TRI-4, Wk 12, Days 254, 255, Mon & Tue

Monday was interesting sleep wise -went to bed at 3:30 (p.m.) but, got up around 7 and got some reading in for school. Today was kind of a long day but I didn't really notice it much. I stayed after for a two hour tutoring class our NMS test this Thursday then stayed another hour to get some x-ray work in.

The NMS is taking some getting used to. Even as our first diagnostic class, I can tell it's got a bit of a different flavor as compared to all our previous classes.

Today's pic is of P!nk from her music video Get The Party Started. ;)

I've gotta get to bed so I can get up early tomorrow and put some more effort & time in with my x-rays... I think I'll need to pick up some nail polish remover ...I guess that sounds better if I say I need acetone. (it's for the x-ray films)

TRI-4, Wk11 Day 253 - Friday

Normally, waking up at 1:30 in the morning would be considered very early but I soon realized I went to bed at 6 p.m. so I guess that wake up time isn't too outrageous, all things considered.

It's not uncommon to be wiped out at the end of the week and this week actually started on Saturday with National Boards and 9 hours of testing over the past weekend. I'm *really* curious to see how I did on those test.

Wow - looking over the academic calendar I've learned there are only 13 class days left before finals. It's getting close to 2:30 a.m. and I have to be careful not to fritter away my time. I woke up this morning thinking of NMS and I believe we have a test in that class next week, probably Thursday. I need to think through my classes and what needs to be done for each one

3/31, Wed - x-ray marking

4/01, Thur - philosophy assn, Quiz & NMS

NMS Diagnosis - print & bind everything on Self Serve, bind class notes & any supplemental material

Diversified - Print any ponies, watch DVDs & practice

Orthopedics - Bind class notes, Print ponies

Physiology - Print out review notes for current chapters - find all previous review notes for previous two semesters of material. This is going to take a LOT of work.

Basic - get all handouts organized & print ponies/resources - practice x-ray marking for upcoming exam.

Fund Dx - Print any ponies for the Final

Nutrition - print any remaining ponies for Final

Pathology - print all ponies for final exam and bind previous exams to already made & binded powerpoints

Pro-D - just show up ;)

Philosophy IV - Call Illinois Dept. of Professional Regulation to obtain state laws, contact chiro in Urban area to get E/M codes. As a backup, I might want to get laws regarding practice in Virginia or any other place where I already have E/M codes from chiro's.

Well, this is a start. I need to make the most of this weekend as well as any other available time. The more work I do now, the less likely I'll be pulling my hair out the week of Finals. ;)

BTW - did I mention I got another A in Pathology II? :)

Almost forgot...I also need to submit my application for the Master's Program...

TRI-4, Wk11, Days 250, 251, 252 - Tue, Wed, Thur

Just a ton of reading these past few nights, at least on Tue & Wed - not so much tonight except for going over ponies for our pathology test tomorrow. I think my brain might be kind of "out of it" since boards. I've had some classmates tell me they've been having trouble retaining any info since boards but, I haven't really noticed that myself, just being studious.

I have learned that the other time during the year boards are given is in September sometime during the first week or two of school. I'd imagine completing tri-5 in the summer then taking boards would be the best scenario possible and being a tri-4 and taking them at the same time as midterms might be the most challenging -

Almost forgot, I got an email from Ann in Ireland - if you're reading this I will get back to you - just dealing w/ test this week.

The thought of staying up all night and studying for Path crossed my mind. I think I might just get up rediculously early to study - not that I need it to pass but, I don't think it would take a whole lot more to really dominate this test tomorrow - maybe even get a 100% on it. ;)

TRI-4, Wk11, Day 249 - Monday

It was a late start today for many, many students who took boards over the weekend and I was no exception.

Today's pictures represent some of the medical equipment I bought today. I also got a great deal on a new adjusting table. It's a model our book store just got in and I like it a lot better than the model I was previously considering. Both tables started out at the same price of $299 but, having adjustable legs, a carrying case and shipping all added about $150 extra to the one table but, was all included w/ the newer model. Seems like better cushioning on the one I got also. :)

I did opt for the Littmann stethescope, it was between that one and the Welch Allyn brass stethescope. The Littmann came with a lot of extras plus, it's the one I see most doctors wearing on television. ;)

I also went with the Lithium Ion handle and the PanOptic opthalmascope. I checked on eBay to get an idea of what those PanOptic scopes went for and found a few with a Buy It Now price of around $450 which kind of indicates that we're getting a heck of a deal as students and, for only $25 extra I was able to get the traditional head opthlamascope which will be needed for comp boards. From a diagnostic point of view, I liked the idea of the newer Pan Optic scope and figure my future patients are worth it. ;)

That's about it - I've just been predominately reading for most of the past five hours for upcoming test - Pathology and Nutrition. Nutrition is on Wednesday and Pathology is on Thursday.

