Tri-6, Wk10, Day 380 --- T-Minus 11 Days

Dr. Donna Mannello says, "Acute cholecystitis is noted here in the right upper quadrant, pancreatitis - epigastric, appendicitis - right lower quadrant, diverticulitis - left lower quadrant" I've been listening to that phrase for well over a half hour now. I've been using the repeat buttons a lot and listening to small bits at a time until I think I've got them or, at least well exposed. :)

Dr. Mannello is a super, super nice lady who teaches Physical Diagnosis at Logan. A group of us guys, after class, decided she's pretty much the female equivalent of House, M.D. She comes from a family strewn with medical doctors and once related a story to us about how happy her family was when she was accepted to medical school and their subsequent chagrin when she told them she wanted to become a chiropractor.

We've got 11 days left before our third exam in Phys Dx II. I'm not sure if it was midterms or the looming thoughts of upcoming Comp boards or the realization that in a little over a year I'll be finished with this program and have to predominately rely on myself in order to help my patients but, I've pretty much been studying round the clock for the past few weeks.

I remember in my not so distant past that I generally used to think of women before I'd fall off to sleep but now I think about Neurology, Part II boards, physiology, Phys Dx, Dx Imaging and whatever else I've been imbuing myself with throughout the day. Of course, there was a cute female medical student on YouTube demonstrating abdominal palpations so, maybe I could combine the best of both worlds. ;)

A mystery Tri-10 sent me props via comment on the 90% I got on the written portion of our Dxi midterm which was very much appreciated so, if you're reading this then I'd like to say thank you :)

I've noticed something interesting about listening to my Physical Diagnosis lectures over and over. In a class like Diagnostic Imaging if I listen to the class lecture over I'm not surprised by many new things. I might not remember everything from the first listening but I at least realize that I heard the stuff before. With Dr. Mannello's lectures, I keep hearing new things that never seemed to penetrate my brain in previous exposures. Even with 3, 4 and 5 exposures, I keep hearing new words and ideas. I guess that could partly account for why my Dxi grade is so solid and my Phys Dx grade is like a leaking ship but, I'll keep at it.

We have a study guide for phys dx provided by our teacher. It's numbered with 40 different points she wants us to know for the exam but, there's only going to be 30 questions on the exam. Then I'm looking at some of the questions on the study guide which reference certain tables to know in the book. 12 tables are referenced that we need to know. Then I look at one of those tables ...take a fun table like diarrhea for instance, and I notice 11 different types of diarrhea along the left hand column and 5 different categories of things we need to know about each one listed across the top. So....that one question on the study guide actually means we need to know/memorize/learn 55 things to know that table ...that one of twelve different tables. To be sure, there is much to learn.

BUT - I still have 11 days left. AND - a nicer table like, Tender Abdomens only has 8 things to know. :) I need to keep in mind how impressive someone like Dr. Mannello is and all the knowledge in her head, how she's like House and how I'd like to have the same knowledge. This is my opportunity to learn this stuff. I mean, really - when else in my life will I ever have this much time to devote to diarrhea?! While that may sound a bit funny (and I suppose it is) I also have to keep in mind *why* I'm learning this stuff. It's because I'm going to have actual people with actual issues that will be looking to me for help and if that's their issue then I need to know about it.

A question I started asking myself last trimester when I didn't feel like studying was "How good of a doctor do you want to be?" That question had a way of helping me get re-focused.

The home stretch of this semester looks pretty clean and rather do-able. We only have 17 exams between now and becoming a Tri-7! Let's see.... in addition to those exams I need to knock out one more hour of community service for Professional Development, make a couple Goal Poster's for Patient Communication, take one more Comp Board, sign up for one more specialization technique, register for Irene Gold, and ...that's all I can think of right now.

Today during lunch I was able to volunteer and complete a research project to give myself an extra 3 points towards my EENT grade. There's only one other study available but it requires 10 visits and I don't think I want to devote that much time to getting an extra 3 points for Pediatrics. The study I participated in today was being conducted by some MD we've got on campus who doesn't actually teach a class so I'm not sure what his role is with the school. He's a very nice man who was doing a study dealing w/ the heart. He had some kind of EKG machine hooked up to his computer. The study came with a questionnaire which ask all about your life which got me thinking about my life. In addition to school, about the only other things I'd like to add into my life would be Karate, Lifting and Piano which, is pretty much what I've always worked on getting into my life. I guess running would be another thing but that maybe could fall under the umbrella of lifting.

