to do with moving classes into Tri-10 which somewhat precluded upper tri students from retaking classes they were unable to get through in previous trimesters such as 7, 8 or 9. I've just got 8 & 9 to get through.

I don't know. One moment at a time here. And, this moment is begging for sleep.

There is some relief with having a patient to care for because it precludes one from becoming too bogged down in their own trite issues. I've got my homeowners insurance paid again ...looks like I had forgot to do that when it was due - just have to get word to the bank that I'm covered again. Banks are kind of particular about that sort of stuff. Property taxes are another concern but, I've been charging almost everything I can to conserve cash. I think I can get by with a grand if I put off Part IV boards until next May. I know my car needs some attention, it sounds & feels like bearings may be going out. I'd like to at least get my tires rotated. Which reminds me - I need to ask off for next Thursday and Friday. Those days will be golden for getting some personal life stuff taken care of. There's maybe a form to fill out at the office for taking vacation days but I'm tempted to send Dr Hogarth an email asking for the days off - at least it might serve as a reminder if he says something to me tomorrow.

Dr. Hogarth is my clinician at St. Peters. He's very good at his job and does a good job tolerating me. Dr. Kane is the other clinician. As interns we get split up between these two doctors. I really wish I had something class related to talk about -- still don't remember anything...let's see ...

Wed - Class - Clinic Meeting - Clinic

Thur - Class - Clinic Case Reviews

Fri - Class - Clinic

Sat - Class

Sun - Class

Monday - Class - Clinic Case Reviews

Tuesday - Class - Clinic

Wednesday - Class - Clinic

and ...hopefully - praying - I can take two vacation days - one on Thur and one on Friday - we don't have school those days due to homecoming which ...is something else I really haven't gotten to enjoy mainly due to the long commute to school.

Geez - i have to get some clothes washed for clinic tomorrow!

Tri-8 Wk6 Day 483 - Monday

2011-06-13T20:01:00.002-05:00

All kinds of excitement going on at the Logan campgrounds as of late and, I guess this would be the time of night, after I get home, that I'd discuss such things with my wife but, she's been dead for quite some time now so I suppose this blog is as good a substitute as any.

In the last week we've lost Korina, Dr. Scott & Dr. Bub - FYI - The only only person I know that's gone 100% is Korina. Dr's Scott & Bub have yet to be confirmed through official channels.

Without a doubt, Korina was the nicest looking of those three to be let go however, Dr. Bub was going to be my senior advisor so ....hmmm ...maybe I go back and try with Dr. Kettner? I'm not sure.

Bub has a diplomat in neurology. I'm not sure if any other teachers at Logan have that diplomat.

Korina is extremely interesting. I would like to have gotten to know her better.

So very few people that we meet really get remembered for a very long time. I can't even remember all the Walgreen stores I've worked at much less all the people I worked with. Just a smattering of memories.

Tri-8 Wk5 Days 481 & 482 - Thur & Fri

2011-06-13T19:54:00.002-05:00

placeholder - went to the Lake of the Ozarks after clinic on Friday - Takes less than two hours to get to the condo from St Peters and, it's taken me as long as an hour 40 minutes to get home from St. Peters so ....for an extra 10 minutes of driving, the lake is well worth it. In fact, Saturday, I got more studying and homework done then any other day of this semester. Might have to do this again. :)

Tri-8 Wk5 Day 480 - Wednesday

2011-06-08T22:36:00.002-05:00

oh yeah, i had a comment I still need to post about the majority rule thing. In my head I was thinking about things like smoking where, since only 25% of the people smoke and 75% do not then it's alright to toss people who smoke out in sub zero or heat warning temperature

or, with school - a majority of people via the lottery will end up pretty decent so there isn't any need to worry about the exception like me who lives 50 miles away from his clinic and has to be out there 5 days a week -

how freakin crazy is that?!

I started out with 4:30 a.m. alarms on Mon, Tue & Wed ....slept through them until about 5:30ish

My intent was to get out and get some exercise in.

I'm so trashed physically right now it's not even funny.

kind of thinking of riding my bike tomorrow - have to see how my sleep turns out - hate to fall asleep at the wheel of a bike ;)

trying to recall what we did in classes today ....

oh yeah - lots of nutrition this morning -

The teacher actually had pictures straight from a Nobel winning paper from 1986 (circa)

it was the basis for how many think about cholesterol today. upon reflection, it's kind of so-so in light of today's knowledge but, it will be a while before any current studies and research actually become best practice ...research indicates it takes about 15-20 years before what's known actually makes it into "best practice"

Dx Imag III was after that for two hours. Dr. Kettner is always fascinating listening and thank god I record his class because the sleep monster was jumping on me during most of the first hour.

I'm almost too tired to walk.

I'll let the alarms continue to go off at 4:30 because, if nothing else, I've been getting to school on time.

too tired to thik

i have heard I get 6 days off from clinic

I need to use two of those days during our upcoming homecoming otherwise I'll have to go up on Thursday for a case presentation and it will take me twice as long to drive there as it will to listen to the stupid presentations

Tri-8 Wk5 Day 479 - Tuesday

2011-06-07T20:38:00.002-05:00

I had four different alarms on two alarm clocks all going off between 4:18 and 4:30 with 5 min delays. I was hoping for non-stop alarms going off but I didn't hear a darned thing and didn't wake up until 5:20 a.m.

If nothing else, I did make it to school with plenty of time to spare. Non of it really mattered as far as my activator class was concerned because I got kicked out. oh well. My best guess now is to drop the class officially and see if I can finish up the weekend activator class. This could turn out to be a good thing.

Just a big non-stop day, class to class to class to class and then straight to clinic where, today, I got the joy of sitting up in the office for 3 1/2 hours to do a whopping 2 minutes worth of work - if that ...however long it takes to write my initials down about 8 times when other interns turn in patient files. What an amazing waste of time and I'm quite certain this was just another in a line of time-wasting mundane things that was added to the curriculum.

I think it's one of those classic blunders when institutions think perfection is achieved when there is nothing left to add instead of considering the possibility that maybe, sometimes perfection is achieved when there's nothing left to take away.

From my perspective, I think Logan has a pretty strong program in the beginning and they're still struggling to get things figured towards the ending trimesters.

Honest to God, all this driving is just eating me alive. I spent an hour & 40 minutes getting home from clinic today. and the way those stupid Case Reports are set up, I have little choice but to deal with rush hour traffic on those two days as well.

My Evaluation of those Case Reports: Actually, they're probably one of the most worthwhile things I'm involved in this trimester and Dr. Hogarth does a really good job.

I've made it no secret telling other students how good I thought the clinic was at St Peters and I kind of wonder how much of an effect that had on the lower Tri's decisions when it came to picking their clinic since the St Peters clinic was one of the first to get picked & filled up.

Definitely a very worthwhile process - ie, Case Reports.

Definitely killing me and shortening my life. most probably anyway.

how hard can it be for the powers to be at Logan to consider students who own their own home and live out of state? they spend so much time trying to tell us how to care for others and yet we, as students, get short-changed so much.

and there is very definitely a "majority rules" type mentality at Logan. As long as the majority of the people are happy then consideration for everyone can take a back seat.

The whole thing has given me new appreciation for all those civil rights legislation's passed in years gone by. It's like the only way you can make certain people care about others is to make it a law.

Alarms are set - dead tired - scarcely got little more than an hour to take care of business at home after i got home.

Lab Interpretations & a Dermatology Exam this Friday ....

Tri-8 Wk5 Day 478 - Monday

2011-06-06T22:23:00.002-05:00

Got alarms set for tomorrow at 4:18, 4:24 & 4:30 a.m.

Did what I could today.

Looking to do better tomorrow.

Tri-8 Wk4 Day477 - Friday

2011-06-06T00:50:00.002-05:00

just kind of a placeholder here for last Friday.

Everyone seems fond of telling me there's only one year left.

Well, it's one year remaining provided I can get everything done that needs to be done.

BUT - it's not a matter of passing time. It's a matter of being able to do enough within that year's time.

It's more like say you can bench press 500 pounds but need to bench 600 in order to graduate. Maybe you can make it, maybe you can't.

This has really been an isolating type of trimester. Kind of strange. There are very few, if any people from my class that eat lunch in the cafeteria, I might see someone one day out of the week. Most everyone lives close enough that they can run home after our last class to change clothes or get a bite to eat.

My parents have kind of been scarce as well. I'm pretty certain I've heard from them more in previous trimesters but I think maybe I've heard from them once in the last three weeks.

Tri-8 Wk4 Day 476 - Thursday

2011-06-02T07:16:00.002-05:00

PT III canceled this morning.

Still need to be to school by 9 a.m. to finish my mail duties from clinic.

If I didn't have outgoing mail duties yesterday at clinic I probably would have left.

Yesterday I learned PT - Physical Therapist are legally able to rate concussions in the state of Ohio however, Chiropractors are not - are you kidding me?! Are people really that stupid and ignorant when it comes to the education of a chiropractor?!

I pulled up the educational requirements for a DOCTORATE in Physical Therapy from Washington University, one of the most respected schools in the nation to see what kind of education PTs have in comparison to chiropractors. It looks like a very good program and I'm sure it produces some of the best PTs in the nation, probably the world but it's a far cry from the education of a chiropractor.

The program shows 4 entire semesters of Clinical Experience - kudos, this is a good thing.

However, when it comes to classroom learning the entire program consist of 5 semesters of classes. Only 19 hours of classes the first semester and a whopping 24 hours of classes the second semester. I've never had so few classes. I've been over 30 hours since my 2nd semester and currently juggle 35 hours *with* clinic! and we don't just have classes for 5 semesters - we have them for TEN semesters.

I'm not seeing anything in the way of hard core chemistry either - I don't see two years of chemistry and a year of physics as a prerequisite and I've not noticed either of those classes as requirements to become an RN either - another very highly regarded profession.

I don't see a year of biochemistry.

I do see one semester of human anatomy. At chiro school we have an entire YEARs worth of Gross Human anatomy which means we're dissecting the entire human body from head to toe.

I do see a couple of classes with the word "diagnosis" in them but not nearly as many dx classes as we've taken at Logan. We've have more diagnostic imaging diagnosis alone.

So, chiropractors have more than double the classes as a PT doctorate level program and yet we aren't capable of concussion assessments? Are you kidding me?

Jesus - in addition to that year of human dissection we spend another semester with the brains we've removed from our cadavers in another class called Neuroanatomy - and that's JUST the anatomy of the brain - we have other classes for pathology, normal function and neurology. Pathology - that's another class entirely missing from the PT program.

I'm not knocking the PT program - it's a great program and I'm half wondering how if I can get into the program - it takes less time and I'd have a good job waiting for me at the end.

Oh well - gotta get to school -

The first of two months worth of 5 day a week clinic duty starts today.

Something radical is going to have to take place to ensure my survival and I'm not even talking about just school survival anymore.

Tri-8 Wk4 Day 475 - Wednesday

2011-06-02T00:01:00.001-05:00

Just shoot me in the head now.

I turn 45 July 7th. My new goal is to make it that far.

Tri-8 Wk4 Day 474 - Tuesday

2011-05-31T16:47:00.003-05:00

Well, I think I might be moving on to acceptance of my crappy 600 mile weekly driving. What a bunch of crap. One interesting thing regarding learning about having to come in 5 days a week was that I only recognized one of those days one at a time even though I saw the entire monthly schedule every time I saw it. I think I only saw what I was able to handle. The first time I saw the schedule I only saw that I had to come in on Mondays and it wasn't until later on that day when I looked at the schedule again that I saw that I had to come in on Thursday as well.