TRI-4, Wk11, Day 248 - Sunday

National Boards, Day 2

The first day of National Boards testing was a rather impressive display by the NBCE.

About 1200 people across the nation were taking Part I and 223 of them were at Logan. The test were held in the Purser Center at Logan College. All the main entrance doors to the center were locked and candidates for testing had to enter a side door to the auditorium. For final registration we had to show two forms of identification then we got a badge with our originally submitted passport type photo to wear around our neck. Zip-lock bags were available for anyone that happened to be wearing a watch, or had a cell phone and even a certain car keys were not allowed. To enter the lobby of the Purser Center we had to pass through two metal detectors which were manned by a couple police officers from Chesterfield, MO. Once inside, our seats were all assigned. At each end of the Purser Center were large digital clocks, the kind you might see at the end of a 5k race. Ear plugs were provided for anyone that wanted them.

Prior to our first test, we spent 15 minutes going over rules and regulations regarding the test. One thing I found very interesting was not only would your test be invalidated if you were suspected of cheating but, a test could also be thrown out if statistical analysis of the test indicated any improprieties. I ended up finishing each test with about 10 minutes to spare but there were a lot of people who finished sooner, most notably people in Tri-5 or above tended to finish very quickly.

During our first test, I was on #57 of 100 when a Tri-5 next to me raised her hand to have her test picked up. The first test was General Anatomy which covered all of anatomy and embryology. The second test was over Spinal Anatomy which also included a bit of embryology. The second test must have been a bit harder because I made it to #80 before the girl next to me was finished.

It's about 4:45 a.m. right now and I'll probably head out around 6 a.m. I got to bed a little later than anticipated last night (pushing 9 p.m.) but I still woke up around 3 a.m.

I know there's a group of people heading over to the Lumiere (?sp) tonight which is a very nice local Casino and, last week, the notion of heading out for a few beers to help unwind and celebrate a bit after testing seemed rather appealing but, as the end of these boards looms near, I find myself thinking of other task ahead such as the three test we have in Week 11.

I know I can do really well in Pathology and would like to get another A but I just need the time to sufficiently study. We also have a test in Nutrition which could also be an A if only I get enough study time in.

I think the most pressing thing on my plate right now would be the state laws I have to obtain for two different states for our Philosophy class. If it comes down to it I may have to make a trip to Springfield Illinois and maybe the Capital of Missouri to pick those laws up in person if they can't be mailed to me in time.

Today's pictures are of the Purser Center. It's really an impressive looking building. Back when my brother graduated, his ceremony was held over by West Port Plaza since the Purser Center hadn't been built yet. It's nice to see the college continually improved. I've heard talk of three more improvements for Logan. There's supposed to be a 2nd floor added to our Health Clinic, some expansion of the Fitness area which would include a new building and some talk about another building added in the vicinity of the Purser Center. Of course, I'm hardly an official liaison for Logan but, I'm still confident improvements will be made. The inside picture of the Purser Center is pretty much the view I had while taking the test.

Well, I better get moving. My thoughts coming home regarding the testing was thinking more in line of opportunity. These things we're being tested over we should know as future chiropractors and these test give us the feedback needed to know if we need to brush up on anything. Unofficial NBCE grades will be available on April 30th.

TRI-4, Wk10, Day 247 - Saturday

If I have to be at school for classes or exams I count it as a day so, today is Day 247 due to Day one of National Boards, Part I.

In May it will have been two years since I quit my job to start at Logan. I still have anatomy powerpoints on my walls from classes I took in Tri-1. I guess it might not hurt to Review a bit while I'm blogging here.

SAD - that's how I'm remembering different joints in the body.

Synarthrodial - fixed, immovable

- Suture

- Gomphoses

- Synchondroses

Amphiarthrodal - slightly moveable

- Syndesmosis

- Symphyses

Diarthrodial - freely moveable

- Saddle, aka Sella

- Gliding,

- Hinge, aka Ginglymus

- Pivot, aka Trochlear

- Ellipsoid, aka Condyloid

- Ball & Socket, aka Spheroid

The mnemonic MOANER is how I'm remembering what comes from Nerual Plate embryologic cells

Macroglial

- Oligodendrocytes

- Astrocytes

Neurons of CNS

Epidymal

Retina Cells

Review the Brachial Plexus a bit but, I already knew that one pretty well.

For the Brachial Arches I know Arches 1, 2, 3 & 4 provide for Cranial Nerves 5, 7, 9 & 10 respectively then noticed a cross relationship in that those cranial nerves end up being both sensory and motor nerves in the body.

CN 3, 7, 9 & 10 are the parasympathetic nerves in the cervical region and, along w/ Sacral nerves S2, S3, S4 make up all the parasympathetic nerves in the body.

Regarding Geniculate bodies and Colliculus in the brain

Lateral Geniculate & Superior Colliculus go w/ the vision while

Medial Geniculate & inferiior Colliculus go w/ the auditory pathway

I believe the Middle Cerebral Artery is the location of most vascular accidents in the brain.