The preceding would cover professional and personal aspects of my life. Considering social aspects, the first thing that comes to mind would be finding someone special to share everything with.

It's past my bedtime but I don't feel much like going to bed. Tomorrow is the day we get out at 11 a.m. but two of our three classes have been cancelled (I think Part IV, National Boards is going on) and the remaining class cancelled it's first hour so that only leaves the second hour. I have 50 minutes of class tomorrow. The strange thing even with that hour is that we're meeting in the classroom instead of the lab so we're not going to be doing any of the PT stuff. I'm not really sure what we'll be doing tomorrow or why we're still supposed to go in for one hour, one class, ....

Have I learned anything?

Right Upper Quadrant - acute cholecystitis, i.e., gallstones

Right Lower Quadrant - acute appendicitis

epigastric region - pancreatitis (or problems w/ stomach and duodendum)

Left Lower Quadrant - Diverticulitus

Yep and I even know a few specialized test such as the Psoas & Obturator test to help check for appendicitis.

Signs -

starts w/ a "B" aka rebound test - done on same side of appendix, quick release

Rovting sign - done on opposite side (LLQ)

Kehr sign - ....can't remember but have seen it a couple times and at least remember the name.

Dance sign - no bowel movement, could be a sign of intussuseption, probably on the left side (lower left quadrant)

Cullin Sign - ecchymosis around the umbilical

Grey Turner sign - ecchymosis on the flanks

Well, I'm learning a bit ....

School is my job and I only have to work an hour tomorrow. Regardless of when I get to sleep I'm still going to leave early as if I still had my first hour class otherwise I'll get mired in rush hour traffic. One or two hours of PT - I can still read my book and figure out what to read on my own based on what we did last week.

Not sure what to leave as a pic ...I know - how about that cute MD student? Hmmm, now I know I need some sleep but, obviously, I haven't studied enough and need to cram more academia in my brain before bed so my reverberating circuits will be academic based. I think I need a drink ....(hence, today's pic)

Tri-6, Wk10, Days 377, 378, 379, Mon, Tue, Wed

I'm not sure why I wasn't blogging the last few days. If I'm not blogging literally then I seem to be blogging mentally. We learn so many interesting things and since I live alone and so far from school this is about the only medium I have with which to share this aspect of my life.

This past weekend was very productive ...hmmm, looks like I mentioned that in my last blog.

I did notice our teacher wrote the chapter on Infection (and a few others) in a Book I've been checking out of the library called Clinical Imaging. I thought that was pretty cool and figure it's probably a good source to reference for test questions. I've been debating on buying the book for a couple semesters now and finally bit the bullet and ordered it online from Barnes & Noble.

It's almost hard for me to comprehend how much has been spent on books this semester but I'd have to say it's well over $2,000 at this point. Even online, the best price I could find was still over $200.

Earlier this week, I picked up yet another book for Physical Therapy (PT) called Clinical Orthopaedic Rehabilitation. I've noticed most of our books now contain the word "Clinical" in them, maybe that's part of what makes them all so expensive. I was able to find this book online for $88 plus tax but there was no guarantee I'd get it before December 8th which is a little late so...I bit the bullet again and forked out another $125 at the school bookstore. That purchase kind of left me with a bit of an ill feeling, moreso than the more expensive Clinical Imaging book but, maybe that's because this purchase wasn't as thought out, just something I needed for the class.

I got great rates on five other books I bought this week! Maybe less than $60 for the whole lot! :)

Two of those books are supplemental books for my Physical Diagnosis class and I've had both checked out from the library since the beginning of the semester but, other people wanted the books also so I had to return them. Still, the pocket sized Bates companion book I was able to pick up for only $5!!! and I got a brand new Bates' Guide to Physical Examination & History Taking with CD ROM for only $25.

The remaining three books I bought all deal with Neurology, two are kind of fun reading which include The Scientific American Brave New Brain and Cerebrum 2010. The last one is a specialized technique that a classmate gave a talk on this past Tuesday. Unfortunately, it coincided with my Diagnostic Imaging Tutoring so I had to miss it but did get a chance to talk with her about it later that day. The techniques is known by it's acronym, B.E.S.T which stands for Bio-Energetic Synchronization Technique.

