Staying Involved with Sports Council

When I first started here at NUHS, I was excited to join the Sports Council. National University of Health Sciences in Florida has one club that is unique to our campus and that is the Sports Council. Overseen by Dr. Carlo Guadagno, the ACA's sports chiropractor of the year, the Sports Council volunteers at various local sporting events throughout the year. Upon joining, I soon found out the majority of outreach events were primarily for the interns because they are the ones who can provide treatment to the athletes at the events. I still went to the events and volunteered in other ways, but I couldn't wait until I was an intern so I could treat the athletes. Now that I am intern, I can go to these events and provide treatment to the athletes under the supervision of a licensed DC.

Students at NUHS have minimum outreach hour requirements. Students must earn on-campus and off-campus volunteer hours. In addition to the volunteer hours, students must also obtain clinic outreach hours. The Sports Council events count as either off-campus volunteer hours or clinic outreach hours. They give us the opportunity to give back to the community more often than any of the other clubs. That is why I am staying involved in the club by attending the meetings when possible to mentor the students in the lower trimesters, review the lessons being taught, and to stay informed on the events.

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This week, the Sports Council had their first meeting of the trimester. The meeting went well. I made an announcement regarding an upcoming seminar, Dr. G discussed the schedule, they announced the upcoming events, and then the president of Sports Council took everyone through some stretches for the rest of the meeting. They even made a handout of the stretches we did.

It was a great meeting; I am looking forward to staying involved in the meetings and going to the upcoming events. The Sports Council at NUHS-Florida is just another unique opportunity at our school. If you have any questions about student clubs or student life in general, please email me. ChristopherKotwicki@student.NUHS.edu

Radiology Report Writing and the Chiropractic Radiologist

I have found that when most people think of a chiropractor or a doctor of chiropractic, they think of the traditional physician who palpates and adjusts the spine. One may not often think of chiropractors as radiologists. The fact is the doctor of chiropractic degree allows one to do many different specialties. One specialty that is offered through National University is radiology. The Diagnostic Imaging Residency/Master's Degree Program is a three-year program at NUHS that one can begin after graduation. I do not intend to go into it, but it is an excellent program.

Currently, I am in Radiology Report Writing. In this class, we must write radiology reports as if we were radiologists diagnosing any pathology on the advanced imaging given to us. It is a unique class because it is good preparation for those of us who might want to pursue a diplomat in radiology. We have two radiologists on our faculty both of whom are practicing radiology with a DC degree. Dr. Rudy Heiser and Dr. Heather Miley are both National University graduates and board-certified.

We have had a plethora of classes about reading radiology and diagnosing films so it is nice to have a class where we can practice the skills and write reports in case any of us want to pursue that specialty. In Radiology Report Writing, there is a systematic way to read films and write reports. One must look at and comment on the alignment, bone, cartilage, and soft tissue. Then, based on the findings, one has to make a diagnosis and recommendation such as referring to an oncologist due to the presence of a metastatic lesion.

Up until this point we have taken:

  • Normal Radiological Anatomy and Variants
  • Radiation Physics and Technology
  • Fundamentals of Imaging: Arthritides and Trauma
  • Fundamentals of Imaging: Skeletal Dysplasia, Tumors, Endocrine, and Hematopoietic Disorders
  • Orthopedic Musculoskeletal Imagine
  • Fundamentals of Imaging: Chest and Abdomen

Currently we are in:

  • Radiographic Positioning and Radiology Management
  • Report Writing and Advanced Imaging

That's a total of 14 credits in radiology alone and that doesn't take into account the multiple times we see films in other classes such as Anatomy or Evaluation and Management. We have to write 30 radiology reports to pass the class. We also have to take 30 X-rays to graduate. The program at NUHS is very strong in radiology, so I highly recommend anyone interested in becoming a radiologist to look at National University. I feel very prepared to read and diagnose films as well as write reports if necessary.

