Archive for tag: faculty

Catch Ya On the Flip Side

It's a bittersweet entry this week, as this is my last blog as an NUHS student. Sad right? I can't believe it's been a year and half that I have been sharing my "wisdom" with everyone. It's been an incredible three and half years. I know its cliché, but the time really did fly by. It seems like yesterday I was sitting in orientation with Dr. Stiefel, listening to how rigorous the next 3+ years of my life were going to be. He wasn't joking either. Those first 2 years, I was a slave to my textbooks, notes, and presentations. The load thinned out over this past year in clinic, but the practice and studying was still and will always be a huge part of my week to week. 

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Jeff, Guy, and I at a graduation dinner on Saturday.

I cannot thank our professors enough for the countless hours of help and dedication they've put towards us:

  • I'd like to thank Dr. Jennifer "Vice-Grip" Illes for being patient with me constantly nodding off during her post-lunch E&M courses, and of course for teaching me how to adjust!
  • The incredible Dr. Jaya Prakash helped me understand pathology and microbiology in a way I never thought I could.
  • Dr. Richard Leverone, Dr. Terry Sandman, Dr. Heather "Awesome DACBR" Miley, and Dr. Rudy Heiser made me realize how much I love radiology, and who knows, maybe one day I'll follow in their DACBR footsteps.
  • Then there is the always smooth, Dr. "Wiki-SRI-dia" Sridharan Manavalan, who along with Dr. Leslie Pearlstien, taught us the ins and outs of the human body in anatomy class.
  • Who could forget the dynamic Lombard duo of Dr. Robert Humphreys and Dr. Daniel Richardson? Dr. Richardson always made class a blast, especially when he couldn't find his glasses that were always resting on top of his head. I can't thank Dr. Humphreys enough for allowing me to co-manage his Florida neuro cases, and teaching me a lot of his tricks of the trade along the way; and yes, I still owe you lunch, Doc.
  • How could I have gotten by without the incomparable Dr. David "Coach" Seaman? I can break down the conversion of just about anything you throw in your mouth to the enzymatic level thanks my advisor and pal, Dr. Seaman.
  • I am more than confident in rehabbing just about any condition that will walk into my office, thanks to Dr. Tim "You can always be faster" Stark. Dr. Stark has always been there with either quip or advice whenever I've approached him. Thank you.
  • For the past year, Dr. Rudy "wild-assed-clinician award recipient" Heiser, has molded and refined my clinical skills. Dr. Heiser has let me learn through mistakes, treat in my own way, and all the while made sure I was doing it correctly while offering great advice along the way.
  • None of this would've been possible without the countless time and effort put in by Dr. Joe Stiefel. Dr. Stiefel not only taught, but administrated, and handled all the behind-the-scenes activities that made the Florida Campus what it is today.
  • Finally, I'd like to thank my mentor and friend, Dr. Chad "The Intimidator" Maola. There is no way I would have been the student, or the intern, or the doctor I am without all the extra time Dr. Maola put in with me. I'll never forget the day during my last final exam of third trimester, when he came in halfway through the exam and told me to report to his office as soon as I was done. The conversation Dr. Maola and I had that day in his office is the reason I am as good and confident at what I do. I know Dr. Maola has taken some flack over the years for the extra time he has taken with me, but I want to let him know that it never went unnoticed.

Enough with the goodbyes. My time at NUHS has been great. I can't believe all that I've learned over the years, and all the friends I've made along the way. Congratulations to the graduating class of 2012!

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Jeff, Guy, Dan, me, and Margaux

All of us down here have plans on practicing in Florida. Margaux plans on pursuing veterinary chiropractic in the St. Petersburg area, Dan Johns has his eye on a practice in Fort Lauderdale, Guy Reshamwala is taking over one of his older brother's practice in Hudson, Jeff Bourguignon will be independently contracting in Tampa, and of course I will be opening my practice in Tampa as well. My door will always be open, and I will continue to answer any emails that come my way. Thank you to everyone who has read the blogs, and Ms. Marie Olbrysh for allowing me to send in my thoughts each week.

