Tri-6 Wk13 Day 389

[6:30 a.m.] At school & ready to roll. I slept in kind of late and didn't get up until after 5 a.m. so I didn't want to take the time to hit the treadmill and prefered to get to school at a decent time. I don't have my Virgin Mobile Wi-Fi so I'll need to check for any new Pediatrics ppts prior to class. I brought Neurology with me to study before classes start and listened to Dr. Kuhn's Dx Imaging lectures.

FOOSH - Fall On OutStretched Hands

misdiagnosis and inability to properly manage the pain - no dx means not knowing RDS is a benign condition. If not diagnosed, a common outcome is death by suicide. RDS is a progressively...

[10:13 p.m.] Heading to bed. Got to stay focused. Need to get up early and get to school early. I need to do better than getting to school at 6:30 as I did today.

Tri-6 Wk13, Day 388

[6:50 a.m.] Got some good studying in this weekend. Sunday was especially strong. I started with Neurology before 7 a.m. switched over to CCR around 10:30, went to Logan at 1 for Dx Imag tutoring then ended at China Buffet around 5 p.m. and ready over my Phys Dx.

[8:35 p.m.] Time sure is a squirrelly little thing. It's crunch time and I need to get to bed (or study if I'm staying up). I haven't forgotten about that treadmill/study idea I wrote about the other day. As a start I did manage 1/2 mile on my treadmill at home this morning. I really just want to get out of the house and get to school at a decent time. 5 a.m. is a good time to get there. Dx Imaging seemed to go from impulse velocity to warp speed today. Thank god it was only an hour. I delved into my books tonight to augment the confusion I experienced today. New things I have to figure out and get used to in a hurry. We only have three classes left in Dx imaging and still need to cover almost all of the tumors section.

I think I'm going to have to be happy with my B/B+ grades in Pediatrics and EENT. Unless the test grades are close to perfect at the onset and with every exam, it's pretty tough, if not mathematically impossible to push up past that 93% mark necessary for an A.

Next Monday - we get 5 extra credit points just for showing up at Jurisprudence! How cool!

Everything is going pretty well, I've been putting in a great deal of effort this trimester and do think I've kicked things up a notch or two.

HCP was interesting today. I rocked my the adjustments with my patient and in lecture we all got our Health Clinic Manuals, and signed a sheet for our business cards which, I wasn't even aware that we'd be getting. Beyond that we got sheets for the physical examinations we'll be doing with our new patients as well as transfer sheets for established patients. Which reminds me - I had a request from a student today to be their intern so I need to forward then an email from the health clinic letting them know what to do.

[9:06 p.m.] OK, that's done. Right now it looks like we have 87 people tentatively eligible for internship next trimester. ...lots of other emails in that logan.edu inbox ...plenty of work ahead. I just have to keep my head about me and maintain the highest degree of effort I am capable of then I should be fine.

Sleep was a little rough last night. Quality sleep isn't always the easiest thing to come by for me. I think it was after 1 a.m. before I finally entered my first sleep cycle.

thinking ahead ...

• 11/30 - Tue - 2hr Pediatrics, 2 hr Pt Communication, 1 hr Dx Imag Tutoring, 2-3hr Div V.
• 12/01 - Wed - 2 hr Phys Dx, 2hr Dx Imag, 2hr Phys Dx Lab - 10 female pelvic exams followed by Comp Board testing for rectal examinations.
• 12/02 - Thu - 2 hr Neurology, 2hr EENT, 3hr CCR
• 12/03 - Fri - 2hr PT, 1hr Phys Dx, no Pro-D I'm thinking ...good day to get a HUGE jump on studying! :)
• 12/06 - Mon - ?
• 12/07 - Tue - Div V Final Practical
• 12/08 - Wed - Phys Dx Exam 4, Phys Dx Lab Final Practical
• 12/09 - Thu - CCR Final Practical
• 12/10 - Fri - Div V Final Exam // Neurology Final Exam (9am & 2pm)
• 12/13 - Mon - Jurisprudence Final Exam // Dx Imag II Final Exam (7:30am & 11:30am)
• 12/14 - Tue - Phys Dx II Final Exam // EENT Final Exam (9am & 2pm)
• 12/15 - Wed - Pediatrics Final Exam // CCR Final Exam (7:30am & 11:30am)
• 12/16 - Thu - Patient Communication Final Exam // Physical Therapy Final Exam (7:30am & 9am)

Not bad - I counted only 14 exams. Then ....start studying for Part II National Boards - Irene Gold starts the Friday before Tri-7 starts (1/7/2011)

