Swing on the Spiral

Looking forward, while looking back and spinning while standing in place.

Term 2 - Genetics, Parasitology, Community & Preventative Medicine, Neuroscience, Immunology, and Physiology.

Yet, when I think back, I just remember the bright sun. I think this was the first term I really understood it's power down in the Tropics. Living on campus gives one a false sense of the island in many senses. The AC is on everywhere, all the time and since the buildings are relatively clustered, you really don't have to go outside for a long time to traverse around. Even going to IGA (the "supermarket") and the beach was rather restricted in Term 1 (my roommate had a car, so we'd wait until HE wanted to go) and I'd go in the evenings.

But living off campus showed me this other world of Grenada. I talked to more people from the Island, learned about the weather patterns and previous droughts (it was a bad one this time), found a market that has locally produced foods and snacks (local plantain chips!!), and generally started to get a sense of the people here. They are friendly, they like to have fun, and I think, if I were back home, I could pick someone from Grenada out after talking to them for a bit, just certain mannerisms and ways they speak.

You don't get that on campus though - it's essentially a giant resort. No pool though, and you can't go to the beach on campus(2 stars). And the Grenadians play two roles: Security & Maids - which gives a distorted lens of this island as dangerous and poor. Both of which belay the diversity on the island. I know because I felt that way living on campus!

One thing that now rings quite true was when my advisor, Dr. B, said during Anatomy lecture that he walked home after dark almost all the time, and never had a problem or felt unsafe.

Oh yeah, medical school. I wish I used a quantified self tracking tool to chart my feelings towards each course over time. Initially, I thought Neuro was awesome, but then at some point it got annoying, and then fluctuated back to alright with potential for interesting subsets. I was excited about Immunology, and, as previous posts indicate, grew frustrated with how it was taught but still liked the material. Physiology was always alright at first, but then it grew on me. And Dr. H was excellent - one of the best teachers here - even if he does watch Fox & Friends every morning. I've done diabetes research in the past so that was a known interest, but I was surprised to find myself really enjoying the Endocrinology section. Parasitology gave a great global perspective and showed how debilitating certain, entirely preventable, diseases could be. Genetics went by in a flash, I just remember many of the diseases were quite rare (as opposed to parasitology - interesting what society focuses on). Community & Preventative Medicine was not taken seriously by anyone, unfortunately, though I enjoyed it - but felt that the principles of the course needed better integration with the bulk of the material we learn in medical school.

Now Term 3 is coming to a close this week and the much rumored about Term 4 is making its presence known through emails and syllabus/handouts. Term 3 is a funky combination of what I'd say is Public Health with a good chunk of Psychiatry. We learned about Malpractice, the recent health care reform, epidemiology, ethics and evidence based medicine. These things are fresher in my head and deserve their own post - so they'll get one.

While Term 3 has progressed, I've also been writing a Review paper on Electronic Health Records and Health Social Networking. This supposed to be the last part of my Research Fellowship and now I'm struggling with whether to continue with a great boss and interesting research(I'm pretty sure he wants me to stay), or find somewhere else to learn new things. I want to learn about Health Impact Assessments and maybe also about mobile health tracking devices.... nevermind all the other potential opportunities out there I haven't checked out... I don't anticipate much time to do much of these activities this semester, but I am looking at a winter break that is, at this point, open. On top of that, my current position helps me pay my rent ... not something guaranteed with other opportunities...and I've published 1 paper so far, with a second one nearly complete...so will have to do some reflecting on this... any advice appreciated!

That is Medical School Year 1 (MS1) and I'm spinning in place in Term 3 , looking at MS2 and beyond. Sometimes I get sick of being so far away, on a hot little island. But then I saw a former work colleague's IM picture of the old Map Plotter (printer) spewing paper. That made me appreciate my decision to come to Medical School on the Spice Isle.

The Neuro of Music

Great post over at the Nature Blog network on the neuroscience of music and pleasure:

"Why do we enjoy music? Well, simply put, research shows that music elicits a number of physiological changes including increased release of dopamine from neurons originating in the ventral tegmental area, a mid-brain structure associated with the emotional reward [1]. This reward for music that we enjoy evokes an autonomic response subjectively referred to as "shivers down the spine." [2]. This is a robust and highly reproducible phenomenon."

I will have to catch up on those papers, but it is really interesting that the "shivers down the spine" you get from really good music is a real, physiological phenomenom. Makes sense. And if you've never felt it, you need to get some better music! Also note the parahippocampus is NOT correlated with pleasure, which makes sense considering it's proximity to the amygdala (fear response center). It also makes me wonder how people with Parkinson's experience music later in the course of their disease considering the lack of dopamine...

I would take issue with the implicit assumption that only "pop music" can produce such a response - although he does put the caveat of "consonant"(will have to read this more in-depth after finals!). I think it is much more tied to the emotional context of the music, state of mind of the listener and familiarity with the music being played. I can get the shivers from anything from Yo-Yo Ma to Tool and a lot in between. Most of the time it is based on my understanding of the music and/or lyrics, but the prerequisite, for me, seems to be quality musicianship.

For those floating around in the blogosphere... what music has given you the shivers?

Physio Testes

Or how Dr. H made physiology fun through corny jokes:

"We know that increased heat decreases the viabilty and production of sperm. Studies have shown that men sitting crosslegged with their laptop (on laps) the testicle closer to the laptop (hotter) produces less. Another quick way mentioned is to see if the male wears tightie whities. If so, tell him to change to boxers.... now, if you don't believe me consider this: ever seen batman? does batman have children? I rest my case."

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.

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.

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...