Friday, April 30, 2010

Ingrown Toenails and Funny Bones

Distractable has a great post on the relevance of Physics to clinical practice - it's on old post but a good one and it came back to mind cause a friend got an ingrown toenail. Dr. Rob (distractable) discusses the physics of ingrown toenails and also gives us the following clinical rules (yes, this is on the USMLE):

This is why the presence of an ingrown toenail, which is evidence of a hyper-gravitational podiatric state, is invariably accompanied by the following:

People step on them – scientists have proven that a foot with an ingrown nail is 10 times more likely to be stepped on than those without.
Heavy objects are kicked – careful analysis has shown that objects such as coffee tables, lamps, and even large appliances move into the path of a person with an ingrown nail.

I would like to add to this the Ulnar Rule, which is observed by anyone who has taken Anatomy. Once you learn that the Ulnar nerve (or mulnar as some like to call it) is in fact your "funny bone" you are doomed to a life of hitting it at least once a week. What was once an annual event is now a regular part of your life. Thank you Gross Anatomy.

That's all for now - time to get back to Renal.

Thursday, April 29, 2010

Renal Yellow Highlighter

It seems appropriate doesn't it? What's not appropriate is how ridiculously behind I am in Physio and how I can see a train wreck of finals ahead.... if I can only switch tracks...thank big bellied buddha there is no more no material for Neuro.

Immuno... still no news on that front and no idea how I did. I'll take a pass at this point. grade just came out on Angel - and I'm happy with it. An improvement from my terrible midterm performance and keeps my GPA intact - phew! I still can't stand Dr. S though and am contemplating doing DES to alleviate the misery of others...

Also, I need some new study music. Non-lyrical music is of course key, but I've been listening to Coltrane, Air, Trainspotting/Primal Scream and Theivary Corporation way too much. Yeah I got some Yo Yo Ma in there too, but really there must be something else out there to sooth my studying brain, but I can't seem to find the time to find it. If you have suggestions, lemme know - I preciates it.

Monday, April 26, 2010

Immuno Rage

I cannot quite remember any class that has inspired such rage. It was not the material itself, which I liked, or even the obscure clinical trials, some of which were interesting but mostly boiled down to: oops, this TNF blocker for rheumatoid arthritis gives you cancer (which the FDA didn't spot until after it was approved) or uh-oh, looks like you can get progressive leukoencephalopathy from your psoriasis meds (all of which convinced me to tell everyone I know to stay away from Phase 1 and 2 trials).
I also feel like a good chunk of immunology is guesswork - we know how certain things interact and many of the big players, but ultimately it's an extermely complex system that we're just scratching the surface of. And when we mess with one thing, say nTregs, the consequences are often unexpected and vary widely from model organisms. There are many diseases that people are suffering from today and I do sympathize with the urgency to develop drugs to help them even with incomplete info. I guess that is part of the challenge of medicine: sometimes it means operating on partial info in desperate situations, especially with cancer and painful, chronic diseases.

But anyway, what really got me about this course was the questions! For some reason the way these questions were worded and presented with the material just burned me up! I have not felt this angry at a class before. I can maybe blame the heat, or that I needed on object at which to focus my unspecified rage (Dr. S), but I don't know. After the exam there were the typical discussions about questions and complaints about the course. I managed to distill my issues into two main points:

  1. The material was presented poorly from the beginning without a big picture, proper diagrams, or any good interconnection and context. We were expected to straight up memorize random letters and names with little info for how they interacted and that just don't work for me!
  2. There were major inconsistencies between the material presented in class, the notes provided and the lack of a real textbook meant we went shopping for various sources (purple book, white book, red book, brown book, HY, wikipedia) many of which gave conflicting info about basic topics (like HLAs that never showed up on the exam btw)
These two factors combined with poorly worded questions made for an extremely frustrating course. When I said this to a few people outside the test, one guy said the following "Those are two great points that, as SGA representatives, we have brought to her attention. She said you will thank me later for teaching you how to learn." Wow, haven't seen such arrogance and idiocy since the days of Bush II. Yet, if I did well and got within the grade range I think I did, I will admit that the trial by fire of having to teach myself the course did at least emphasize that I am a dedicated visual diagram learner. I understood this before, but I suppose now I know it for sure. But let's not be too conciliatory until the grades are out...

Thursday, April 22, 2010

Happy Earth Day!

Check out my post at the Global Pulse Journal blog for Earth day!

Saturday, April 17, 2010

Immunology... or how not to teach a class

I am continuously reminded of how much of a visual learner I am and perhaps this is why Dr. S's Immunology course, until this point, has been a struggle. I cannot pay attention at all during lecture and the notes, though thorough, are very text based with few diagrams. I need diagrams!
But on top of that, the order in which the material was presented just did't work for me. Immuno was a course I enjoyed in undergrad and generally found interesting (I even shadowed at an Allergy Clinic) but I found myself starting to hate the course and the professors.
I didn't realize my problem was how the material was presented until I put together T cell activation on my own. I used a combination of Wikipedia (decent article) with a copy of High Yield Immunology. I also referenced the class notes to make sure I had what I needed to know. Then I took it all and drew out a diagram with all the relevant cytokines. And it makes sense. Macrophages are cool again, CD4+ T helper cells rock and I can appreciate how HIV kills.
I've had poorly taught courses before, but never could I say exactly how to make them better. With this course, I think a better integration of cytokines into the Th section along with more and better diagrams, coupled with big picture understanding would go a long ways to improving it. And a coherent lecture would help too.

Thursday, April 15, 2010

SGU Crossroads

There are three roads from the roundabout near my apartment. One road leads to the airport, one road leads to Grenada and one road leads to Campus.
A bunch of clinical tutors live in my building. I talked to them a few times and had seen them in labs. I went to do my laundry the other night and they were having a party and invited me to join them. So I went down to enjoy some home cooked south indian meals (rasam, pulyaogre(sic) and more). Just couldn't pass that up!
Talking to some of them I learned that SGU has a program for medical graduates from other countries (in this case India obvs.) to come and teach for 2 years at SGU while they apply for residencies in the US. Turns out a lot of them do get their residencies and SGU gives them a third year to match if they need it.
It was encouraging to see that "true IMGs" that were not US citizens could make it into the states for residency through SGU. They were celebrating successful matches for four of their colleagues - all going to respectable places from Chicago, to Rochester and NYC.
It seems there are many routes to SGU, but a lot of them lead to where people want to go...

Sunday, April 4, 2010


Eh - what just happened? Oh, midterms. Compared to the other test takers out there, Term 4 and especially those who just took the boards, I feel a bit unworthy of logging any complaints about exhaustion from term 2. The exams went well but I am learning that med school tends to take your studying habit errors and magnify them.
I am always quite excited to get my score reports back. But I'm seeing a pattern - those things I knew that I did well, and those things that I did not understand so well I didn't do so well.... hmm, how does this help my inability to pick a method of studying?? I can say that my method of "no paper notes" and doing everything through annotating PDF docs has been working at least as good as scribbling a bunch of stuff on paper. So I'll stick with my... green studying.

Anyway, there was also whole healthcare stuff that passed. Yeah, about that. I think it's a good thing, but really cannot say so much in detail before I read up on it (June) and get the impression we will need to tweak the bill with add-ons in the years to come. I do intend on reading this wonderful Grand Rounds from SeeFirst though.

I also got a fan. I paid too much for this fan but since you apparently need psychic powers to predict when a fan will be posted on SGU POST and email that person the instant the put it on sale, I sucked it up and paid for it at the hardware store. Am very glad as my Midterm AC electric bill was more than the fan.