The End of NBA Dreams

It's unfortunate how the dreams of Isaiah Austin were crushed by the results of an unexpected diagnosis.  He was diagnosed with Marfan Syndrome, which is a mutation in the Fibrillin (a glycoprotein) gene.  Fibrillin serves as an organizing center for elastic material to be deposited on the surface of microfibrils, allowing normal stretching of tissues.  This mutation leads to abnormal elastic tissues, decreasing the elasticity of tissues.  Therefore, if Isaiah Austin were to overexert himself, the increased load on the heart and large blood vessels (rich in elastic tissue) could cause them to rupture, unable to expand to accommodate the increased blood flow.

It was a honorable gesture for the NBA to recognize Austin and his accomplishments.

Alzheimer's Disease

Neurodevelopment

I'm bored... I'm bored! The seemingly endless activity and curiosity of a six year old can be a source of frustration for many parents and caregivers.  However, be patient, as these children at age 6 have just reached the peak of their neuronal synapses (connections) in the prefrontal cortex.  These levels remain fairly constant until about age 14, when the neuronal synapses decrease.  Therefore, the brain is the most malleable during the range from age 6-14.  Let the child explore and become immersed in an enriched environment as these experiences will determine which synapses remain and which are pruned (due to lack of activity) as the child matures into adulthood.

Chef Curry

I had promised to make a meal for the homie, Megan.  I planned to get my Chef Curry with the pot on... 360 with the wrist boi.  I knew what I wanted to make making it a simple task to go to the local grocery store, IGA, and collect the necessary items.  First on the list, sweet potatoes; I see the sign for sweet potatoes just to proceed to find an empty basket, nevermind.   Next on the list, chicken breasts.  Oh there's the chicken... chicken backs?  Nevermind.  How about milk? Not a single type.. no regular, soy, or almond milk.  That's when take-out started to sound fairly appetizing.  With IGA timing is king, if you go on the wrong day everything could be cleared out; such is life on the island.  However, we are in much better condition than a few years past, as the older graduates remind us how fortunate we are to simply have a large chain grocery store.

Anyway, I just ended up ordering some orange chicken, shout out to the Usual Spot.  I did sauté some kale though, so that counts for something right?

Stop and Think

Post-exam is always a good time for reflection.  It allows a short time to catch a breath before the next wave of information crashes down.  Granted, I did have a week with no new material, it still felt like there's constantly more and more material that I overlooked and failed to master before.

In the struggle to keep up with material, everything seems busy, busy.  Sometimes I tend to just wake up and just get busy with the day without thinking about how that day would be handled.  In essence, busyness can be a form of laziness, if I don't take the time out to delineate my plans for the day.  Efficiency towards the wrong task is actually ineffective.  When I am solely focused on the next task, my prayer time is rushed I don't truly appreciate the uniqueness and gift of another day.  That's when God seems to, through one source or another, say slow down son.

After the mini, I went to the beach where Joel reminded me that I'm not that great of a swimmer.  Nonetheless, it was nice to catch a break and enjoy creation near its finest.

Limitless

I haven't found one of those pills yet, so I guess I'll just keep studying for my exam tomorrow.  But  our neurology block starts on Wednesday, so maybe I'll figure out hey to make one soon!  I'll sell the pills and make enough to pay off a.... week's worth of tuition, or more likely just the interest accumulated during that week of schooling.    

Overview of the Digestive System

Just in case you wanted to know what was going on during the swallowing of that In-and-Out cheeseburger, or in my case: peanut butter and honey sandwiches.  Man... I've had so many of those the past few days.  Not to mention dropping the glass bottle containing honey and frantically trying to clean it up before the ambush of ants comes along.  A stabbing pain in my foot this morning reminded me that I didn't sweep well enough; it was just a small piece of glass though.  Mom and auntie Alma, I'm starting  to miss home cooking, it's not quite the same when I do it.

One of the benefits of being on the curriculum track is that I have more time to integrate material and create study products such as this.  The quality on my iphone is fairly poor, so here's a link to view the image on google drive, which allows more zooming in and out:   GI overview My upcoming exam this Tuesday is on the gastrointestinal tract.  It is very scattered, but mildly so compared to my usual diagrams, some of my study products look more like a game of connect the dots.  Here's some of the details that I omitted.  