I'll leave everyone with an excerpt from one of my early blogs, a fable I took from Aesop's fables: "Hercules and The Wagoner":

A carter was driving a wagon along a country lane, when the wheels sank down deep into a rut. The rustic driver, stupefied and aghast, stood looking at the wagon, and did nothing but utter loud cries to Hercules to come and help him. Hercules, it is said, appeared and thus addressed him: 'Put your shoulders to the wheels, my man. Goad on your bullocks, and never more pray to me for help, until you have done your best to help yourself, or depend upon it you will henceforth pray in vain.' 

Always take responsibility for what you are doing, and remember that self-help is the best-help. Never stop learning, and never stop practicing.

Catch you guys on the flip-side,
Dex

Never Stop Learning

Hello everyone.  I know I'm looking forward to only a three-day week this week and the food-coma that will be induced Thursday. I always look forward to Thanksgiving. I'm fortunate to have a huge family, who are local for the most part, equipped with two grandmothers who are incredible cooks, and one uncle who's a chef. Not to toot our own horns or anything, but we do turkey-day right. 

Today I'd like to share with you, probably, one of my last case presentations that walked into the clinic last Friday. This patient presented with strange neck and upper shoulder pain that began 4-5 days prior. The patient could not pinpoint a certain action, or mechanism of injury; he had not lifted anything heavy nor sustained any trauma. As the patient was sitting and telling me his story I could notice he was struggling with some nasal congestion. I then began to ask the patient if he had been feeling sick as of late, to which he answered that he had been fighting off some nasal congestion and a sore throat for about a week. Ding, ding, ding! So now we have a patient with some weird neck and upper shoulder pain: that is worse with laying down for extended periods of time and while on his drive to work; that feels better with massage during a warm shower; who has been fighting off what sounds like an upper respiratory infection. What's the next step? If you guessed a physical exam to rule out any life-threatening conditions, you are correct.

The patient was informed of the risks of a physical exam, he consented, and off we went. Through the physical exam we ruled out a disc issue and facet involvement. In fact, the only instigating exam finding was pinpoint tenderness at a nodule at the right suboccipital area (base of the skull), and the same in the area of the left sternocliedomastoid muscle area (left side of the neck). As soon as I palpated over these nodules, the patient would note that was his pain generator. One should not jump to the conclusion of muscle spasm just because palpating over a muscle is tender. What caused that "knot" to form? This is where listening to the patient is key, but not allowing the patient to give you a diagnosis; that's why you are the doctor and they are the patients. 

Remember, that pesky sore throat? I did. I decided to take a look down the patient's throat, and what did I find? His throat was fiery red on the right side. Can you see where I'm heading from here? Now here is where I only give myself an 80% (very generously, if Dr. Maola has anything to say about it). I honed in on a throat infection that was causing inflammation of lymph nodes beneath the suboccipital and sternocliedomastoid muscles leading to neck and upper shoulder pain. This made sense with the red throat, stuffy nose, and alleviation of pain when the lymphatic chains were manually drained by massage in a hot shower. Seems pretty sealed up, right? Wrong.

Dr. Chad Maola, our dean of academic assessment and mentor of mine, saw a very big flaw in my diagnosis. He asked me to take a look inside the patient's ears. Sure as I'm writing this right now, that poor patient's right ear was red as could be; an ear infection was the root of all the pain! The ear infection was causing the lymph nodes to swell, and the infection was draining down the eustation tube (tube that connects the middle ear to the throat for drainage) to the back of the patient's throat causing a sore throat.

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Image from Northwestern University

Now, I could have managed the patient for a throat infection and manually drained the lymphatic chains and offered the patient some relief, but what would have happened if I didn't notice the ear infection. With an ear infection in adults, ear pain is an end-stage symptom, right before tympanic membrane rupture. In real life, if this patient came to me, paid me $80 or so for a diagnosis, then had to turn around and head to an urgent care clinic to spend another $80 for them to tell him that he in fact had an ear infection rather than a primary throat infection, he wouldn't be very happy.

