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

Exams and Clinical Natural Medicine Presentation

This past week I had two exams and gave two presentations. The exams were in Advanced Technique and Jurisprudence. The advanced technique exam was an open-ended clinically oriented exam, in which the questions were how we would diagnose and treat a patient who presents with a specific set of symptoms. When I first started the program at NUHS, these kinds of questions were pretty difficult, but now that I am in clinic I am able to put all the information I have learned over the past 6.5 years of post-secondary education to use. My clinician has been giving me feedback on what I need to do better and because of that I now understand how some things that may be overlooked in a history, could actually be vital to the diagnosis. I earned an 'A' on that exam, and I credit the constructive criticism I have been receiving in clinic for excelling in the clinically based case study questions.

The other exam was in Jurisprudence, a class that is all about the laws and regulations that affect chiropractors at the national and state levels. The exam covered practice guidelines, license requirements for the state of Florida, record keeping, coding/billing, and patient consent. The curriculum at NUHS really covers all the bases from how to be an effective diagnostician, to the finite details of running a practice in accordance with the law. I don't know how I did on the exam yet but I do know I have learned a lot in that class and there is still more to know.

In Clinical Natural Medicine, we were each required to give case presentations from chiropractic offices. I used a case from my chiropractor at home that was an excellent lesson we could all benefit from. The case was about a man who came in while the doctor had a full waiting room. The patient appeared to have a normal shoulder injury and associated neck pain, but when the doctor heard the history he knew something was going on. The patient had lost his balance and bumped into the wall. When I mentioned that to the class everyone was interested by it and wondered why one would lose their balance.

I then told them the next detail the doctor heard, the patient wet the bed the night before and stumbled out of bed when this happened causing him to fall on an out-stretched arm. The patient was injured but the question was how was he injured? Why did he lose his balance? The doctor consulted the patient's primary care doctor and referred him to the ER because he suspected a neurological problem caused his loss of balance and continence. The patient went to the emergency room and he had emergency surgery to remove a brain tumor. Despite a full waiting room and a typical shoulder injury presentation, the history made him aware there was something else going on. My colleagues made the same conclusion as my chiropractor that the patient needed a referral for possible SOL. 

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It was a great lesson. The professor was able to relate to the case, and said in real life, abnormal conditions will present in your office when you least expect it. One cannot let a full waiting room and insignificant physical presentation lead a physician to a quick diagnosis. NUHS has done its due diligence since everyone would have made the same call as the doctor and saved that patient's life.

Please email me with any questions at ChristopherKotwicki@student.nuhs.edu

Functional Taping for Musculoskeletal Injuries

This past weekend I took a taping seminar in Tampa with Dr. Gregory Doerr, the co-founder of FAKTR. In addition to writing the FAKTR classes, Dr. Doerr wrote a taping class called Functional Taping for Musculoskeletal Injuries or FTMI. The class started with the question, "Why do you tape?"

Taping has three types of applications: microcirculatory, neurosensory, and structural. Practitioners should apply tape only if the application is appropriate for the patient, and we can do that through brief orthopedic testing. We are taught kinesiology taping in the curriculum, however, taking a certification class will always help better one's understanding of any topic. Dr. Doerr uses these taping techniques every day in his office. I personally had the pleasure of shadowing him in New Jersey, and was able to see him evaluate and treat patients using the same taping applications he showed us in the seminar. The taping class he wrote is made up of tape jobs he came up with, as well as specific applications from other taping classes such as FMT, Kinesio TapingĀ®, and Spider-tech.

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We were shown about 80 tape jobs throughout the class and we were able to practice the tape jobs after each demonstration. By the end of the weekend, we were shown how to tape almost every body part and given an evaluation to determine if the application would be beneficial. It was incredible to see the changes the tape made from the pre-application test to the post-application test. The class really reinforced how powerful the modality of taping truly is.

This is my second certification and the coolest part is having both FAKTR and FTMI gives me the Functional Soft Tissue certification. Just another certification to add to my curriculum vitae to show my capabilities. Our professors at NUHS have certifications of their own including board certifications. Some of the professors are also instructors for technique classes and teach on the weekends.

After the first day of the seminar, my colleagues and I went to historic Ybor City, a historic district in Tampa. We stopped by Coppertail Brewery and finished our night with a late dinner at a local restaurant. Ybor is another location in the Tampa Bay area with tons of fun things to do.

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