The Student Physician

Nearly two and a half years, countless exams, memorization of facts and figures, pathologies, prescription drugs, and maneuvers that scare you to death -- and you think you might actually know "something" (but not everything). And then the first patient walks through the door and you realize nothing you could've possibly done thus far could have prepared you for what you're about to experience. Welcome to being a student physician.

Throughout my various collegiate undertakings, I've felt ignorant. There was never much of a point to thinking I knew everything or even all that much because I was constantly reminded that whatever bits and pieces I've pulled together meant only a drop in the bucket toward what's out there. I hate feeling ignorant. Maybe that's why I'm constantly reading and researching -- because I know that I don't know anything.

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Ricky in Radiology Positioning class
(Special thanks to Dave Aiello and Ricky King for this picture.)

Dr. Harrison, our clinician, brought up an excellent point last week (he has LOTS of amazing pearls of wisdom). He said that the stuff that we learn the best is the stuff that we're faced with. If there's a condition that we, a family member or friend, or a patient has, we WANT to learn about it. And so we learn those things the best. But when something is sitting right in front of you, there's this overwhelming need to know it -- right now. Sometimes that learning curve can be pretty frustrating.

Questions get asked. Tell me about your family. How are you feeling? What's going on in your life right now? Can you describe this or that sensation? As the physician, you're supposed to know, not only what it is they're talking about, but also how to put all of it together to make sense of what is in front of you. It's a complex task. Then you have to take the person in front of you, and figure out how to make them better, take away the pain they're having, help them cope with what's going on in their life, and help them re-enter their space of wellness. And of course, you hope that they're working with you on this. This takes skills they don't teach in school. We can take all of the interviewing skills sessions, basic and clinical sciences, and psychology classes and still not be able to put all of these "issues" into the complex Being that sits in front of us. So, as I sit here wearing my white coat, I can honestly tell you that nothing I've done over the last two and a half years prepared me for my first patient. Not a thing. Not even remotely. Of all the things I've learned, even over my whole life, listening seems to be the most beneficial.

One of my biggest fears when starting clinic, besides being worried I wouldn't know what to do, is that I would be stuck with pure musculoskeletal cases. I know, this is chiropractic and musculoskeletal would theoretically be a big part of most chiro's practice, but I wanted the hard cases. And I'm getting them. From complex vascular issues to hormone imbalances, I've had to do research in the first week on topics that we didn't learn in any of our classes. Before any physical exams, before any orthopedic testing, just doing the history, I'm learning so much. I love learning this way. Get a topic, find out as much as you can, and then apply it.

Pick up a copy of Harrison's Internal Medicine, and also a copy of the Textbook of Natural Medicine, and Textbook of Functional Medicine. All three of these will serve you very well. Even though these three are great resources, there are some things that still require digging. I love a challenge. Good thing I'm in the right field.

Have a great week everybody!

Hey, Everybody! Welcome Back!

Two weeks of break isn't anywhere near long enough. It seems like just about the time that I get into a new groove of being out of school, things start up again. But, this time -- it's different. I'm an INTERN!

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My intern badge

Last week was the first week in Student Clinic. We went through procedures and charting info and a bunch of other things. I think it's going to be AMAZING! Dr. Harrison (our clinician) has taken the time to explain so many things to us already. It's a whole different world, now. I don't know what I thought it was going to be like, but it's different. And I think it's going to be great. I started out this week as a secondary, and I see my first patient on Wednesday.

Break was wonderful. I was able to take some time off, do some volunteering, and work on some projects. I feel "lighter" -- having been able to accomplish some things that I hadn't had time for thus far. That having been said, I'm still behind. That's not tremendously surprising. I'm making lists and slowly getting things done.