The originator of BEST is Dr. M.T. Morter Jr and a past president of Logan. The premise of his system is rather interesting. Wait a minute ...I don't actually know the premise. It would be more correct to say that I am interested in learning more about this system based on the little I've heard and read thus far, hence, the additional books. The book, Dynamic Health is written by Morter so I'll have to get back to you once I've read it. What I've heard is that our thoughts have an influence on our health. That seems reasonable enough. I'm hoping these new books will aid in my understanding. I've already got the high powered medical text so, we'll see how well these other books gel.

We've got 12 more days until our 3rd Physical Diagnosis exam. This next one will be over the abdomen, hernias and the rectum. We took a vote on whether to have the exam next Friday or the following Monday. 30 people voted for next Friday and 35 voted for the following Monday. I was in the following Monday category.

We also have an EENT exam next Thursday. I *need* to get to the research lab and sign up for a couple studies. Our teacher, Dr. DeGeer, is giving us 3 extra credit points per class for two studies. I've already got 2 extra credit points from our last two quizzes so that's a total of 5 points per class which means a legitimate grade of a B+ could turn into an A! I need more of those :) Which reminds me - on the last Pediatrics quiz I got back the teacher wrote "Totally Stunning, ! Scott" at the top of my paper. That's even better than a smiley face, in my opinion. :)

Geez, I've got a lot to learn. To get a better grade on Exam 3 of Physical Diagnosis II, tonight I'm going to learn Abdominal Signs Associated with Common Abnormalities.

These signs include

Sign - What it is - What it indicates

1. Blumberg - rebound tenderness - peritoneal irritation & appendicitis
2. Cullen - Ecchymosis around ummbilicus - hemoperitoneium; pancreatitis; ectopic pregnancy
3. Dance - Absence of bowel sounds in the right lower quadrant - intussusception
4. Grey Turner - ecchymosis of flanks - hemoperitoneum; pancreatitis
5. Kehr - abdominal pain radiating to left shoulder - spleen rupture; renal calculi; ectopic pregnancy
6. McBurney - rebound tenderness & sharp pain when McBurney point is palpated - appendicitis
7. Murphy - abrupt cessation of inspiration on palpation of gallbladder - cholecystitis
8. Rovsing - Right lower quadrant pain intensified by left lower quadrant abdominal palpation - peritoneal irritation; appendicitis

This is cool, we covered Blumberg, Murphy and Rovsing signs in our Physical Diagnosis lab today and I listed to my phys dx class lecture on the way to school and learned (heard) about Cullen and Grey Turner (over and over and over again)

Oh, the other thing I pounded into my head on the way to school was Caput Medusa which are veins showing around the belly button due to increased venous pressure due to hepatic (liver) issues.

One other thing - today in Dx Imaging we covered a disturbing case involving a 73 year old female. Metaphorically speaking, I think the surgeon that operated on this lady should be shot.

Take a look at this vertebrae. We have 24 of them which stack on top of each other to form our spinal column. Take a look at the overhead view of the vertebrae (the one on the left). Do you see that hole in the vertebrae? That's what our spinal cord runs through. Those pieces of the spine that are labeled (spinous process, Lamina, Transverse Process and Pedicle) surround and help protect the spinal cord. Our 73 year old female patient was experiencing back pain. The surgeon determined there was spinal stenosis - basically, the opening for the spine to run through wasn't big enough for the cord to run through, there was pressure on the cord so his solution was to CUT OUT AND REMOVE all the posterior pieces of the vertebrae!!! He removed everything but the body of the vertebrae and he removed those parts of the vertebrae from no less than 4 levels of vertebrae. Basically, her entire lower back had those pieces cut out - Sawed out - .... This whole procedure and case swam around in my head for hours and hours after that section of our Dx Imag lecture today. The number of muscles and ligaments that had to have been removed in such an operation is mind boggling. Then I'm thinking - Where the heck does the psoas muscle originate from now???! If memory serves, that muscle originates from the transverse process of the lumbar vertebrae then, on it's way down to the proximal inner head of the femur, joins with the illiacus muscle but ...if there are no transverse process?!?!

What kind of stability does this patient now have in their lower back!?

Oh yeah - now I remember the supposed reason for the stenosis or narrowing of the spinal canal - "disc herniation" ....are you kidding me? I saw the MRIs of this patient. She actually had gorgeous disc space and at best, maybe some bulging of the disc. It just sucks. This case elicited quite a bit of emotion. When I see 73 year old female, I'm thinking "Grandma" and that was no way to treat grandma.