2011 should be one heck of a year. Somehow, I'll be taking 35 hours of classes, caring for around 1/2 dozen patients (maybe more), manage three different 25 hour weekends of studying with Irene Gold, taking SOT on the weekends and starting my Internal Health Specialist program ...oh yeah, and Part II National Boards. :) Awesome! :)

Today's pic is of me studying :) hehehe

T6 Wk12, Holding @ 387 - Friday & FOCUS

I'm studying a great deal of the time. So much so, that trying to fit in more time to study may not be as fruitful an endeavor as striving to increase my focus during the times I am studying. I'm going to start a pattern and have written up in a Word document a set of personally imposed criteria to help me focus more on my school work and get more out of the time I spend studying. This is what I have so far on my list:

1. Turn Off Television - this normally isn't a concern but, during our holiday break, I've had my television on more often than normal.
2. Turn off NetFlix - Netflix isn't much good w/o the television on. I *might* opt for classical music in the background while I study.
3. Shut down fgs. this is an extension for facebook games. Obviously, I don't want to be dealing with games if I want to get the most from my study times.
4. close all browsers not related to school work. I have 4 sub listings for this which include a) close gmail, b) close Facebook, c) close any IM programs running (usually aren't any other than gmail) and d) minimize bookmark bar. (less to look at means less chance for distraction)
5. put in ear plugs, if available ( i have some in now!) :)
6. Set phone to silent. I'm not sure how crazy I am about this one but, if my goal is to maximize productivity and focus then it's probably worth doing.
7. Set up a time frame to focus on school work. for example, I'll start at 3:15 and stop at 3:45 - basically, I'm just scheduling my time
8. no cigarettes. probably good for my health also but, if i have a cigarette in my hand then that's one less hand I can use for typing or turning pages besides. I need to learn to get used to doing things w/o them.
9. be showered, cleaned up, dressed and ready to study ....I threw this on one at the end and maybe there's something too it. as long as I'm getting things done I don't much care what I'm wearing or if I've showered or not. However, there could be some positive psychological advantages to getting these basic things done, even on my days off school. It's sort of like that philosophy about "Live each day as if it were on purpose"

It's 3:43 p.m. now. I'll go for a half hour of school focus to start with. I suppose blogging this stuff gives me an extra measure of accountability to help me get things done.

updates to follow ....

T6 Wk12, Holding at day 387 - Thursday/Thanksgiving

Thanksgiving Day. I didn't do much in terms of studying on Thanksgiving Day. I listened to our last Phys Dx lecture a couple times while playing on the computer. Probably better than nothing but not ranking too high in terms of studying.

Tri-6 Wk12 Day 387 - Four Hours of Class Today :)

[5:10 a.m.] been up since about 4:05. [5:18 a.m.] Found my car keys!!! :)

Regarding yesterdays goal posters, we had an interesting presentation yesterday by a classmate who is from the Virgin Islands. When he talks about eventually expanding his future practice with his brother he mentions things like opening an office in the next island over. He mentioned Trinidad is South of his island, has a population of about one million and only 2 or 3 chiropractors. He's as sharp as they come and the population of the Virgin Islands will definitely benefit from his practice.

I'm enjoying a watered down cup of coffee right now. In addition to my keys, I also found my phone this morning which was in my "window not up all the way" car. It is raining this morning. I should head out soon, maybe at 5:30 so I don't get hammered in traffic. I'm hoping it's going to be a little lighter than normal since Thanksgiving is tomorrow. I'm thankful for my family, and the rightous school I attend. ;)

[8:32 p.m.] Today was a super nice day. We had two classes in the morning, Phys Dx and Dx Imaging. Phys Dx was short, succinct and packed with information. Dx Imaging is always packed with information and I think my brain hit redline at 10:35 a.m. with 25 minutes of class left. I mentioned this to a fellow classmate as we were leaving for the day and she mentioned she had the same experience and also looked at the clock. For her, brain meltdown occurred at 10:46 a.m. There was a ton of information conveyed today. Since we got out early from Phys Dx, I listened to most of Dr. Mannello's lecture again and was also able to listen to an hour of Dr. Kuhn's Dx Imaging lecture while driving home from school.

I stayed at school for an extra hour to get some things printed out at the library. I was fortunate enough to get hold of my parents and arranged to meet them for lunch which was a super nice way to kick off this holiday break.