Mouth:  

The hard palate, gingiva, and dorsal tongue have prekeratinized or keratinized epithelium, as keratin helps provide the tougher structure as opposed to the thinner and more permeable non-keratinized epithelium found on all surfaces of the mouth.  This is why drugs are more quickly absorbed under the tongue.  

The lips  are red because the blood vessels are very close to the epithelium, separated by a thin vermilion zone.  Stress can contribute to a lack or excess of filiform papillae contributing to white stripes on the tongue or a hairy tongue respectively.  

Salivary amylase clean the teeth by dissolving starchy foods stuck between the teeth.  Bacteria contain an enzyme called levansucralse which breaks down sucrose to glucose and fructose.  the glucose is used for bacterial glycolysis and acid production and the fructose forms the bacterial biofilm (plaque) on the teeth.  

Esophagus:

The upper esophageal sphincter relaxes immediately after swallowing to allow the food to pass then increase to a pressure above resting pressure to push the bolus (ball of food) down.  The contractions continue until the lower esophageal sphincter (LES) relaxes to allow food into the stomach then returns to resting pressure.  Achalasia is a failure of the LES to relax leading to difficulty in swallowing, regurgitation, and/or chest pain.  A technique called manometry is used to determine the pressure within the esophagus.

Stomach:  

High acidic leading to activation of digestive zymogens (inactive forms of enzymes).  The endocrine hormone Ghrelin controls the hunger sensation as is increased when the stomach is empty.  Various weight-loss drugs target this hormone to decrease the hunger sensation.  Ghrellin is also reduced in gastric bypass patients, which presumably contributes to success in various treatments. I am speculating that one problem would be the lack of nutrients that those with a non well-balance diet would receive.  People can feel hungry even after eating much junk food because of the lack of nutrients the body is receiving, and the Cheetos puffs and Dr. Pepper lack the nutrients that our body craves, thus leaving us hungry despite finishing the whole bag.  The reduction of ghrellin may decrease the indication a lack of essential nutrients, leading to a false sense of meal satisfaction.

The protective mucus of the stomach gives protection against the acidic environment.  However, when this mucus layer is broken down, typically by Helicobacter Pylori, it leads to a peptic ulcer.  This ulcer production can be promoted by drugs such as Ibuprofen.  Peptic ulcers can be treated by drugs known as proton pump inhibitors Omeprazole and Esomeprazole and H2-Receptor antagonists [Ranitidine (Zantac), Cimetidine (Tagamet), and Famotidine (Pepcid].

Liver:

The gatekeeper.  The portal vein carries blood from all of the organs to the liver for detoxification and metabolism.  It contains super-cells called hepatocytes which are rich in mitochondria, smooth ER for detoxification, rough ER (protein synthesis), and golgi.  

Pancreas:

The pancreas is a big storehouse for digestive enzymes.  It contains zymogens which remain inactivated until it reaches the duodenum, where the slightly lower pH activates it.  During acute pancreatis, which can be caused by alcoholism, the zymogens become activated in the pancreas, causing it to degrade.  The pancreas makes bicarbonate, which acts as an acidic buffer, but it lacks the protective mucus of the stomach.

Small Intestine:

The bulk of food digestion occurs in the small intestine.  It contains a brush border which aids in absorption of nutrients and increases the surface area.

Large Intestine:

Responsible for the reabsorption of water and inorganic ions.   Normal flora (healthy bacteria) thrive in the small intestine and assist in breaking down nutrients that we lack the enzymes to do so.  The breakdown of these enzymes usually leads to sulfur production, causing that familiar odor that you try to deny... One time, many years ago, my sister farted on an elevator full of people at Magic Mountain and my dad kept going on, making jokes about how terrible it smelt. He was unaware who passed gas.  Soon after, my sister's eyes started to water and she smacked my dad on the arm in a fit of embarrassment as we exited the elevator; her normal flora produced a not so floral smelling odor.

Rectum:

Here's the quickest way to get drunk:  The rectum contains a relatively superficial venous plexus that allows for quick absorption into the bloodstream and entry into the digestive system without first going through the liver.  Therefore, some engage in the process of  butt chugging this has very dangerous consequences, as the effects of alcohol are magnified.  