Come on Sofia! this is how I remember the different foramen (holes) that each of the cranial nerves pass through ....

Come - cribiform plate (olfactory n.)

On - Optic canal (optic n.)

Sofia - S.O.F. (superior orbital fissure) (occulomotor n.)

Sofia - S.O.F. (trochlear n.)

Sofia - S.O.F. (Trigeminal n.) (V1)

Sofia - S.O.F. (Abducens n.)

Im in a mood - Internal Auditory Meatus (Facial n.)

Im in a mood - Internal Auditory Meatus (Vestibulocochlear n.)

(for)

Jugs - Jugular Foramen (Glossopharyngeal n.)

Jugs - Jugular Foramen (Vagus n.)

Jugs - Jugular Foramen (Spinal Accessory n.)

Hey! - Hypoglossal canal (Hypoglossal n.)

CN V has three subdivisions, V1, V2 & V3 - V1 works well with the mnemonic - for V2, the maxillary division of the trigeminal nerve we have foramen rotundum and remember Rotate to the Max - for V3, we have the foramen ovale and remember, Oval Man

Speaking of foramens, we need to remember the embryological foramens which are temporary and go away after we're born - two have relationship to the heart and one for the liver -

Foramen Ovale - this is between the right and left atria of the heart - it fills in and becomes the fossa ovalis (foramen is a hole, fossa is a depression)

Ductus Arteriosus - this shunt bypasses the lungs as an embryo and becomes the ligamentum arteriosum

Ductus Venosum - This bypasses the liver and becomes the ligamentum venosum

I think I pretty well know lesions of the visual pathway and what kind of visual field affects can occur, this is mainly done by means of a quick drawing, a classic lesion would be known as a bitermporal hemianopsia which, isn't nearly as difficult to understand diagnosis when the words are broken down

bi - meaning both

temporal - we're talking about the temporal or lateral (outisde) fields of vision

hemi - that's 1/2! :)

anopsia - ya just can't see ;)

so, bitemporal hemianopsia means your field of vision is occluded off to the right and left sides.

Tel, Di, Mes, Met, My!

This has been a fun one and a lot of mileage can be gained from it.

we basically add "encephalon" to each of the Tel, Di, Mes, Met, My to get an early stage of embryological development in the brain

Tel - Telenchephalon - gives rise to the Forebrain

Di - Diencephalon - gives rise to the thalamus and all things thalamus as well as the pineal gland and posterior pituitary

Mes - Mesencephalon - Middle Brain or Mid-Brain -

Met - Metencephalon - Pons & Cerebellum

My - Myencephalon - Medulla Oblongata

Cranial nerves which relate to each section are as follows:

Tel - CN 1

Di - CN 2

Mes - CN 3, 4

Met - CN 5,6,7,8

My - CN 9, 10, 11, 12

That's a start anyway.

Something interesting about the 12 Cranial nerves - four of them - an entire 25% are dedicated to the eyes.

CN's 2, 3, 4 and 6 all devoted to the eyes. Very sensitive sensory nerves we have there.

For hearing, I think of SLIM -

after sound has traveled through the ear to the Cochlear Nucleus of CN VII, we have

S - Superior Olivary Nucleus

L - Lateral Lemniscus

I - Inferior Colliculus

M - Medial Geniculate body

I'm trying to remember from neuroanatomy but I also thought I used the acronym MILK but, maybe that was for the visual pathway -

OK - time to head out! :)

Thursday, Wk10, Day 245 & 246 - Wed & Thur

Last day of class before boards - tomorrow we have off to study. Sat we have two test - General Anatomy and Spinal Anatomy which also includes all our Embryology - 220 question. On Sunday, we have our remaining four test. Pathology, Physiology, Microbiology & Chemistry - 440 more questions. 110 questions and 90 minutes per test.

Our Pathology teacher, Dr. Gray gave everything he had today to give us as much information as possible to help us with the boards. I can't say I consciously remember everything he taught but maybe something will look more familiar on the test due to his efforts. He actually kept teaching after the bell rang and then kept teaching throughout our break and didn't stop until the next teacher came in to start the next class. I do remember how to recall that Buochand's nodes go with the proximal joints of the hands - he said he used to remember "Broximal" for proximal (replacing the P in proximal w/the letter B) I'll remember that. Heubner's nodes are found in the distal joints. Broximal goes with RA - Rheumatoid Arthritis. Ulnar deviation of the phalanges also goes with RA and that's something I noticed on one of our teachers for NBS - definite ulnar deviation so I figured she was in the early stages of RA.

One of the things Dr. Gray went over in bath was more forms of spina bifida - (better get my notes for accuracy since anything could be on the boards) Here we go - a form of spina bifida called rachischisis is when then brain is not covered with any bones. To avoid spina bifida, females need to have adequate amounts of folic acid in their systems and it needs to be present during the first 10 days of pregnancy, well before most women know they're pregnant. Moral of the story - all women of child bearing age should have adequate amounts of folic acid in their diet. Dark green leafy vegetables as well as fortified cereals are sources of folic acid but supplementation of about 400 micrograms should still be taken and, if one is trying to conceive then start those doses about a month before trying to conceive.