What ended up happening ....this patient was having trouble getting hold of the physician who performed the surgery so she want back to the MRI doctors to ask for help. When the radiologist finally looked at the films he described as what the surgeon did to his lady as "criminal", so much so, that the surgeon did end up losing his medical license.

It just so happened that the radiologist MD is friends with our Dx Imaging teacher and in the hopes of helping to prevent any further tragedies of this nature, the radiologist ended up sharing the MRI film to be used in our classes at Logan.

If I understand this correctly, it seems a contributing factor to this fiasco was the fact that the lady had very good medical coverage which was able to cover the cost of the six digit surgery.

It's just sad because the remaining days of this ladies life was altered for the worse. I obviously do not mean any disrespect towards surgeons. This was just a tough case to swallow.

Tri-6, Wk9, Day 376, Friday - Scheduling Tri-7

I'm catching up on my Friday blog on Sunday night and I can't really remember what I did Friday after school. I know I spent some extra time printing out material for my classes. I *do* know what I did Sat & Sun and that would be nothing but School Work! I hit it by 6:30 a.m. on Saturday by listening to my Neurology class and cleaning up my notes. I maybe should have limited myself to no more than 4 or 5 hours on neuro then moved on to something else.

I can't say I'm the most efficient studier in the world but, I certainly put the time in this weekend.

While going over my notes & audio for several classes I was a bit stunned at how much of a difference having Internet access has made. I found single pages where up to six different class periods worth of notes were taken. With the Internet, I've gotten up to 10 or more pages worth of notes from a single class. The main reasons for this is because now I've always got access to the powerpoint presentations the teachers are using in class and I can always look up anything I don't understand and add that information to my notes as well.

Tomorrow morning is a big day regarding my Tri-7 schedule.

I'm reminded of that fine line between fear and excitement - how they are the same physiologically and what differentiates between the two is our perception. That's kind of how I'm feeling now.

For 2011 it looks like 18/22 or 11 straight days in Jan which, isn't too bed. 26 straight days in February (27 if you count graduation) and 26 straight days in March.

This is where it would really pay to live closer ....

I'm going to sign up for Activator, for credit tomorrow at 6:30 a.m. then, on Nov 17th at 6:30 a.m. I'll sign up for Advanced Basic, a weekend class for no credit. I'm already signed up for the Internal Health Specialist program which starts the weekend of March 5/6 then, I'll be signing up for Irene Gold National Board review which actually starts the weekend before Trimester 7 starts (Fri, Sat & Sun) On Jan 13th, I'll take, and pass, my competency board examinations so I can start my clinical internship. We have off for MLK day on the 17th (Yahoo!!!). The upcoming weekend, Jan 22/23 I'll start my Advanced Basic weekend class then I'll have a weekend off on the 29/30th. First weekend in Feb (5/6) I'll have another full weekend of Advanced Basic then the following weekend, starting on a Friday (2/11) will be Irene Gold Nat'l Board Reviews (11/12/13) then, the following weekend, I'll have Irene Gold Nat'l Board Reviews again (18/19/20) Hey! I get a day off for Presidents Day! (Yahoo!!!) The following weekend I'll only need to attend a graduation ceremony on Sat (2/26) and that concludes February.

First weekend in March I'll miss my last two Advanced Basic classes but, the teacher, Dr. Montgomery already said "we can work that out" mI'll have to trust him on this matter and take what comes. I'll have my first IHS classes that weekend (3/5 & 3/6) ...and here's a big reason for taking Advanced Basic over SOT in Tri-7 because the following weekend would be SOT but, Part II National boards are the following weekend (3/18-3/20) so, by taking Advanced Basic I'll have the weekend prior to Part II off. After Part II boards, I'll have 3 weeks and 4 days until Finals.

Somewhere in that whole mess we'll have Midterms...those grades are due from the teachers on Friday, March 11th.

Well, time for bed - I'll get up at 4:30 a.m., leave home at 5 and be to school by 6 a.m.

This is going to be a great week. :)

Today's picture is the impression I get when thinking about my future. :)

update - Dxi II Midterm Written - 90%!!!!!

I wasn't sure who to call this time of night so I thought I'd shout it out here - I got a 90% on the Dxii II written midterm exam!!! YEEHAW! :)

The slide exam was a little weaker with 84% but, I misread one of the questions -that OCI question and I mis-bubbled part of the exam and had to go back and erase and refill in my answers correctly and ended up guessing on question #8.

