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
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
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
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
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!
Hello, everyone. The office in our clinic was eerily quiet this
morning. Everyone seems to be still waking up from his or her
4th of July holiday, and I'm definitely one of
them. It's a tradition here in Florida to hit the beach on the
4th, and far be it from me to break a tradition.
Tuesday night my buddies and I took off to The Friendly Tavern on
Reddington Beach to sing some karaoke with the beach locals, and on
Wednesday, we fried on the beach the majority of the day. I wasn't
finished with the beach, so my buds and I went back out Friday
after work and stayed out till Sunday morning. Fun in the sun will
definitely take it out of you, but it's important to have some time
to unwind and clear your mind every now and again so not to get
burnt (pun intended) out.
Sand Key Beach
Starting at National
I always get a kick out of receiving emails from prospective and
current students about what's concerning them, or what they're
taking from the blog, plus it gives me a direction to follow. After
all, this blog is for you guys.
This past week a prospective student sent me a killer email
asking what he could expect when starting at National, how he could
prepare, and how he could be sure that he and his future classmates
would be eventually ready for the next step of their education. I
wrote the student back, and today I'd like to paraphrase what we
discussed, just in case anyone else out there has the similar
In my opinion, preparing for this program is more of a mental
game than anything else. Too often I see students enter this
program with the mentality that they are still in undergraduate.
Please realize that you will be entering a doctorate program
equivalent to med school and quite a bit of work and responsibility
will follow. I made this mistake myself my first trimester, and I
had to work twice as hard in subsequent trimesters to make up for
it. So please, learn from my mistake in this regard, and work hard
from the beginning. Aside from being mentally prepared for this
program, I think the next best thing to do to prepare for Trimester
1 is to review basic anatomy, as it will be a large part of your
1st year and provides a solid base for further
Fellow classmate Sue studying.
The first year or phase at National is dedicated solely to basic
sciences. I still don't understand why it's called "basic"
sciences--microbiology, biochemistry and pathology are anything but
basic--but anyway. This is done to ensure that each student is well
versed in the framework of being a physician, and so that in the
second phase of your education, a clinical thought process can be
applied to this foundation. I know this can sound pretty
intimidating, but in actuality it is very doable. Everyone here at
NUHS wants you to do well, and the school takes a ton of steps to
The Florida campus currently has a 20-student cap on its class
sizes, which ensures a unique almost 1-on-1 learning environment.
In addition to the smaller class sizes, there are peer tutors
available (I'm your guy for radiology, shameless plug), professor
office hours, and open lab times for practice. The key to having a
successful education here is to allocate enough time to study every
day, keep current with the material, and like what you are
There will be a ton of work ahead of you, and there should be.
With the title "doctor," comes a lot of prestige and even more
responsibility and it's our duty to be prepared for whatever is
thrown in front of us. The workload has chilled out quite a bit
since making it to clinic, and looking back on it, I would do it
all over again. When that first patient thanks you for helping
them, it makes all those hours in the library in front of books and
notes worth it.
I hope this entry was more inspiring than intimidating and sheds
some light on what to expect when entering NUHS. It's not all work;
there is definitely time to play also. I'll be the first to tell
you that. I hope everyone has a great week.
Catch ya on the flip side,
Good morning all. I can't believe it's already Week 14 of my
seventh trimester. It doesn't just seem like the tri has flown by,
but the last 2-1/2 years also seem like a blur. I've learned a lot
this trimester about being a physician, and I'm ecstatic to put
what I've learned to use next trimester in Student Clinic.
I'm so surprised at the amount of information I've been taught,
and even retained a bit of, over my time here at National. I can
remember starting first tri in cadaver lab and literally shaking as
I walked into my first lab practical final. I used to think there
was no way I could take that many classes and pass, let alone
retain the information for future classes and tests. We've become
so conditioned to the rigorousness of the program, that now I stare
down the 12 finals I have over the next 2 weeks without a
Where does this confidence come from, you may ask? The answer to
that riddle is by being prepared. I had to learn how to learn, if
that makes any sense. It took stumbling and sub-par performances my
first trimester to teach me how important it is to be prepared. I
want to say over that first break between first and second tri, I
studied for about 2 hours a day to be ready to kick some butt when
we started up again. I've kept this tradition alive now for 2
years, and for 2 years I don't remember a single exam I've been
nervous for (except for national boards).
