Hurricane Irma

This week was like nothing I have ever experienced before. School was closed all week because of the incoming Hurricane Irma, the strongest hurricane ever recorded in the Atlantic with winds of 185mph winds. It was a category five hurricane, projected to make landfall at the Florida Keys and come straight up the west coast of Florida. The predictions changed almost hourly but eventually the initial prediction would come true.

Irma came up the west coast of Florida and many towns had mandatory evacuations. Flood zones were faced with mandatory evacuations; thankfully I am in the 4th of the 5 evacuation zones. I stocked up on water and nonperishable food items.

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Since I wasn't in a mandatory evacuation zone, I chose to stay since I have pets, and the closest family I have is in Virginia. The hurricane came and went in a day.

Thankfully, by the time the hurricane reached St. Petersburg it had weakened from a category 5 to a category 2. I was in the second story of a concrete apartment building and my building didn't sustain any damage during the storm, nor was there any flooding. We lost power for a few days and my Internet was out for over a week. We were lucky in Pinellas County compared to the southern-most counties of the west coast of Florida. Some are still without power and suffered substantial damage to their homes. My thoughts and prayers are with those in need here in Florida, down in the Caribbean, and in Texas.

It was certainly a unique experience and I was extremely fortunate to be in an area that wasn't hit with the storm when it was at its strongest. Prior to Irma, St. Petersburg had not suffered a direct hit with a hurricane in over 60 years. This was a unique event for this area and hopefully it stays that way.

Thank you for reading my blog. If you have any questions please email me at ChristopherKotwicki@student.nuhs.edu.

Finished with Classes - Starting Clinic Full Time

With the conclusion of Trimester 8, I have finished my lecture and lab coursework at National University of Health Sciences. Over the two-week break between trimesters 8 and 9, I had clinic three days per week on Monday, Wednesday, and Friday just like during the trimester.

Over the weekend of the first week of break, two of my colleagues and I attended the Florida Chiropractic Association's National Convention in Orlando, Florida. This was the second year in a row I attended the convention and it did not disappoint. There were many influential doctors lecturing, and I attended lectures regarding sports rehabilitation, nutrition, research, and management of internal disorders. I also took a photo with one of my favorite former NUHS professors, Dr. David Seaman who is now teaching postgraduate full time and promoting his own line of supplements through Anabolic Labs.

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The following week, I used two personal days on Wednesday and Friday before returning to clinic on Tuesday for Trimester 9. With Wednesday, Friday and Monday off for Labor Day, I had six days off in a row and I used it to take a trip out to the Grand Canyon.

I flew into Las Vegas, Nevada, on Wednesday morning and drove 6 hours to the North Rim of the Grand Canyon. I woke up the next morning and began my run at 4:30am. I ran rim-to-rim, which is 24 miles in 10 hours. The top of the Grand Canyon is over 8,000 feet above sea level. This could pose a problem for someone with altitude sickness. Prior to this trip I have never been to such a high elevation so I was unsure if I would get altitude sickness or not, so I decided to find out what supplements would help if I was so unlucky. I supplemented with Gingko Biloba, an herb we learned about in botanical medicine. There are some research studies that provide evidence that Gingko Biloba may help prevent altitude sickness. I didn't suffer from altitude sickness during my adventure. I am not sure if the Gingko Biloba helped but it certainly didn't hurt. 

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I went rim-to-rim in 10 hours with an elevation change of 10,700 feet, as the top of the north rim is 8,300 feet, the bottom of the canyon is 2,200 feet, and the top of the south rim is 6,800 feet. It was an intense run, probably the most intense run I have ever done.

I returned to Florida the following week to begin clinic full time. It is really exciting that I will only be treating patients now. This trimester I have parts 3, 4, and Physical Therapy, of the National Board of Chiropractic Exams. I will also discuss how I manage life in the clinic and the lessons I learn.

Thank you for reading my blog, if you have any questions about student life at NUHS please email me at ChristopherKotwicki@student.NUHS.edu.

The End of Trimester 8

With two weeks to go in Trimester 8 and only finals left, I am starting to feel a huge weight lifted off my shoulders. In two weeks, I will be done with classes for the DC program at NUHS. It is bittersweet to think how the end is near. In just two more trimesters, I will be graduating from NUHS. The only thing left for me to do in this program is finish my clinical internship. It has been a great learning experience thus far.

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Since I am in Clinical Internship 1, I have had to learn the ropes. My clinician and the students in Clinical Internship 2 have been helping me along these past 13 weeks and I really have come a long way since week one. I had a monumental day last week. I had a patient who had back pain for over two years. The patient was a weightlifter and always experienced the pain during workouts. After one treatment, the patient was out of pain for the first time in over two years. It was humbling to be able to help someone, and the shock on the patient's face when the pain was gone is something I will never forget. It was a much-needed reminder of why I chose to become a chiropractor and why I am proud I chose National.

Even though I am nearing the end of the program, there is still a lot of work to be done. These next two weeks are going to consist of reports, finals, and national board exams. It is easy to get stressed out thinking about all the tasks ahead, but my sister reminded me just the other day to just take them on one at a time. My friends who came through this program before me always told me to find balance between life and school. I have tried throughout the program to live that way though it is not always easy.