Overall, I'm ending up with a B for midterm and was only 1 question away from a B+. Maybe only having one hours sleep the night before the exam messed up my slide portion a bit - that part of the exam is timed. You see each slide for so many seconds then "Ding!" next slide. We have plenty of time for each slide, just can't mess up any. Of course, without all the additional study I may have missed more. I'm going to do better on the Final and Definitely get no lower than a B+ in that class. I'm wondering now if an A is possible....

HMMMMMM......I have an 87.7% average in that class which *should* be a B+. I wonder why the midterm grade says a lowly B....

Hmmmm (again) our final (written + slides) is worth 95 points. I'll need to get 92 of those points to get an A .... oh well, at least it's possible :)

96% on the final to get an A

87% on the final to get a B+

Tri-6, Wk9, Day 375, Thursday

"look at the rotation of the head" says Dr. Bub as we watch the fight video at the start of our 2^nd hour of Neurology.

Neurology is a pretty fun class. Our teacher, Dr. Bub, always starts the 2^nd hour of our lecture with a fun video that's related to what we're learning in class. I had an idea of putting down a few lines in my blog during each class but, that first line was all I had time for – Waaaay too much material to spend time doing anything other than trying to absorb everything coming our way.

Dr. Bub did go over some of our fill in the blank questions from our midterm so I was able to copy them down to review. Here is a sample of one of our questions;

QUESTION: Your 72 year old hypertensive patient presents in your office one morning complaining that he has noticed difficulty walking because his right leg is weak. He states that his right arm feels like it is getting weak too and he is dropping things from his right hand because he cannot hold onto them. He also cannot get his right arm up over his head to comb his hair. He has also noticed that he seems to have double vision when both eyes are open. If he closes one eye, his vision is fine. This all started several weeks ago and it seems to be getting worse over time. During the history, his speech is fluent and memory/recall is good. One examination you notice that his left eyelid seems to be drooping (blepharoptosis). His left pupil is 7mm and the right pupil is 3mm. On testing the extraocular muscles, he could not elevate, depress, or adduct the left eye, but abduction of the eye was fine. When asked to smile, the left side of the mouth did not elevate, but both sides of the forehead wrinkled. There is weakness, increased done and hyper-reflexia noted in the right upper and lower extremities. A right sided Babinski sign was present. On finger to nose testing on the left there is no ataxia or tremor, however, on the right, the patient had difficulty elevating the right arm sufficiently to attempt the test.

38. What is the significance of his speech being fluent and recall being good?
39-40 List 6 abnormalities noted in the examination and the structure/part of the nervous system responsible for the demonstrated abnormality.

Internet in the classroom was a lifesaver today. Both of our teachers (neuro and EENT) had posted new powerpoint presentations just before class and I was able to download both ppt's and copy the pics & verbage into my notes.

There's a lot to get figured out this weekend before signing up for my Tri-7 specialty classes. We got info on Irene Gold Part II National Boards prep today and that will be taking place on the Friday's and weekends of Jan 7-9, Feb 11-13 and Feb 18-20.

Hmmm, that's not too bad. My IHS weekend classes don't start until March but I also think we'll be taking our Part II Boards in March but haven't been able to find the date yet. The NBSE website doesn't have the new schedules up.

hehehe ….just checking my mail – I've got library fines for $10.75 so my in class internet has probably already paid for itself because I usually check my logan.edu email in class and can quickly renew my books online if I get a notice my books are overdue. In Tri-1 I had over $150 in library fines!

I better get some school work done before bed. We have our PT class tomorrow morning. I have a feeling I don't have the correct PT book for that class and I bought every PT book that was in our Tri-6 section from the bookstore. It seems the books we specifically use for the class are kept in different areas.

Oh, I played doctor today in our Clinical Reasoning class. Last week I caught a fracture that the ER docs missed and this week I pretty much called the diagnosis right off the bat …well, it wasn't really all that difficult, just a broken radius at the distal end but, I did know it was called a Collies fx. It's kind of tough to have to go through all the hx and examination procedures when you know you just need to get some x-rays taken of the patient.

Today's pic – We're going over Imbalance Vertigo & Hearing Loss in EENT and today's picture is from that lecture. It's called Frenzel lenses and gives a magnified view of the eyes (in case you didn't notice) J

T6, Wk9, Day 374, Wednesday - Dxi II MT!

