TRI-5, Wk8, Day 302, Wednesday

Well, in 12 hours I'll be back at school and in the midst of my Dx Imag. exam. Dr. Kuhn, our teacher has told us that up to 1/3 of classes have failed this first exam. It's completely ironic that Div IV should be the class I have most reason to be concerned about.

For Rad Positioning we signed up for our rooms yesterday. My partner and I choose ...I think it was room C. or maybe B ...I don't quite remember but I would like to have been tested by either Dr. Kuhn or Dr. Guebert, they are the best at radiology and both seem like reasonable & fair men. My partner was a little concerned that they might be too difficult. However, Dr. Kuhn ran me through a timed x-ray set up and I was able to finish well within 5 minutes and Dr. Kuhn said I did a decent job. I did a mock chest x-ray which requires a slightly different type of film and remembered that fact and was able to set up the equipment with a 0.06 second x-ray time which is well below the tenth of a second which is recommended.

I ran a little late getting to school this morning and missed Cardio which, is a bit ironic because one of the things which caused me to be late was finding some worksheets specifically for that class. I rather regret not making it to that class because it is quite interesting. I was even thinking about it this morning after my shower. Thoughts in regard to residual volume (RV) in the lungs. Dr. Christy was claiming that the RV didn't represent any actual amount of air which got me thinking. If the lungs were void of air then there would be two possibilities. One, that the tubes in the lungs would be a vacuum or two, all the tubes in the lungs would be collapsed and, since neither of these options seem even remotely viable, I would have to conclude that there is actual air left in the lungs even after complete exhalation. I still need to talk with him about this.

I did complete my Lab Dx assignment last night or, rather, about 1 or 2 a.m. this morning. I sometimes think one of the main functions of our teacher in that class is to make sure we're not stupid. There are ways of thinking about lab test or pathology (another class he taught) that might seem intuitively correct but, that may not be the case. One of the questions in our assignment was counterintuitive to me. He asked why chiropractors should NOT utilize lab test. I found this odd because in class he would seem to be a proponent of all doctors testing their patients when appropriate. It did occur to me that if his belief was to have chiropractors test their patients with lab test then perhaps he asked "why not" in order to help bolster his own arguments towards chiro's performing lab test.

Friday is our Basic III midterm. Basic is rather intriguing. I know from experience that both my brother and his fiance have employed basic technique in their practice and I also know Troy has performed Lumbar pressures in patients with acute back pain. Oddly enough, when I came in there a few years ago one of my brother's associates was treating me and said he didnt' want to touch me because I was in such acute pain. I'm guessing he forgot what he was taught in Dr. Montgomery's class regarding basic. ..I'm thinking of another associate, I think her name was Michelle and she did take the time to show me how I should be getting out of bed or into and out of a car. These are things Dr. Montgomery showed us just last week.

In biomechanics we focused on the intervetebral disc which provide cushioning between our vertebrae.

There's so much work to do with all these classes. While getting good grades or grades good enough to move on to the next trimester is an obvious objective there is also a great desire to learn enough to be an effective and competent physician. I have been pondering the possibilities of becoming a mixed tri, meaning I would take two trimesters to complete tri-6 then go back to full time as a tri-7 after that. Some people do that by choice and some by default because of an insufficient grade. I need to get no less than 85% in all of my remaining points available in Diversified which, can be kind of a tall order. The written final in that class has a reputation for being amazingly difficult which means I would have to ace all the remaining practicals. We'll see what happens.

Physical Diagnosis was pretty fun today. We did a little more looking in the ears today and the teacher had an otoscope with a camera attached to it that hooks up to a computer. Maybe next week I'll have her take a pic of the inside of my ear and I can post it on my blog. It was noticed that my right ear has what looks like two perforations as if I may have had tubes in my ears at one time. I'm not sure and will have to give my parents a jingle to find out.

Today's pic is of the Welch Allyn digital otoscope like the one used in class. It was introduced by Welch Allyn February 6, 2008.

TRI-5, Wk8, Day 301 - Tuesday

We've got an extremely important dx imaging test coming up this Thursday and, I'm not sure why but we got hit with an assignment in Lab Dx which is due the morning of our dx imag exam. The assignment is in lieu of a couple classes which we're cancelled but, I think I would have rather had the classes. The assignment is consuming more time than if we'd have had the classes in the first place.