I was thrown off track a little towards the end of the day. I think I have to start regarding the time I need for studying more like work. If I were at work I could not stop everything I was doing and chat online for a couple hours with other people. I'd be fired. I need to get that same attitude towards my school work.

Today's picture is of the new addition to the health care building Logan is adding to the campus. Four new eisels were put up in front of our library today showing different aspects of the new addition and it's quite impressive. I'll be looking forward to it's completion.

Tri-6 Wk12 Day 387 - 5h 42m to Pediatrics

[1:38 a.m.] got coffee brewing. We have a pediatrics exam, a quiz that needs to be knocked out for pediatrics and a couple posters that need to be completed for Patient Communication.

[4:09 a.m.] posters are completed for Pt Comm and all relevant materials have been printed out for Pediatrics. I'm going to be taking a hit in Peds which pretty much sucks but, there's only so much a person can do with the time they are given. Fortunately, a fellow classmate posted a study guide. It's about 25 pages so I'll have time to look over it all but won't have a lot of time to get much committed to memory.

Today's picture is what I printed out and put on a poster for my Personal Goal. I found the diploma online then used MS Paint to add in my name and a date of April 21, 2012. :)

[6:35 a.m.] I've been at school for about 45 minutes, completed the pediatrics quiz due today and learned that the vision boards I wasted so much time on this morning may now be turned in next week since a good number of people simply haven't done them. What a crock of you know what! Still, I was just reading an excerpt from an article on PubMed about a 15 day old who had necrosis of an undescended testis so ...I suppose things could be worse ;)

I did find an interesting site covering information on surgical procedures for children at http://med.brown.edu/pedisurg/Hasbro/PatientInfo.htm

[5:33 p.m.] ...The Phys Dx Grade has been posted. I think I already guessed I would get a solid score in the 23 to 25 range and, as fate would have it, I scored a 24 out of 30 or an even 80%. I must admit, I was a bit disappointed in the grade even though it's what I thought I'd be getting. I was hoping to be surprised and maybe see a 27! :) I started serious studying for that exam 12 days out. I might have to talk with our teacher to get some advice on how to do better.

Emotions kind of run up and down throughout the course of a day but, as busy as we are there is little time left to dwell. I know now I could have done little to nothing regarding my vision board and devoted all my available time to studying for Pediatrics which, I would like to have done, especially since I had the potential for such a strong grade in that class (i.e., B+ or A).

[9:01 p.m.] OK, I was a bit dumbfounded after I saw my Phys Dx grade because I wasn't sure what else I could do to get a better grade. I did quite a bit for the grade I got. Having the Internet available was a huge help. In fact, for my first two exams, I took a total of 13 pages worth of notes, 5 pages for the first exam and 8 pages for the second exam. With the Internet at my disposal - by the time of our third exam, I'd accumulated 41 pages worth of notes! That's 28 pages for a single exam as well as a score that's a full grade and a half better than my previous two efforts.

Somehow ...I'd like to do better. I utilized FlashMyBrain.com and FlashcardExchange.com, regular paper flashcards, both loose and w/ ring binders, highlighted, marked up and read the book multiple times and, at the end, started looking at the Swartz Phys Dx book that was used in previous trimesters. Actually, with the internet access I was able to pull that Swartz book up online via studentconsult.com and incorporate many of the pictures from the book into my notes. Now, where could I have improved?

For this Phys Dx exam, I started studying 12 days out. What did I start? I started making flashcards and marking up the book, dissecting the various Chief Complaints and looking for pathgnomonic differences between the diseases & issues to help provide for a differential diagnosis (ddx). OK, I can start sooner. Including this week, I should have close to three weeks,... well, 12 days until the 5th of December and maybe an extra day or two before our fourth exam. So, start now is one thing.

I never really had a schedule or planned study times for Phys Dx. I'm not exactly sure how to schedule this (as simple as it may sound) but, that's probably something to look into. I know many teachers talk about devoting some time every day to studying but with 13 classes I'm not sure how realistic that is. If I were to consider 12 classes and say 10 minutes of reviewing information for each class then we're talking about two hours of time which can be a considerable amount of time and it's not just the two hours but also maintaining focus for the entire two hours. If I had a daily type focus on 9 classes then we're talking about 1.5 hours which is a little more manageable.