Now that I've passed the midterm point of Diagnostic Imaging II, I believe I feel confident enough to start refering to diagnostic imaging as dxi, pronounced "die-eye" LOL

I think I did reasonably well on today's dxi midterm, probably better than the average. I think I'll get a grade of B or B+. I'd be sorely disappointed with anything less than a B and quite ecstatic with an A! :)

Ironically enough, the pic I had in yesterday's blog of osteitis condensans ilii (OCI) was on the exam and I kind of figured it would be but, when I read the differential of the question I wrote down an answer of OCI even before we saw the corresponding x-ray on screen. Seeing the x-ray on screen simply confirmed what I already knew BUT ...I may have been a little too cocky because had I actually *read* the entire question (according to other people) the question asked what question we should have asked the patient about their past and, of course, that question would have pertained to the patient having any multiple full term pregnancies. So, I probably took a hit on that question.

These dxi exams are some of the most interesting test we take. They've got a little bit of everything in them starting with slides we must answer questions about in both multiple choice and fill in the blank format. After the slides we have the written portion of the exam which also includes multiple choice, fill in the blank and matching.

There was a purportedly great "Money pony" document consisting of a collection of factoids which were supposed to be strongly correlated with this exam but, upon completion of the exam I quickly concluded that money pony was worth maybe 34 cents and anybody that solely relied on it for their preparation will probably be disappointed with their grade. Our tutor told us flat out, ahead of time, that even with the pony people still got D's and F's last semester.

For readers unfamiliar with the term "pony" it's a loosely used acronym which stands for test which students "Pass On to Next Year"

The money pony had 7 matching questions on it but, I was able to build that up in the preceding days to encompass over 50 matching questions in a nice little table format. I'm certain with a little more preparation and discipline and I can improve upon all the scores I got on these midterms come finals.

Exams are good. Up until now it's kind of like shadow boxing and never getting hit. These test hit us and punch us and bloody us up and help us focus our efforts. Fortunately, I didn't perceive any low blows this semester and whatever grades I got were pretty much what I deserved.

Quite often and usually around New Years Eve many people resolve to do better but I can't wait until New Years Eve. I was thinking today of how that resolve has to be a daily event. One in which each day is perceived as a wellspring of great opportunity for improvements. Thinking further I've contemplated the notion that each moment needs to be looked at in that manner. An omnipresent attitude of hope is good but also seems to require a larger picture view to take in account for things like exhaustion and various activities of daily living.

Speaking of exhaustion, yesterday's nap didn't turn out so well, mainly due to soliciting phone calls, but I was in a horizontal type position for nearly an hour then I snuck in some cat-nap time this morning from 3 to 4 a.m. and got to school at 5 a.m.

It's not quite 6:30 in the evening but I don't think I'm going to make it much longer. It's time to get this ship battle ready again as quickly as possible. I'll need to get back in the gym, upgrade my eating, not stay up so late on school nights and probably work on cutting way back on the number of cigarettes I smoke while commuting. Cutting out the commuting smokes could save me about 1/2 pack a day. Not sitting out in the garage with my laptop (as I'm doing now) could probably cut out another pack. I was a bit inspired one day when I heard in class that cutting down to something like 10 cigarettes a day can cut certain risk by 20% which reminds me of what Dr. Kuhn said about benefits from weight reductions of 10 to 20% when dealing with patients. He advised us, when dealing with patients, to make sure they knew they didn't have to fit back into the clothes they wore in high school but that even a modest weight reduction would have healthy benefits.

OK - Todays picture is going to be of Ochronosis! I spent quite a while finding a picture of this on the Internet. It's a rather fascinating disease. The patient with ochronosis is lacking an enzyme to metabolize homogentisic acid which is a waste product somehow related to tyrosine. It takes a good 30 years for enough of this waste product to accumulate in the system before the patient notices any the ill effects of the disease. One remarkable finding associated with the disease is disc calcification along the entire spine. I figured there may be other diseases that could have this effect but, at this point in our student career, we don't know about them which makes that particular radiographic image pathognomonic for ochronosis. In other words, it can only be one thing. I was anticipating this question on the exam and it was in the form of a fill in the blank question. This was another one where I wrote the answer down prior to the slide being shown. But, the question associated with the slide mentioned a 36 year old patient so I knew we were in the correct age frame. Today's pic is similar to what we saw on the exam.