This venous plexus is also a common cause of hemorrhoids, caused by increased venous pressure due to straining or other effects.

1. Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999; 402:656.

Parasites

In honor our recent medical protozology and helminthology lectures, here is a video.  These creatures really are amazing in detail and features.  It's amazing to see God's creativity even in something so miniscule.  The first parasite in the video, Leishmania spp., is transmitted by the sand fly, which can be found in Dominica.  Fortunately, I have not ever heard of anyone being infected with the parasite.  This parasite can be distinguished by the amastigotes (developing parasite with no visible flagella) found within macrophages.

Eat your Carrots

A patient has night blindness, follicular hyperkaratinosis, and increased susceptibility to infection.  Which vitamin is he most likely deficient in?


A lack of Vitamin A is a cause of all of these symptoms.  Various forms of vitamin A are derived form Beta-carotene, which is high in carrots.  However, Beta-carotene levels are even higher in sweet potatoes.  Green leafy veggies are also a good source of Beta-carotene.  Vitamin A plays a role in the formation of rhodopsin ( a photoreceptor of rod cells) which is vital to the reception of dim light, thus contributing to your night vision.  So, yes, mom was on to something when she said to eat your carrots to see better.

However, a common misconception is that they increase your overall vision, which isn't necessarily true as Vit A does not contribute to cone cell formation, which function best in bright light and color detection.

Khan Academy

Part of medical school is determining how you learn best.  I've always considered myself a learner by reading something, which could be confirmed by assessment tests I was recommended to take.  However, many times these tests are skewed by our underlying picture of ourselves or how we were conditioned to learn throughout our early years of schooling.

I have notice that youtube has been a great source of learning for me, as it helps me to get a clear overview of the material in ways that a book summary could not.  Khan Academy, Armando Hasudungan, Andrew Wolf, and others who make videos with the blank screen technique seem to make learning easier.  I would recommend Khan Academy to anyone, as they now teach such a broad spectrum of subjects.

Slow and steady

The last couple of days have been very relaxed.  No lectures during this week, as this is the first time we are able to reap the benefits of being on the curriculum (aka slow track) track as opposed to the accelerated curriculum that the majority of students have chosen.

It's been nice having that extra time in the morning to devote to mastering old material and integrating new information instead of rapidly absorbing new materials and lectures.  I will have more time this week to compare notes from various lectures and take some time to directly prepare for the USMLE Step 1 exam.

Physician Compensation Report/ Medical School HQ

 Medical School HQ Podcast, a must listen for pre-med students,  recently released a new podcast about the physician compensation report.  This report surveyed many doctors from various specialties inquiring about salary and job satisfaction.

Interestingly, rheumatology, is the specialty that increased the most in compensation from the previous year, with a 15% increase!  This might be due to the increased popularity of talk in food allergies, such as the gluten free trend and dairy allergies.  Nephrology had the biggest decrease with a 8% decline.  This is surprising to me, as I have been hearing about many new kidney disease and dialysis centers opening up.

Among all physicians, self-employed physicians made more with $281,000 than employees with $220,000.  The ratio is much smaller among family practice physicians $188,000: $180,000 with self-employed physicians making more.  It will be interesting to see how this ratio changes next year as the effects of the Affordable Care Act should be more evident.  With a much higher percentage of the population insured, it would seem to reduce the number of patients who choose to pay out of pocket for treatment.

One disturbing trend, while small, is that the average time spent with patients is decreasing among primary care practitioners.  Out of the five options, 13-16 minutes was the most common time span spent with their patients.  This is discomforting, especially when considering how few times throughout the year most people visit their primary care physician.  However, physicians are required to thoroughly master the physical exam and be highly skilled in quickly looking for clues that might lead to any possible diseases.  With much practice, 13-16 minutes may be adequate time to address the patients concerns.

The article can be found here:
Physician Compensation Report 2014

Gluten

I came across the following blog post that gives good insight on gluten and the removal of grains as advocated by diets such as the Paleo Diet:

Paleo Diet

Cooking

I've been putting propane tank to use every once in a while.  Here's some of my work.  Usually I'm able to find spinach at IGA and the local carrots are probably the sweetest i've ever tasted.

Fake it til you make it

Just getting ready to assess a "patient" for any abdominal abnormalities.  Today was our second session of guided clinical skills lab.