One thought that's crossing my mind is to incorporate this review time with exercise, in particular with cardio. During my ASP (Accelerated Science Program) days I did manage to hit the gym on a regular basis and press a single button on the treadmill to do a 5k. I think the school gym opens at 5:15 a.m. so, if I leave the house by 4:30 a.m. I can arrive at 5:15 and get that 5k in as well as review for at least 4 classes by 6 a.m. Another nice feature here is that I can still get to the cafeteria shortly after 6 a.m and have another hour until the first class. So ...if that treadmill time is used for review then maybe the other hour at hand could be used for newer material. to learn? notecards?

I need to keep this plan in mind. Did I mention I got up at 1:30 a.m. this morning? It's 9:30 now so, I can still get 7 hours sleep and get up at 4:30, maybe leave home by 5:30....

btw - if anyone out there reading this has any study ideas that has worked for them then please comment and share :)

Tri-6 Wk12 Day 386 - 3h 35min to Phys Dx II Exam

[5:40 a.m.] at Logan and set up to study. I had forgotten about my other classes today until I was reminded by a classmate last night. We have two hours of Jurisprudence and then our Phys Dx Exam so there will be time for extra exposure to Phys Dx! After Phys Dx we have an hour of Dx Imag, Lunch, CCR for an hour then a four hour "Boot Camp" from 1 to 5 p.m. I'm not exactly sure what the boot camp is all about. I think it's either for our Professional Development or Patient Communication. I just need to make sure I find a seat in the Purser Center with an outlet close by. I've been listening to recorded lectures since waking this morning ...mainly Table 11-4 on Diarrhea and Table 11-3 Constipation. I may update this blog throughout the day. The picture I've tossed up for today is of the inside of our Purser Center. :)

[5:53 a.m.] - focus on matching for rectal lesions - she (teacher) said it would be on the exam - Learn this now - focus.

[12:07 p.m.] - Phys Dx Grade not up yet - thinking I did pretty solid - hoping for no less than a score in the 23-25 range...

[8:20 p.m.] - Phys Dx grades probably won't be up until tomorrow. I've got 11 hours before the Pediatrics exam but I am much too tired to pull an all nighter.

Holding at Day 385...

I need to make to this quick so I can get to bed by 9 :)

Dr. Mike Wittmer had some interesting things to say this past Tuesday at the end of our Diversified V class. He talked about how, when he was a student, he would determine what grades he wanted at the beginning of each semester which, in and of itself isn't too unusual. What made his planning a bit unique, in my opinion, was that in determining his grades he also calculated how much time he thought he would have to commit in order to obtain each grade.

He gave an example using anatomy. He figured to get an A he would have to put in maybe 40 hours per week but also figured to get a B he might only have to put in 10 hours per week so, in that case, he might opt for the B so he could devote the balance of his time to other interest.

This weekend I was a bit up and down with my studying. Friday was alright, Saturday consisted of more time sleeping & napping then studying but today, Sunday, was pretty decent.

I realized I was freaking myself out (i.e., adding undo stress) from conceding that I didn't know everything well enough to guarantee I'd be able to get an A on tomorrow's Phys Dx II exam. So, instead of wasting time worrying that I didn't know everything as well as I wanted to I sort of throttled back my expectations and told myself I just wanted to do better than I have been doing in that class. That small shift in my mindset made it much easier to focus and get some productive study time in.

This is almost something I learned in my past but had forgotten about. The whole notion of setting extremely high goals and wanting to be perfect can also be a cleaver way of avoiding action all together since it's very easy to tell yourself that you probably won't get an A (or reach whatever high standard was set) and then throw in the towel since the high goal probably won't be reached anyway. I used to pull that kind of crap a lot in my younger days.

I am passing the class but ....that's all I can say. There are so few questions on these Phys Dx exams (30 total) that as little as 3 questions can swing thing an entire letter grade. 20 out of 30 is a solid D. 23/30 is almost a C+. hmmm, 24/30 *is* a C+ and an even 80%.

I'll get up no later than 4 a.m. tomorrow and head out ASAP to get to school as close to 5 a.m. as possible. Coffee is ready to go and I'll be getting a decent night's sleep tonight.

Tuesday is another issue. I've got a Pediatrics exam and am holding with a solid B in that class. I've kept up with that class the best I can but don't have any focused studying in for the upcoming exam. Sleep might be sparse tomorrow night but, we only have 4 hours of class on Wednesday and no exams so, little sleep may be acceptable.

We also have to make up two vision board type of goal posters for out Patient Communication class. I'm thinking I'll print some stuff out from the internet and paste it to my poster boards. My goals are pretty simple. One board is to be of out professional life, what we want to do and achieve as a chiropractor. My hope is to be able to help a lot of people. As far as income is concerned, I'd like to be in the black my first year out and maybe had my monthly income at least half of what it was when I was working before going to Logan. In my second year I'd like to be able to match what I was making before going to Logan.