When you look at that picture (and recall you can click on the picture to make it bigger) you're looking at the lumbar vertebrae (the bones in your lower back). Notice the brighter white lines that run horizontal, separating one vertebrae bone from the next. Those white lines are where your cushioning disc are supposed to go and, on x-ray, those disc should appear black. They appear white because they've been calcified which is kind of like a transition step on the way to becoming solid bone. With ochronosis, that calcification of disc can occur along the entire spine.

Currently, there is no cure for ochronosis.

T6, Wk9, Day 373, Tuesday - Electives & Dxi II

Dxi II Midterm is tomorrow - current plan involves going to bed about 30 minutes after posting this blog, waking up around 9 p.m. then chugging the soda and/or coffee to keep at it until game time tomorrow. I might actually make it to Uncle Bill's at 2 or 3 a.m. to polish up some studying there then get to school by 5 a.m. (and hoping I can find an open door!)

Next Monday we have to pick at least one specialized class for next trimester. We pick at least one extra class for credit and can add a 2nd class for no-credit (pass or fail option). The teacher recommended just picking one but I can't really see letting an opportunity for extra learning slip by so I'm sure I'll be signing up for two.

We have a slot in our Tri-7 schedule for one extra class and there are four classes we can choose from to fill that slot - Gonstead, Tompson, Activator and Kinesiology. I may go with the Activator for that weekday class.

Additionally, we have 6 other classes which are only available on the weekend. They all run for 9 hours on Saturdays and 6 hours on Sundays and are held for three weekends each. I know I'd like to take Advanced Basic with Dr. Montgomery and a lot of that simply has to do with the fact that it's Dr. Montgomery. Other classes include SOT, COX, Graston, Upper Cervical and ART.

Graston and ART are proprietary methods. I like the idea of SOT .... I think Advanced Basic is only a one semester class so I might take that during a different trimester. I've already signed up for the Internal Health Specialist (IHS) post graduate program and the first day of IHS conflicts with the last day of Advanced Basic. Dr. Montgomery already told me he'd work something out with me but I really wouldn't want to miss one of his classes.

It's all interesting stuff. If I take two per semester then I'll be able to get in 6 total extra classes by the time I graduate. Some of those classes have consecutive classes. SOT has a beginning and intermediate course and possibly a third depending on student interest (need at least 6 to hold the class)

Arthritides, Arthritides, Arthritides. I'd really like to do well on this midterm. I got a B+ on the Dxi I midterm and would like to do as well on tomorrow's exam. I think I've got good potential for a B type grade. I'll need more study to help solidify that B range grade and, if the study is superlative and I learn just the right things then maybe an A is possible ...tough to say. This class and Phys Dx are the ones that knock people back so even the B would be quite respectable.

For the record, it's not that any student couldn't get an A in any one class - the thing is, we've got 13 classes and each require time.

....looking ahead ....next tri is 12 classes and 34 hours. with an extra specialized technique I'll be back at 13 classes and 37 hours (up from 33 this trimester) as well as the IHS program starting in March ........

March... I'm thinking we may have Part II National Boards in March ....

I think I'm going to go to bed now.

oh - Today's pic - there are a lot of interesting radiographic pics to choose from but the one I picked is probably the easiest to talk about. It's osteitis condensans illii or OCI. It occurs in females who have had multiple full term pregnancies. That's all we really have to know about it (especially if it shows up as a multiple choice question) It's bilateral and symmetric in its presentation and usually presents with triangular sclerosis at the SI joint. The toughest thing is probably just knowing that multiparous means multi-pregnancies.

T6, Wk9, Day 372 - Monday

Damn tired!

However, there was something I noticed today that I've noticed in weeks gone by and that is whenever I adjust a patient, I get happy. It doesn't seem to matter what mood I'm in but, if I give someone a good adjustment it's like someone flipped a switch and I become happy. I've been noticing this in HCP II over the past few weeks.

I was ready to crash tonight at 6:30 but figured I should put some effort into my upcoming Dx Imag exam on Wednesday. I did get 10 nice arthritide pics up on facebook. Here's a link for anyone interested in checking them out Link To ARTHRITIDE Pics.

Today's pic is the album cover I made up for the photo album.

I sure wouldn't mind getting away w/ 5 hours sleep tonight, then I could get up at 4, get moving and maybe get to school .....well, maybe even getting up at 5 and getting to school by 6 would be good. by 5 would be better though ;)