I think if I'd have recognized that I was having to go in 5 days a week initially that I would have walked out of the classroom.

AND ....it looks like my marathon driving starts this week ... Hell - today alone I put on over 150 miles.

oh yeah ...I need to turn in a sheet for our meeting tomorrow telling how many people in St Peters I've met ...now, this is one of those things that should be available as a soft copy but St Peter's is a little behind the times when it comes to electronic records.

OK - that sheet's filled out and ready to be turned in

next - PT review application due tomorrow ...

well, that PT application has turned into looking up and scheduling all the logistics for my Part III & Part IV boards as well as PT as well as the one subject I need to retake for Part II.

I need to check w/ NBS if I can take the review for Part IV next year in April, just prior to May testing. I'm way too tired and stressed to remember much of anything and don't want to risk $1,235 on an exam I'm not sure I'll be prepared to take.

Tri-8 Wk3, Days 470, 471, 472, 473 - Tue, Wed, Thur, Fri

2011-05-30T15:29:00.002-05:00

Apparently, clinic is now manditory 5 days per week. That's 120 miles of driving per day, 5 days a week MINIMUM! - 600 miles of driving per week - MINIMUM.

At this point, all I can say is Logan can go to hell.

With only 3 days of clinic per week I've already broken over 600 miles due to other activities such as marketing or ARC.

The extra two days per week are for listening to and presenting case reports.

I'm not really sure what to say, do or think about this latest development. It's pretty much insane and asinine.

We have senior research projects we're supposed to be working on and, with that, we are to procure a teacher from the school to act as an adviser. Asking a teacher to take on such a position seems to be the most unpopular question one can ask. It's not something most of them like to do or be a part of.

Part IV National Boards applications are now being accepted. I don't think I'm going to be able to pull the trigger on this. $1235 cash is required - no credit cards, just cash equivalents. Exam dates of November 11,12 & 13th. I've already put out over $600 cash for reviews. One of which I've already partially taken.

It's late Monday - Memorial Day. Class resumes tomorrow with day 474. There seem to be some schools where the students are enthusiastic about chiropractic but, I can't say this is necessarily one of them.

If things keep up as they have been then I can only imagine that if I ever manage to graduate then the last thing in the world I'll be wanting to do is practice chiropractic.

Tri-8, Wk3, Day 469 - Monday

2011-05-23T22:11:00.002-05:00

Today was class from 7:20 until 11 a.m. and then I hung around and was able to get in four hours of rad conference in along w/ write ups for 5 sets of x-rays so, i've got half of the hours I need now for my Tri-8 rad conference requirement and I'll have to keep up the write ups for another five weeks.

We also have Lab impressions to do over the next 10 weeks and the first one is due this week. We get a case, i.e., 42 yof w/ c/c of blah, blah, blah ... then we get their vitals, CBC work, chem lab and urinalysis and need to provide a ddx and dx and how we would care for them.

Let's see ...last Friday was a 6:30 a.m. start at school, the preceding Monday ended at 11 p.m. Got clinic tomorrow, Wednesday and Friday. oh heck - i just remembered I need to update Dr. Hogarth on my adjustments - I *think* the 5 I did at ARC maybe count towards the 200 total I need to get in by graduation.

man it get's late quick - kind of a late night getting home but, only a 13 hour day so nothing unbearable. I do need to update my online Google calendar and sync it with my iPad - still have some other computer stuff to do as well regarding downloading materials for my 18 classes ---- nope - only 17 classes -

10 are structured classes that we meet w/ a teacher during the mornings and the other 7 are kind of like classes that we have to do on our own like the 10 weeks of lab impressions or 6 weeks of xray reports.

I really wanna think I can do this (get through the semester) and I really would like some decent grades to go with this semester. A few of those extra classes we're doing only have the option of getting an A or an F (or an incomplete) Getting it all done is the key. Dr. Guebert told us today that there are still Tri-10s with incompletes from Tri-8 coursework ...so ....wish me Luck! :)

Tri-8, Wk2, Days 464, 465, 467, 468 - Tue, Wed, Thur, Fri

2011-05-22T06:52:00.002-05:00

Time to catch up :)

We can start with yesterday, Saturday, 5/21/2011 at Laurel Park in St. Peters, MO where I worked on six patients from the Cystic Fibrosis charity event walk. It was tough keeping a dry eye while listening to the stories of some of the people I worked on. The very first lady I saw told me the 12 year old girl she was walking for had died last week.

Friday was a day of early meetings starting at 6:30 a.m. followed by classes, then clinic then a stop at a classmates house who was having a little pre-party followed by the beginning of Tri party held at Hot-Shots over on Manchester in MO. I learned a few new chiropractic type moves both at the clinic and with friends later on at the pre-party.

OBGYN was rather interesting, our teacher is an FACOG, the American Congress of Obstetricians and Gynecologists or, a fellow. As I understand things, specialist like this are kind of like Mega-Doctors. After they put in their four years to get their MD they go on for another 4 years learning about a specialized area, such as OBGYN.

ACK! well, my computer crashed yesterday and it looks like what was written above is all that got saved.

oh well - the darnest thing about OBGYN is when we were talking about various secretions and watching slides of those secretions on a ladies fingers and the teacher commented that it was OK to touch a vagina ....then she recanted and said, it's OK to touch your own vagina. It was quite interesting though because, as she pointed out, the more serous effusion & clearer type of secretion was easier for sperm to swim through and thus make it easier to get pregnant. Something else the teacher mentioned and I kind of want to confirm this with more sources but it was mentioned that Green Tea can help produce a vaginal secretion that is more conducive and hospitable to sperm.

Last Monday, I spent the evening at the ARC - Adult Rehab Center sponsored by the Salvation Army in downtown St. Louis. They open their doors for medical type care on Mondays & Wednesdays. We mainly just did physical type stuff, blood pressures and so forth along w/ some physical therapies and some adjusting when indicated. I did get a couple thumbs up from a few of the guys w/ the A to P move I layed on them ;)

OK, better get this posted and update things for today. (Mon, Wk3) :)

Tri-8 Wk2, Day 463 - Monday - 50!

2011-05-16T15:38:00.003-05:00

Let's see .....

My head is probably still a little in the sand but, I'm pulling it out and dealing with things the best I can. I did hit my 50th adjustment today ~finally!!! So, that will get rid of the Incomplete grade "I" that I had in HCP III. I also finished up the Gonstead retake over break to get rid of the F I had in that class. I think the only thing left to deal with is the F I got in SOT which, I simply stopped going to half-way through last semester. It was a ZERO credit extra class I was taking so I didn't think the grade would matter one way or another since it is a no credit class. I still have to find out but, maybe now I can get my student loan check which I *really* need.

Checking my mail, it looks like I've sold another shirt off Zazzle and got an email yesterday stating I had a check coming from Google for my Brachial Plexus video. That could be a nice little source of extra income. Once I see the money for real once, then the math brain shifts gears and I instantly figure if one video earns me $135 then 10 would put me over $1,000 and 100 well done videos might be able to give me enough per year to pay the property taxes on a pretty nice home.

I have ARC tonight. ARC stands for Adult Rehab Center. I have no idea what I'll be doing there but, the shift is from 6:30 to 11 p.m. Which means getting home late but still having to get up early. I think I still need to stop at the gym to invest at least 1/2 hour

I almost forgot, the highway leading to school was closed again this morning. It was closed Friday night when I was coming home from the Arthritis Walk I'd volunteered to help with then again this morning. This morning it was closed due to an accident and someone died.

Looks like I'm going to have a patient stopping by my place before I leave for ARC tonight.

Saturday Clinic Shift, Holding at Day 462

2011-05-14T16:55:00.002-05:00

What a HUGE difference getting a decent night's sleep makes! Even though I spent almost as much time driving back and forth to work as I did with today's three hour shift, I found myself reluctant and sad when I had to leave work today.

When anyone has a new patient at the clinic we play our own version of House, MD with regards to the white board. All the available interns will sit around the white board and listen to the facts & findings about the case and are all free to contribute to the diagnosis (dx) & treatment (tx).

We had two pretty nice cases we reviewed today.

Heck again - I've got to get moving on figuring out all the work I need to get done for the coming week & semester.

Wk1, Day 462 - Friday

2011-05-14T07:01:00.002-05:00

I gave my first school sports physical yesterday! He was a really good kid and his mother was quite grateful which was pretty darned nice. It was a big learning experience. I noticed any apprehension which was present before giving the exam was immediately replaced with caring once I met my new patient. Given the young age I tried to be as positive and emotionally supportive as I could with the young man.

Heck - gotta leave for Sat clinic shift!

Tri-8, Wk1 Thursday, Day 461

2011-05-12T14:20:00.000-05:00

Just a single hour of PT III this morning. A much abbreviated schedule due to the Tri-7 comp boards going on today and tomorrow. I stuck around and got in an hour of my radiology conference requirement (1 of 10) and downloaded and printed out a bunch of material for most of my classes.

Tri-8, Wk1 Wednesday, Day 460!

2011-05-11T22:35:00.000-05:00

pardon the brevity of these post -

yesterday was 13 hours long

today was 14 hours long

i don't know what tomorrow holds but

Friday is already scheduled to be 17 hours long

i work clinic on Saturday

and have some extra shift at some Drug rehab center in St. louis on Monday

need to beef up the dr bag to be able to handle some basic emergency type stuff, things like dealing with a pneumothorax (where to cut) and a cricoidectomy ...That was from Dr. Lanny

Then our Dx Imag teacher was mentioning needing to learn about different surgeries. who knows but, i do recall that our pharmacology class helped me the most in learning about why and how chiropractic is effective.

tough, tough schedule - really having my doubts

Tri-8, Wk1 Tuesday, Day 459!

2011-05-10T20:07:00.002-05:00

Physiology
Chemistry
Clinical Sciences
Microbiology
Pathology // General Diagnosis
General Anatomy
Principles of Chiropractic
Spinal Anatomy
Neuromuscular Diagnosis.
Diagnostic Imaging
Chiropractic Practices

Rad Pos

2011-05-09T04:35:00.002-05:00

[Holding at Day 458]

One final cup of coffee before I head off to school to jump through another hoop via Radiological Positioning and take a few x-rays of some phantoms. I'm looking forward to re-establishing my habit of stopping off at the gym on the way home from school. I have to think of exercise as another necessary class I need to attend in order to make it through these last three semesters. That attitude seemed to work well for me this past semester, in Tri-7.

The actual Tri-8 semester starts tomorrow - got plenty to do to finish getting ready.

Best Day of the Week, A Day Off, Friday Clinic

2011-05-07T04:13:00.003-05:00

[Holding at Day 458]

[4 a.m.] I actually have a day off today!

[7 a.m.] (insert BIG time gap here) OK, I've actually just wasted 3 hours on the Internet! Oh, well, it's been a while since I've been able to do that and I have been enjoying some coffee and the light sound of rain outside my window (which sounds much better then outside my slightly opened garage door)

I did muster the courage this morning to look for a grade in the Gonstead class I just got done taking over my break (break?! what break???) At the very least, I do hope I passed the class but, passing grades alone aren't going to do much for my GPA. I at least want to finish the DC program above a 2.5 which, I'm already above but, can't afford crappy grades and still hope to maintain that GPA. I lose the opportunity to take Master's classes w/o a high enough GPA.

anyway - Thursday would have been the best day of the week because I got to have lunch with my Dad and really enjoyed the time with him.