I better get back to studying. Spina bifida is a defect in the neural tube which, eventually becomes the spine but, folic acid also helps prevent defects of the brain such as anencephaly. Today's picture of an individual with anecephaly. While it may look disturbing, it's far less graphic than many of the pictures we see in school.

Some of the other defects we've seen can be even more disturbing and messed up. For instance, a nose placed above the eyes and the eyes as being centralized into what looks like one big eye in the middle. There's an extraordinary number of things that can go wrong with a developing fetus - no wonder over 50% of fertilized eggs are naturally aborted. Just being here - anyone reading this - has had so many things go right that it's astounding. By and large, most everyone we see on a day to day basis are absolute masterpieces.

Tuesday, Wk10, Day 244 - Tuesday

Two more full days of classes, one day off then two days of National Boards, Part I.

Nutrition was actually kind of interesting today. We had three powerpoints full of tiny print which showed everything that was in a carrot. Literally, hundreds and hundreds of nutrients. I believe the teacher was pointing out the fact that taking a supplement, such as Vitamin A, still doesn't compare to all the nutrients we get from eating real food. Another example she gave was of an apple which contains only 5 mg of Vitamin C. She said that because of the other nutrients in the apple, such as bioflavinoids that the 5 mg of Vit C in an apple had the equivalent of a 1500mg supplement.

Oh, we started cervical adjusting today in Diversified. Pretty cool stuff. I'm going to need plenty of practice - which reminds me - I still need to order my adjusting table. We also learned today that we can use equipment such as our opthalmascope from a company called Hines but, for whatever reason, they are not allowed on campus to give their presentation so we have to go off campus to see what they have to say. Must be some lucrative deal between Allyn Welch & Logan.

Well, it's after 5 p.m. and I've had my hour plus of screwing around so I better get back to studying for those boards. :)

Monday, Wk10, Day 243 - Monday

The most common cause for bone cancer is "Mets from someplace else" as in Metastasis - shows up in the vertebrae as ivory white - along with Paget's dz (aka Osteitis Deformans) and Hodgkin's Lymphoma - Prostate cancer causes hyperosteoblastic activity 80% of the time which can cause the L4/L5 veterbrae to appear bright white on x-ray.

Both Ortho and Pro-D were cancelled today so we had a 4 hour break. I got adjusted during my lunch hour and was on a traction machine for my neck and laid on some heating pads - good time.

I've got to stay focused and get to bed early - one piece of advice I've heard from everyone taking the boards is to get plenty of sleep the week leading into boards - I should be in bed by 9:30 tonight.

NMS lectures today included extensive talk on the subject of sympatheticotonia which was a phrase coined by a Dr. Korr. The doc was a PhD at an osteopathic school and studied the phenomina of sympatheticotonia starting in the 1940s and researched it for over 20 years. It deals with hyper sympathetics and research is still going on today on this topic.

A premise of subluxations is that they block the bodies natural tendencies of inhibition - inhibiting an inhibitor is known as disinhibition - a chiro removes subluxations and the inhibition of the inhibitors is removed which means we get to settle down the hyperactive sympathetics.

With conditions such as neurocardiogenic sympathy (NCS) which, is an increase of parasympathetics, MD's may treat such a condition with beta-blockers which are sympathetic inhibitors...

It would appear that in an attempt for the body to stay in a state of homeostasis, an increase of parasympathetics by the body is met with an increase in sympathetic stimulation - to reduce the sympathetic stimulation (via the beta blockers) is to help decrease the parasympathetic condition of NCS.

Another interesting thing I learned today was that lymph nodes are innervated by sympathetics.

This is interesting - I did a quick search on a Rene Cailliet, MD & director the the department of physical medicine and rehabilitation at the University of Southern California. The Dr. talks about the importance of a lordotic (or normal) curve in the cervical spine. He states incorrect head position leads to improper spinal function and a head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine which can pull the entire spine out of alignment. Forward head posture can also result in loss of vital capacity of the lungs, by as much as 50% which can then lead to heart and blood vascular disease. There is also a loss of gastrointestinal function as well as an increase in pain because proprioceptive signals from the first 4 cervical (upper neck) vertebrae are a major source of stimuli which create the boy's pain controlling chemicals (endorphins) With inadequate endorphin production, many otherwise non painful sensation are experienced as pain. the complete article may be found here http://curezone.com/forums/fm.asp?i=1521120#i

Anyway - Dr. Rene writes a column known as the "Pain Series" and is finding sympatheticotonia as being present in many diseased states.

I guess the moral of today's blog is to get adjusted regularly to help avoid sympatheticotonia as well as all the hardships associated with a misaligned spine.

