AMSA Suture Lab

Suturing is a practice that all doctors must learn, not just surgeons, as suturing is done by general practitioners as well to assist in the closing and healing of a wound.

 Yesterday, AMSA (American medical student association) put on a beginner's suture lab for its members.  The instructor was very helpful and was previously a medic in the Army, so he had plenty of experience.  We had a chance to suture pig's feet together after making an incision longitudinally.   I learned how to tie a basic surgeon's knot and to put in basic horizontal sutures.  I also was able with some help to do  vertical and horizontal "mattress" sutures, which are used for deep subcutaneous gashes.

 

In the short hour and 20 min. I found myself getting better, and lost track of time doing the sutures.  It is an important skills, and like anything else must be improved with much practice.  I can assuredly
say that suturing pig's feet is much more fun than eating them.

High Fructose Corn Syrup

The seemingly unavoidable chemical that's slowly crippling the health of many in America is high fructose corn syrup.  Simply paying attention to labels on what they eat will lead the average American to realize that he's consuming large quantities of this sweetener.  The The Omnivore's Dilemna is a book that provides an in-depth account and cause of the drastic switch in the American diet.  It mentions the governments' subsidizing of corn as the primary driving factor for the surge in high fructose corn syrup additives.  Since the farmers were getting subsidized for their corn production, they produced more of it than ever before.  The sugar accumulated after processing the corn is higher in fructose than naturally found in most foods.

The potential problem with high fructose is its quick metabolism.  As opposed to glucose, fructose  must be phosphorylated before being broken down to be used for glycolysis.  This leads to the usage of phosphates on fructose that would otherwise be used towards making ATP for energy.  This causes a decreased metabolism.  Additionally, fructose bypasses PFK-1 controls in the liver, which are responsible for converting glucose to glycogen (branched form of multiple sugars) for later use.  Instead of being converted to glycogen, as is the case for glucose, fructose is stored directly as triglycerides (fats).  These two components are causes for the increase in obesity seen in America, as most diets are composed of fast foods and processed foods with elevated levels of high-fructose corn syrup.  Granted, fructose is high in naturally sweet foods such as fruit and honey, these were historically seasonal treats consumed in moderation.  In addition, these natural foods are not high in calories, so they are not as readily converted to triglycerides as high-fructose corn syrup added to foods already dense in calories; the ratio of sugars plays a role in metabolism.  Our body has the mechanism to compensate for low levels of fructose, however this drastic increase in  high-fructose corn syrup to most processed foods is leading to a health care crisis.

Glitch in the Matrix

A few things I’ve learned or reaffirmed for myself the last few weeks:

·      Habits and routines are the buffer for periods of low willpower

·      Exercise is the best start to the day

·      Tomorrow never comes

·      Medicine is a calling

   Just trying to get back on a steady schedule.  The last few weeks have been fairly unproductive for me.  After being disappointed by my last test score, it led me to reevaluate how I’m spending my time and what I want my schedule to be like in the future.  However, the scheduling part kind of got neglected.  I usually am most productive when I know what I want to accomplish that day.  Beginning the day on a whim more often than not concludes in a mediocre day as I did not have any idea of what I wanted to accomplish that day and therefore no gauge of it the day was successful or not. My best days begin with exercise in the morning.  In the morning, because otherwise I feel like it will take up too much time out of my day at night or afternoon.  In the morning because it leaves me liberated during the afternoon and night to accomplish what I want to without any interruption.

   

I began to stay up really late and wake up when my body felt like it.  In reality, I was afraid to set expectations in fear of not reaching them and thus avoiding the disappointment of setting those goals.  It’s been said that each action is done in an attempt to avoid pain and gain pleasure .  Thus in neglecting my scheduling it was a physiological trick to avoiding dealing with the disappointment of not reaching a set goal.  You can’t fail to reach a goal you never set.

    

One mistake I made was reading part of the four-hour workweek by Tim Ferris.  Not the best book for someone in my position.  It served as a quick reminder of things that I would not have the opportunity to do as a medical student.  It was slightly disheartening hearing about someone talk about designing a lifestyle that allows for 4-hour work weeks and his adventures traveling to various countries and mastering different hobbies all while running a business from his laptop.  And I am looking forward to 80 hour weeks in residency, long nights on call, and days being subjected to rapid-fire questions commonly known in the medical profession as “pimping”  by attendants.  This thought, albeit selfish, lingered for a while.  Would I have time to dabble in writing, travel, try potential business opportunities, piano, learn Spanish?