My email address/ Contact info

My primary reason for starting this blog was to give people a glimpse into medical school in the Caribbean and address any concerns or inquiries.  However, I don't really know much about my audience: level of schooling, particular interests, and reason for visiting this blog. Therefore, if you have any questions about anything feel free to shoot me a message at theblackjacksparrow@gmail.com or comment on any of the posts.  If I get any particular requests I'll try to address that via a post or answer the questions via email.

Cardiac Cycle Notes

Sorry for the poor quality, but here are some notes of my notes on the cardiac cycle.

It's Lupus!

This past week, we had a Ross alumni come to give a presentation.  She went on to explain how us Ross students are at an advantage when it comes to clinical rotations.  As opposed to our U.S. medical school colleagues, we are exposed to clinical medicine much earlier.  We also have those extra six weeks of advanced intro to clinical medicine (AICM) after our four or five semesters in Dominica are finished. By the time we enter our rotations, we will be exposed to more than stateside students.  

This semester our clinical activities involve having a standardized patient come in while two students practice interviewing this patient.  At the conclusion of the interview, the whole group of about 8 students brainstorm a list of possible diagnosis based on the results of the patient interview.

Tell me about your poo...

Well I didn't do as well as I hoped on my first mini, but i passed... barely.  Now we're on to the gastrointestinal system.  

Don't be so quick to flush the next time you have a bowel movement.  Carefully examine the texture, color, size, and smell of your bowel next time.  It may indicate more than you might expect.  The stools shown in the picture above indicates the amount of time it takes for your food to pass through your G.I. system.  Generally the food you eat is passed within a couple of days, however it can take up to 5 days for some stools to be passed, in which case your stools will likely look like type 1.  Most people with normal G.I. have type 3 or 4 looking stools.  For a test run, eat a bowl of sweet corn kernels, wait and observe.

Type 1 stools are the ones that have been sitting in the intestines the longest and generally indicate a lack of fluids or normal flora, stress or not enough fiber.  If you have this type of stool, avoid alcohol or at least drink plenty of water, as alcohol will cause dehydration and delay the passing of toxic materials out of your system.  Fiber acts as the "glue" keeping the stools together, as it is not digestible but is integral to the structure of the stools.  

The link between a decrease in dietary fiber and an increase in colonic cancer is due to the fact 

that some of the secondary products of bile acids are carcinogenic. However, by consuming 

dietary fiber, the excretion rate of bile acids increases and allows the individuals to get rid 

of them before carcinogenic products are produced. The excretion of bile acids also causes 

more cholesterol to be converted to bile acids in the liver, there by decreasing serum cholesterol 

levels.  Fiber for the win!  Some great sources are: beans, whole grains, brown rice, nuts, vegetables, fruit.

On the other end of the spectrum, are Type 7 stools.  Diarrhea is usually caused by a bacterial or virus infection from foods or water.  It is the body's way of rapid cleansing.  Once again, be sure to hydrate, as your body is losing water fast.  

Chinese Gaokao

http://www.businessweek.com/articles/2014-06-06/china-girds-for-high-stress-gaokao-weekend

And I thought I studied alot...  The SAT/ ACT on steroids in China is going on this weekend.  These students spent countless hours to prepare for a test that determines which college they will be attending.  Extreme claims such as: lunch and dinner breaks limited to 3-5 minutes and a constant amino acid IV drip to ensure constant focus have been associated with preparation for this weekend marathon of a test.  These academy sessions can last from 5:30 A.M. to 10 P.M.  This test has a lot more riding on it then our SAT/ ACT because it is a determinant of which profession one will "match" into, as students go into medical school directly out of high school.  Some of the Chinese hospitals still have dormitories, causing students to earn the more literal term of being a "resident" than in the U.S.

This leads me to wonder how great the quality of life is for these students.  When you spend that much time towards one goal, it must be completely demoralizing if that goal is not obtained.  I find myself fortunate to be in a country that still finds value in having well-rounded students with various life experiences.  There's no way I would be prepared for medical school directly out of High School and am glad that I had the opportunity to defer my career plans a few more years instead of having my distant future determined by a single test.