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

Theories Provoked by Dermatology Class

Another week of clinic and class is behind me. My colleagues and I did another set of X-rays in Radiographic Positioning but this time we were taking X-rays of the thoracic spine. We set up three views on one another but only captured two on the models. We set up for Anterior to Posterior, Lateral, and Swimmer's Lateral. Swimmer's Lateral is only indicated if the patient presents with upper thoracic or lower cervical spine pain, so it isn't used as often because it is more of a spot view. We also had to write a case report in Radiology Report Writing.

We also had a quiz in dermatology on hyperpigmented lesions. I got a 90% on the quiz, which was fine by me.

While learning about hyperpigmented lesions, we discussed melanoma, the most common type of skin cancer. We talked about the appearance, diagnosis, and conventional medical treatment of melanoma, which is usually removal and biopsy.

The most fascinating part of the lecture was the differing incidence of melanoma throughout the United States. Two things that are associated with melanoma are sun exposure and chemical exposure. In the first class, we talked about chemicals in sunscreens that we should avoid such as oxybenzone. There is inconsistent evidence about the chemicals in sunscreen and their effects on the body, but there is a fear of a carcinogenic effect and there is evidence of altered systemic hormone levels after application.

Through my own research, I found oxybenzone is rapidly oxidized after sun exposure. Oxidation is a damaging process, which is why we need plenty of antioxidants from natural foods like fruits and vegetables. Instead of chemical based sunscreens, one should use a mineral based sunscreen that isn't absorbed through the skin such as zinc oxide. Finally, the most fascinating part of what I learned about melanoma is that the incidence is highest in states with weaker UV indexes and less year round sun exposure. According to the CDC, Utah, Delaware, Vermont, and Idaho have the highest incidences of melanoma in the United States. Maine, Washington, Oregon, Iowa, New Hampshire, Minnesota, and Montana all have higher incidences than sunny Florida, Texas, and California.

2017-06-02_map
https://www.cdc.gov/cancer/skin/statistics/state.htm

From the data above, one could theorize it isn't cumulative sun exposure that causes skin cancer but more likely inconsistent exposure. Our bodies produce melanin when exposed to the UV rays emitted from the sun. Melanin serves as a natural sunscreen as it reduces the amount of radiation one can absorb through the skin. The higher amount of melanin is the reason people of darker complexions have a lower incidence of skin cancer.

The other theory is vitamin D is immunoprotective and the constant absorption of vitamin D in sunnier states could be protective against skin cancer. Research has shown vitamin D deficiency is associated with some types of cancers. It is plausible skin cancer may also be associated. It has been noted that people who live above the 37th parallel line in the U.S. are less likely to achieve adequate levels of vitamin D from sun exposure during the colder months.

2017-06-02_map2
http://www.health.harvard.edu/staying-healthy/time-for-more-vitamin-d

If one was to look at the two maps, one would see 11 of the 12 states with the highest incidence of melanoma are above the 37th parallel. I think the increased incidence above the 37th parallel is a combination of inconsistent sun exposure, vitamin D deficiency, and chemical sunscreens. When I lived up north, people would get an average of three months of consistent sun exposure. We would get really dark tans and then become extremely pale in the cold winter months. I think the inconsistent flux of melanin production may also be a culprit, rather than consistently producing a small amount of melanin throughout the year like most people in Florida. It is polarized in the northern states. It is basically all or nothing.

If people with darker complexion have a lower risk of skin cancer than people with lighter skin, it may be the melanin production process itself. It is a class I didn't think I would take as a chiropractor and it is a topic I never gave much thought. I may never have known had it not been for another fantastic lesson from the brilliant faculty at NUHS.

That's all for this week. Please email me at ChristopherKotwicki@student.NUHS.edu if you have any questions about NUHS.

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.

2017-05-25_xray

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.

2017-05-18_nametag

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.

2017-05-18_interns

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.