Yesterday at the clinic was pretty fun also. So far, I tend to be happy there and the only drawback is that god awful drive. We're supposed to meet 5 people from St. Peters by our next meeting. I'm not sure how much time I can dally around in St. Peters to meet people but, I guess I'll have to make the time since I need to find 10 new patients before I graduate.

I've got an enormous amount of stuff to take care of, better get to it! :)

I was looking for a pic of just me and my Dad but today's pic will have to do. It's me, my Dad and my Grandma! :) Taken just ..geez, just 6 days ago up in Minnesota :)

Gonstead, Board Reviews, 4th Wedding Reception

2011-05-06T11:48:00.002-05:00

[Holding at Day 458]

We had our Gonstead final this morning. 10 pages written. It was my choice to go to Minnesota this past weekend but, it was not a choice without consequences.

Prior to leaving for Minnesota, I had an 83% average during our first four days of class. In the four days after getting back from Minnesota my average was 48%. So, I went from a very respectable B (just shy of a B+) to nearly 20 points below an F.

That sucks

Makes me feel pretty crappy about myself.

Mondays test was one of the hardest, emotionally, and I just felt like a worthless piece of sh*t while taking that exam.

Today, I just wanted to crumple up my exam like that guy did on Shawshank Redemption when he threw it in the trash and said, "There's your two points!"

Then I thought (again) of Chevy Chase's Las Vegas Vacation when the blackjack dealer recommended "buying a bullet and renting a gun"

So, my thoughts are kinda in the crapper. I've wondered, from an academic perspective why all my anger and violent type thoughts are directed towards my head. From the beginning of Tri-7 the thoughts have oscillated between

wanting to flush my head down the toilet
shooting myself in the head
chopping off my head
stabbing myself in the temple with my pen (that was a new thought formed today while taking the Gonstead final)

I do recall various personality disorders and remember a distinction between those wackos who might hurt other people and those wackos that would only hurt themselves. I guess I would fall into the latter category.

As far as benefits of heading to MN, I know my Dad was happy and I got to take some pictures of my Mom with her brother so, in that regard, I'd probably do it again.

I still may have passed the Gonstead class but, given the diminished self perception over the preceding trimester, I really could have used something positive with regards to school.

oh well. .....

let's see, i've already driven about 84 miles today so I guess I'll start my next 50 miles to work ....then 50 miles home ....184 miles today alright - ....yeah ....this is going to work out well. ..... :(

Some Tri-8 Hoops

2011-05-05T00:38:00.003-05:00

[Holding at Day 458]

just want to get this list down somewhere which was provided by an upper tri on facebook - these are a few of the things we need to do in addition to our 35 hours of class and 3 to 4 clinic days each week and god knows what else...

35 pt credits,
10hrs of xray interpretation (which apparently you cant start getting credit for til may 10th),
10 lab interpretations (they won't be posted until a few weeks into the tri. They put all of them up at once on selfserve so i would suggest doing all them at once... then u just have to submit one a week),
5 hrs of marketing and
a marketing paper,
30 xray reports (15 new and 15 corrections posted every monday in the little room across from Erica's office in radiology,
2 phantoms and
2 patient series (doesn't have to b your own patient)
2 case reports written (listen to 20 from others) and last but certainly not least,
PRO D - you have to attend a boot camp and then do a post grad seminar (u need 12 hrs - 1 weekend - and they have some that are free if u aren't already enrolled in one. They will send u an attendance verification and u just turn it into dr. goodman.) sounds like a lot but if you do as much as u can at the beginning its not that bad...

Part IV Mock Exam -

2011-04-29T17:58:00.003-05:00

[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.

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

2011-04-28T20:10:00.005-05:00

(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.

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

2011-04-27T21:27:00.003-05:00

(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 $$$$ :)

Gonstead & Part IV Board Reviews

2011-04-26T21:04:00.002-05:00

(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 ...

Thyroid Comment & What's going on?

2011-04-25T07:53:00.003-05:00

(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.

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

2011-04-23T09:48:00.000-05:00

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.

Goto Live Streaming Graduation to watch!

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

2011-04-20T19:03:00.002-05:00

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

2011-04-20T03:40:00.002-05:00

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.

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

2011-04-18T01:12:00.003-05:00

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.

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

2011-04-16T13:12:00.004-05:00

[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.

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

2011-04-14T21:17:00.002-05:00

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!

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

2011-04-12T10:58:00.001-05:00

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

Tri-7 Wk13 Day 449 - Friday

2011-04-10T15:46:00.002-05:00

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

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

2011-04-07T22:16:00.002-05:00

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 :)

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

2011-04-05T21:40:00.002-05:00

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

Tri-7 Sunday - Thyroid Talk

2011-04-03T18:52:00.002-05:00

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 :)

Tri-7 Wk12 Day 444, Friday

2011-04-01T15:25:00.002-05:00

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

Tri-7 Wk12 Days 442&443, Wed & Thur

2011-03-31T23:28:00.002-05:00

I don't even know where to start ...I left home around 5:40 a.m. this morning and got back home about an hour ago at 10:30 p.m.

...good news text on the way home - tumor found in thyroid was benign - that's the 2nd time we've had to check on a tumor for a patient and this is just student clinic. Went to the real clinic over in St Peters tonight and they diagnosed a case of Lupus and had another patient come in with a kidney infection. I figure sooner or later we'll get some people with back issues ;)

Heard 2nd hand that a student got kicked out of school for cheating ...I heard that 2nd hand but, I do know first hand that they are no longer at the school. My head always swarms with topics throughout the day and on the way home but ...things seem to dissipate and get harder to recall when it's time to blog sometimes.

It's a Loooooong ride home from the clinic in St. Peters - a flat out 50 miles. I did stop at the gym (again) to at least get in a half hour of cardio to give my heart a helping hand along w/ a few sets of weights afterwards.

The good news was the I have zero plaque buildup in my carotid arteries - particularly at the bifurcation of the internal & external carotid arteries but, the arteries may not be as elastic as God intended so I'm supposed to follow up with that. I feel like I've spent more time under Dx US than I have in bed sleeping lately.

Had four patients scheduled for today but 2 where a no show and a third was almost missed due to my meetings tonight at St Peters but was able to reschedule so I ended up with 2/4 for the day and that brought my total up to 32 ...only 18 more to go. I actually scheduled patients on our first day of finals ...I wonder how many I'll be able to get in ;) LOL yeah .....

Talked to my Gonstead teacher today to see what kind of an F I got on his midterm and it turned out to be a pretty bad F. I guess with all the other classes I managed to get through with very minimal studying I was able to pull on prior classes and knowledge but, this Gonstead is a whole new ballgame with its own set of rules.

oh, by the way ...regarding yesterdays post about Tagamet and Zantac - I think I forgot to mention that reps from those drug companies did try to talk and present their studies at a conference after H. pylori was finally established and proven and those reps got laughed off stage which, is why those companies now have to rely on the unknowing public to plead their cause because most of the public doesn't know any better.

It was a bad F in Gonstead. I need a 90% on the final to pass that class (actually an 88% would do it) but, the teacher came up with a 90 (math is my forte but, I let the slight miscalculation slide) LOL

I can only laugh. However ....I did find out that there is a Gonstead class given between semesters for a mere $1,000 because so many people end up failing that class .....sounds like quite a racket to me! (just kidding but, it's late and I'm soooo tired ....)

Oh, and there will be a full day of class on Saturday - basically just a total repeat of a Monday. There's also a full day of Loomis (teacher's name) IHS that day and I had a patient scheduled for a complete physical ...those all can't go together ....ugh .....

I'm probably going to opt for the classes because I need all the help I can get - reschedule the physical to next weekend and I'm still going to try and sneak in a regular adjustment at 11:30 a.m. that day.

We can hang out at the clinic as much as we want (provided we're in clinic attire of course) and, if I only lived closer I could see myself doing that but, I don't think it's going to fly very well with home being 50 miles away. I am hoping to learn a lot there. :)

i just realized there are only two full weeks left - 10 days of classes then we have 5 days of finals. ....next week is our last full week then four days the next week then finals starting on Friday. I'll get that weekend off then Part IV board reviews start ..I guess I should look at that envelope from NBS

Geez.... my break is three days long ....NBS Part IV board reviews start Monday, 4/25/11, 8:30 a.m. to 5 p.m. and the same schedule on Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday and Monday .....Then on Tuesday ....I start my shifts at the St Peters clinic ....

HEY! I finally get a day off on Thursday - Cinco de Mayo!!!! Yahoo!!! I'll work again on Friday then I might actually have 3 days off before Tri-8 starts ...

Here's the kicker ...what if I have to take Gonstead again? I've heard it's offered but I've also heard people have AF'd the class which means - Attendance Fail ....

I guess we'll see when we get there ...

It's after midnight - I better get my four hours of sleep in before it's too late ...

Well, I can certainly say my life is not boring ;)

Tri-7 Wk12, Day441 Tuesday, Tagamet & Zantac

2011-03-29T17:56:00.002-05:00

The Great Ulcer Drug Rip-off

Perhaps the greatest scam ever perpetrated by the pharmaceutical industry upon an unsuspecting and uninformed public involves a small, spiral-shaped bacterium named Helicobacter pylori.

H. pylori was discovered in April 1982 by two Australian physicians, Dr. Barry Marshall and Dr. Robbin Warren. In 1983 the two doctors proposed that the bacterium is the cause of peptic (duodenal and gastric) ulcers. Dr. Marshall even went so far as to innoculate himself with the bacterium to prove his point(1). The discovery was met by deafening silence from the medical community and created great anxiety within the pharmaceutical industry. At the time, highly profitable antacids such as cimetidine (Tagamet) and ranitidine (Zantac) were used to treat about 90 per cent of all ulcer patients and generated sales income of over $8 billion per year(1,2). Cimetidine and ranitidine do not cure ulcers, but merely mask the symptoms. The relapse rate after cessation of treatment is 50 per cent after six months and as high as 95 per cent after one year(1,3).

Nevertheless, courageous medical researchers took up the challenge and it soon became apparent just how widespread and serious the H. pylori threat is. Not only did research confirm that over 90 per cent of people with peptic ulcers are infected with the bacterium, but it also became clear that H. pylori infections can be eradicated and the vast majority of ulcers cured by a one-week treatment with antibiotics and antibacterials(2,4,5,6,7,8,9).

I'm in a crunch for time so I just copied the first few paragraphs from this article. If you want to see the entire article, complete with references, just click on the title to the article. I don't think the article goes into what the discoverers of H. Pylori had to endure as a result of their discovery but, it was substantial. Since the drug companies stood to loose so much money Dr's Marshall and Warren lost their funding and eventually left the country and went to the UK where the government - who pays for the health care of their people, were more than interested in the discovery of H. pylori and NOT interested in paying out exorbitant amounts of money for treatments like Tagamet and Zantac which merely masked symptoms and never cured anything.

From what we learned in GIUG today, ulcers actually become larger and more numerous when on the old, traditional medication like Tagamet and Zantac.

So, what's the companies eventual response? Tagamet & Zantac are now off schedule which means a prescription is no longer needed and both can be bought over the counter (OTC) by millions of people who wouldn't know H. pylori from a Honda.

Granted, some people do hypersecrete acid in their stomachs but never to the extent to justify the number of scripts that were written in the past for those two drugs and probably certainly not enough to justify what's being sold today.

Maybe ...the drug companies that put out the antibiotics and antibacterials to cure the H. pylori should do a better job of informing the public and boost their bottom line ;)

Non pic today, gotta come up with 5 exam questions for dx imaging and study for a Geriatrics exam tomorrow.

oh, btw ...we could tell the same kind of story with ibuprofen. If you're curious about a reputable site to get your information then you might consider the website for the American Gastroenterolocial Association found at http://www.gastro.org/.

