Archive for tag: holidays

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.

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,

Happy 4th

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 question.

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 topics.

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 ensure that.

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 doing.

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,

Happy Holidays from a Closet Nerd

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 quiver.

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).

Dex -christmas Palm Tree

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.

Catch ya on the flip side,

Giving Thanks

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 Thanksgiving feast.


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.

Vitamin D

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 regulates.

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.

Take care,