Shooting Our First X-Rays

Now that my colleagues and I are in clinic, we will be treating patients mostly on our own with some help from our clinicians. Within our scope, we are able to order advanced imaging. Some doctors refer out for films, but others take X-rays in their offices. Since it is in our scope, we must learn how to take X-rays, not just read them or know when to order one.

As I mentioned in my previous post, we are split between clinic and class. One of the classes we are taking is radiographic positioning. In this class, we need to be able to determine the position of the patient, the position of the bucky (a device found underneath the exam table that the cassette and grid is slid into before shooting X-rays) the position of the cassette, the distance the patient should be from the bucky, the distance of the X-ray tube to the bucky, and the settings for amount of radiation to use in the beam. We need to set the speed and density of the X-ray beam based on the patient's size and distance. Then we need to enter the numbers into the machine, some of which we need to calculate. Once we are all clear, we start the machine and shoot the X-ray. We each shot X-rays on cadaver models.

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After shooting the X-ray, we took the digital image receptor to the computer and viewed the image. We shot our first successful X-ray and had to pose for a few pictures.

We experimented with the amount of radiation to see what would happen with increased and decreased radiation exposure. It was part of our assignment and we determined the more radiation used, the worse the X-ray was. We learned it in theory but it was amazing to see it in person. It drove home the point that we need to be cognizant of the amount of radiation we use when we expose our patients. This is to ensure a minimum amount of radiation exposure and to achieve the highest quality image for diagnostic purposes.

In clinic, we shoot films for anyone who needs it. This class has helped me understand how to do it and though I hope my patients never need X-rays, I am pleased to say I will be able to do it if necessary.

That is all for this week, if you have any questions about student life at NUHS, please email me at ChristopherKotwicki@student.nuhs.edu

Phase Three Begins - First Week as an Intern

After all the basic science classes from biochemistry, anatomy, and microbiology, to the clinical sciences classes like advanced diagnosis, neurological systems, and clinical nutrition, I am now officially a student intern at the National University of Health Sciences. It really is an amazing feeling. I am so close to becoming a chiropractic physician I can almost taste it.

I am in 8th trimester, which means I am splitting time between clinic and classes. I will have clinic on Mondays, Wednesdays and Fridays. All three days start bright and early at 8am but end at different times. Monday is 8am to 4pm, Wednesday is 8am to 3pm, and Friday is 8am to 2pm. I will finally be able to utilize everything I have learned.

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After beginning with 16 people in my cohort, my friend Kelsey and I are the only two left on fast track from our original group. Many slowed down from our group and students from the trimesters ahead of us slowed down and joined us. Kelsey and I will be graduating together in April 2018 with four other students who started in the trimester before us.

The school split the six of us into two groups of three. Kelsey, Brandon, and I are in the Whole Health Center at the Caruth Health Education Center. We are with Dr. W. Scott Harrison, a National graduate with 30 years of experience. The other three interns are at the Pinellas Park Clinic. They provide acupuncture at the Pinellas Park Clinic, so it worked out that the three students who took the acupuncture course, ended up in the clinic that provides that service. I did not take acupuncture, so I didn't mind which clinic I ended up going to.

If I had the choice, I would have chosen the Caruth clinic. I am with the more experienced clinician and I am with two of my closest friends from the program. After clinic orientation, I was ecstatic to get started. We took a tour of the clinic and went over the standard procedures within the clinic. National University of Health Sciences utilizes electronic medical records and we spent most of the first day becoming acquainted with the system. After the tour, we posed for a picture to commemorate our first day. We are very excited to get started.

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In addition to the three days of clinic, I have two days of classes on Tuesday and Thursday. I am taking the following 11 classes:

  • Ethical Management of Chiropractic Practice
  • Risk Management and Legal Issues
  • Clinical Natural Medicine
  • Doctor-Patient Relationship
  • Dermatology
  • Evidence-Based Practice IV
  • Sports Medicine
  • Advanced Technique II
  • Comparative Technique and Listings Systems
  • Radiology Management and Report Writing
  • Radiographic Positioning

Though I have started clinic, I am still taking classes so I need to study in my off time as well as review for the boards. I will be taking Parts II, III, and PT in the near future and need to stay sharp to pass.