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Sunrise over Tampa Bay

The Master's has been ongoing. My classes right now are in Botanical Medicine and Immunology. I've learned so many fascinating things. Last week I got stuck in researching zonulin and tight junctions. I've been trying to pool together all of the locations that contain tight junctions in the body, so I might be able to link proteins and chemicals that disrupt the tight junctions with disorders that occur at those locations. I have to stop myself sometimes, from going too far down the rabbit hole with some of my research -- because I'll get so engrossed that I forget about everything else. Sometimes I have to stop myself at the point of too many questions. It turns out that some of the ones that I came up with last week (according to my professor) don't currently have answers. I guess I'm not the only one with questions.

I'm looking forward to the Tri mixer -- whenever that will be -- and Wednesday with my first patient. I'm secondary on patients before then, so that will be interesting as well. Mostly, I just want to say how excited I am to be here.

Welcome back, everyone! I'm glad you're here.

We Made It - Week 14

We made it! Well, almost. It's week 14 -- which means there's only one week left. This week and next week are finals. This week is mostly practical finals, but I have a few written as well. Acupuncture, the practical, was over the weekend. We also had the clinical entrance exam for physical therapeutics. We have to pass that exam, in order to progress to the clinic and treat (using those modalities). We were all pretty nervous -- because we're all anxious to get to clinic.

After next week, I'll be in Tri 8. Tri 8. (did you hear that sang angelically and see the beams of sunlight streaming down onto those two words?). They did. We've been talking about schedules and who will take what shift -- and how nervous some of us are. I'm not nervous -- at least that's what I'm telling everyone. I'm anxious to see what all we'll end up doing. What most people don't know is that any of the St Pete College and NUHS students can come to our clinic for free (and their immediate family too). We're really hoping that we see a lot of people -- that need all kinds of help. We do more than MSK -- just to let you know. I'm really hoping to get some functional medicine and nutrition patients as well.

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So, after the "festivities" of the next 2 weeks, we have break. Break (did you hear the angels again?). This will be the first break that I've actually had since Fall of 2012 -- not because we didn't have a break, but because I was so busy. I worked, moved, studied for boards, worked -- and now, I finally get a break. I'm so excited! What will I do? I am going to a festival, the first weekend of break -- and I'm really looking forward to it. I haven't been to one here in about 4 years. I'll be volunteering as a Medic (only requires CPR certification), and I always have an amazing time. I also still have Master's work to do (which starts back this week), and random stuff around the house -- projects, prospects, and purpose. I'm trying to stay focused on finals and studying, but the allure of "free time" is haunting the back of my mind.

So, I figured you all needed to see something new around the area, so I went to Gulfport. I don't know why I haven't taken you all to Gulfport before -- it's only a hop, skip, and a jump from my house. While most people spend their nightlife in Ybor in Tampa or in Downtown St Pete, I tend to go to Gulfport. My favorite karaoke bar (O'Maddy's) is there -- where on random weekend nights I might be found singing Pink, Bonnie Raitt, or Evanescence. Really, Downtown Gulfport feels like a really small town right on the beach. There are some little shops, open air bars/restaurants, and a beach. It reminds me of the little beach towns in movies from the 50's and 60's.

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Gulfport Casino

So, featured in the pictures today is the Gulfport Casino -- right at the center of Downtown Gulfport. Here's some history about it: Then And Now: The Gulfport Casino Ballroom. The Casino, as it stands now, was built in 1934 -- and architecturally it fits into the time -- beach-Craftsman era. They host all kinds of events there now -- including ballroom dancing. If you're in town -- before or after you come by the school, I recommend stopping by. And if you see me at karaoke, I might even sing you a song. I know that I'll be spending some time there over break. I'm really looking forward to it.

So, I'll see you guys after break. Good luck on finals. Enjoy the time. Next Tri means big, big things.

