MSK, week 4

This is the last week of the MSK block which covers all manner and forms of rheumatoid disease. It is heavy on material but is well taught overall. It’s easy to feel overwhelmed but it also the point in the semester where the stress levels are more constructive than destructive and where one begins to feel more motivated to study for the final exams, as opposed to putting it off until later. In fact, you can see this in all student types in the class as the study carrels fill up and those you never see in the library begin to put in their time. I am glad this is the last week of the MSK block, as it feels like it’s time for a change and in contrast, the endocrine / metabolism block is supposed to be much better taught, or at least is much better received by the students in general.

3rd year program alternatives

3rd Year looks like hell. My friends walk around like zombies – tired, stressed and with a hunger for brains knowledge that can’t be satisfied. All of my close friends from 3rd year chose to do their year through the traditional larger, tertiary care, teaching hospitals. There is an alternative that I have known about for some time but which I have never really considered. The alternative 3rd year program is offered through a smaller community hospital, located a good 2 hours from the larger city. This has never been a consideration in the past because it would mean that I would have to relocate myself away from family and friends to this smaller center for the next year. Now that third year is once again on the distant horizon I find myself weighing the pros and cons of completing the alternative 3rd year program.

Pros -

• Smaller group of doctors that students work with
• More chance of actually getting a meaningful reference to help with CARMs
• More opportunity for focused learning
• A much higher instructor to student ratio
• More personal time to prep for exams?
• Focus is on family med
  • Could be a good thing because practicing family medicine in a smaller center is actually of interest to me.

Cons

• Distance from friends and family
  • Still a large concern and would mean additional costs.
• Focus is primarily on family medicine
  • Could be a bad thing because I still haven’t quite decided that this is what I want to do, and my exposure to family medicine thus far has not all been positive.
• Limited exposure to medical specialties / rare cases
  • How much do you actually see as a third year student?
  • No exposure to the traditional CTU set-up, as all complex cases are transfered to the larger hospital setting.
  • Less exposure to internal medicine than one would receive at a tertiary care center
• Exam time prep may be problematic
  • Because of less exposure to different cases / specialties

From what I have seen and what I have heard is that this program is great, that is to say if you’re interested in practicing as a generalist when you’re done (which I think I am). Regardless, I intend to apply and to see if I will at least have the opportunity to participate.

MSK, week 3

It is MSK week 3 and the case as well as the lectures have all centered on osteroporosis. The weather has definitely changed for the worst and I can see the resignation in my classmates faces as they gear up for the coming winter. There is a general fatigue that has crept into the class as a whole. Stress levels are beginning to rise as people realize that we’re past the 1/2 point in the semester (we’ve got 7 weeks left) and that they have done little or nothing to prepare for exams. This will no doubt grow into a sense of panic as the actual exams get closer and is something I am not looking forward to. I find it hard not to get carried away with the rising tide of anxiety, despite my best efforts to ignore it. Ironically – this also seems to be the time that students come together. The mutual suffering seems to give people a common experience to relate to. Needless to say, I am already looking forward to the end of the semester and can’t wait for the Christmas holidays to come.

I just swallowed my gum …

… and now I’m wondering if it’s going to take its sweet time moving through my digestive tract. The urban myth is that it takes seven years to digest, which I have never really believed but never really questioned either. I mean if it were true then all those pieces of gum I swallowed during my undergrad should be popping out right about now … Lucky for me someone else was far more interested in the gum digestion question than I was and actually took the time to answer it.

The question and answer were published in a recent Scientific America article, Fact or Fiction?: Chewing gum takes seven years to digest by John Matson who interviewed David Milov a pediatric gastroenterologist. In the article, Dr. Milov is quick to debunk the idea that it takes seven years to digest swallowed gum.

If the legend were true, Milov says, “that would mean that every single person who ever swallowed gum within the last seven years would have evidence of the gum in the digestive tract,” but colonoscopies and capsule endoscopy procedures turn up no such evidence. “On occasion we’ll see a piece of swallowed gum,” he says, “but usually it’s not something that’s any more than a week old.”

A week old? Even that seems like a long time for something organic to persist in the digestive tract, which begs the question of what exactly is gum made of then?

