1st rotation: The not-so standard of care

I asked, “Where does it hurt? How would you describe the pain?” I can’t forget to ask about their life – what’s new, how are the kids doing, how’s that house renovation going, how are you doing (besides the nasty back pain). Next, explain that I’m going to use my hands to feel around that area. 80% of the time it’s pain in their low back. But after looking at that area, I move on to feel the pelvis, the neck, the shoulders, the legs, and even arms. I do a quick neurological exam. Listening to the heart and lungs is not mandatory, unless there is a reason to check. One hour appointments. This is unheard of at other clinics, but this was the norm at my 1st rotation in OMM – osteopathic manipulative medicine. Most of these patients have sought care in many other areas and doctors before getting to you. Many are understandably frustrated with their pain. Some want to get off their opioid addiction. Halfway through my month-long rotation, I have encountered many different personalities and come to see what OMM is really like in practice.

I was never strong in OMM during the pre-clinical years. I studied just to get by, because who’s going to even use it besides those who plan to specialize in OMM? I know this isn’t the right idea to think about it. Other people will cry, why did you even go to a DO school? But the truth is, we learn the same stuff as MD schools – we just learn extra OMM stuff. However, the general consensus is that board scores will manifest into what specialty you could end up in. This made it easier to put OMM on the back burner, while focusing more on the board-relevant Step 1 subjects. Anyways, clinical rotations are much different that pre-clinical learning. You learn by doing. You can put stories to somatic dysfunctions, and it makes learning OMM more bearable, and dare I say, even enjoyable. It kind of blew my mind how many of these patients come to the clinic in so much pain, and report feeling so much better after the appointment. I realized that OMM has many treatment modalities. Besides the muscle treatments and joint cracking, there is a certain amount of therapeutic value to being able to talk to a caring provider for an hour. Most patients expressed joy after talking about their pain, even if it is to just the attentive listening ears of medical students. I can report getting hugs from patients before leaving. It demonstrates how much a small amount of humanism can be valued.

I’m glad that this is my first rotation. After the intense study schedule for boards, it is nice to be at a laid-back (but still educational) rotation. It has been a good rotation to review basic anatomy again. I have been able to focus on humanism, rather than rush to get to the next patient.

OMM is supposed to be what makes us osteopathic students unique. And although many of us don’t plan to use it in our future practices, it is not just our skill to manipulate muscles or to palpate, but rather our idea of “looking at the whole body” to evaluate and treat these disorders that makes us unique. I always thought that was a cliche idea, but a few patients even brought it up as an observation from going through many areas of the healthcare system. I think that is something to feel good about as a DO student. There are so many factors that can impact ones health. One of my preceptors emphasized how important it is to see the person, not the disease, and I was thankful for that lesson early in my 3rd year.

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Book Club: When Breath Becomes Air

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I started clinical rotations of my 3rd year 2 weeks ago. My first rotation has been in an outpatient setting, OMM focused. It is undeniably a less strenuous rotation than other fields, which has given me more time to read for fun. (Yay! I can’t really remember the last time I did that)

One of my preceptors recommended an audiobook he was currently listening to – “When Breath Becomes Air” by Paul Kalanith. I’m not a huge audiobooks person. I prefer to sit down and open a book. I have been warming up to the idea of e-books, and at first, I thought it was really difficult to enjoy. Lately, I have been enjoying the convenience of carrying a thin electronic that carries a selection of books versus a physical book. I purchased this book from the Apple Itunes library last weekend. I finished the book under a week, teared up a few times, with a grand finale waterworks show at the end. Without spoiling anything, the autobiography follows a neurosurgery resident (so close to graduating) and his sudden diagnosis of terminal lung cancer. It is shocking, but a reminder that rare events like this can happen – and even to doctors. My preceptor and I spoke about how it’s almost taboo to talk about a doctor getting sick, and we forget some times that we could one day also play the role of the patient. Like Dr. Kalanithi demonstrated, that isn’t an easy transition in roles. It’s hard for any of us to feel the loss of control. It’s definitely a book I would recommend to read for a perspective we often forget. That perspective which asks questions about “what makes our life worth living?”

After reading this, it made me ask myself the same questions. Although it’s not the first time I asked myself what and why, it often gets muddled away in the busy and stressful aspects of life. Getting disconnected from my own self is more common than I like to admit. Many thanks to Dr. Kalanithi for being brave enough to share his journey.

Planning (on a budget)

This may sound geeky, but I know I am not alone when it comes to the amount of excitement I get from getting a new planner. Something about having my life organized better makes me so happy! I’ve tried all types of planners throughout the years – daily, weekly, monthly, At-A-Glance, Blue Sky, etc. I have figured out what constitutes my kind of planner. I love a fun, colorful, weekly planner with lots of extra features like motivational quotes, cute sections to write goals, and places to express creativity.

Last year, I tried out passionplanner. I really loved the minimalistic concept of their planners, but found that I wish it was a little bit more colorful. I heard about erincondren planners and I was convinced I was going to get my new planner from there. By the time I picked a lifeplanner, customized it, and ordered a few “essential” accessories, I was looking at a cart worth ~$75. Free shipping only if you spend over $100. So with shipping and taxes, I was looking at getting a planner for ~$90. I know all the cute bloggers and stylish career moms would swear that this planner is worth it, but as a med student, it was a little too pricey for me. I’m glad I looked for other alternatives, and came across Create 365’s “The Happy Planner” for only ~$30 from Staples – with no shipping costs and enough cuteness to keep me happy. It’s also found on Amazon for probably cheaper, but I was a little impatient.