That's where the information in all our powerpoints came from today in class. If you go to the site, look in the upper right hand corner to use the search feature.

You can also find their facebook page at http://www.facebook.com/AmerGastroAssn?sk=app_4949752878

Tri-7 Wk12, Days 440 - Monday

2011-03-28T21:14:00.003-05:00

Looking back at my last blog I noticed we had a freak burst of snow on Friday and it looks like we're getting more snow tonight ...after an absolutely gorgeous & warm day today. Gotta make this quick - only got an hour of sleep last night but I do know tons more about diabetes insipidus - I guess we can start there.

There's Diabetes Mellitus (DM) and Diabetes Insipidus (DI). DM seems to be the more popular of the two diabetes and with DM we have Type I and Type II. Type one is the kind where the beta cells in the pancreas just aren't able to do their job of creating insulin very well anymore and with Type II we might have the insulin available but the receptor sites just aren't so receptive anymore.

With DI, instead of talking about insulin, we're talking about ADH, Anti-diuretic Hormone which also goes by it's more scientific name of arginine vasopressin or AVP or, more simply vasopressin. ADH helps a person regulate (and retain) water when necessary. If you're in the dessert, you'll be happy to have ADH. Keep in mind, a diuretic makes you pee so ...an anti-diuretic is going to prevent that from happening.

With DI we have four major types but, like a lot of disease type situations, on one side of the spectrum we have the necessary element (in this case ADH) not being made and on the other end of the spectrum the ADH isn't being very well received.

Off the top of my head, I'm thinking of a bakery that delivers it's goods to stores to be sold. If you run out of flour at the bakery then you can't produce the goods and soon the stores shelves will be empty. If you can make the goods but the store employees are on strike then the store will be closed and the goods won't be sold.

In the first type of DI, we have Neurogenic Diabetes Insipidus, sometimes called Central Diabetes Insipidus (CDI). CDI most often is the result of trauma to the brain either from an accident or as a result of brain surgery. Incidently, in case you didn't know, ADH is made in the pituitary region of the brain. And, for those that do know and what more detail ...about 5/6th of the bodys ADH is made in supra-optic nucleus and 1/6th is made in the paraventricular nucleus then the ADH travels down the hypothalamic tract into the neurohypophysis where it meets up with the inferior hypophysial artery

so ...like I said, ADH is made the brain and if there's damage to the area where ADH is made then we mess up production and end up with Neurogenic Diabetes Insipidus.

That means no ADH and our patient will end up excreting very large amounts of hypotonic, insipid (tasteless) urine. This condition is usually caused by polyuria (increased urination) and polydipsia (increased thirst) not a cool situation.

OK. Neurogenic is one. When you see the Neuro in neurogenic think of the head.

Nephrogenic Diabetes insipidus is the 2nd type of DI on our list. When you see the "nephro" in nephrogenic think of Nephrons which should make you think of kidneys. You guessed it, nephrogenic DI is a problem on the receiving end of this manufacturing process.

Now, there are places like your sweat glands and small arteries which like to receive ADH but, the kidneys are like the Wal-Mart of receiving when it comes to ADH - the big dog. And, if the kidneys aren't happy - aint nobody gonna be happy. If ADH can't hit it's primary target of the kidneys then it's going to be a lot like if the ADH wasn't there to begin with ...so, we once again have the polyuria (increased urination) and polydipsia (increased thirst)

some reasons for the kidneys being all pissy towards ADH include things like chronic renal insufficiency, lithium toxicity, hypercalcemia, hypokalemia, etc

but ...what if you're born with it?

I once remember reading about the V2 rocket developed over in Germany. With the kidneys, we're talking about a V2 receptor that likes to play nice with ADH. *Usually* likes to play nice and, when the V2 receptor is built correctly, it does play nice.

But, the gene that has the blueprint for making V2 receptors is carried on the X chromosome and sometimes the instructions are messed up and bad V2 receptors are built.

Boys have an X and a Y chromosome - it's what makes them boys. XY

Girls have two X chromosomes, it's what makes them girls. XX

If you're a boy and you have bad instructions for building the V2 receptor then you're kind of screwed because you only have one X to rely upon.

If you're a girl and have bad instructions on one of your X chromosomes ...well, you're in luck because you happen to have a second X chromosome which will probably have to correct instructions for building V2 receptors! :)

So, you'll see this form of Diabetes Insipidus more often with boys since girls get that extra chance of making things right.

Of course, theres more to it than just receiving. Just because the truck backs up to the warehouse door doesn't do much good if it just sits there.

So, V2 is the welcoming committee for ADH but then we need a little something called "aquaporin 2" and, that comes from the aquaporin-2 gene, of course. That gene has the instructions for building aquaporin 2. That gene makes the kidneys water channels so that water can be re-absorbed.

But, what if there are bad instructions for making aquaporin 2? Those instructions are not carried on the X or Y gene so it's an equal opportunity gene and, if it's bad may affect either gender.

Both parents will have to have a bad set of instructions for making aquaporin 2 in order for the offspring to get screwed which, tends to make this cause of nephrogenic DI more rare than the V2 congenital kind.

I've gotta get to bed ..pushing 10 p.m. ....

Gestational DI is a third type of DI. We're talking about pregnant ladies with this one and ...let's just get it out there - it involves having elevated levels of placental cystine aminopeptidase! Yeah, you heard me.

hmm. that long, confusing word ends with the letters -ase. So, we must be talking about an enzyme, right? Right.

we could also call it vasopressinase. so, basically vasopressinase eats up all the vasopressin and, once again, we're left without any vasopressin (ADH) in the system

Dispogenic DI is the last type and this involves primary polydipsia - drinking WAY too much. So much that there really isn't a need for an antidiuretic hormone because there's no need to be conserving water. This can cause other issues though. there isn't a standard treatment for the dispogenic variety of DI but, sometimes it's caused by a mental illness so, if the mental illness can be fixed then the dispogenic DI might get fixed as well.

Today's picture is of Koilonychia or a "spoon-shaped" nail. not having enough iron in your body is typically the cause of koilonychia which, has nothing to do with diabetes insipidus but, i thought I was going to be talking about bochdalek hernias and things like that which is what we talked about today in class but I got carried away with DI so those other fun things will have to wait. :)

Tri-7 Wk11, Days 438 & 439 - Thur & Fri

2011-03-26T12:45:00.003-05:00

Yesterday was pretty amazing and the only disappointment was getting to my first class 20 minutes late due to a freak winter snow fall that caused a few accidents on the route to school which delayed me a bit.

Our Geriatrics/Neurology teacher, Dr. Bub was going over a post-stroke protocol which, if he was to ever get back into business is what he said he would want to focus on as a service. It sounded like a lucrative & fascinating type of endeavor with a lot of basic (and not so basic) neurology involved. I've found it interesting how some debilitating events or diseases affect the extensor muscles of the body or sometimes just the extensor surfaces. The elbow would be an example of an extensor surface.

With physical therapy, a stroke patient might undergo electrical stimulation of the triceps muscle in order to help straighten their arm but, if only e-stim is given to help achieve this objective then the patient will still have trouble performing this movement on their own without the electrical stimulation to their muscles because the first part of the neurologic pathway is missing. To pick up an object you must first have the desire and other associated thoughts which eventually lead to the motor cortex in the brain and then down the spinal cord then to the muscles. Thoughts of initial desire and ensuing neural pathways are very real and need to become ingrained in the brain. It's like, we can push a car from point A to B but, we shouldn't skip that initial step of putting the key in the ignition and turning the switch. With a stroke patient, they may be missing some wiring and have to undergo a process of finding and/or creating new neural pathways in the brain.

I got to talk with Dr. Bub a little after class (and which I would have recorded the entire conversation) but parts of what we talked about dealt with therapies that can actually alter the receptors on red blood cells, some other therapy can change sodium ions to potassium ions. We also discussed how back when the dinosaurs roamed the earth that there was more oxygen and a stronger magnetic field and how by manipulating those two factors we can alter physiology. Apparently, the Detroit Tigers baseball team is using a therapy for their pictures between innings to help avoid injury and keep their pictures strong. This is all stuff I have to look into and research more but, very exciting non-the-less.

After Geriatrics we had Activator class and a mistake I kept making in class ended up showing me just how very real the Activator protocol was. After laying a patient down on the table we can view the leg length and touch various parts of the body and via the mechanoreception and other neurological processes end up altering the leg lengths. Nothing is really changing as far as a patients actual leg length but different muscles can be stimulated to contract or relax in such a way as to give the appearance of one leg or the other getting longer or shorter in various positions. When I was checking leg length with reference to the 4th lumbar vertebra I found one of the short legs became shorter so, I was to adjust the L4 vertebrae in order to correct the situation. This is where I made my mistake. When you put your hands on a persons iliac crest, their L4 vertebrae should be aligned with those crest so, I was finding the L4 vertebrae, which I was to adjust, but messed up by thinking I was on the 5th lumbar vertebrae and kept moving up one vertebrae thinking I was moving to L4 but was *actually* moving to L3. I did this three times but the legs would never even out. Once I realized my mistake, I put the activator gun on the correct vertebrae, applied the adjustment and the legs evened right out. Utterly fascinating!

After Activator class I had to run to our lab at school to get some diagnostic ultrasound (US) done on my left elbow which had become swollen shortly after an intense workout last Friday. When I got to the US room one of the doctors there had just popped out into the hallway saying they needed a volunteer and I said look no further! There was a representative from GE in the Dx US room going over things on their US equipment so, I layed down and had them scan my neck, carotid artery, jugular, ICA and stuff like that. It was cool to hear my heart beat via my carotid artery and I spent a good 20 or 30 minutes being examined like that. Afterwards we got to my elbow and forearm and I was tickled to death that a couple of my differential diagnosis (ddx) ended up being things the other doctors in the room were considering. One ddx I came up with was an offshoot of another more normal diagnosis that's found in the lower leg, a process known as compartmental syndrome which happens when the calf and other muscles in the leg end up becoming inflammed and the fascia around those muscles can't expand to compensate for the enlarged muscles. This crossed my mind because when working out a person can get a significant "pump" in their muscles. A process where by a lot of extra blood perfuses the muscles being worked and causes them to become tighter and strain against the fascia. A cool part was that my ddx was initially dismissed then, at the end of the study I heard the chair of our radiology department mention that it could be a compartmental syndrome in the forearm! hehehe That was nice :)

Another initial thought I had was simply an inflammed bursa and I think I mentioned that in my last post. I did learn that the bursa for the elbow isn't something that's as clearly defined or deliniated as say, a bursa in the shoulder.

One ddx I did not consider was cellulitis which, as the name implies is an infection of the subcutaneous tissue (fat layer) just under the skin. We did notice hyperemia throughout the subcutaneous layer to a degree which was out of the norm. However, regarding cellulitis, there we would normally see a red mark and have some kind of puncture wound to the skin and I didn't have that nor did I have a fever or any other symptoms. However ...I have had some sore kidneys in hte last couple weeks which was unusual. My thoughts there included thoughts of this new Propel Zero nutrient enhanced water beverage I've been drinking. That drink includes sucralose which, I believe is one of those artificial sweeteners which is derived by replacing a hydrogen atom from a glucose molecule with chlorine. Chlorine, like you might use in your pool, has a way of killing bacteria which isn't a good thing if it's killing bacteria that your body gets along with. Althought it's not as widely found in the literature, the kidneys have a bacterial flora just like the intestines so I was wondering if the sucralose from the new water I started drinking maybe killed off some of the good flora in my kidneys which, would then leave my kidneys susceptible to other bacteria and pathogens that aren't as well received by the kidneys.