I adjusted the patient's cervical spine which resulted in an instant sensation of ear drainage and sent him on his way with some instructions on dripping in some warm garlic olive oil into his ear, continue to massage out his lymphatic chains in the shower, and to seek a physician for antibiotic therapy to clear up the infection. Sure enough, the patient felt ear pain that night, found relief from the garlic olive oil, and after visiting his general practitioner received an antibiotic prescription to resolve the infection. The patient was happy, and I learned yet another valuable lesson from Dr. Maola and my patient.

I hope today's entry helps someone down the line. Assess every option and always allow the patient to tell you what their signs and symptoms are, and then you diagnose them. I hope everyone has a quick short week and a terrific Thanksgiving!

Gobble Gobble,
Dex

Wellness Fair

Hello, everyone. The weather down here in Florida is finally cooling off, and it feels incredible. Don't get me wrong, I love hanging around the beach and cooling off in the pool, but not much beats sitting at an outside bar on a Sunday watching some football and not sweating through your clothes.

Speaking of watching some good football, how about those FSU Seminoles? Granted we played Duke this past weekend, but 48-7 was a blowout, and I got to see it live and in person. My younger brother and I made the trip up to Tallahassee for the weekend to catch the game and party a little bit. We had a great time, and I realized how much I miss college.

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All College Day

We had a really cool, world-learning adventure last week at St. Pete College's All College Day. Dr. Jennifer Illes recruited us 10th trimester interns to perform blood pressure screenings at this SPC faculty event. We set up our NUHS table, outfitted it with brochures and cards, and started with the screenings.

I was happy to see so many of the SPC faculty and staff take so much interest in our school and clinics. This wasn't just an opportunity to practice taking blood pressures on people, it was killer practice on how to market and communicate with people who weren't all that familiar with our clinics, or profession for that matter. Now, more than ever, I am realizing how important of a trade it is to be able to communicate with the public in such a way that shows that you are knowledgeable, but at the same time able to show that you are likeable and easy to understand. This skill is invaluable, and only comes from practice.

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I would recommend jumping at any opportunity you could that requires you to talk to the public. Being able to communicate with patients in the treatment room is extremely beneficial, but you first have to get them in the door. I will be performing screenings for my own office in the months to come, and the practice we had last week really opened my eyes to how the public really views our profession, and how I'll have to work to sway people my way.

Negative Nancys

My uncle forwarded me an article last week that I thought was awesome and would like to share with all you Negative Nancys out there. The article by Hope Gillette titled "Negativity and Complaining is Bad for the Brain, Experts Say," alludes to the fact that the brain reacts differently in response to disturbing or negative information. Listening to as little as 30 minutes of complaining can damage neurons within the hippocampus, the part of the brain that deals with problem solving. The article gives some simple tips to avoid the inevitable day-to-day complaining that will be hurled your way, and even how to flip the problem on chronic complainers. It's an easy read that I thought was pretty cool, plus it gave me an excuse to tell the complainers in our office to keep it to themselves.

Congratulations!

Congratulations to everyone who passed their board exams; all the interns down here in the Florida clinic did extremely well. Hard work always pays off; so don't stop now! 

I'd also like to congratulate our very own Dr. Rudy Heiser on his second consecutive WAG (Wild Ass Guess) award win this past weekend at the ACCR (American College of Chiropractic Radiology) convention. The WAG is the pride of the DACBR community and Dr. Heiser has brought it home to NUHS Florida for the second year in a row. Florida campus representing!!

I hope everyone has a great week.

Catch you guys later,
Dex

Welcome Back

Hello all and welcome to my final trimester's blog! I can't believe that in 3 short months I will be a full-fledged Doctor of Chiropractic.

It seems like last week that I was sitting listening to Dr. Joe Stiefel warn us of how rigorous the next few years will be. He wasn't joking either. Now, as I look back on the trimesters past, it seems like it was all a breeze; but if I really sit and remember how my life was just a few years ago I realize that I was a hermit and slave to everything chiropractic. I would wake up and arrive on campus hours before my first class to study, duck out of lunch early to review material, and get home and read for another few hours before passing out to be ready to do it all again the next day. After remembering all of that, I still would not change a thing.