  

It was then reminded why I got into medicine in the first place.  Learning about fascinating advancements in medicine daily and the complexity of the body. Dedicating my time to helping someone restore their health gives purpose to my time at “work”.  I enjoy what I’m learning in the classroom and during clinical activities and look forward to implementing these teaching on actual patients.   

  

Well, back to studying…

Testosterone Replacement Therapy

Testosterone Replacement Therapy has been a subject of much research and use among fighters and the general population.  Recently, a top condender, Vitor Belfort has been missed out on a title shot for use of TRT which has recently be banned by the Nevada athletic commission.  Other fighters, such as Dan Henderson and Chael Sonnen have also been affected by the banning of TRT.

The increase in use has had mixed receptions from those who just want to see exciting fights at all costs to those who believe that TRT diminishes the integrity of the sport of mixed martial arts.  Many times the acceptance of drugs such as TRT are accepted based on the quality of marketing.  Their marketing scheme has made TRT be perceived as something other than steroids, which it is.  Testosterone is a major steroid that contributes to the secondary characteristics that are associated with men, such as: sperm production, sex drive, large muscles and deep voices.

Many of the commercials on TV market towards those with decreased libido.  The question "Are you suffering from Low T?" has become more and more popular.  TRT has become big businesses, and the prescription of this drug for decrease sex drive has become an increasingly accepted form of treatment.

One effect of TRT is the increased production of RBC's, which is initially a good thing for those in MMA, as they will have increased oxygen flow thus increased stamina, which can be a great thing when standing toe to toe with someone trying to take your head off.  However, this also increases the volume of the red blood cells that the heart must pump throughout the body, and this may lead to a deadly combination especially when considering how physically fatiguing MMA can be.  An article in the "Journal of the American Medical Association" even reported an increase of 30% in deaths and heart attacks in older men.  However, these results are disputed by various sources such as in this Harvard article.  TRT

Should TRT be banned in the interest of promoting fair competition or the in the interest of preventing cardiovascular problems?  Will the banning of TRT simply lead to the advancement of the use of similar, possibly synthetic hormones?  Should contact sports simply just be a laboratory for the advancement of human performance, do you as one comedian put it... "just want to see a MF fly."

Phineas Gage

The prefrontal cortex is the last to develop; it is significantly proportionally larger in humans when compared to other species and relates to intelligence, self-awareness, consciousness of perception & experience.  It is important in the various traits that separate humans from other species; namely our awareness of our existence and executive functions including:  Motivation, decision-making, responsibility, social control, rule learning, “willpower”. It is interconnected with brain regions involved with emotion (amygdala) arousal systems, and attention 

There may be reduced volume in individuals with psychological disorders such as depression, sociopaths, schizophrenics, ADHD.  This is why many sociopaths can commit heinous acts without feeling much guilt or sense of social injustice.   

Phineas Gage (1823-1860) was a friendly man who had respect of his peers and coworkers as a man of integrity and fun to be around.  Following a tragic railway accident, a metal rod pierced his maxilla, orbit, and prefrontal cortex in the fashion of a javelin.  He survived the accident, but was subject to peculiar changes in personality.

Pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ."  After the accident Gage was described as
.... fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man... 

This case lead to a great curiosity about the functions of various parts of the brain, and remains a relevant story about the importance of the pre-frontal cortex.  It generates a curiosity about how much of one's personality or uniqueness is limited to a particular part of the brain and if the uniqueness that make humans a distinct species would be adapted or shuttled to a different part of the brain in the case of such a lesion.  Also, in the midst of growing concerns over brain trauma due to contact sports such as mixed martial arts and football, how much of that goes on to affect a person's daily activities and personality.  More on that later.

http://en.wikipedia.org/wiki/Phineas_Gage

Hoop life

We won our game yesterday against a solid team.  The new courts are pretty nice, but unfortunately they're uncovered.  Which on rain days usually means slick courts or rescheduled games, but that's life on the island.  It's a nice break and opportunity to embrace some competition on the court.  We're currently 4-0.  

Portsmouth Clinic

This past weekend, local churches and a visiting churches from the U.S. put on a clinic.  I was originally scheduled to do the history of present illness, however they needed another person to auscultate for heart and lung sounds so I switched to that.

It was fun getting an opportunity to review some of the examinations I learned last semester and improve my skills.  There were children and adults, and it was interesting to hear how fast the small children's heart was beating.  The smallest girl produced the most rapid and profound heartbeat, but she sat there as calm as can be.  Her father replied "Yes, very very active" when I said she must be a handful with such a strong heart beat.

There were three brothers wrestling in the grass besides our tent.  When he came for his examination, I asked him if he ever had heart problems to which he replied... "yes, only when my brother kicks me in my heart."  The struggle of being the youngest brother.