For my personal life ...well, a lot of my satisfaction is going to be derived from my chiropractic profession. It's kind of a given that I'll be getting a convertible 968 Porsche which isn't too huge of a goal. Those cars were only made from 1992 to 1995 and they're old enough now that decent ones can be bought for under $20,000. I had it's predecessor, the 924 back when I was 19. The 944, which most people are familiar with came next and the 968 was the last of it's line. I've never had a convertible before and I'd like to have my first one be that 968. Beyond that, I don't have any huge material dreams but, a main reason for that is because I'm single. If I had a wife then I'm certain new goals would naturally materialize such as a bigger home so as to help support a more traditional family life, including children. Which ...makes me think of pediatrics again ....

Neurology is another class I need to do better in. I'm doing a little better than just passing in that class but not nearly as well as I'd like to be doing. I know the things I'd like to know in that class and just need to learn them. I don't know my spinal tracts as well as I'd like. I'd like to have lesions and symptoms at the tip of my tongue and not something I have to grope around for. As a chiropractor, I think these are things I should know as well as anyone.

Well, in spite of the 1,001 thought ruminating around in my head, I better conclude this blog and get my butt to bed.

Today's picture is a cross section of the spinal cord. It's a nice, clean simple picture. We've studied everything listed in that picture and I recognize everything labeled in the picture but I need to know everything better ...much better.

Tri-6 Wk11 Day 385 Fri - T-Minus 3 days to Phys Dx Exam 3

I got an "A" on my EENT exam!!! I was actually a bit giddy when I saw that score last night (Friday) but I don't seem to be as mentally loquacious this morning. A nap may be in order.

I was hoping for a solid EENT exam grade but still a bit surprised since you could miss no more than 4 out of 60 questions in order to get an A.

Phys Dx Exam 3 is Monday. I should do better than my previous exams but it still seems like there is much to get solidly memorized and even more to still go over.

Pediatrics Exam 2 is on Tuesday. I still have everything to do in order to get ready for that exam.

I think I am going to take my advice and go lay down. I definitely want to get a good night's sleep tonight to try to help myself be at my best for Monday's exam.

Today's pic is my grade from this week's EENT Exam. :)

Tri-6, Wk11 Day 385 Thur. T-Minus 4 days to PhysDx Exam 3, 5 days to Pediatrics

I certainly gave my EENT exam a valiant effort. I'm not sure if I've been able to achieve my objective of getting an A. I could only miss 4 out of 60 to get an A and that's dubious, at best. Oh well, time to focus on more Phys Dx & then Pediatrics the day after.

I'm pretty tired tonight and haven't studied anything. I watched some Star Trek & threw caution to the wind on my way home and bought some chips and soda of all things.

I think I'm still getting used to the destitute and stark loneliness since my neighbor died. Things are much more quiet and lonely. More often than not, the last time I speak to another person in a given day is upon leaving school then, not again until I see someone come into the cafeteria in the morning.

I've been thinking more and more about memories lately. At the surface, memories would appear to be an element of the past however, since memory is akin to putting something in storage it would appear that memories are for our future since that is when we would retrieve them.

I know people tend to query that time keeps moving faster as they get older but, I would supposist that' it's merely our perception in much the same way that driving to a new destination the first time seems to take the longest while subsequent trips don't seem as long. That, and, along w/ the mathematics of aging ...to wit - at age 10, a single year represents 10% of our existence, while at my age, 44, a year comprises less than 2.5%.

Nothing too startling here - I think I just need to make this an early night and get some sleep :)

Tri-6, Wk11, Day 384 - Wednesday, T-Minus 5 days to Phys Dx Exam 3 - 14 hours to EENT Exam

This blog entry may have the longest title of any blog to date. I am in the midst of studying EENT and am reading an article on Pharyngitis. While reading the article I'm looking up several words to help make sure I fully understand the meaning of the article. I thought it might be interesting to make a blog of the words I'm looking up. Some of the words I felt silly about looking up after I saw the definition but, at the time I saw them the full meaning wasn't 100% clear.

1. Serosanguineous - a descriptive term for a substance that oozes or is discharged from the body that contains blood & serum.
2. Lymphadenopathy - abnormally enlarged lymph nodes.
3. periungual desquamation -
4. hematuria - blood in the urine
5. exanthem - widespread rash usually occurring in children
6. erythematous - redness of the skin caused by dilation and congestion of the capillaries
7. adenopathy - adenomegaly (enlargement of a lymph node)
8. Kawasaki dz - a febrile, exanthematous, multisystem vasculitis of importance because approximately 20% of untreated children will develop coronary artery abnormalities.