Happy Week 13

Have you made your study schedule yet for Finals? (You know they actually start next week, right?) My schedule is somewhat made; exams, practicals, and last minute assignments have been entered, and from this point I just have to get busy! I'm on a brief reprieve from the Master's, until next quarter starts (during Week 15 here), and I've had off from Acupuncture for the last 2 weeks, so the Universe, and school, saw fit to give me some time. Of course, I still feel behind and also am a little bit panicked (as always happens). Right now it looks like 6 exams for me next week, and 7 the week after that. I'm already ready, but will definitely be more ready for a break.

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Sunset at Treasure Island Beach

Last week's Cadaver Workshop was AMAZING! I was, admittedly, a little nervous when I found out I'd be going over the musculature. After all, other than diagrams, I hadn't been back in the lab since I left basic sciences. And I hadn't worked on the back or limbs since first and second tri. I'd forgotten how much I love being in there. I suspected that would be the case, but I was actually thrilled and surprised at how much I remembered. I loved it so much, that I'm going back this week to do it again. We did a bit of show and tell, and also asked questions and quizzed the students that showed up.

We had students from the undergrad program, PA program, nursing, and EMT at St. Pete College. I'll be interested to see who comes this week. It's absolutely invaluable experience. It also reminded me how much I enjoy teaching. Back in undergrad, my internship was TA-ing biology for non-majors. THAT was an experience. It's frustrating, sometimes, to be teaching people who aren't always interested in what you have to discuss, or to approach things from a manner that everyone can understand (or that encourages clarification).

I have been planning, for about the last year, to spend at least part of my career teaching. I'll be honest; I'm really looking forward to it. Who wouldn't want the opportunity to geek out on a regular basis, and get paid to do it? What would you teach? Biochemistry? Physiology? Functional Medicine? Nutrition? Yeah, I could really get into that. The tough part will be finding a location that will allow me to practice, and has opportunities for teaching.

Last week, I did a Rehab demonstration on therapies to use for Rheumatoid Arthritis. I learned a lot in prepping for the demo -- like how the joints in RA patients can be hotter than normal, and how heating the joint itself can be damaging (but heating the muscle is fine). I learned how important it is to protect the joint -- even to the point of how the patient sits. The "point of relaxation" for the knee, for example, is full extension. This is the position that is least likely to promote joint degeneration. There are other positions for other joints. This week, I'm giving a presentation on Raynaud's Phenomenon (which I've had since I was a teenager) and therapies for treatment. I fully intend to go get my thick wool gloves for the demonstration -- just for effect. Although, if they continue to keep it so cold in this building, I'll have to wear them all the time. It does make it difficult to type and take notes.

Photo of sunset at Treasure Island beach from another angle
Sunset at Treasure Island Beach

There haven't been any other events going on for the last week or so, other than a ROCK tape seminar this weekend (that I didn't go to). But if you remember back, not that long ago, when I volunteered at the St. Pete Beach Classic and met Mr. Incredible, I have something to share. Mr. Incredible found ME! Last weekend, I received an email out of the blue, from Mr. Incredible himself, who found the blog and wrote me. (I do answer all of the messages that come through here, in one way or another.) He's starting on a new adventure with his training. Feel free to check out his blog: Superheroes on the Run.

All right kids, have an amazing pre-finals week! Remember to keep going to the gym, keep sleeping, and keep eating good food. You'll be glad that you did.

Week 12 - Breathe

We're nearing the end of the trimester. It's the calm before the storm. Since my classmate Lexxi just reminded me, I'll remind you. Did you: do your FAFSA? Taxes? Register for classes?

This week starts the last minute projects and presentations before practicals and finals. Actually we have part of a practical on Friday for PT. I'm going to rehab a knee with Rheumatoid Arthritis -- which I'm finding as a bit of a struggle. How do you give someone exercises for a degenerating joint, when they have to move the joint? I've been pondering it quite a while. Here's hoping I come up with something good.

This week and next week, our program hosts a cadaver lab demonstration for the nursing, PA, and other health professions programs that we share space with. For those who aren't familiar, we share some campus space with the St. Petersburg College health profession programs and Barry University PA programs. Since some of our classroom space is at the St. Pete Caruth Health Education Center, we see a lot of students from other programs running around -- including RN, PA, EMT, etc. Unlike our program, they don't have cadaver exposure, which always surprised me.