If you know me down here, you know I joke around a lot during
the day, and may even have a little reputation as a partier, but
now you know my secret of being a closet nerd. I love to learn, and
the material and skills we're picking up intrigue me, so studying
has become more of a hobby than anything else. I hope this message
gets across to those that have asked me how to beat their
test-taking anxiety. By making your chore a hobby, it makes being
prepared that much easier and hopefully drops your anxiety
levels--that plus a 12-pack doesn't hurt either.
Thank you to everyone who has been reading the blog throughout
the trimester and especially those who have taken the additional
time to shoot me emails. I would also like to thank Mrs. Marie
Olbrysh [editor] and Rachel Campbell [webmaster] for making this
blog a reality, and Deb Bechtel for constantly reminding everyone
about the blog and to continue reading it.
I hope everyone smashes their finals and has an incredible
winter vacation. Happy holidays to all, and if you find yourself
around Tampa, shoot me an email so we can meet up for a drink.
Good morning and welcome back. I hope everyone's long
Thanksgiving weekend helped as much as mine did. I needed a little
break to gas the engine back up for finals. The weekend was full of
good food, good people and good times.
Thursday could not have been better. I have to give thanks for
my family. They've always been there to support me in any way I
needed, as well being excellent cooks and putting on a heck of a
The Florida State Seminoles also deserve some praise after
getting a big win against the Florida Gators on their home field,
Saturday. It's the second straight season the Noles beat the
Gators, and the first time since 2003, that we've gone undefeated
to all the teams in the state of Florida--not too shabby!
We may celebrate the holidays a little differently down here in
Florida than in Illinois. The weather is beautiful this time of
year, and we tend to be outside as much as we can. If you're a dork
like me, then you would realize more sun = more vitamin D! Yes, my
brother and cousins made fun of me on Thursday after spitting off
some facts about vitamin D and its numerous health benefits. Being
that I didn't get to finish my rant then, I'll take the time now to
give shed some light (pun intended) on this unsung hero.
There is almost no population of people studied thus far that
maintains an average vitamin D level above 36ng/mL, with the normal
physiological range being 32-100ng/mL. I believe these levels are
as low as they are because people aren't given the proper education
on D's benefits and dosing. Vitamin D is unique because it
functions as a hormone rather than a vitamin. Vitamin D has as many
mechanisms of actions in the body as the 1,000 human genes it
Research has shown that doses as low as 2,000 IU per day of D
may produce enough of the naturally occurring antibiotic
cathelicidin to cure common viral respiratory infections such as
influenza and the common cold. So maybe taking some more vitamin D,
may be an option rather than taking a flu shot each year (just a
thought)? The common cold and the flu aren't the only things
vitamin D is good for.
Research has proven that Vitamin D supplementation can be
beneficial in managing conditions such as hypertension,
osteoporosis, osteoarthritis, MS, depression, type 2 diabetes,
musculoskeletal pain, and it can even prevent insulin-dependent
diabetes. In a recent study, a total of 341 out of 360 subjects
suffering from chronic lower back pain were completely relieved
from supplementing with vitamin D for 3 months.
The current upper limit of Vitamin D supplementation set by the
Institute of Medicine is 4000 IU a day. This is simply not enough;
research has shown that 4,000 IU/day of D has no effect on calcium
levels in the serum or urine. Our optimum serum D levels should be
in the range of 32-100 ng/mL. We could achieve this by
supplementation of 4,000-10,000 IU/day.
How vitamin D is absorbed and utilized by each person is
different, and dosing is therefore no different. A good rule of
thumb for vitamin D dosing is: If you are under 110 lbs., you may
want to supplement with 5,000 IU/day; if over 110 lbs., 10,000
IU/day. I know 10,000 IU sounds like a ton of supplement, but in
reality 10,000 IU only equals 0.25mg.
Feels good to get that off my chest finally. I hope everyone has
a killer week, and start studying, if you haven't already, for
finals start next week.
• The Florida Campus
• Shadowing a Chiropractor
• President's Visit & Lecture
• What to Do in Florida
To read older blog posts, scroll to the bottom and click the "Older Posts" button.