That wasn't too bad. As long as I'm here I'll use this forum to answer some questions about pharyngitis.

1. Which of the most common pharyngitis pathogens is associated with the highest risk for potential life-threatening complications? group A beta-hemolytic streptococcus (GABHS)

2. What is the mode of transmission of viral and GABHS pharyngitis? mostly by hand contact with nasal discharge

3. What etiology of pharyngitis is more likely in the absence of nasal discharge, cough, and conjunctivitis: bacteria or viruses? bacteria

4. What type of pathogen is the most common cause of ‘sore throat’ (pharyngitis/tonsillitis): bacteria or viruses? viral

5. What pathogen causes most cases of bacterial ‘sore throat’ (pharyngitis/tonsillitis)? GABHS

6. What clinical feature is associated with infectious mononucleosis, but not with 'strep throat': red pharynx (injection) with exudates or posterior cervical lymphadenopathy? posterior cervical lymphadenopathy is associated with mono ///- anterior cervical lymphadenopaty is associated with GABHS (strep throat)

7. Of all ‘strep throat’ (GABHS pharyngitis/tonsillitis) complications - both purulent and non-purulent (see lecture) - which one is not preventable or treatable with antibiotics? Non-purulent complication, glomerulonephritis

8. Name two ‘strep throat’ (GABHS pharyngitis/tonsillitis) complications that are associated with an elevated antistreptolysin-O titer. rheumatic fever & poststreptococcal glomerulonephritis

9. What are Pastia’s lines? body folds & creases

10. What pharyngitis condition is associated an adherent (=cannot be peeled off) grayish membrane of the pharynx, uvula, and soft palate & tender cervical lymphadenopathy? ...well, until I hear otherwise I'm going with Vincent's Angina.

11. A - Which sore throat condition presents with strawberry tongue, anterior lymphadenopathy, wide spread skin rash and edema and erythema (=red) hands and feet? ...until I hear otherwise I'll go with Kawasaki's dz

12. 1. Analyze Table 2 (p.1469). A. What clinical symptoms are most strongly correlated with GABHS pharyngitis/tonsillitis?

B. What age group has the highest incidence of ‘strep throat’?

I'm dead tired and need to get some sleep

Pic of the day is Periungual desquamation - a complication of Kawasaki's syndrome.

Tri-6, Wk11, Days 382, 383 - T-Minus 5 days to Phys Dx Exam 3

Wow, my last post was T-minus 10 days to Phys Dx Exam 3 and now we're down to 5. There's also an EENT exam tomorrow which is why I'm listening to EENT teacher, Dr. DeGeer as I type this. I have to decide whether or not to sign up for an extra class next trimester.

Yesterday's commute to school was quite interesting. There was a car in the fast lane and one in the middle lane going the same speed. Kind of a typical situation. The slow lane was clear for miles (as it often is) so I moved over to the slow lane to pass the two cars traveling side by side. Then I noticed the middle vehicle, a red truck, increased their speed to keep me from passing. What ensued was remarkable. That truck would cut in front of me and hit the brakes, get behind me and flash his brights. I'd move two lanes away and they kept buzzing me.

My biggest temptation was to pull over on the side of the road, hoping the guy in the truck would follow suit then pound them into the ground. It's unlikely they would be expecting someone that weighs 294 pounds who has benched over 500 pounds and has a background in Shorin-Ryu karate to be coming at them. Of course, I knew the probability was such that I was probably going to be on the road longer and they'd eventually need to exit.

On the way to school today I was thinking about the redneck derelict in the truck and it helped me to make a decision about signing up for an extra class this morning. My thinking was I want to be as far away from people like that as I can possibly be and I figured coming in extra weekends to take another class would be a good step towards further differentiation.

Now, I just need to decide whether to take SOT or Advanced Basic. I want them both (eventually) If I sign up for Basic, I'll miss the last two classes then have to make them up but, I've already got permission from the instructor (Dr. Montgomery) to be able to miss those due to the Internal Health program conflict. If I take SOT then I'll miss two days of Irene Gold however, I would consider it only one day missed because *if* the last day of Part II review is like the last day of Part I review then ....well, then I'm rationalizing it's isn't like missing much. I'm going to post this, step outside and think things over.