I got stuck on Monday when I first started working on it and concluded that maybe I wasn't thinking straight because I was tired but, after looking at it again tonight, I'm still a bit stuck. Apparently, from a couple comments I've gotten on Facebook I'm not alone. I think it's a little after midnight on Wednesday morning and I've already gotten some sleep in for the night and really need to make good use of the time I have before class tomorrow morning.

Our Cardiopulmonary Dx class has been pretty interesting in spite of a bias I have towards the heart. I'm not sure why but I don't have some of the terms firmly planted in my head.

Let's see ...

decreased compliance means increased recoil means restrictive dz

decreased recoil means increased compliance means obstructive dz

and, apparently, there are only three kinds of obstructive dz's, asthma, emphasema & bronchitis.

Maybe it's like how some names are easier to remember than others. Well, I need to crack open my Yochum & Rowe's radiology textbook and get to work ....oh, and finish that lab dx assignment. It looks like all my studying for Basic III will be done on Thursday night.

TRI-5, Wk7&8, Days 299 & 300, Fri & Mon

Wow, was that really day 300 on Monday? Holy Cow. We've got our Dx Imag midterm this Thursday and Basic III midterm on Friday. I also shadow interns again this Friday. We have to dress up a bit when working in the clinic so I bought a few new shirts, ties & pair of pants last week before my first stint in the Health Center.

Next week, on Wednesday (my birthday!) we have our Radiologic Positioning exam which is scheduled from noon to 4 p.m. or however long it takes for everyone to finish.

I guess this is a pretty tough semester. Unlike earlier in the semester when I asked people what they thought, I'm now getting responses like "it's the toughest semester yet" when before some people thought it was the easiest. Of course, the people that thought it was easy hadn't done any of the reading yet and we hadn't had any midterms either.

For the most part, I've been pushing myself harder than the semester has been pushing me which means I've generally done everything I'm supposed to in order to get through the semester. Div IV could still hold me up.

I noticed in Laboratory Diagnosis (lab dx) today that I'm starting to develop a bit of a theory towards disease (dz) and our current means of classifying various dz's. I can't quite fully articulate the paradigm but, it seems like for most dz's it's like we have a bunch of dial meters with little needles and when ever a certain combination of those needles go into the red zone then we may conclude we have a specific dz such as Grave's dz or diabetes. The little meters I'm referring to would be the various test we can perform on patients (pts).

Some dz's may be more conclusive with a single evaluation such as may be the case with Ewings sarcoma or Paget's dz via x-ray but, others require a more specific combination of lab results.

Part of this new way of thinking may have gotten an extra kick from our Physical Dx class. We've been exposed to various dz over and over again, dz such as Cushings, Addisons, Cretinism and Myxedema again and again but, each time we're seeing the dz from a slightly different vantage point. Today in Phys dx we were specifically studying the faces or facies associated with different dz's. Quite literally, picture after picture of people with various dz's and what their face looks like with each dz.

Overall, it is a bit fascinating. Maybe from all the commuting I do I'm used to seeing my speedometer and tachometer which is where I'm getting the guage idea from or perhaps from older types of computers and equipment which uses such little dials to monitor things.

I suppose if a doctor could see an ongoing set of data for a pt in terms of laboratory test then we could see the progression from a healthy to dz state ...the thought here is with intervention but another type of thinking is more along the lines of "pre-diseases" or when certain changes in the body manifest themselves with partial symptoms of what may become tagged as a specific dz.

OK ....I'm going off on tangents now and Googling various dz's. Need to get back to bed ...just enough time to get an extra hour of sleep before I have to get up for school. :)

TRI-5, Wk7, Day 298, Thur - Brachial Plexus

I sure am getting a lot of mileage out of my YouTube brachial plexus video. It's been watched over 23,000 times now, used in PT classes as well as at the New York College of Chiropractic for three trimesters and now I'm corresponding with an anesthesiologist in a hospital located in Munich, Bavaria who wants to use a clip from the video in a lecture she's giving to her medical colleagues in about three weeks. I sure would like to attend that lecture! :)

As is, I'd like to re-cut the clip they're interested in this weekend. I wonder if it's any coincidence that I was watching a YouTube clip of 99 Red Balloons by Nena earlier in the evening. (Nena is from Germany)

It's almost 1:30 a.m. and I'm having an amazingly difficult time getting to sleep... I might have to push my alarm from 4:30 to 5 a.m.