Probably the best part of being in that US room was the amazing amount of brain power present. We had four DACBRs (board certified radiologist) including the head of our department. Dr. Hahn did the US on my elbow and forearm since he's a bit of a vascular specialist. The first lady to work on my neck was a DACBR involved in a fellowship with the head of radiology and then there was the GE rep who knew a thing or two about anatomy as well. What an amazing crowd and what an education! I was on cloud 9!

I spent about 4 hours in the clinic after that and managed to get two more CMRs knoced out, scanned one patients feet for foot levelers and even got an impromptu adjustment in. At the beginning of week 11 I had only 21 adjustments in but, by the end of the week it looks like I'm sitting at 28, that's quite an improvement.

I have to get to work on my Endocrinology paper that's due this Monday morning. Not being able to use the means I'm accustomed to in that class has proved to be quite detrimental and by that I mean not being able to use my laptop to take notes and look things up. For GIUG, I noticed I have 48 pages worth of notes but for Endo, I don't really have any and my grades in that class reflect that fact. So, I really need to hit a homerun with this upcoming paper in order to pass the class. I'm not sure if the teachers realize how very far ahead of us they are and how many words they use that we have to look up. I know people play games on their cell phones but, I don't see that happening on the laptops. One of our teachers made a comment Thursday to be sure to pay attention and stop playing games on the laptops but, as I looked down my row at all the people who had their laptops out, every single one of them had word documents up and were taking notes as I was.

Well, if my newer patients can keep coming through I should be able to at least get pretty close to the 50 adjustments I need. I'll do my 4th CMR next Saturday, take care of some other obligations at my St Peters clinic this coming Thursday, should be good on my hours since I almost have the minimum needed already. All that will help take care of my HCP/clinic class.

I think, on the 4th and 5th of April we have our next Endo and GIUG exams and I'll need a strong grade in Endo.

My Gonstead class is the only other one I need to get to work on. I still need to see the teacher to see how I faired in his class, that may be the only one left that can hold me back, assuming I get my Endo grade up. I need to work on everything but, finally have a good chunk of this weekend to myself.

One more reception tonight for my brother and his new wife ...that starts at 5 which is a bit early but, we'll see how it goes. I was thinking of spending an hour or two there, then leaving and maybe coming back for the end of it so I can get some more study time in. There just isn't all that much time to take care of everything and I really need to stay focused on school.

I have one browser open with things I looked up from classes but don't remember if I ever mentioned them or not.

Astrocytoma and Ependymoma are two cancers of the spinal cord. The ependymoma is the nicer of the two because it can more easily be removed. The Astrocytoma infiltrates the spinal cord, fusing with it and is virtually impossible to remove because you'd have to remove the spinal cord with it. Astrocytoma is more normally found in pediatric patients.

We've also re-visited syringomyelia which, can be caused by an ependymoma or even with patients with neurofibromatosis Type II. A syringomyelia is a fluid filled cyst one might find on the spinal cord.

Today's picture is of a low-grade astrocytoma.

Tri-7 Wk11 Day 437 - Wednesday

2011-03-23T07:00:00.006-05:00

[7-ish a.m.] Things are definitely getting back on track. So far, I've found everything but my camera and appointment book. I was especially happy about finding my watch this morning. We weren't allowed to have anything other than the clothes on our back during our board exams this past weekend so all other contents had to be put in a zip-lock back and, I guess during the flurry of travel to Wisconsin right after boards a lot of things got misplaced.

I'm starkly learning that not only do things take time but *everything* takes time and if you want or need the time ya gotta take it.

[9-ish p.m.] Home :)

had a couple more cancellations today, one for Friday and one for tomorrow due to a teacher giving a test at 11 which is a usual lunch hour but, I did start with a new patient today.

Went to the gym on my way home and walked out feeling like my bones were being ripped from my body. Not sure what's up with my kidneys but they've been hurting for a week or two now. I bought some Cranberry Juice today to try and help the situation. Left elbow has an inflamed bursa that's like a tennis sized water balloon.

OK, what words got looked up today?

Dysbiosis - from Wikipedia we have - (also called dysbacteriosis) refers to a condition with microbial imbalances on or within the body. Dysbiosis is most prominent in the digestive tract or on the skin, but can also occur on any exposed surface or mucous membrane such as the vagina, lungs, nose, sinuses, ears, nails, or eyes. It has been associated with different illnesses, like inflammatory bowel disease and chronic fatigue syndrome.

Mural Thrombus - a thrombus that originates in the wall of a cavity, particularly on a diseased patch of endocardium (which is referring to the inner wall of the heart)

it's kind of a big deal for all the blood that's in the heart to get pumped out. sometimes a patient might have a kind of silent ischemic attack which is when a part of the heart dies. if that happens then some blood might pool in the heart which can form a thrombus which is an aggregation of blood factors - you know, like when you cut yourself and a clot forms. When the blood clots and is stationary, not moving in the heart then it's a mural thrombus. If or when that clot decides to break off and see the rest of the body then it's called an embolism.

Thus, as Dr. Kettner has stated, "An embolism is a thrombus on vacation." :)

The other stuff i looked up today was during our AK class, things like "How to Open and Close an Ileocecal Valve". That's the valve between our small & large intestines

Todays pic is our loved ileocecal valve pic :)

Tri-7 Wk11 Day 436, continued (Tuesday)

2011-03-22T18:41:00.002-05:00

GIUG -

ended up looking up a lot of terms while in GIUG today so, I'm just going to recap them

tomo-,-tom, -toma, -tomic, -tomize, -tome, -tomical, -tomically, -tomist, -tomous, -tomy

(Greek: cut, incision; section; more often used as a suffix)

Transhiatal Esophagectomy (THE) - removal of the esophagus.

Globus Hystericus - a term given to the sensation of a lump in the throat causing difficulty with swallowing when there is no physical cause.

Spoke Wheel Sign - http://radiology.rsna.org/content/241/3/947.1.full

Achalasia - a rare swallowing disorder that affects about 1 in every 100,000 people.

Secretagogue - a substance that causes another substance to be secreted. One example is gastrin which stimulates the H/K ATPase in the parietal cells.

Esophageal aperistalsis - a rare motor disorder of the espohagus characterized by the inability of the lower esophageal sphincter and esophageal muscle to relax as well as dilation of the esophagus.

Aperistalsis - the absence of peristalsis, i.e., a failure of the normal waves of contraction and relaxation that moves contents through the digestive tract.

Harmatoma - a benign tumorelike growth made up of normal mature cells in abnormal number or distribution.

We also mentioned candidiasis or thrush which is a funcal infection but, I believe this was in reference to THE (transhiatal esophagectomy) and a reason for having to remove the esophagus.

Radial Myotomy - this is a treatment for achalasia. Our teacher seems to prefer botulinum toxin injections.

Tri-7 Wk11 Day 436 - Tuesday

2011-03-22T07:10:00.003-05:00

~8 a.m. - Still looking to get engaged & in gear. Seems like the sleep apnea has come back with a roaring vengeance and I feel like I've been run over by a Mack Truck. I'm not exactly sure what to do. I don't think I'll be able to stay awake for the ride to school, I've been there before.

~11:50 a.m. - extra sleep seems to have done the trick, ready to head out. It's interesting that when I've had difficult nights sleeping that any make up sleep I'm able to get soon after seems to solely consist of REM sleep - nothing but dreams. Even if I nod off in class for 10 or 15 minutes, it's all very vivid dreaming. Same thing with 30 minutes to an hours worth of sleep at home - straight to vibrant & vivid dreaming. I think it's supposed to normally take 90 minutes or so to hit that stage of sleep so I'm not exactly sure what the mechanics are behind it but it sure seems to help. I'm out of here and do think I can get through all my classes as well as clinic!

Tri-7 Wk11 Day 435 - Monday

2011-03-21T08:38:00.006-05:00

Well, it was a good weekend but, not being the perfect individual I'd like to be, I'm falling short a bit this Monday morning. I fell asleep within 10 minutes of getting home late last night and overslept this morning. Our first class for today and tomorrow is cancelled so we can work on a diabetes paper that's due next week. I knew I was running late for my second class but thought I'd get there for my third class however the scant time I left myself, which is usually enough, wasn't quite enough this morning since I still had a lot of my little necessities packed in my car ...

I really need to find my phone, I'm sure it's in my car somewhere ....

I'm thinking it's easier to do things right away when you get older because if you don't do it right away you might forget what you were wanting to do in the first place ...

I think a lot of my friends have nice ways of expressing things that I don't always have the words for. A latest post from a classmate reads, "Time for post-boards life reorganization" aint that the truth ...

I kind of also need a post-wedding/marriage time for reorganization, I think there is another reception at my parents this coming Saturday night then the one in Minnesota next month. I really need to get my Dad into the clinic to help me get my four CMRs. I've got four weeks left of school.

All I can think to do is to salvage as much of this semester as possible.

[1:30 p.m.] I keep bouncing back and forth from taking care of things and writing in this blog. I think the last thing I did was fall asleep.

About a week or two ago I was discussing the difficulty level of school with some classmates and one of them pointed out some law school (which that person has never attended) and said it was much more difficult than Logan. I kept my mouth shut but, I was thinking in my head that the person purporting to know so much started the DC program when I did and has taken off an entire year since starting so, who are they to judge the difficulty level of a program they haven't even been fully imbued and apparently will be leaving again to go to head off on a different career path after this semester is over.

Another classmate of mine ended up dropping the program entirely last week. I guess I was thinking of these things because today looks like one of those very rare "no show" days for me and I was thinking that missing a single day is probably still better than missing a year or dropping out entirely.

There are so many stars that have to be aligned just right to make a good go at this school thing. I was kind of reminded of that again this morning when nothing was as I was accustomed to in terms of heading out the door for school. I did my best this weekend with attending my obligations. There's such a cumulative effect when sidetracked. I was taking advantage of some of this extra time today to clean and sort through the hundreds and hundreds of papers I have on my tables and desk and found stuff still cluttering up the place from my trip to Vegas last month.

On the plus side - this is all a fantastic opportunity to become more of the person I'd like to become which goes back to one of my original objectives for heading to Logan in the first place.

I need to get back to the cleaning and organizing. The mess I have here reminds me of my current semester ...so much stuff I'm not sure where to start. Missing a day is a bit of a blip of the radar but, I'll try to use today like I did when I found out I had gotten St Peters for clinic and work to make it into a huge, positive opportunity.

[3:45 p.m.] got several hours of cleaning in but it's not appearing to make much of a dent. I am on my fifth load of laundry though :)

[6:30 p.m.] with the little I tried to eat I'm reminded of the dysphagia I'm dealing with and as Dr. Kuhn mentioned it could be a beginning of presbyphagia. However, I did notice in the weeks I was working out before this weekend that I had zero episodes of dysphagia w/ regurgitation of the bolus. so, in my head I'm figuring my neurology is working better with regular workouts. I can only guess the episode today is related to the demands of the weekend.

Tri-7 Wk10 Day 434 - NBCE Part II, Day 2

2011-03-19T01:41:00.004-05:00

12 hours from now I'll be completely done with Part II boards and about 100 miles closer to Wisconsin.

I was 100% drained last night and passed out on my bed due to pure exhaustion shortly after I got home and just woke up. (at about 1:30 a.m.)