TRI-4, Wk9, Day 242 - Friday

Got a B on my Fundamentals of Diagnostic Imaging Midterm Exam!!! WooHoo! Yahoo! Yippie! :D

I figured I scored in the B to C range on my last two midterms and Fund Dx was a good one to get the higher range grade on because it's a 4 credit hour class as compared to 2 hours for my philosophy class. My philosophy grade hasn't been posted yet but I'm pretty darned happy with where I'm sitting right now for midterms. I've got more A's & B's than C's and that's always a good thing :)

I'm not including my Neuromusculoskeletal Diagnosis (NMS Dx) class because I intentionally blew off the first test to help maintain my sanity but, I will have to be held accountable for our remaining test. (the lowest test grade in that class is thrown out)

Two of my C's are actually C+'s so, I've got a great chance of pushing those up to B's. I haven't actually figured this out yet but, I think there's a chance of making the Dean's List.

Heck... I just put my grades down on a spreadsheet & to bring them up to a 3.5 to get on the Dean's List will require a considerable amount of improvement but, it is possible. One of my four credit hour classes will have to become an A and that could happen with NMS or Path, with Path probably being the most likely candidate.

I did get a nice comment by a fellow chiropractor who has been practicing for 41 years and he reminded me of something I've heard several times before but kind of forgot about. He mentioned how he still loves to go to work every day.

For some reason, I seem to have chiropractic type monologues constantly running through my head. I'm either talking in my head to prospective students about going to Logan or future patients or general talks about health and various aspects of chiropractic. At least my daydreaming as become much more productive than it used to be. (I admit, the lottery billboards I see on the way to school can still throw me off on a tangent) ;)

I have to get focused here and have a plan for studying for boards. Here's a kicker - the week after boards we have FOUR exams! Yikes! Two of those exams are for Nutrition and Pathology and I figured I can parlay my boards studying to coincide with those upcoming exams. The other two exams are for NMS and Basic. With NMS, I need to get a 3.5 or B+ out of the class to have a chance at the Dean's List. That's a completely diagnostic type of class so the material won't be specifically related to Part I boards ...although, there is a fair amount of Spinal Anatomy & Neurology associated with that class so maybe there is some overlap. Basic is like two classes in one. We have the lab portion where we learn Basic adjusting and the x-ray portion which currently involves x-ray marking. I've already got a B in that class and need to move that grade up to at least a B+. I think I can put up a white background on my computer monitor and use that as a light box for reading my x-rays ....

I was also thinking about going to the review sessions at Logan tomorrow and possibly going to a hotel afterwards just to have someplace different as well as a place to totally focus on studying.

For tonight, I think I'm going to prep for our third Pathology exam.

In honor of the fine grade I got in Fund Dx, today's picture is an x-ray of an upper thoracic region. Currently, I'm aware of four non-skeletal diseases one may glean from an x-ray; prostate cancer, pancoast tumor, Paget's dz and Abdominal Aortic Aneurysms. This x-ray reminded me of the pancoast tumor which would appear in the apex of the lungs. Normally, air shows up as black on an x-ray as is the case with today's picture. In the case of a pancoast tumor the upper portion of the lung(s) would appear white.

Come to think of it, various problems with the thyroid, such as a thyroid tumor could be diagnosed as well. If you look behind the upper thoracic vertebrae, you'll notice a column of lighter gray, that's the trachea and it's a lighter gray due to the air in the windpipe. I've seen x-rays where that gray column was deviated and there's got to be a reason for the deviation. Due to the proximity of the deviation, a lesion of the thyroid would be reasonable hypothesis for the deviation. The x-ray I saw was from an Emergency Room where the obvious deviation was missed and, the patient did have a thyroid tumor.

One thing I've learned about x-rays is that if you're the doctor reading the x-ray then you are responsible for everything on that x-ray. So, if a patient has cancer or any other dz that can be seen on an x-ray it needs to be caught or else the doc can be sued for malpractice.

I guess that kind of addresses the comment I get sometimes from people who don't think we'll use all the traditional doctor type classes we have to take to be a chiropractor because if you don't know about all the diseases that are out there then you're certainly not going to catch it on an x-ray. Also, if a chiro comes across any other dz during a routine physical then there is a legal obligation to refer the pt out if necessary.

Btw - if a transverse process is missing on an x-ray, it could be a congenital condition but it may also be a metastatic cancer which has eaten away at the TP, again, another reason to refer out. I guess I knew more than I thought. ;)

TRI-4, Wk9, Day 241 - Thursday

I'm not quite sure what to make of the two midterms we had today but, if I had to sum them up in one word, that word might be "fun". :)

Our philosophy exam was something else - 80 questions! :)

Now, our teacher - who happens to be Dr. Montgomery, told us there would be about 10 questions relating to various chiropractic techniques and who invented them. He has a list compiled of about 170 different chiropractic techniques and I had flashcards made up which covered the first two of three & a half pages of techniques which, really only amounted to 40 cards since most of the techniques have the originators name in the technique and didn't need to be memorized. When I was studying those flashcards earlier in the wee, one of our Dean's list students commented that they weren't the thing to be studying and not to waste my time on them ...well, I should have just listened to what our teacher told us... It was an interesting exam. Dr. Montgomery is a brilliant teacher & chiropractor.