TRI-5, Wk7, Day 296 & 297, Tue & Wed

Apparently, I know a thing or two about drugs according to my score of 100.33% on Monday's Toxicology (aka pharmacology) Exam. Amazingly enough, my diversified score is at the other end of the spectrum. I can't say I agree with all the rationale behind the score I got on my first practical but, we must play nice and do the best we can to still get through the class. I'm not sure how likely that is but, I'll do what I can.

All my other classes are solid but, we still have to get through midterms for Dx Imaging and Rad Positioning. There's an HCP exam this Friday but I haven't found anyone who really knows what to expect on that exam or what it's about. Guess I'll find out. Our Basic Midterm is Friday, July 2nd with Dx Imag next Thursday and Rad Positioning on my birthday -- Wednesday, July 7th. :)

TRI-5, Wk6&7, Days 294 & 295, Fri & Mon

Just got done watching Dirty Dancing. The movie takes place in the Summer of '63, before Kennedy was shot, the Beetles ...and three years before I was born. The movie was released August 21st, 1987 and I remember the first time seeing it on television at my Grandma's house and how my Dad's sister, Pat, was enamored with Patrick Swayze and commenting how he was "all man!"

One of the first shows I remember watching at my Grandma's with the entire family present was about 13 years earlier with the first airing of The Six Million Dollar Man which first aired January 18th, 1974. If memory serves, it was an episode where he pulled out a fence post, complete with concrete mortar and threw it like a javelin.

I think the best movie of the 70s, in my opinion, came a few years later in 1977 with Star Wars. I'm not sure how many people were aware at that time of it being Episode IV, A New Hope ...I certainly wasn't.

My second favorite movie of that decade is Grease. :)

TRI-5, Wk6, Days 292 & 293 - Wed & Thur

Just finished up our Lab Dx exam. Once again, simply reading the assigned material and attending every class probably wasn't enough to ace that exam. I don't think it was all that hard but, I need to know more detail about more aspects of the subject matter. We'll see how it goes.

I learned I have a three hour break now since the next two hours are devoted to more Diversified testing and I already did that on Tuesday. One hour of cardio dx and a blood draw then I'll be done w/ the day.

TRI-5, Wk6, Days 290 & 291 - Mon & Tue

Well, I've never put so much time and effort into getting a couple C's like I got today and yesterday. These test kind of went beyond basic knowledge as taught in class. In Cardio, for example, it wasn't just enough to know what all the wiggles on an EKG readout meant but we had questions such as, "Consider a pt on an antidepressant...." ....then I'm wondering if this is an SSRI type anti-depressant or perhaps an amphetamine - ..probably SSRI but, geez... not exactly something we covered a great deal in class.

I'm thinking the extra credit we were given on this test should help out quite a bit. We had 10 different EKG strips and I felt pretty good about my answers. I can spot a 4:3 2nd degree AV Wenkebach heart block from a mile away - and I did on the extra credit (teacher confirmed it when I handed it in) There were only 35 questions on the cardio dx exam but the teacher still gave us a full two hours to work on it.

It seems like the things we are taught in class we are simply expected to know, it's not so much what we're tested over but rather a baseline of knowledge upon which other questions may be asked.

I got a slightly higher grade in Phys Dx. That test was much more detailed than I was expecting but, now I know and believe I'll do better on the next test.

I think I'm getting used to the longer days - 15 hours yesterday and 13 hours today ...just the way it's probably going to be for my remaining couple years. I've heard in the last few trimesters we don't have a break between semesters since we'll be working clinic duty.

oh well - we've got a Lab Dx exam on Thursday so, I've got to finish learning and memorizing all that baseline knowledge then start digging into the details behind a couple dozen diagnostic test. Piece of cake! :)

Today's picture is of a capillary tube after it's been spun in a centrifuge. We get to test our blood this Thursday after our blood draw for hematocrit levels and the pic of the tube is what ours tubes should look like.

just thinking ...from our original class size projections, Phys Dx was the 2nd most failed class last trimester so, at least I'm ahead of that curve. Well, better get to memorizing a few dozen lab values before i go to bed tonight.