At our school, Logan, Part II boards are first taken by students in their 7th and 8th semester. As a fellow student pointed out yesterday, we're being tested on subjects for classes we haven't finished yet. Still, that was the same situation for Part I and I passed all those sections. However, everything has been a bit different for me this trimester and there's a good chance I may be taking some of these boards over again. I did notice that, in addition to the slew of Tri 7 & 8's that were taking this exam there were also a lot of people in their 9th & 10th trimester still trying to get through Part II. The lady sitting next to me was finishing up their Part II exam and then had Physiotherapy boards *after* the Part II exams last night and then she'll be finishing up Part II today with me and then taking Part III boards on Sunday.

.....

Today, our final two exams will be over ACS and Practices. ACS stands for Applied Clinical Science. I'm pretty sure my ACS will yield better results than Practices which encompasses the Gonstead technique of adjusting. We are taking that class now but, in terms of grades, it's my lowest grade out of all 13 classes I am taking.

.....

Wow, already after 3 a.m. I'm heading straight to Wisconsin after my last board exam and need to get some laundry done and get the address to the hotel I'm staying at punched into my GPS so I know where I'm going. Final studying might be a good idea but, you do what you gotta do. I really hope & pray that there are no other things to sidetrack my efforts for the remainder of this trimester. It's going to be tough enough to get through as is.

Tri-7 Wk10 Day 433 - NBCE Part II, Day 1

2011-03-18T04:34:00.002-05:00

Today is the first day of National Boards Testing, Day 1. Ideally, I'll leave for school in about 40 minutes and get there about 6 a.m.

Today also marks 400 days until graduation.

Boards, wedding reception (#2 of 4) then back to school.

CMR on Monday (2nd of 4) for clinic

See as many patients as I can and do what I can to salvage my classes for this semester. 11 of the 13 classes have been strong and just need to work on bringing 2 grades up.

We learned yesterday of some new additional project we need to do for our HCP class and some other big project for our Research Methods class.

Also, I'm not sure if I mentioned this yesterday but we're supposed to be able to continue with our adjustments even after this trimester ends up until Tri-8 officially begins so, that will help me get my needed numbers. I've also been under the impression that adjustments we've done in Tri-6 may count towards our total needed of 50 adjustments.

I'm not sure where the chips are going to fall for everything going on for this semester. Time to go - wish me luck! :)

Twas the Night Before Boards ....

2011-03-17T20:00:00.002-05:00

holding at Tri-7, Wk10, Day 432 ...

...not getting too far on tonights blog. Talked to my brother for about an hour then have a flurry of IMs, post & chats w/ friends

phone.... that was Mom.

It's kind of ironic that I haven't seen my parents in a couple weeks and the next time I see them will be in Wisconsin.

It's gotten very late, already after 10 and need to get to bed.

Tri-7 Wk10 Day 432 - Wednesday

2011-03-17T07:39:00.002-05:00

Wednesday was our last day of class before boards. We have four weeks left before finals. When first coming into Tri-7 I was using Tri-4 as a kind of mental template. Tri-4 was my easiest semester at Logan. We had boards in Tri-4 and I was expecting something similar for Tri-7. I remembered that being imbued & immersed in studying with the likes of Irene Gold and NBS tended to help my focus but, Tri-4 is nothing like Tri-7. I was talking with a classmate yesterday and quickly realized the magnitude of all the days lost this trimester. Between Irene Gold and NBS is a total of 15 days which either took away from class studies or patients. Adding in an extra specialized technique would add another 6 days for a total of three weeks - that's three solid weeks ...21 days of all day activity which took away from the task at hand. I completely lost another 4 days due to my brother's wedding which ramps the total number of days lost to 25 and with all the other miscellaneous snow days, power outage, IHS, etc., we came figured close to a month worth of days were lost.

I'm concluding week 10 and literally over 4 of those 10 weeks were gone. I've got a wedding reception immediately after my last board review so this coming Saturday and Sunday will be another two days lost. School at Logan, especially as a Tri-7 is MUCH too demanding and difficult to be losing all those days for anything other than focusing on classes and clinic. But, being able to see what's happened in hindsight does help to explain the extreme stress, bad attitudes and why my insides seem to be shaking so often.

I have four weeks left in the semester and need a strategy to help salvage everything I can. I still have my biggest priority set as getting through HCP - clinic and getting in 50 patients so I can make it to my outpatient clinic in Tri-8. St Peters is the big goal right now.

UGH .... fingers are still trembling ...maybe that will go away -

anyway, i do need a final stragegy - got sidetracked this morning from friends on IM. Need to get ready for school now.

I won't be counting today as a school day since our Tri has no classes in order to study for boards but I will be counting tomorrow and Saturday since we're required to be there for our National Board exams.

Tri-7 Wk10 Day 431 - Tuesday

2011-03-16T05:04:00.002-05:00

The blog got away from me last night and forgot to post. I see one patient today and have three scheduled tomorrow at 11, 11:30 & 12. I'm not sure what we have going in classes today but the main focus now will be the National Boards testing on Friday and Saturday and the bulk of those exams (4 of them) will be on Friday. I'm hoping all my patients will show up today and tomorrow. It's after 5 a.m. and I need to get moving.

Tri-7 Wk10 Day 430

2011-03-14T22:54:00.004-05:00

A friend from the UK reminded me of something I had been thinking about recently and that is we seem to both do worse when isolated so, keeping this in mind I opted to stay at school tonight until 9:15 studying with some classmates for tomorrows GIUG exam.

GIUG tomorrow, maybe a patient on Wednesday, not sure, and a couple of appointments on Thursday which is our day off to study for boards then 4 part II exams on Friday then 2 part II exams on Saturday - finish Boards at 11:30 on saturday then head off to Wisconsin for a party Saturday night then back home on Sunday then back to school on Monday and try to salvage what I can of this semester.

Today's pic is a pair of kidneys with pyelonephritis. If you have an infection in the urethra it's called urethritis, if it's in the bladder it's called cystitis and in the kidneys it's pyelonephritis.

Tri-7 Wk9 Day 429 - Passed Dxi III!

2011-03-12T06:00:00.003-06:00

A few weeks back I thought about Lee Iacoca's autobiography and recalled a passage in the book which stated a thought from Lee soon after he took over as CEO of the Chrysler Corporation, "It's a good thing god doesn't let you look a few years into the future or you might be sorely tempted to shoot yourself." Apparently this was due to the fact that he knew Chrysler was bleeding but, what he didn't know, and was soon to find out, was that it was hemorrhaging.

I've pondered over my recent Don't Care attitude and wondered how that might relate to my brains self preservation mechanisms (assuming there is such a thing which, I think there probably is) and I was thinking that not caring is a slightly better thought pattern that wanting to shoot yourself, even if only metaphorically speaking, thoughts of self harm can not be a good thing. So, I ended up putting myself in a place of not caring, still showing up for all my classes but letting the chips fall where they may.

I was pleasantly surprised when I got my Dx Imaging III midterm grade and not only passed but did so with a couple points to spare.

I've learned the thoughts and feelings I have been having are not uncommon throughout my classmates. I can cite a few reasons why this trimester has been particularly difficult.

National Boards
Irene Gold Board reviews
NBS Board Reviews
SOT class
IHS class
School closings due to Snow Days
School closings due to power failure
My Brother's wedding
various certifications and extra activities
starting clinic a week late due to Comp Boards exam retake

Some of the items listed may be common throughout the year and some are more specific to myself or having clinic at this time of year. Both the Spring and Fall semesters may get hit with National Boards. Irene Gold was my choice and takes up three full weekends (Fri, Sat & Sun) which eliminated 9 days from current school focus (classes). NBS is going to be required for everyone taking boards and takes away four more school days and cause another clinic day to be lost. SOT was my choice in wanting to learn more. SOT is a great class and I wish it was part of the regular curriculum. It's been two years since we had any snow days. This also took away from pt appointments. The power failure happens from time to time with bad weather. My brother's wedding was a good thing but cost me another clinic day. I can't remember all the various certifications or extra activities but they tend to take away from possible clinic time - every Tri-7 semester students have to deal with that and starting clinic a week late is just something I had to do and has a lot to do with falling asleep during the first attempt at taking the written exam.

A classmate expressed a majority of class sentiments with the following post on facebook.com

LOST: One large piece of sanity. Last seen at Logan College of Chiropractic studying for boards, treating patients, and taking midterms. Answers to the name Tori. Disposition is somewhat friendly with a snarky attitude. If found, please call the St. Louis Funny Farm at 314-GON-NUTS.

Another classmate I talked with yesterday said he was looked up "depressed chiropractic students" on Google and commented that he wasn't sure if this was what he wanted to do with his life.

I've also noticed the effort to respect ratio for chiropractic school is somewhat dismal. It's hard to think of another profession which requires as much effort and has as much of a jaundice view towards the profession by so much of the general public. Much of this is founded on simple ignorance of what it takes to become a chiropractor. 90% of our studies involves taking the same classes one would take if going to medical school. That doesn't mean we're missing 10% of what they learn either because we have 10 semesters instead of 8 and those extra two semesters makes up the balance of what we learn with respect to adjusting techniques.

I think I've mentioned this before but, after 3 years at Logan, I've concluded that the two main things I chiropractor does is diagnose and adjust. I say diagnose because that's what 90% of our classes consist of and I say adjust because that is our primary form of treatment. The ironic thing is that Texas is pushing legislation to remove diagnosis of diseases off the pallet of what chiropractors are legally allowed to do. The public, in general, really needs to become aware of what chripractors have to go through in order to get their degree. There's far too many people who would be stunned at the level of science oriented classes that need to be taken. They would be stunned at how much our coursework mimics that taken by medical students.

At the other end of the spectrum we have states like New Mexico that are trying to combat the deficiency of doctors by passing new legislation to allow chiropractors to prescribe medications.

Things will come full circle eventually. T'here are things chiropractors do that no other health care professionals do. It all goes back to a sign I saw in my 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." With this I recall one of the secondary reasons for enuresis being neurological. I recall hearing from a patient first hand who, after I did pelvic work on them, reported back to me that the night of sleep they had after that work was the first night they'd had in recent memory that they didn't have to get up in the middle of the night multiple times to go to the bathroom.

We introduce movement into joints which have previously been lacking movement. Motion in our joints is a key to health and it's a big one.

Chiropractic is very advanced medicine. We have many very plausible reasons and explanations based on solidly accepted medical knowledge of the human body and nervous system in particular but science regarding the human body, as a whole, still doesn't know everything. Eventually, as science bears out more an more, then the benefits of chiropractor will eventually become accepted facts in all communities.

Honestly though, there would seem to be enough on the table to already accept the benefits of chiropractic. .....i guess you could insert many hours worth of discussion here but, I've got a patient at 10 a.m. today that I need to get prepped for.

Regarding my preceding notion of not caring ...as best as i can tell those were transient thoughts perpetrated by stress and innate instincts based on self preservation.

I *finally* hit 20 adjustments this past week. I kind of wonder if we couldn't just have 50 appointments instead of 50 actual adjustments in order to move on to outpatient clinic :)

I'm wondering about this because 2 of the 5 appointments I had last week were canceled. I only have 5 more weeks until finals start. Getting only three adjustments in per week will not cut it. I'm continually hopeful that things will work out but reality keeps slapping me in the face.