Over the last couple weeks we've had a few students bring in their brothers or sisters to sit in class with them and I can't help thinking that my Mom would enjoy sitting through our classes for a day. I especially think she would enjoy Dr. Montgomery's class.

That's something else I've noticed at Logan - if I have a test during our last class of the day and think I might be able to get some study time in during earlier classes I'm usually mistaken because the lectures tend to be rather interesting and it's almost hard not to pay attention to what's going on in class.

Fund Dx was a *really* interesting exam. The test were actually personalized for every student. Our class had to wait outside while Dr. Guebert laid out all our test then when we came back in the room he called out where each of our test were and we sat down in the seats accordingly. A few of the questions included our names such as "Dr. Dukowitz, you've just purchased an existing chiropractic business..."

Dr. Guebert is another genius at the school and I mean that rather literally and wouldn't be surprised if he was a member of Mensa. He has a no-nonsense type of teaching demeanor but with a good sense of humor and his classes are fun as well as extremely informative.

I'm guessing my grades for the two test today are in the B to C range... just checked - no grades posted yet :)

We've got two hours of physiology tomorrow. Fortunately, the rest of the class felt the same way I did about having our final before boards and overwhelmingly voted against taking our final exam early. We're just reviewing topics in that class but I have a very difficult time learning from the fast paced verbal only input. I'm not sure if I can get all my study guides together before the next class and may just bring a physio book to class to look at during class tomorrow.

Including Friday, we have 8 days before boards and 4 days of class. This Saturday is another review session by the teachers and I may end up going to this one. One thing I probably need to get done before boards is to call a few Departments of Professional regulation to get a list of laws pertaining to chiropractic.

Along with a few other students, I got an email from the VP of enrollment at Logan about making a video tape about why I chose Logan. I'd like to participate but the times available for taping (there were only two) conflicted with my classes & intern appointment. It got me thinking though of a guy I worked with at my last job who was a chiropractor but couldn't make it in the business. He didn't go to Logan. Then, I think of all the people I know that went to this school and how successful they have been.

We've got another Slice of Logan coming up the week after boards and I'd like to participate in that as well but I'm not sure what lies ahead regarding my classes.

Time to switch focus to final preparation for Part I, National Boards - Eight days to 660 questions. I'm looking forward to it. :)

TRI-4, Wk9, Day 240 - Wednesday

Had two midterms today & grades were already posted for Diversified and I got another A! :)

Good grades sure have a way of taking the edge off. Got two more midterms tomorrow - gotta get to bed.

Today's picture is of the letter A which is the grade I got today in Diversified ...oh, and on my last Pathology exam - and my last philosophy test as well as the ortho midterm practical last week. ;)

hehehe

TRI-4, Wk9, Day 239 - Tuesday

Wow, not only did I get a comment from my Mom yesterday I was also honored with a comment from Dr. Ross Carter, D.C. He's got a great looking website at http://www.gentledr.com/ and you should really check it out! Good stuff :)

There was something my NMS teacher said yesterday that caught my attention right away. He mentioned that with increased amounts of substance-P that resulted in an increased number of receptors for substance-P. However, this is not always the case. In the brain for instance, if we smoke or do coccaine or anything like that then we have an increased level of dopamine but, the cellular response to a feel good chemical like dopamine is to down regulate the number of dopamine receptors.

So, at least with regards to dopamine and substance-P, it would appear that if you're in pain, it will be easier to feel the pain as it continues - ie, greater sensitization but, if you're feeling good then it will be harder to feel good from a constant source of dopamine -

anyway - it was a good day today. I forgot about a simple orthopedics practical I was supposed to have today but, my partner went home sick so we rescheduled it for March 30th.

Dr. Montgomery - aka the Zeus of Chiropractic gave me a cervical adjustment after our Basic class today. He uses a technique called Spears which is just phenomenal. I don't think it's one of the 14 basic techniques taught at Logan but I have heard that Dr. Montgomery will teach it over a couple weekends to people that are interested.

Basic Nutrition - Vitamin K: we've got two types, K1 and K2 - you can get K2 from butter but not from margarine.

Pathology - went over some pathology of the prostate today, also the teacher mentioned that whole milk is 3% even though it's not generally listed as such.