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The truth is, I love what I've gotten into and after working in the clinic for the past 8 months, and I can honestly say I have a passion for what I'm doing. For all the prospective DCs reading this, that is the key to not going crazy and being a successful student and eventual doctor. Have a passion for what you are getting yourself into, and please do not trick yourself into thinking that this program is an easy way get a doctorate degree, because it most definitely is not. Sorry, I'm not sure where that rant came from. Anyway, I'm stoked to get my final trimester underway and even more excited for graduation in December.

This is only the first blog of the tri, and I plan on hitting as many topics as I can regarding different treatment options, getting ready for graduation, what I'm planning for after graduating, and probably some embarrassing stories from the weekends or when something goes amiss with a patient. If anyone out there ever has a question, please shoot me an email (dexalvarez@student.nuhs.edu) and I will do my best to answer your query--and you may get a shout out on the blog--after all, this blog for is you guys, the readers.

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For anyone who may have missed it, my birthday was last week (yes, I am still accepting presents), which meant a weeklong celebration, all kicked off by a killer surprise from my fellow interns, Dr. Heiser, and Shirley Raychel. The remainder of the week was taken up by dinners with family and friends, a few drinks here and there (Ha Ha, "a few""), a weekend at the beach, and 3rd row seats to the Bucs season opener on Sunday. Not too shabby. I hope everyone is getting settled into the fresh tri and if there is anything I can help with please don't hesitate to ask.

Catch ya on the flip side,
Dex

Knowing When to Ask for Help

Hello all. Well, my weekend was capped off right, with Spain winning the EuroCup for the second consecutive time. Sunday morning my pals and I met for breakfast, all in our Spain jerseys and began getting ready for the final match that started later in the day. By 5 p.m., my buddies and I, along with anyone else in a red jersey, were on cloud nine watching La Furia Roja raise the EuroCup once again. This was the first time in history a national team has won 3 major titles in a row (EuroCup2010, World Cup 2010, EuroCup 2012).

I suppose that's enough gloating for now. Today I'd like to share a little tale about a patient I began to see last week. This patient had been seen before in our clinic about a year and a half ago for the same complaint of dizziness. The patient had been previously diagnosed and treated for cervicogenic vertigo. The treatment given a year ago did help her condition, the patient reported, but never really got rid of her dizzy spells. I say dizzy spells, because what the patient described didn't sound like vertigo. The patient was experiencing a sensation of falling through the ground, almost as if she was riding a down-going elevator. The spells could come at anytime during the day and were reported to not have any correlation with head movement or any other triggers. After working the patient up, my differential diagnosis was leaning towards a cerebellar issue, possibly cerebellar fatigue.

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Dr. Humphreys

Neurological issues are somewhat difficult to nail down with a definitive diagnosis and treatment. Realizing I may be a tad over my head, I called in the big guns, Dr. Robert Humphreys, neuro-extraordinaire. It just so happened that Dr. Humphreys was here in Florida at the time, and took an hour out of his busy day to help me and my patient, and perform a neuro evaluation. I can now say from experience, that sitting through a lecture is one thing, but actually watching Dr. H perform his exam and reason through subtle cortical findings to reach a diagnosis, is something completely different and extremely educational. Dr. H used functional neurology to determine that the patient was experiencing this symptom of falling due to a decreased ability of her left cerebrum to communicate with her right cerebellum. Activating, or jump-starting, the left side of her brain with propioceptive input and known left-sided brain activities eliminated the patient's secondary symptoms and previous positive cortical findings. It is our hope, that with the treatment plan Dr. H and I came up with, the patient's dizzy spells will also be eliminated.

I learned a lot from this patient. Aside of this being a cool case, and getting to work with Dr. Humphreys, I think the real lesson here was knowing when to ask for help. Yes, I could have treated the patient how she was treated previously, she had reported that the previous treatment had even helped, but would that have been what was best for her? The patient's best interest should always be at the forefront of treatment, not the doctor's pride, or ease of a treatment regime. My patient appreciated me telling her that I didn't know exactly what was wrong with her, but I would find someone who could find out.

I hope everyone enjoyed the story today, and enjoys a nice break in the middle of the week for Independence Day. I plan on spending the day on the beach Wednesday doing what I do best.

Catch everyone on the flip side,
Dex