Some of the components, such as sweeteners, are broken down, but the gum’s base is largely indigestible. The Food and Drug Administration defines chewing gum base as a “non-nutritive masticatory substance” that may be composed of any number of natural or synthetic elastomers, or rubber-like materials, as well as plasticizing softeners, resins and preservative antioxidizing agents. The permitted elastomers include natural, tree-derived chicle, a gum chewed by indigenous Central Americans, and the somewhat less traditional butyl rubber, which also finds use in the manufacture of inner tubes.

Wait a minute – all these years I’ve been chewing on something with a similar composition as an inner tube? Ugh … Well it can’t be bad, can it? I mean, if I did happen to swallow the odd piece of gum (and I’m admitting nothing here)…

As Milov and his colleagues wrote in Pediatrics in 1998, chronic gum swallowing—or swallowing gum in conjunction with other indigestibles—can spell trouble.

Uh oh …

The team’s report describes three children suffering from gum-based gastrointestinal blockages, two of whom received gum as positive reinforcement for good behavior and regularly disposed of the treat by swallowing it. In both cases the children became constipated, as the gum snowballed into a substantial “taffylike” mass that required extraction. In the third patient, a girl just a year and a half old, four coins were found lodged in the esophagus, fused into a single blob by a wad of chewing gum.

After reading this I know that I am definitely going to spit my gum out from now on … or at least try to swallow less.

Check out John Matson’s article, Fact or Fiction?: Chewing gum takes seven years to digest, for more information.

MSK, week 2

Week 2 of MSK covers normal joint function, cartilage and osteoarthritis. In some ways it would almost be better to cover the cartilage before learning about bone because of the fact that bone originally forms from cartilage (to put it simply) and also that cartilage formation is an aspect of bone healing. Regardless, this week is better organized than last week (which isn’t saying much).

My impressions of the MSK block aren’t the best. It covers a lot of material and seems to be poorly organized overall. Key concepts are either unintentionally missed (“oops – we meant to cover that but didn’t”) or outright ignored (“Go look it up yourself”). I feel as though the material is not coming together as well as it has for the previous 2 blocks, GI and Blood & Lymphatics. My stress levels are climbing because of this and I know I am not the the only one. The others that I talk to in the class admit that they are feeling overwhelmed and a little frustrated. I haven’t reached the point of being overwhelmed … yet, but I will definitely have to put in some good book time over the weekend to make sure I am happy with where I’m at.

It’s like studying in a fridge …

The turning leaves across campus are signaling that autumn once again has arrived. This is in conjunction with a turn in the weather as the nights have become cool and the mornings crisp. Fall coats are being rescued from their closets, dusted off and worn with impunity.

This is also the season where the library makes its’ slow transition from summer to winter. I am positive that there is some administrator in charge of heat in the library who has deemed it inappropriate to warm the building before the end of October. At times I find it s like studying in a fridge. I suppose I could study at home but I find there to be way too many distractions. Depending on the day and subject studied I would rather clean house than crack a book. So – in order to get anything done, and to keep focussed on the material at hand, I tend to sequester myself in a small desk somewhere in the science library, which, like I say, is freezing this time of year.

I have tried alternatives. I have tried coffee shops and have ended up in wired debates without resolution. I have tried the theological libraries scattered about – my reasoning being that they don’t really have anything to study – right? I mean they probably only have one day of the week where they have to really prepare for – right? Regardless, I found it be way busier and way more rowdy than I was expecting. Kind of like the Arts library – which is really more like a coffee shop than a library. Nope – my preference is the old science library, not the new biomedical library with it’s cramped desks, and bright flashy looks. I prefer the musty smell, and general emptiness on the old science library. I just wished they’d turn up the heat so and give my chattering teeth a break.

General Information about Vaccines in Canada –

I have a good friend who is currently debating whether or not she should have her child immunized. It’s hard for me to rationally debate this with her because I have such a bias for immunization, but I do respect her need to weigh the options before making a decision. While talking to her about vaccines in Canada I found it a good exercise to compile a couple of quick points regarding safety and monitoring for her information as well as mine. I’ve coupled these with a few patient education websites for further clarification and included these below. I hope if you have similar questions, or know of someone who does, that you find this helpful.

1. How are vaccines approved for use in Canada?

- The biologics and Genetic Therapies Directorate (BGTD), i.e. Health Canada, regulates vaccines for human use in Canada

- To be approved, vaccines must meet acceptable standards of production, safety and potency

- BGTD is also involved in post-marketing surveillance of vaccine safety.