Well, I really need to get studying - two midterms tomorrow and two on Thursday. I think I'll do pretty well in Diversified. It's been a HUGE help to be able to practice with a fellow student. I've got to get my own portable table soon. I also think I'll do pretty well in philosophy. Fund Dx is going to be a challenge but, I've never missed a class and did get some good studying in over the weekend. My Basic adjusting class may be my weakest link right now. I'll devote a good amount of time to that tonight. :)

TR

TRI-4, Wk9, Day 238 - Monday

Week 9?! How the heck did that happen??? Neuromuscularskeletal Diagnosis (NMS) class was understandable but complex today. If there was ever a time to review notes for a class then today's class would have been it. I'll try to do that here.

In our homes we have different kinds of wired connections. We may have 110v wires for a lamp, 220v wiring for a refrigerator and a coaxial cable for an internet connection. In the same way we have different kinds of nerve fibers running throughout our body. In NMS today, we focused on pain. There is an A-delta fiber in our body which is used to conduct sharp, localized pain and we also have a "C" fiber used to conduct a more diffuse type of chronic pain. We talked about the C fiber today and how it conducts pain. Detecting pain is also known as "nociception".

The initial cause of the pain may be chemical, mechanical (aka tactile) or thermal (aka heat). A very interesting aspect we talked about was at the junction from one C pain fiber to the next. A substance known as Glutamate is always being released from the terminal end of one pain fiber to the next pain fiber which eventually leads to the brain for interpretation. Released glutamate finds receptors called AMPA which stands for alpha-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate ....so....we'll just stick with AMPA.

Now, when we have "real" pain - or I'd hasten to guess a more intense level of pain then a threshold is crossed and the terminal end of our C pain fiber releases Substance-P which looks for NK-1 receptors. Those AMPA receptors are usually bound w/ Magnesium but when substance-P enters the picture and finds NK-1 receptors then the Magnesium leaves the AMPA which then allows Calcium to enter the nerve fiber. This causes the nerve to depolarize which then causes us to interpret pain.

With chronic pain, we have what is known as the "Wind Up Phenomenon" which means that pain receptor sites on our nerve cells will increase. With a greater number of receptors, less input will be needed to stimulate pain. We may call this sensitization hyperalgesia or even hyperasthesia.

I'm still trying to get a handle on all this but, from my current understanding, the substance-P also facilitates production of Nitric Oxide (NO) and prostiglandin-E2 (E2 for short) and an increase in NO and E2 causes a greater production of substance-P which is how that vicious cycle of pain sensitization occurs.

Now, what else happens as a result of excess substance-P? Well, there is something called NGF which stands for Nerve Growth Factor. At this point we have to realize something. Earlier, when I said the nerve route eventually gets to the brain where we interpret the signal as pain then we must be aware that the route to get to the brain is in our spinal cord. Specifically, there are tracts in our spinal cord and the route the pain takes is along tracts called Lamina 1 and 2. Also keep in mind that anything we perceive via our peripheral nervous system must travel via our spinal cord to get to our brain and there is a lot to be perceived! This Nerve Growth Factor (NGF) stimulates the growth of new nerve cells - ie, new axons to sprout from lamina 3 & 4!

Lamina 3 & 4 is where A-beta fibers travel. Those fibers carry mechanoreceptor impulses. Mechanoreception is basically movement of the body, sometimes referred to as proprioception and it's from the tracts occupied by those fibers which sprout the new nerve cells when eventually can end up connecting with the incoming pain fibers. This is where things get interesting because if the impulses from movement end up connecting with the incoming nerves for pain then simply moving may cause pain since those movement impulses are now also sending extra signals to the pain fibers. A result of the sprouting and new connections to pain fibers is known as Albdenia ...I probably don't have that word spelled correctly because I couldn't find anything on the internet on it - have to check my book...

The last part of the story here is how the body can help prevent these pain cycles, especially the new connections. For now, we've learned of 5 chemicals the body can send to the rescue. These 5 chemicals are

1. endorphins
2. enkephalin
3. nynorphin
4. GABA
5. Glycine

There is something known as the PeriAquaductal Gray (PAG) Area (I'm thinking this is somewhere in the brain) which makes endorphins which stimulates mu-opiate receptors - essentially, the endorphins help to block NMDA channels which helps to inhibit substance-P. Of course, one way the PAG is stimulated is by pain.... it's kind of like an on/off switch with regards to it's stimulation by pain.

What a minute ...notes update ....the PAG is part of the Decending Inhibitory Pathway (DIP) which...I guess is part of the brain... :)

Another part of the DIP is called the Nucleus Raphe Magnus (NRG) and that part of the DIP releases Enkephalin. This (as are the first three things in my list) is another opiate which can help reduce pain.

#3 on our list is Nynorphin which is released by an interneuron and is 10x more effective than morphine - everything shuts down (regarding pain) when nynorphin is released.

GABA - aka gamma-aminobutyric acid is something I've mentioned in previous blogs (we first learned about GABA in Tri-2) and is an inhibitory chemical.

Glycine is released by Renshaw cells which, I believe are in the spinal cord.