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Trimester 8 posed a new challenge by adding clinic into the mix. Balancing class, clinic, board review, and a social life has been more difficult than just class alone. It wasn't easy, but I got through it. The classes in Trimester 8 are on the boards so that has been a huge help because I am studying for both at the same time. Besides that, I have been trying to take on one thing at a time, which has really helped when things seem insurmountable. Rome wasn't built in a day and the last two weeks need to be handled the same way.

I am going to miss classes and walking into our building where the NUHS banner hangs from the balcony. Next trimester I will be in Clinical Internship 2, which means I will be in the NUHS Whole Health Center in Pinellas Park for 5 days a week. I am looking forward to starting this new chapter in my schooling and hope to continue to improve my patients' health. 

Guest Speaker and Visit from my Sister

This past week in Sports Council, we had a guest speaker come to talk to us about life in practice. Joe Giovatto, DC, spoke about his experience running a sports practice and working for the U.S. Olympic teams. Dr. Giovatto discussed the modalities he uses in practice and how it is important to have as many tools as possible to treat patients. At NUHS, we also stress using a variety of tools when working with patients. Chiropractic adjustments are a powerful tool, but as a physician one needs to be able to do a functional assessment, use an instrument for soft tissue, adjust extremities, stretch shortened muscles, tape when necessary, and use manual muscle release techniques. 

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Dr. Giovatto also spoke about working with other professionals and understanding your role in an interdisciplinary setting. I had the pleasure of speaking with him after the presentation and it turns out we are both from New Jersey and actually attended the same university. We are so lucky to have successful practitioners come and speak to us about their life in practice and in a small enough setting that we can get one-on-one time with renowned professionals in the chiropractic field.

I am happy to say my sister came to visit me this past weekend as well! It was great to see her and finally get to show someone firsthand what life is like in St. Petersburg. We did all my favorite things. While I was in clinic, she was enjoying the amenities at my apartment complex, including the pool. That night we went out to eat by the beach before heading downtown to visit the local bars. The following day I took her to the botanical gardens in Largo. Being from New Jersey, neither of us have had the pleasure of seeing such diverse gardens. The subtropical climate is perfect for all different species of plants and I was happy show her all the unique sites at one of the many parks in the area.

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Later that day, we went to Madeira Beach, one of the many beautiful beaches in Pinellas County. It was overcast skies but the weather was still enjoyable. Afterwards we walked along John's Pass boardwalk and checked out some local shops. We ended the evening back downtown for the Tampa Bay Rowdies soccer game. The Rowdies won 2-0, which was a lot of fun.

The next day, I took my sister to the St. Petersburg Museum of Fine Arts and we spent all afternoon there seeing many of the priceless pieces. My sister likes to paint in her free time and was astounded by the detail of many of the pieces. Afterwards, I took her to the Tampa airport, which is a 20-minute drive away. It was a very fun weekend. It is nice to have an international airport nearby because family and friends can easily visit from anywhere.

Preparing for Boards and Finishing our PICO Presentations

Now that I am in clinic, the waves of exams have let up. Since this is my first trimester of clinic, I still have some classes and exams. That said it, is not nearly as rigorous as the basic and clinical science phases. Though I have less exams, I have Parts 2, 3, 4, and PT of the National Chiropractic Board Examination. In order to be a licensed doctor of chiropractic, one needs to earn a DC degree and pass all the parts of the national licensing exam. Each state has their own laws for licensure and many also have state exams.

In addition to seeing patients, my colleagues and I have dedicated a lot of time to studying for the board examinations. I will be taking Part 2 in August, Part 3 and physical therapy in October, and Part 4 in November. Part 2 consists of six tests in general diagnosis, neuromusculoskeletal diagnosis, diagnostic imaging, principles of chiropractic, chiropractic practice, and associated clinical sciences. All of these subjects have been covered in the curriculum, and while going through the prep books I have been using my notes from class as references. The classes at NUHS do a great job at preparing students for the board exams because of the in-depth basic and clinical science classes. We try and study for the boards in clinic for at least an hour every day.

One of the classes I am currently taking is structured around evaluating research and presenting the findings. PICO is an acronym for Population, Intervention, Comparison, and Outcome. I wrote about it previously in another blog, but now I have finished my presentation and can discuss what I did for the class. I compared chromium picolinate with metformin in patients with Type 2 diabetes. I used numerous articles that looked into a multitude of measurements to compare the effectiveness, including fasting blood insulin, fasting blood glucose, and HbA1c. I was surprised to find out that chromium is seen as a controversial supplement. There are systematic reviews that showed improvement in HbA1c levels in patients with Type 2 diabetes. I also found an article discussing the molecular mechanism by which chromium works.

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Image Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308119/

Chromium supplementation helps with Type 2 diabetes in many ways both in intra and extracellular signaling. Chromium is about half as effective as metformin in decreasing HbA1c. Metformin on average decreases it by 1.1% and chromium decreases it an average of 0.6%. The pharmaceutical intervention is superior to the supplement, but the difference is still significant compared to placebo, and it was a fascinating finding because I initially thought there would be no effect. Chromium can be found in broccoli, grapes, whole wheat, potatoes, and garlic. If one does not want to supplement, one can achieve adequate levels of chromium from those dietary sources -- broccoli and grapes being the most abundant sources.

That is all for this week. Please email me any questions you have at ChristopherKotwicki@student.nuhs.edu