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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tri-7 Wk12, Day441 Tuesday, Tagamet & Zantac

The Great Ulcer Drug Rip-off

Perhaps the greatest scam ever perpetrated by the pharmaceutical industry upon an unsuspecting and uninformed public involves a small, spiral-shaped bacterium named Helicobacter pylori. H. pylori was discovered in April 1982 by two Australian physicians, Dr. Barry Marshall and Dr. Robbin Warren. In 1983 the two doctors proposed that the bacterium is the cause of peptic (duodenal and gastric) ulcers. Dr. Marshall even went so far as to innoculate himself with the bacterium to prove his point(1). The discovery was met by deafening silence from the medical community and created great anxiety within the pharmaceutical industry. At the time, highly profitable antacids such as cimetidine (Tagamet) and ranitidine (Zantac) were used to treat about 90 per cent of all ulcer patients and generated sales income of over $8 billion per year(1,2). Cimetidine and ranitidine do not cure ulcers, but merely mask the symptoms. The relapse rate after cessation of treatment is 50 per cent after six months and as high as 95 per cent after one year(1,3). Nevertheless, courageous medical researchers took up the challenge and it soon became apparent just how widespread and serious the H. pylori threat is. Not only did research confirm that over 90 per cent of people with peptic ulcers are infected with the bacterium, but it also became clear that H. pylori infections can be eradicated and the vast majority of ulcers cured by a one-week treatment with antibiotics and antibacterials(2,4,5,6,7,8,9).

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

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

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

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

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

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

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

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

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

Tri-7 Wk12, Days 440 - Monday

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tri-7 Wk11 Day 437 - Wednesday

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

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

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

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

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

OK, what words got looked up today?

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

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

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

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

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

Todays pic is our loved ileocecal valve pic :)

Tri-7 Wk11 Day 436, continued (Tuesday)

GIUG -

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

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

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

Transhiatal Esophagectomy (THE) - removal of the esophagus.

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

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

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

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

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

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

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

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

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

Tri-7 Wk11 Day 436 - Tuesday

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

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

Tri-7 Wk11 Day 435 - Monday

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

.....

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

.....

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

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

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

Today also marks 400 days until graduation.

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

CMR on Monday (2nd of 4) for clinic

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

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

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

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

Twas the Night Before Boards ....

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

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

phone.... that was Mom.

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

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

Tri-7 Wk10 Day 432 - Wednesday

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

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

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

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

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

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

Tri-7 Wk10 Day 431 - Tuesday

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

Tri-7 Wk10 Day 430

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

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

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

Tri-7 Wk9 Day 429 - Passed Dxi III!

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

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

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

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

1. National Boards
2. Irene Gold Board reviews
3. NBS Board Reviews
4. SOT class
5. IHS class
6. School closings due to Snow Days
7. School closings due to power failure
8. My Brother's wedding
9. various certifications and extra activities
10. starting clinic a week late due to Comp Boards exam retake

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

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

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

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

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

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

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

Things will come full circle eventually. T'here are things chiropractors do that no other health care professionals do. It all goes back to a sign I saw in my chiropractors office back when I was in 8th grade. "If yours is not a chiropractic problem then chiropractic will not help but if yours is a chiropractic problem then nothing else will help." With this I recall one of the secondary reasons for enuresis being neurological. I recall hearing from a patient first hand who, after I did pelvic work on them, reported back to me that the night of sleep they had after that work was the first night they'd had in recent memory that they didn't have to get up in the middle of the night multiple times to go to the bathroom.

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

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

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

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

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

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

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

pt a - 5 min, possible 10

pt b - 5 min, possible 10

pt c - 5 -

pt d - 5 -

pt e - 4 -

pt f - 5 -

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

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

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

In order of priority

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Plan lets chiropractors prescribe drugs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tri-7 Wk9 Day 427 - St Peters Clinic Shift

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

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

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

Mmmm, yum ...better :)

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

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

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

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

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

Nocturnal Enuresis - Bed Wetting

Tri-7 Wk9 Day 426 - Tuesday

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

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

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

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

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

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

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

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

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

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

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

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

Tri-7 Wk9 Day 435 - Monday

Coffee in hand, 3:30 a.m.

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

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

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

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

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

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

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

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

Tri-7 Wk8 Day 434 - Friday

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

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

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

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

Tri-7 Wk8 Day 433 - Thursday

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

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

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

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

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

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

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

Tri-7 Wk8 Day 432 .....

This is nuts. I'm dead tired. Applied Kinesiology midterm is tomorrow along with our Activator midterm. I had a couple people remind me by text that we had to get a certification by the NIH (National Institute of Health) completed by tomorrow for our Research Methods class so.... as you can see by todays pic, I got that done.

The NIH website said it would take three hours to complete but I was able to beat that time along with perfect scores on all four exams. I'm not even sure what it's for anymore but I do recall reading about some ignoble experimentation done on people in the past which would be good not to EVER repeat.

Rocky, rocky, rocky trimester ... I need to make some flashcards up to help get some stuff memorized for my AK midterm exam tomorrow, it's 10:08 now, let's see what I can get done!

...10:39 ...got 11 done. My heart is pounding. I have to lay down for a bit - maybe a quick nap until midnight.

Lose 3 Pounds in One Hour! ;)

Tri-7 Wk8 Day 432 - Tuesday

Whew ...started this blog over four hours ago then got mired down in school stuff. Hit the gym after board reviews today and weighed myself before and after my 60 minutes of cardio and had a weight drop of 3 pounds. I thought I might have been sweating a lot because I noticed a 2+ drop after my last workout and was curious if it would happen again.

I'm beat. We've got a Geriatrics Midterm tomorrow and I can't afford to stay up late for it because tomorrow's classes and board reviews run from 7:20 a.m. until 8 p.m. and ...I'll be leaving by 6 a.m. as usual. Actually, I better leave a bit earlier than that if I want to get any studying in for Geriatrics. I should be able to muddle my way through it but, that isn't exactly the performance level I'm looking for.

I learned our Activator Midterm was going to be during our 2nd half of class on Thursday from a fellow student. I thought it was going to be on Friday so there isn't going to be much time after I get home tomorrow night to study for it. I'm not sure what to say. It's hard to figure out a plan other than just trying to get away with very little sleep tomorrow night ...dang ...keep forgetting the days. I better just get to bed.

I hadn't planned on a 15+ hour day tomorrow.

christ ...getting text from classmates trying to figure out what's going on. It looks like we have an exam in AK this week on Thursday. I thought I'd be in class or school before now to be able to look at the white board we have up front which list all our exams coming up.

This is going to be dismal.

AK used to be a four hour class but it got cut back to two hours this semester. It seems like the teacher is trying to cram about 80% of what was previously taught into our remaining two hours per week with her. I've learned at Palmer that the class isn't even allowed on campus. I'm not sure if there's anything to the technique or not but, it should probably be made into an elected technique and not part of the core curriculum.

I think our Dx Imaging III midterm is next week ...at least I know about it and have some time to prepare. I don't know about the IHS program anymore, at least not at this time. Maybe next year. Things seem to be unraveling too fast with this current trimester and I'm not sure (at the moment) how to salvage everything. Even at 8 hours of class this weekend for IHS there's still my two hour commute which means 20 hours doing something that has nothing to do with getting through my current semester.

I really should have moved closer to school before this whole thing started at Logan.