As part of a battle plan, I can work to get in two adjustments per week with my room partner. That would be 10 more adjustments. I will be getting one of my room partner's patients which I could maybe do the same thing with to give me 10 more adjustments ...that's kind of a tall order but I need to at least work to make it happen. I've got a solid weekly schedule going with one of my patients to give me 5 more adjustments and I picked up a new patient this past Thursday which, theoretically could give me 5 more adjustments ...well, that's 50 but, I have another patient I thought I could count on and he was one of my cancellations yesterday. I'm not certain how well I can fit in those two appointments per week. At a minimum, at least once per week

pt a - 5 min, possible 10

pt b - 5 min, possible 10

pt c - 5 -

pt d - 5 -

pt e - 4 -

pt f - 5 -

at a minimum, with the 6 patients above that I'm considering is 29 additional adjustments. It's really close. I need to get one more new patient transferred over (pt b) and hope like heck that all the remaining patients are able to keep their appointments (rolling my eyes) I guess this is good practice for maintaining some type of composure when dealing with things you don't have any ultimate control over.

Other than getting through clinic, I need to get through my classes. Diagnostic Imaging III was my biggest concern because so many people in the class ahead of us failed the class and had to take it over but, with so many failing they all got special permission to retake Dxi III and IV together to be able to stay with their class.

Gonstead class is going to have to be my special project to be able to pass that class. Endo is another class of concern. We have an exam in Endocrinology on Monday and an exam in GIUG on Tuesday then regular classes on Wednesday and no class on Thursday so we can study ...HOWEVER - Thursday is my clinic day and I can't afford to miss any clinic days so I do have appointments scheduled.

In order of priority

Getting through Clinic is my number 1 priority. I want to make it to outpatient. I want to learn what they have to teach me in the St Peters office
Getting through ALL my classes is my next biggest priority
Passing Part II Boards

Part II boards is this week so I'll need a bit of a push and focus this coming week for boards then that part of the semester will be OVER.

I have to leave in 95 minutes to give a physical. That physical will take about two hours. In addition to getting in 50 adjustments I need to have 75 hours of clinic time and 4 CMRs. The CMRs are Case Management Reviews by doctors at the school. Today will be my second one. I only had one patient in my initial list of patients that needed a CMR. I am planning to get my Dad into the clinic on March 26th for a physical to get in my third CMR. Then I'll need to do a regional exam on one of my patients to get in the fourth CMR.

OK - time to get ready for my 10 a.m. appointment.

Today's picture I found from Googling the phrase "holding it together" and is a pretty good representation of how I feel.

Tri-7 Wk9 Day 428 - Dxi III Midterm, Don't Care ...

2011-03-10T03:31:00.002-06:00

I recall reading a business psychology article once which dealt with goal setting, motivation and actual achievement. When outside forces set a goal for you and the goal is beyond the belief of what the person thinks they can achieve then performance was shown to be well below what the individual was capable of in the first place. When those same outside forces set a goal that was well in reach then studies indicate that the goals was exceeded.

Right now, I think I'm in a situation of performing below mandated levels. It's an odd psychology that's taken hold this semester and being chronically exhausted probably has a great deal to do with it. I just don't seem to care.

I've been with Logan for nearly three years now and have cared a great deal for those three years. I would stay up all night to study for exams the next day if I thought it would give me any type of benefit what-so-ever but that is no longer the case. I'm showing up for everything and that's about it. Maybe it's the stresses.

In the first trimester, the biggest stressor had to have been when the school said they were going to ban smoking on campus and suspend students on their third violation. I started smoking about 10 years before most of these students were even born. I wouldn't expect many of them to understand but I had to consider the very real possibility of getting suspended from school and having to find another place to complete my chiropractic education. The threats associated with the smoking ban where all a big joke anyway and the whole thing never completely came to fruition because even after passing a student vote the smokers at Logan ended up being tolerated anyway and the school put up smoking huts or designated smoking areas.

Maybe getting slated for the St Peters clinic in Tri-7 is having a similar effect on my as the smoking ban/suspension threat specter did in Tri-1. There's nothing wrong with the clinic, in fact it may be the best clinic out of the five available. It's the nearly 120 miles per day I'll need to be driving on the days when I do have clinic which, now-a-days is a minimum of three days per week.

I remember when I was trying to pledge a fraternity on campus and would be away from home for 16 to 18 hours at a time on a regular basis, sometimes longer and there wasn't a single person I talked with that had any inkling what that was like. In fact, most of the responses would qualify as condescending. However, last week when classes started at 7:20 and then we had board reviews scheduled until 8 p.m. there ended up being a plethora of post on facebook about the 12 or 13 hour day so many had to endure. Everybody seemed to understand quite clearly when it was happening to them.

I get the same thing now with driving. Nobody seems to have the vaguest clue as to how spending a minimum of two hours a day stuck in rush hour traffic could have an adverse effect on ones blood pressure. This was my situation for the first three semesters of the DC program which, in itself is hard enough but add those two hours (and sometimes three or more) of rush hour traffic I had to deal with each day and my blood pressure did skyrocket. That was with 100 miles of driving per day and that drive was due to the main highway leading to school being shut down. Now, we're going to bump that up another 20 miles.

But really, how do chiropractic students not have a clue of how something like that can raise a persons blood pressure. Is the youth of the school really that clueless? It's annoying to have situations which nobody understands.

4:03 a.m. and I'll need to head out soon to at least offer up some pretense of caring about todays Dxi III midterm exam.

It's hard to say I really care about any of it. I know I mentioned before that I've had more thoughts about quitting this program more times in the first two or three weeks of this semester than all the other semesters combined. The best response I've had from that is to be reminded that I've had thoughts about quitting the program before. Don't people listen? I know I've had those thoughts before. For most students that thought will flutter through their mind at least once a semester. The qualifying difference is that those thoughts have ruminated through my head more than all other semesters combined.

I think the relative isolation I have to the school due to my lack of proximity is probably a big underlying culprit. That along with the fact that so much of my work is done solo. There's never much, if anything, in the way of studying with other people except for days like today. When we have an exam I can go to school early and I'll be able to hook up with a few other classmates who also show up early to study and it makes a HUGE difference having other people to study with. That's not usually the case though. The vast majority of studying I do is completely on my own.

Apparently, I have 17 adjustments counted in clinic. I need a total of 50 adjustments to be able to get into outpatient clinic which means getting to practice in St Peters. I should at least hit 20 adjustments after today. Missing one of my first clinic days due to my brother's wedding in Vegas was probably one of the worse things that could have happened in terms of school performance. It was a great thing as far as my brother's life is concerned and not the type of thing I'd ever want to miss but, it terms of getting through school and missing not just two full days of class but missing that early clinic day in particular has proved to be rather devastating in terms of the overall effect it's been having.

So now, it's shower, get dressed in clinic attire and head to school. I have 1 hour and 45 minutes at lunch time to treat three patients. It should only be two patients but one, my room parter, doesn't want to stay and be treated at the time she was scheduled so I have to deal with that shit and squeeze it in during the lunch hour which also takes away from any extra study time that could have been done after my 2nd patient of the day.

Again, it's a total lack of understanding by people who are in much different positions than me from people who aren't taking a full course load or who have never taken a full course load trying to tell me their view of something they don't know about in the first place. I skipped an appointment I had last week but that was something I was "told" about two hours before the fact. The appointments I had today were scheduled a week in advance and agreed upon beforehand. Last week I was just told I was scheduled for later on that day which, in true Tri-1 fashion meant waiting a couple hours more than necessary before I could head home as well as putting me in the middle of rush hour traffic.

The only thing that really makes Logan tolerable right now is in the comfort of knowing it will eventually, one way or another, be over.

It's funny, usually after a night's sleep my attitude is reset to it's normal positive self. Not so much this morning.

I know that if I fail Dxi III that I can take it again along with Dxi IV and still stay with my class. Gonstead has be a bit concerned because I didn't do very well on that exam and can only pass the class by getting a strong enough grade on the final.

It's all very, very close this semester. It's totally unlike any other semester. Of course, well meaning people will simply tell me I've been through this before without having the faintest notion of what they're talking about.

Plan lets chiropractors prescribe drugs

2011-03-09T18:52:00.007-06:00

House Bill 127 is making it's way through to New Mexico legislature to allow chiropractors to prescribe prescription medication. I read the article then read through the responses. Most responses seemed informed except for the first one I read where a reader disagreed with the part of the article that said the hours and subjects taught in medical school and chiropractic school were almost identical. Well, below was my response ... (link to original article here)

To help inform those who may not know any better, I'm in my 7th semester at Logan College of Chiropractic in Chesterfield, MO and here are the exact classes I've taken to date

First of all, you need the standard two years of Chemistry (inorganic & organic) with associated lab work as well as a year of physics and biology as a minimum prerequisite, regarding semester course work in the DC program ...

1st Semester - Gross Anatomy I with lab (ie complete dissection of the human body), Biochemistry I, Histology & Cell Biology, Philosophy I, Spinal Analysis, Spinal Anatomy

2nd Semester - Gross Anatomy II with lab (continuing dissection of the human body), Neuroanatomy with Lab (this is where we study the brains we removed from our cadavers along with neural pathways), Biochemistry II, Physiology I (incidentally we use Guyton's Textbook of Medical Physiology which is the same you'll find in most medical schools), Microbiology I with Lab, Philosophy II, Diversified I (an adjusting technique)

3rd Semester - Embryology, Physiology II, Microbiology II with lab, Pathology I, Public Health, Philosophy III, Orthopedics I, Diversified II, Basic Technique I (another adjusting class)

4th Semester - Nutrition, Physiology III, Pathology II, Philosophy IV, Orthopedics II, Diversified III, Basic II, Neuromusculoskeletal Diagnosis, Fundamentals of Diagnostic Imaging

5th Semester - Biomechanics, Physical Diagnosis I, Cardiorespiratory Diagnosis, Laboratory Diagnosis with Lab, Pharmacology, Diagnostic Imaging I, Radiographic Positioning, Diversified IV, Basic III, Health Center Practicum I (initial clinic experience)

6th Semester - Physical Therapy I, Jurisprudence, Patient Communication Skills, Clinical Reasoning, Physical Diagnosis II with lab, EENT (Eyes, Ears, Nose, Throat), Neurology, Pediatrics, Diagnostic Imaging II, Health Center Practicum II

7th Semester - Diagnostic Imaging III, Geriatrics, Endrocrinology, Gastrointestinal & Urogenital Diagnosis, Physical Therapy, Applied Kinesiology, Gonstead (another adjusting technique), Soft Tissue Technique, Research Methodology, Health Center Practicum III

8th Semester - Case Management, Athletic Injuries, Physical Therapy III, Clinical Nutrition, Rheumatology, Obstetrics/Gynecology, Dermatology, Diagnostic Imaging IV, Health Center Practicum IV, 5 Competency Modules

8 semesters is where Med school ends but to be a chiropractor you have to go another year (2 semesters) to become a DC. It might interest some readers to know that medical doctors teach such classes as EENT, Pediatrics and Pharmacology. It might be even more interesting to know that there are chiropractors that teach at medical schools. One of the top radiologist in the country (probably in the world) teaches out at the Colorado School of Medicine and is a Chiropractor as well as the author of the radiology text book most schools use. The Dr. that teaches our embryology and pathology II course also teaches at the St. Louis University School of medicine. He told us the only difference in the embryology class was that we (chiropractors) go more in depth than the medical students. Our latest Anatomy teacher came from the Albert Einstein College of Medicine up in New York and her predecessor taught at SLU Medical School (both are Chiropractors)

I just started student clinic this semester and will doing outpatient clinical work for my last year (3 semesters, in addition to classes). Last year I made a video clip on the brachial plexus for an Anesthesiologist who needed it for a powerpoint presentation she was using to help educate other MDs in her hospital. I've also worked with a patient who had a heart block and last week diagnosed a benign lipoma using diagnostic ultrasound. I use the same Littmann stethoscope you see on the TV show House MD and have the same high quality Welch Allyn equipment (otoscope, ophthalmoscope, aneroid) that you'd see in any MD's office.