Thank you for reading my blog! Please email me at ChristopherKotwicki@student.NUHS.edu if you have any questions.

The End of Trimester 7

After multiple standardized patients, case reports, mock physical exams, practical exams, and written tests, I am moving into the next phase of my professional schooling. I start clinic at the beginning of next trimester! I will no longer be seeing standardized patients; I will be seeing real patients and will put my clinical reasoning and physical capabilities to use.

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I have finals next week in modalities, end range loading, physical therapy, advanced diagnosis, clinical nutrition, radiology of the chest and abdomen, and psychopathology. This past week was great and was exactly what I needed before the stress of finals ensue.

Dr. Ted Forcum, chiropractor for the PGA tour, U.S. figure skating champions, and U.S. track and field champions, came to our school to lecture on kinesiology taping and demonstrated his functional assessment and tape application. He used a combination of screening tools from the National Academy of Sports Medicine (NASM), Selective Functional Movement Assessment (SFMA), and the National Strength and Conditioning Association (NSCA).

After finding discrepancies in movement, he used kinesiology tape in specific areas to "change tissue tension." The results were astounding! The application resulted in a significant increase in range of motion and decrease in pain during palpation. He practices in Oregon, but was in Florida for the American Chiropractic Association's Rehab Council over the weekend. He explained how he uses the kinetic chain in how he approaches treatment. It was very useful information.

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This week, I was also awarded a scholarship for "leadership at NUHS and in the chiropractic profession." I was honored to receive this award and it is the scholarship I am most proud of. I was humbled to receive this award because it was based on my professor's recommendations rather than my own testimony.

Being seen as a leader comes with great responsibility, but we as chiropractic physicians will all be seen as leaders to our patients. We will be sought out to help our patients with their pain, problems, and goals. We need to help lead them through their journey both with active intervention and by setting an example.

My advisor always says, "If you are going to preach a healthy lifestyle, you need to live a healthy lifestyle." Being seen as a leader by my mentors has reiterated that advice. It was a great reminder that my actions will impact others. The effort I put in at school doesn't just affect my grades; my knowledge will affect the health of others. With this in mind, I am ready to take the next step in my journey into becoming the physician I sought out to be. 

If you have any questions please email me at ChristopherKotwicki@student.NUHS.edu

 

Complementary & Alternative Medicine to treat my Strep Infection

Last week I left Washington D.C. and came back to Florida with strep throat. I have theorized that many factors lead to a compromised immune system such as stress, lack of sleep, poor nutrition, and excessive alcoholic consumption on St. Patrick's Day. I was given my diagnosis and medication by a medical doctor in Virginia and, in addition to those interventions, I supplemented my diet with antimicrobial foods.

Tea

At NUHS, we take two nutritional biochemistry classes, three nutrition classes, and two botanical medicine classes. In Nutritional Biochemistry, we discussed micronutrients like zinc and Vitamin C and how they can be immunopotentiating. In Botanical Medicine, we discussed functional foods as well as herbal supplements like Echinacea and Goldenseal, which are immunopotentiating and antimicrobial. To combat this infection I decided to take the prescribed antibiotics but prescribed myself a healthy diet of antimicrobial foods.

Strep throat will go away with or without antibiotics, however one can remain contagious for two to three weeks if one does not treat with antibiotics. I do not believe the literature took into account diet and herbal supplements, which are also broad-spectrum antimicrobials and may have similar effects to the antibiotics. That said, I did not want to risk it because I live with my girlfriend and go to school with people who are not sick. I did not want to infect my classmates or significant other. I bought an over the counter supplement with zinc, vitamin C, Echinacea, ginger, selenium, and other micronutrients essential to the immune system.

In Nutritional Biochemistry, we discussed nutrient and drug interactions of the supplements. Zinc can affect absorption of antibiotics and reduce their effectiveness. One must wait three hours between consumption of each in order to ensure absorption. In order to soothe my throat, I gargled with salt water and drank plenty of green tea. In order to enhance the tea's soothing and medicinal properties, I added fresh ginger root, lemon, and raw unfiltered honey. The ginger, lemon, and raw honey are all anti-inflammatory and antimicrobial. Green tea is also an abundant source of antioxidants. 