Today's picture is the seal from the Sacro Occipital Research Society International

Tri-6, Wk10, Day 381 --- T-Minus 10 Days to Phys Dx Exam 3

Needing a break from Phys Dx. It's Saturday afternoon and I've gotten a good 6 hours in of listening to lectures, making notecards and looking over notes. Probably over half that time was reasonably effective.

I did make my one class on Friday - for a fleeting moment I almost considered not going but never really considered not going. Dr. Zilke gave a great lecture and it was well worth my time. I think Dr. Zilke does a little bit of what our Professional Development class tries to do but he's probably better at it. At the beginning of each class, he'll bring in something from the library he considers worthwhile for us to check out. This Friday, DrZ brought in "Nine Steps to Greater Achievement" by Pisciottano. Ironically, when Googling to learn more about Pisciottano (whom part of our Purser Center building is named after) I learned that Pisciottano's business, Pro-Solutions declared Chapter 7 bankruptcy just a week earlier on November 4th, 2010.

It's kind of funny, in a way, but somewhat of a common situation which I've seen in myself while learning to become a doctor. Just because I have learned which aspects of daily living might be best for me doesn't necessarily mean I'm practicing those aspects. I have thought about this on different fronts and wondered who makes for the best physician in terms of providing the best health to the patient and to those ends I would have to answer that the patient themselves makes for the person most able to contribute to the betterment of their health via their actions and behaviors in the majority of cases.

I think of the differences between my Dad and myself with this regard. Due to my chosen profession, I would know more about the intricacies behind exercise and it's benefits to the human body however, my Dad and his training partner, are both better at me when it comes to consistency and implementing this behavior into their daily lives.

Furthermore, until something happens to "break" in their bodies, my Dad's consistent habits of exercise and healthy eating are going to do more for his health then any pill he could get from an MD or probably from any adjustment from a chiropractor or any other health care professional out there. The main reason for this is because the patient (in this case, my Dad) is with himself 24/7. A 15 minute to the chiropractor once a week leaves 10,065 minutes left in the week where the patient is on their own and reaping the benefit or cost or whatever lifestyle behaviors they wish to engage in. Perhaps this is the reason simply getting a pill from an MD is so appealing, because the few seconds it takes to pop a pill can last all day and often we can perceive the intended benefit of whatever the prescription medication might be.

However, this brings up another point. It seems far too many people think that taking a pill for what ails them is a cure when often it is not but rather a management tool. I've talked with people taking aspirin for high blood pressure who are hypertensive and pointed out the fact that their hypertension (HTN) probably wasn't caused by the lack of acetacylic acid in their system. In a great number of cases lifestyle may be cited as a primary cause of HTN and positive changes in lifestyle may go a long way in reducing HTN & high blood pressure.

I then wonder, if a patient is not going to make any changes to help their cause then is medication the next best alternative? I really don't know for sure. With aspirin you're inhibiting the COX-1 affect in your body which generally inhibits three things. One of those things has to do with agglutination which is what the HTN patient would be after - kind of like helping to reduce the viscosity of their blood and that's considered a good thing. But, COX-1 also is beneficial to a patient's gastrointestinal and kidney function. So, generally speaking, you get one good thing and two bad things from the aspirin.

Now, just to be clear, I'm not necessarily talking about the patient who has had bypass surgery and their physician recommends an aspirin a day but rather otherwise healthy individuals who would put taking any kind of medication in the same exalted, feel good category of exercising and eating right without being aware of any of the drawbacks associated with whatever medication they may be taking.

Another thing people should be aware of is having to take a medication daily. Why daily? Why isn't taking a pill once good enough? I'll tell you part of the reason for this is because your liver detoxifies the system, it helps get's rid of stuff that's not supposed to be in your body. Maybe the liver has better things to do then to metabolize medication every single day because that's part of what it's doing when a person takes medication every single day and, as Dr. Hilgarner pointed out way back in Tri-1, matter has limitations. You can get away with almost anything in the short term, aspirin, cocaine, heroin, even Crestor but, in the long run something has got to give.

Enough soap box stuff, I need to get back to studying. I did get another comment from the Tri-10 student (wishing them well on Part IV boards!) with some advise about Phys Dx. That comment was well received and resulted in extra Phys Dx study last night and much of that was focused on the tables ...actually, almost all of it. I need to switch my studies over to EENT since we have an exam this week but, I might like to sneak in a little Dx Imaging just for the fun of it ...

Here are the tables from Chapter 11, The Abdomen, that I need to know...