MD students go through USMLE (United states Medical Licensing Examination) Steps 1, 2, 3 ...

The Chiropractic analog consist of National Boards, Parts 1, 2, 3, 4 and PT. I can only speak for the first two Boards test but they consist of 9 hours of testing over a two day period and cover everything and anything we've learned up to the point of taking the exams. So, check out the first 7 semesters worth of course work up above and you'll see what's fair game for the Part II exam I'm about to take in 9 days.

Chiropractors also go through competency boards and OSCE before being allowed in clinic. OSCE stands for Objective Standardized Clinical Examinations ...just like the med students.

There's quite a bit too it and I mean no disrespect to anyone out there who was previously unaware. Heck, a good friend of mine I used to work with thought we went through a 6 month program to become a DC. not quite ... ;)

And now, as Paul Harvey says, you know the rest of the story. (at least a good chunk of it)

Tri-7 Wk9 Day 427 - St Peters Clinic Shift

2011-03-09T03:01:00.004-06:00

I saw my schedule yesterday for St. Peters. My clinic shift days will be Tuesday, Wednesday and Friday. At first, I liked the schedule because I figured at least I don't usually have classes on Saturday but then I realized that we have a meeting this month on the 31st which is a Thursday and if that's our regular weekly meeting day then 14 hour days 4 days a week and once a month we need to work a Saturday shift

That doesn't include 35 hours a week of school which is what I have this trimester nor does it include any community service. Monday through Friday with just classes and clinic puts us at 91 hours a week. Toss in a Saturday shift and anything extra and we're going to be topping 100 hours pretty easily.

I think I need a drink. Coffee should be just about ready ;)

Mmmm, yum ...better :)

Now I think one of the first things I'll buy once I'm working again is a new dishwasher. Lately, there seems to be a film of soap that gets left on my coffee cups that doesn't mix very favorably with my coffee. I'd also like one of those High Efficiency washing machines and a dryer that doesn't occasionally eat my clothes via getting stuck in the drum and scorching them :) Oh, and while we're at it I was looking at a *really* nice 2012 Lamborghini Aventador yesterday for just under $400,000. With a top speed of 217 miles per hour and 0-62 mph in 2.9 seconds, that could really help with any more long commutes I might have back and forth to work. Of course, this translates into being able to devote more time to my patients so maybe it could be a business expense! :D

OK, back to reality. We've got a Dx Imag III midterm tomorrow and a Soft Tissue midterm due by 11 a.m. There's also a Research Methods homework assignment due tomorrow but that's one I already knocked out because I thought it was due last week. Dxi III MT is at 12:55 tomorrow and I've got patients lined up for 11, 12, 4:15 and 6:15. I also have a pt scheduled for Friday and a two hour physical lined up for 10 a.m. on Saturday.

hmmmm.... Our classes for Tri-8 are posted as well as our clinic shifts. We have 16 different classes listed for next semester but six of them seem to be one class split up into 6 different parts or modules.

...I'm getting lost on too many tangents & need to refocus. I'd like to knock out my Soft Tissue midterm before our first class today and we're already pushing 4:30 a.m. Time to hit the shower and get a move on.

Today's Picture is of the Lamborghini Aventador LP700-4 and includes a girl which I also need and would probably enjoy more than the dishwasher ;)

Nocturnal Enuresis - Bed Wetting

2011-03-08T17:56:00.005-06:00

Tri-7 Wk9 Day 426 - Tuesday

Enuresis is involuntary urination. When it occurs at night we call it nocturnal enuresis and, if done during the day, is called diurinal enuresis. The prevalence of enuresis is as follows

30% of 4 year olds
15% of 5 year olds
7% of 8 year olds
about 3% for 12 year olds (2-4%)
2-4% for adults

Within the last week there was a report on the radio about a child holding a sign that said "I'm 10 years old and I wet my bed" Presumably, this was an attempt by the parents to help curb their child's bed wetting but, I might suggest this is probably ineffective and could potential do more harm than good. If you're a parent reading this and are dealing with enuresis and think punishments are the way to go then consider this question. What makes you think your kid is choosing to wet the bed? Hopefully, most people will come to the conclusion that their offspring is not intentionally choosing to wet the bed and will realize that, for the most part, it's something out of their control.

Dr. Zaleski was one of the first physicians who started conservative care for the condition of nocturnal enuresis. He learned from studies that most patients with enuresis tended to have some type of allergy. Dr. Z checked the bladder walls of eneuritic patients and found immunoblobins inherent with allergic conditions.

Dr. Brenaman followed up Dr. Zaleski's studies and followed several hundred children for a 20 year period and found that a full 2/3 of the study population had food allergies linked to their enuresis. Of those 2/3rds a full 60% of them had an allergy to a single food - cow's milk.

One test I've learned of that can help detect this allergy is called the Chvostek's reflex (or sign) which involves tapping the patient's zygomatic arch (bone close to the eyes) and looking for an excessive blink response.

Cases, as previously discussed, would be considered secondary types of causes for enuresis. With secondary types of enuresis, the word from Logan seems to be that chiropractic care may be of great benefit. One teacher from a previous semester commented that there is more documented research dealing with enuresis and chiropractic than for any other ailment.

Primary cases of enuresis would include factors such as developmental delay, genetics, sleep disorders, anatomical variations and ADH levels. With primary causes, it is prudent to consult a medical doctor while using a chiropractor in a complementary fashion.

Today's picture is of a positive Chvostek's sign (CS) as demonstrated on an infant. CS is a classical sign of hypocalcemia.

One final note, statistics regarding enuresis for children less than 4 years old isn't given because studies are generally not done of individuals who are aged 3 or less because the bed wetting is just too common of an occurrence. Even with children approaching 10 years of age you're still likely to find 5 kids out of 100 who are dealing with enuresis. Physiologically speaking, it's not a big deal. Rewards or punishments are definitely contraindicated as means of dealing with the situation. If you want a plan in working with your youngster then consider the following points;

Have a routine, maintain a regular bedtime schedule and no fluid intake in the last hour before bedtime.
Make sure your child goes to the bathroom just before going to bed along with brushing their teeth or anything else you may deem significant.
eliminate milk and citrus foods for two weeks - cereal is easy but consider pancakes, French toast, waffles or eggs.
have the child's spine and SI joints evaluated by a qualified chiropractor.

Two weeks may be too short of a time period to notice significant results but you should still probably be able to notice an improvement especially if the milk or citrus foods were the cause. If positive results are obtained then you can start by adding back one of the foods at a time to help see which was the culprit.

Tri-7 Wk9 Day 435 - Monday

2011-03-07T18:54:00.002-06:00

Coffee in hand, 3:30 a.m.

2nd cup of coffee in hand, 4 a.m.

I've been looking over some material for our Gonstead midterm exam today. It's probably the most I've looked at this material since the semester started.

Regarding my adjustments in clinic, I think I'm still under 20 adjustments and need 50 by the end of the semester to move on to Tri-8. It's going to be close.

5:30 a.m. not much in this blog entry other than a placeholder and another count to my days.

National Boards Part II testing is a week and a half away. I did manage to schedule a physical with a patient I hadn't seen before for this coming Saturday. I do have those SOT classes this coming weekend. It's a bit hard not to feel like crap for not seeing the SOT and IHS classes through. I know there's other people taking them but, not everyone has the same schedule or even a full schedule for that matter.

I feel like I don't know any more about Gonstead or most of my classes any more than if I'd just read a magazine article. For the most part it's just a matter of continuing to do what I've been doing then waiting to see how it all plays out.

Hitting the gym has been going well and it may be the only thing this semester that I'm going to really profit from. I did an hour straight on the super incline treadmill machine yesterday. I can tell my heart is getting more used to the workload and having my heart rate in the 150 range isn't as much of a burden as it was in the beginning. I have to stay vigilant and not overdo any one workout in favor of a consistent pattern of working out. I've hurt myself too much in the past by overdoing any one workout. I think an hour at a time is good enough for cardio at this time, at least through this month.

It's getting really late but, I can still probably make it out of here by 6 a.m. if I get moving.

Tri-7 Wk8 Day 434 - Friday

2011-03-07T00:54:00.002-06:00

I'm trying to remember what I did Friday. Geriatrics was cancelled due to vertigo (teachers, not mine) Oh, then I had a practical for Activator and was hoping to at least get 1/2 right so I could salvage the class and ended up with a 40 out of 50 - I'll take it! It seems like every test last week involved nothing more than studying the morning of the exam then somehow trying getting through it. I'll be darned if I didn't pass every single test last week.

The week coming up may be a little more daunting, especially on Wednesday when we have our Diagnostic Imaging III midterm. The next most challenging exam is probably going to be Tuesday's Gonstead exam. Gonstead is a chiropractic adjusting technique. Tomorrow's Research Methods exam should be pretty easy and Thursday's Soft Tissue Exam is a take home exam that just needs to be emailed in by Thursday at 11 or something like that.

It's 1 a.m. Monday and I am up much, much too late. We had a little get together Friday evening so, instead of crashing by 6 p.m. I was up and out and didn't get home until around midnight ...that's got a way of screwing things up for me. All my nights have been late since then. I guess I'm looking at less than four hours sleep tonight before I have to get up. I might adjust my alarms a bit to try and at least get 4 hours sleep.

No workout on Saturday but got a nice little workout in Sunday night. I put 25 minutes on the treadmill because I wanted to allow a little time for weights and found myself disappointed when the time ran out. Better get to sleep and do the best I can with Week 9! :)

Tri-7 Wk8 Day 433 - Thursday

2011-03-04T04:20:00.004-06:00

It's about 4:20 a.m. Friday and I just got done watching my first viewing of Activator Method Protocol DVD to help prepare for my Activator Midterm this morning. I lucked out a bit and our Activator Practical was I've recorded the audio portion of the DVD so I can listen to it while drving to school then I'll be able to spent a couple more hours before classes start to keep reviewing.

I think I have a patient at 12:30 today but that's it so, it could be an amazing weekend and, for me, an amazing weekend simply means I actually get a weekend to focus on school and not some other extra school related class or activity.

Yesterday was a clinic day which meant leaving home before 6 a.m. and getting home after 9 p.m. but, that also includes a quick stint at Gold's Gym on my way home. I'm still a bit chronically exhausted so I kept the workout to a mere 30 minutes of cardio then headed home since I knew I still needed to study for my Activator class.

I have noticed my short term memory coming back a little bit and was able to take slightly better notes in Dx Imaging yesterday. I'm looking forward to a little time off to be able to focus on my classes. We've got four midterms next week so I'm going to need every minute possible to get my life (school) in order and ready for the test ahead.

I am in survival mode but, I realized this morning that I'm talking about survival mode at Logan which, is a bit above and beyond a normal life of existing so, surviving at Logan may actually be akin to thriving in life overall. Still ...I guess I want to be thriving at Logan and not just surviving.

I better get moving or it's going to be 5 a.m. and I'll still be sitting here.

Today's picture shows something we were talking about in Diagnostic Imaging yesterday. The picture illustrates retropulsion of the posterior vertebral body. The bad thing about that for the patient is that the spinal cord is directly behind the vertebral body. Based on the shape of the vertebrae in the picture I'd say we're talking about a vertebrae in the Lumbar region or lower part of the spine. This person may be paralyzed from the waist down due to that retropulsion.