So, since we do, we host workshops toward the end of each trimester to expose those students to what the body really looks like. Several of our students will spend an hour or more in the lab going through some general parts of the anatomy, and explaining function, etc. I've always been surprised that the other programs don't have cadaver exposure. I honestly feel that dissecting has given me invaluable information that there's no way I would have known otherwise. Even still, when someone asks me a part of the anatomy, my mind automatically goes to the cadavers to visualize it. I do this during classes; I've done this during boards. It helps to actually SEE where the origins and insertions are, how the vasculature and nerves surround and penetrate the muscles, and how the muscles layer and invest in each other.

I haven't been in the cadaver lab since I finished that portion of basic sciences several tris ago. I'm REALLY looking forward to it. I think most of the other student-instructors will be from basic science tris. It'll be fun to get to interact with them. That's a privilege I don't often get.

On Saturday, I went to the Gluten Free for Life Expo. Last year Grey and I went, walked through, and received a ton of samples, coupons, and business cards from local gluten free businesses. This year, I was by myself, as Grey was at an FBLA conference. I ran into Julia, my classmate, and her daughter-in-law, Stephanie.

Beyond running into them and seeing my friend who runs a local acupuncture clinic, the expo was a total waste. And it wasn't just because of the samples and coupons -- which I guess were there -- it was because of the quality of products. If you've ever been to a health food store (and I'm guessing all of us have), you've seen that there's just as much junk food there, as there is at any other store. It's labeled as "organic" or "all-natural" or "healthy", but the difference is only that they use sugar instead of corn syrup, organic versus conventional, and substitute refined with less refined. That doesn't make any of it healthy.

So, I talked with the reps for a company (that I won't name), because they recently reformulated their products. They are dedicated to having gluten free, GMO free products. I respect this tremendously, however, they still have some pretty big problems. Previously, they were using sorghum flour -- which has been a staple in gluten free cooking for a while. Even I have used it on a regular basis (although not for several years). The rep mentioned that they were having problems with their sorghum flour becoming contaminated with GMO soy. So they changed formularies and started using buckwheat and millet instead. The problem is, that these other grains contain lectins, in very high quantity. Lectins, in brains, beans, and potatoes, cause disruption of the tight junctions in the gut -- leading to leaky gut. Leaky gut leads to food intolerance, inflammation, and lipopolysaccharide invasion (toxins from gram negative bacteria that naturally live in the gut). Big problem. Check this out: The Lowdown on Lectins. And if you're a real glutton for punishment Dietary Lectins as Disease Causing Toxicants for far more in depth information.

So, I talked to the rep about how the choices they've made in substitutions are likely to affect their customers. The lady didn't have a clue what I was talking about. But she seemed pretty scared in response and said she'd pass it on to their recipe people. I'm sure it won't go any further. I looked through the ingredient list on EVERY product they had there. The few that didn't have millet or buckwheat had TONS of sugar. *sigh* Gluten free isn't always healthy.

Since my "conversion" to mostly Paleo, I just can't look at food the same way. I'm always thinking about the grain or carbohydrate content, how much I'm allowing my gut to be exposed to the lectins and sugar, and what it's doing to me. I'd say I'm about 80% Paleo now. I go back and forth -- trying to only have rice a couple times a week, and sugar maybe once. It IS a struggle sometimes, especially when I'm stressed out. But I feel SO much better.

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And before I go, I've wanted to share this guy with you all for quite some time. He stands outside a defunct mini-golf turned car dealership parking lot. I often wonder why he's still here -- maybe it's because he's so awesome. I haven't come up with a name for him yet. I'm willing to entertain suggestions. There are lots of oddities around St. Pete.

Have a great week everybody.