Anyway, all this stuff kind of gives a glimpse of some of the scientific theory behind chiropractic health care. These are some of the drugs that chiropractors work with, they aren't handed out by a pharmacist, they're made in our own bodies, they're made in the CNS, our brain & spine. It's like that function follows form principle wherein the shape of an object should be primarily based on its function or purpose. Chiropractors help people maintain the proper form of vertebrae so that nifty little spinal cord may continue to function as intended.

There's so much more to say about all that but I've got to wrap this up. A classic example of what's been talked about here may be fibromyalgia which used to be thought of as a hysterical kind of disease (it affects women about 7x more than men) In the 1970s valium was the standard Rx but more modern research indicates it's probably a problem with the central nervous system. SSRI's (selective serotonin reuptake inhibitors) now tend to be given as "treatment" for fibromyalgia. I put the word treatment in quotes because it's not a cure, the prescription doesn't fix the cause (as is the case with most medications) they're simply a management tool to help regulate symptoms. In the long run, SSRI's may do more harm than good and actually exacerbate the condition they were initially used to help.

TRI-4, Wk8, Day 237 - Friday

Well, I almost had a normal sleep schedule of getting to bed at a decent time and waking up early but, things have gotten kind of topsy turvy and I'm falling asleep soon after I get home from school and getting up outrageously early.

We've got more board reviews today - I'm kind of sick of the reviews and quite frankly, just need some board *study* time. I already have more information in front of me than I could possibly have memorized in the next two weeks.

Our phyiso teacher is actually suggestion (or giving us the option) of taking the final exam for our class BEFORE National Boards - is this man on drugs? Physio is already the strongest subject we have at Logan so it's a foregone conclusion that we probably need to focus on other subjects more than we need to focus on physio.

For some reason, I'm being reminded of big government where the people that are trying to help just keep getting in the way. We used to have a website called IQ Web for all our school classes which was recently replaced with a new school website called Self Service. This is fine but in the process of improvement, we've lost access to all material used in previous classes.

TRI-4, Wk8, Days 235 & 236 - Wed & Thur

Aced our Pathology II exam today! Got a 56 out of 60. I had a situation for two of the questions where I could have split the answers by choosing the same answer for both questions and knowing I'd get at least one of them right but, I also knew I was close to getting a 100% on the exam so I went for it and had them backwards - no biggie - I still did really well on that exam. Our philosophy quiz was simply an open book exam and the we even got the page numbers to refer to on our exam so, I'm assuming that grade will be an A also. :)

Next week I'll have four different midterm exams over two days - Wednesday and Thursday

Wednesday = Diversified & Basic

Thursday = Fund Dx & Philosophy

Those classes will be my focus for the next week.

I still have to decide on my diagnostic equipment. I checked ebay to get an idea of prices and learned the PanOptic Ophthalmoscope head can run $450 even on ebay so, paying a bit less than $140 to get one now is a bit of a bargain. Even the traditional ophthalmoscope head can run well over $100 but, w/ the PanOptic I can add a traditional head for only $25.

Regarding the handle, I'm kind of leaning towards the less expensive model for two reasons. For one thing, it just feels a bit better in my hands, the Lithium Ion handle is kind of small and I also like the fact that the NiCad handle can take C-batteries if needed. For stethoscopes, it's either going to be the brass one by Welch Allyn or a Littmann. I caught a news clip earlier tonight w/ an MD and recognized their stethoscope as being a Littmann.

It's well after midnight but, I'm up for the duration since I fell asleep shortly after getting home from school yesterday so I need to start getting my studies in. More focus. I just need to keep my head in the game and not get sidetracked or dissuaded by the trivialities of day to day living.

btw, I just learned via a comment that fellow chiropractor Ann is from Ireland! How cool is that?! :)

TRI-4, Wk8, Days 233 & 234 - Mon & Tue

Finished up with NBS (National Board Specialist) reviews early today and went straight to the gym on my way home. I just need to stay on top of things and focused this month - we've got a couple midterms this Thursday and three more next week then 660 questions worth of NBCE Part I questions the following week -

...I'm trying to think of a way to maybe use the blog here to help increase productivity by increasing accountability -

- imperfect plan now is better than perfect plan later -

I'll set about memorizing 20 things pertaining to pathology - that's my imperfect plan and it starts now at 3:20 p.m.

[Update] - 6:30 p.m. ...things sure do take time - well, i put 22 things in my head regarding the GI Tract ...that sure doesn't go very far considering those 22 things only cover the first four of 20 different questions we need to know regarding the GI tract. but, it's a start and more than I knew before I started.

We also have a chiro philosophy exam on Thursday so I should probably see what that's about and I'd also like to get down more pathognomic things - Pathognomic are those conditions or symptoms which point to one disease only (or 99% of the time). For instance, Blue/Green pus is associated with Pseudomonas Aeriginosa - gotta remember that as well as any other pathognomic thing I can dig up.

Next imperfect plan - See what Thursday's test is going to be over in Phil IV. It's 6:40 p.m. now.