1. Abdominal Pain - 11 different problems related to ab pain. I noticed I can break these up into about 5 categories. Peptic Ulcer & Dyspepsia and Cancer of the Stomach both deal with stomach type anatomy. The next three problems deal w/ the pancrease - acute pancreatitis, chronic pancreatitis and cancer of the pancreas. Those first five problems would all be in the epigastric region of the abdomen. Moving a little to the right, we encounter the gallbladder which may give us problems such as biliary colic and acute cholecystitis (gallstones). Dropping down to the lower quadrants of the abdomen we have acute appendicitis on the right and acute diverticulitis on the left along with acute mechanical intestinal obstruction. Mesenteric Ischemia makes up #11.
2. Dysphagia - there are a lot of medical terms which use the prefix 'dys' which seems to imply problems, difficulties or pain. Dysphagia is difficulty swallowing, dysmenorrhea is painful menstruation, dyspareunia is painful intercourse, dystaxia is difficulty controlling voluntary movements ...hey, i see that word taxi in there and we use taxi's to move about dont' we? Dys is kind of fun, isn't it? :) Anyway, Dysphagia should be an easy table. I've broken it down into two categories, Mechanical vs Motor disorders and for the differential diagnosis we'll say Mechanical involves solid foods and regurgitation while Motor dysphagia involves solids or liquids with repeated swallowing (and no regurgitation).
3. Constipation - 12 different types of constipation ...right now I know that an obstructing lesion such as diverticulitis, volvulus, intussusception or heria involves abdominal distention which I should be able to use as a differential since I didn't see that listed with any of the other problems although ...I would think a symptom of pregnancy under the heading of Metabolic Conditions would probably produce some abdominal distention...
4. Diarrhea - two full pages and no less than 10 different types of diarrhea! I know the Osmotic type diarrhea's involve large volumes. I did learn a new word here, "tenesmus" which is when you're straining to go but aren't quite getting the job done.
5. Black and Bloody Stools - Here we learn the word melena which refers to passage of black, tarry, sticky shiny stools ...enough said.
6. Frequency, Nocturia and Polyuria - here we're talking about urination... how often you go, going at night and going a lot. We don't have to know this table for our exam. :)
7. Urinary Incontinence - nope, no urine on this exam, not in this class but, we did spend several days on urine in Laboratory Diagnosis last trimester.
8. Localized Bulges in the Abdominal Wall - only 5 things in this table. We have 3 hernias (Umbilical, Incisional and Epigastric) along with Lipoma and Diastasis Recti. I think I have a bit of diastasis recti. Fortunatelly it has no clinical consequences.
9. Protuberant Abdomens - We're supposed to know 6 F's for this table but between listening to the lectures and checking my notes I've only been able to account for five F's. Maybe teacher made a mistake when she said six. Anyway, here's five F's: Fat, Fluid, Tumor, Flatulence, Fertile (pregnancy). I know the word tumor doesn't start with an F but I can't remember what F word was used... I'll leave the word tumor in the middle of my list, then I'll refer to it as the swingman between the first two and last two F's.
10. Sounds in the Abdomen - Bowel Sounds, Bruits, Venous Hum, Friction Rubs. On this page I have highlighted "Rushes of high-pitched sounds coinciding with an abdominal cramp indicate intestinal obstruction.
11. Tender Abdomens - Abdominal Wall tenderness, Visceral tenderness, Acute Pleurisy, Acute Salpingitis (inflammation of the fallopian tubes), Acute Cholecystitis, Acute pancreatitis, acute appendicitis and acute diverticulitis. I actually already know this table since it seems to mainly refer to the location of the various issues. Just need basic anatomy for this one! :)
12. Liver Enlargement: Apparent and Real - Livers can be smooth, irregular, displaced downward or have normal variations in shape. I'm not sure what question would be asked from this table but, it does remind me of the first liver I ever removed from a cadaver because that liver was so HUGE that it wrapped around to the left of the abdomen all the way around to the back!

That's it. I *really* need to move. Think I'll take my dog for a quick walk then spend a few minutes on the recumbent bike looking over my EENT notes. Gotta shift into EENT, gotta make it happen.

Pic of the day - since we're talking about abdomens, I thought I'd put up a nice one. Of course upon inspection of the picture, I'm noticing the ribs on the right which makes me think of Murphy's Sign which is when I would palpate under the ribs and note any abrupt stop of inspiration which could indicate cholecystitis. Yep....if that's the first thing I think of them I'm definitely getting in enough studying! ;)

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.