Soup

For dinner, I made an antimicrobial soup from scratch using organic bone broth, garlic, celery, peppers, onions, carrots, chicken, and romaine lettuce. I then seasoned it with basil, thyme, rosemary, oregano, and parsley. The bone broth has minerals like calcium, magnesium, and phosphorus. It also contains the amino acids proline and glutamine, which are vital to immune function. Celery, peppers, onions, and garlic are all potent antimicrobials as are the herbs I used for seasoning. Finally the protein from chicken is necessary to help replenish and fuel the immune system. Protein is required in our diet because we cannot synthesize the 10 essential amino acids - phenylalanine, valine, tryptophan, threonine, isoleucine, methionine, histidine, arginine, leucine, and lysine. These are necessary for a multitude of functions within the body and therefore required when one is sick.

I had a complete resolution of symptoms in just two days of this regimen. I highly recommend anyone who has an illness to use complementary treatments in addition to the conventional treatments like antibiotics. If one does not have access to antibiotics, garlic, onions, and oregano are all potent broad spectrum antimicrobials and can be used to help fight the infection. Always seek out a medical professional when you feel ill. Even as someone who knows a few things about diagnosis and treatment of infectious diseases, I seek out professional help when necessary. We all have a part to play in the new health care dynamic; we learn complementary treatments for any and all conditions here at National that will enable me to help my patients in more ways than just adjusting the spine.

That's all for this week. Please send any questions you have to mailto:ChristopherKotwicki@student.nuhs.edu


Infectious Disease. Is it the Seed or the Soil?

I fell ill at the tail end of my trip to Washington, the last day in D.C. I had a sore throat and a headache. I attributed both to a lack of sleep and a few too many alcoholic beverages on St. Patrick's Day. The following day my symptoms got much worse. I had a fever, chills, aches, fatigue, a severe sore throat, and my headache had not let up. That morning I went to a local urgent care in Virginia. The doctor did a rapid strep test and a rapid influenza test. The strep test came back positive and I was given a prescription of antibiotics and ibuprofen. I was asked by my friends, "How did you get sick?" or "Who made you sick?" I didn't have a definite answer but I had a pretty good idea.

As a biology major, I was taught the germ theory that gained prevalence thanks to the work of Louis Pasteur and Robert Koch. The germ theory basically states that microorganisms cause diseases. We now know there are some diseases like cancer, genetic disorders, and autoimmune diseases that are mostly not caused by microorganisms. There are some exceptions such as HPV causing cervical cancer and infectious mononucleosis preceding autoimmune diseases. However, for the most part the germ theory is spot on. So who gave me an abundance of streptococci? I did not share drinks, kiss anyone, or inhale anyone's cough or sneeze; therefore I suspect I did not get strep throat from someone else. So I ask again, how did I get sick?

B.J. Palmer was responsible for bringing chiropractic notoriety and credibility in health care, but he was also at odds with mainstream medicine. B.J. Palmer wrote in the early 1900s, "If the germ theory of disease were correct, there'd be no one living to believe it." This is an interesting counterargument and one that I have to mention because it is going to help my explanation.

There are more than 100 trillion microbes in and on the human body. During my time at NUHS, I was faced with the question, "Is it the seed or the soil." Do germs make you sick or is it the susceptibility to those germs that makes you sick? I was always taught to never sit on the fence, but there is no other way to answer it. It is both. If susceptibility were not the issue, opportunistic infections would not exist. If germs didn't cause disease, healthy people would never get sick.

It is documented that when people are immunocompromised, they are more susceptible to opportunistic infections. Studies have shown that stress, lack of sleep, excessive alcohol consumption, malnutrition, and hypothermia can cause immunosuppression. During my trip to D.C., I did not sleep at least 7 hours each night because I was sharing my bed with someone and it was difficult to sleep in a new place. I did not consistently eat, because the meals were scheduled at specific times and I was catching up on sleep or busy with the conference. I was hypothermic, having not brought a coat and was walking around in 30º weather all week. I was stressed from catching a flight, finding a ride to the hotel, and preparing for lobbying on The Hill. I drank alcohol on St. Patrick's Day. All of these factors lead me to the conclusion that I didn't catch strep throat; I became susceptible to the streptococci that are present in the oropharynx. Strep throat is one of the opportunistic infections seen in those with HIV; therefore it is biologically plausible that anyone who is in an immunocompromised state can contract strep throat.