2. Who recommends what vaccines for use?

A. The National Advisory Committee on Immunization

- which is a multidisciplinary expert group which makes recommendations to the federal minister of health

- All recommendations are published every 4 years in the Canadian Immunization Guide (latest edition was this year – 2006)

B. Provinces and Territories

- Use the NACI recommendations to develop immunization programs

C. Canadian Pediatric Society

- Also has some say in the process, but what exactly I’m not sure

3. Who monitors vaccine safety?

A. IMPACT – Immunization Monitoring program, ACTive

B. CPSP – Canadian Paediatric Surveillance Program

C. ACCA - Advisory Committee on Causality Assessment – Reviews all reported cases of serious adverse events

D. Global advisory committee on vaccine safety – run by the World Health Organization

4. Resources

Here are some good websites which advocate immunizations but which do so in an informative manner.

Parents of kids with infectious diseases (http://www.pkids.org/about_pkids.php) is a non-profit organization which is comprised mostly of parents with children infected with Hep B, C and HIV. Though they seem to be pro-immunization they appear to be interested in public education more than pushing vaccines.

Caring for kids (http://www.caringforkids.cps.ca/) is a governmental page (I think) that has a bit of a bias toward promoting immunization.

Institute for vaccine safety (http://www.vaccinesafety.edu/) is an independent watchdog group which “provide[s] an independent assessment of vaccines and vaccine safety to help guide decision makers and educate physicians, the public and the media about key issues surrounding the safety of vaccines .”

MSK, Week 1

This week I start the Musculoskeletal & Locomotor (MSK) block of study. It will cover a number of different topics including: Normal bone growth and development; Normal cartilage structure and joint function; Metabolic bone disease and calcium homeostasis; and lastly, Inflammatory arthritis. The four weeks of study are tied closely to anatomy and clinical skills, perhaps more so than any other block I’ve taken so far. This also means that the exam will be structured a little different than the other blocks, with the clinical skills and anatomy components being integrated into the written final to a much greater extent.

Shell shock

I know that I might think I have it rough at times and that I complain too much about the hours of mind numbing lectures, more PBL than any one person should have to endure, and the never ending piles of homework. Sometimes what I really need to do is to put this all into perspective. This is something I was able to do this a couple of days ago at a gathering of friends.

It was to be a gathering where we all compared notes on the first few weeks of classes. A time to compare and contrast the different rotations, residents, supervising doctors and new classmates. It didn’t take long before I realized how easy I have it. The person who hosted it had volunteered his place even after working an intense 80 hour week in an internal medicine rotation. This was a mighty big offer, given that I don’t think he had seen much of his apartment over the past week. Although he had no food or drinks to offer, he had cleaned the place in anticipation of having us over. Unfortunately he didn’t last long enough for me to talk to him, as within an hour into the party he was asleep on the floor. There was some debate as to whether or not we should move him to the bedroom but he looked so peaceful that we eventually just left him where he was. At least this poor bastard was getting some sleep! From the looks of the rest of the room my other friends weren’t in much better shape.

As I looked around the room I realized how tired most of the others looked. One friend had her knees gathered up in her arms and was gently rocking back and forth as she looked around anxiously. Another couldn’t seem to sit down for some reason and would jump up to check their pager at every sound. It was a sad collection of the shell shocked and newly minted clerks. This isn’t to say that I wouldn’t love to be there, suffering along side, but suddenly I realized how lucky I am. I still have time for my few activities and I do get to see my girlfriend on a regular basis. I am relatively unhurried with little stress. This will change come finals but for the time being I should enjoy this feeling because I have a strange premonition that it all change come this time next year…

Hematology Week 2

The material we covered last week was dense – full of red blood cell physiology, abnormal blood smears, and problems with loss, increased destruction or decreased production. We discussed the nuances of anemia, as well as the tests and diagnoses for various pathologies. It’s enjoyable but there was a stack of homework at the end of the week, which I still haven’t managed to work through. Unfortunately there won’t be a chance to catch up before Hematology week 2 starts, which promises to be just as heavy (work wise) as the first week.

Hematology week 2 covers bleeding and malignant disorders of the blood, which includes everything from hemastasis to lymphomas, leukemias and myelodysplastic disorders. I am thankful that this block is so well taught because it would mean a hell of a lot of work for the average student (like me) if it wasn’t. In fact two weeks just isn’t enough time to cover all the material that there is (and this is an understatement – I know). This is a comment I could make for almost every block – as it seems that we simply scratch the surface of a subject before we have to move on.