21 day Challenge

Under the influence of Eric Thomas' T.G.I.M. series I decided to make my challenge going to the gym for 21 days straight.  I have heard that it takes 21 days to create a habit, while I don't believe this, it at least provides a concrete number to shoot for.  I completed the challenge and felt good after doing it.  I was less tired during the day after working out the morning, and it helped me wake up as my body began to become accustomed to the routine.  Some days were shorter than others, sometimes only 20 minutes, but it was more about the process than the duration.  One day I had stayed up late so slept in until 10 and planned on only staying at the gym for 10 minutes.  Fast forward that same day and I just finished my third mile on the treadmill, so I realized that the hardest part of a workout for me is just simply showing up.  Instead of developing some intricate workout program as was my first impulse, I decided to just go and figure out which exercises to do once I got there.  I like to do compound movements, such as bench press, squats, dead-lifts to work multiple muscles groups at the same time.  I would do high sets of these exercises, 5 or 6, simply to take the guesswork out of which exercise I'm going to do next.  Sometimes having too many options can become paralyzing.

That's one of the problems with our diet crazed society.  Everything becomes overcomplicated, where sometimes simplicity is the answer.  Sometimes the smallest steps, such as giving up soda, lead to slow albeit the best results.  Detox diets and workouts such as insanity are more glamorous, but take significantly more discipline, which is also a muscle that should be developed by making small successes and building self-confidence.

My next challenge is going to blog for the next 21 days straight.  I guess we'll see how that goes.

14 year old "mini medical student"

This past weekend, we had an event called "mini med school".  This was put on by SNMA the student national medical association.  Which I didn't know what SNMA stood for when a student had asked me (kinda embarrassing); I'll just continue to call if the Black people club.  Mini med school is an event where medical students volunteers show local high school science academy students around different facilities on campus.  I was supposed to be there for an hour from 9 to 10 showing the students around the anatomy lab, but the students didn't show up until around 9:45 so that messed with the rotation causing me to stay until 12.  As the arrived, the teachers still acted like what's the problem? We're here now.  I guess that's how the phrase "Dominican time" came about.  I ended up staying up late to finish media siting lectures, but it was worth it.

We split up into groups, one small group went to visit the simulation lab, but the majority went with me and a classmate into the anatomy lab.  A professor and anatomy lab instructor were present to give the students an overview.  Most students were very excited to see the cadavers.  One of the students peeked our from behind her teacher as she clutched her shirt vigorously in anticipation of our professor pulling the sheets off the cadaver.  They got an opportunity to touch a preserved lung and heart which made them light up.  We then went to the radiology lab where they viewed our 3d touch screen of the human body.  I'm ashamed to say that that was the first time i had been in the radiology lab, so it was as much of a surprise to me as it was for them.  Then they went off to view the physiology and microbiology lab.

We ended with lunch and a session where the students were presented a case and collectively came up with a diagnosis based on the symptoms presented.  Both groups came up with the correct answer with sound reasoning.  I was amazed at how intelligent these children were.  High school in Dominica ends at age 16, so most of the children were around 14-16.  They asked difficult questions such as the effect of racemic mixtures on drugs.  They knew more much more about science then I did at that age.  We closed with current students from Dominica sharing their story and encouraging the students to do well in their classes.  Dominican natives receive a full ride scholarship if they get accepted, but there are various hoops to jump through making it difficult but doable.  I wouldn't be surprised to hear about a couple of them getting into the school.

2nd semester mini 1

Time's almost up!  3...A, 2...no C, 1,... okay A.   That was my thought process as our first mini exam of the second semester came to a close.  Usually I finish well ahead of our allotted time, but this exam took longer for me because Physiology requires more calculations than the other subjects and this exam was mainly cardio and respiratory physio.  Granted I didn't have time to look back at some of the questions I had flagged, I felt it was a reasonable exam.  Regardless of the outcome, I've learned to place more weight on the effort I put into preparation, and I took deliberate steps to place myself in a position to do well.  I can't control the results but I can always control my effort.  I enjoyed the cardiology and respiratory block, cardiology more so than respiratory but nonetheless I appreciated the switch to studying one organ system at a time, it makes it easier for me to assimilate the information.  Afterwards me and a couple friends went to the basketball court to break in the newly assembled basketball courts.  It took me a while, but I eventually got my groove back.  Shots coming down from the sky through the net... who said there wasn't rain on the forecast?