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I don’t think anyone should spend that kind of money for a planner, but I understand that a little cute planner can do a whole lot if you need some order in your life. I’m also excited to see there are also accessories for this brand of planner. With rotations starting, I know it will help me out a lot. I thought I would share this gem of a finding!

Fin OMSII.

Maybe my overly superstitious Filipino mother is to blame, but I am wary of discussing how the boards went before getting any results. I finished last weekend, and I have been avoiding the topic. It’s exactly like that one psych board question about the medical student that avoids thinking about boards after taking boards. What ego defense mechanism is she utilizing? Yup, I’m using the immature mechanism of repression. I am sure (hopefully) that I will be more talkative once board scores are out. But until then, I will bask in the joy of not knowing yet.

In other exciting news, being done with boards (and 99% sure I at least passed) means that I am officially a 3rd year medical student! I am so excited to get out of the classroom finally and be out in the real world. I am excited to learn and add more to my journey. Found this great excerpt from Dr. Desai’s “Success on the Wards”:

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The process starts now. In our medical school, all students get assigned to a “track” and rotation schedules vary. Some students start with internal medicine, others start with OB-Gyn, others with surgery. I started off with the block that includes vacation, and I am so glad I did. I felt the burn out of studying so hard these past few weeks. It is amazing now not knowing what to do with my free time. I have signed up for a trial of Amazon’s kindle unlimited, downloaded a few kindle books. My netflix log-in finally sees me now (and quite often). I TAKE DAYTIME NAPS. I think all medical students need well-deserved breaks. One thing I have learned and greatly appreciate so much more now than in my younger college days – self-care. Not party and forget about responsibilities type of self-care, but the free time to enjoy a home-cooked meal, spend time with loved ones, quiet time alone without working your brain out, exercise, etc. It really helped me get over stressful humps, and I hope that as life is going to really pick up from here, I’ll be able to continue with the self-care regimen.

 

Acute Inflammation

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I always had trouble remembering the steps in acute inflammation involving neutrophils. I came up with a pretty simple mnemonic and I never get a question wrong on this sequence anymore. I really liked how Pathoma describes selectins as “speedbumps” during rolling, which I included in this mnemonic. More coming soon!

More detail below:

  1. Margination – vasodilation slows blood flow in post-capillary venules – cells marginate from center of flow to periphery
  2. Rolling – speedbumps = selectins – cause PMNS to slow down
    1. P-selectin is released from Weibel-Palade bodies – mediated by histamine
    2. E-selectin is induced by TNF and IL-1
    3. Selectins bind sialyl Lewis X on leukocytes = rolling of leukocytes along vessel wall
  3. Adhesion – stops PMNs
    1. Cell adhesion molecules (-CAM) upregulated on endothelium by TNF and IL-1
    2. Integrins upregulated on leukocytes by C5a and LTB4
      1. Leukocyte Adhesion Deficiency – AR defect of integrins (CD18 subunit) = Delated separation of umbilical cord, increased circulating PMNs, recurrent bacterial infections w/o pus, protracted wound healing
  4. Transmigration (Diapedesis) and Chemotaxis across endothelium of post-capillary venules
    1. Attracted by IL-8, C5a, LTB4 and bacterial products

Must haves for boards studying

The best description of studying for boards is that it is a marathon. It is REALLY easy to burn out. No matter how much you study, there is still more you can study – more Qbanks to do, another review of Pathoma and drugs to know, NBMEs to practice, and the list can go on and on.

The reality is no one wants to burn out before the big test day. With only 2 weeks left, I’m less focused on learning new things and more on being ready for the real day. I have been reviewing my old notes and doing questions throughout the day. Besides having a creative outlet (like my subpar sketching on my iPad), I have found the smallest things to be really essential to my mental health. A cup of coffee in the morning, a daily workout, loving texts, and my sweet pup are getting me through. I ran out of room to draw the endless snacks that also help. I also couldn’t draw my mom, but she is probably the real reason my life still has some order to it.

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Back to work!

My 1st StitchFix!

Real quickly – one of my latest obsessions is this really great idea from San Francisco called StitchFix. I have an addiction to online window shopping for clothes, and it’s not the best way to spend my free time because I end up not getting anything. Not to mention how hard it is to shop for affordable and stylish petite outfits. I also hate shopping at the mall. If you told teenager me we were going to the mall, I am always ready. Nowadays, not so much. The lines, and the people…yeah you might just find me in the food court.

Anyways, I heard about StitchFix awhile ago but finally decided it was now time to change my closet up. My closet is 20% stuff I wear today, 70% stuff from college and high school that I would be lucky to fit into nowadays, and 10% of why did I buy this again pieces. Plus, I really need a new look for clinical rotations coming up. I am so amazed at how easy it is to start an account. You answer a few questions about your style, sizes (they have petites woohoo), price ranges, etc. You can also decide what you don’t want to receive, since StitchFix also sends jewelry, shoes, and purses. I opted out of receiving any accessories. They also ask for your pinterest profile to see more ideas of your style.

I really liked that you don’t need to get a delivery every month, which is really nice for poor med students like me. Each box comes with 5 things hand selected for you. Pictures of my first box:

IMG_2487IMG_2488I loved that they provide a cute note from your stylist (gives it a personal feel!) with cards on how they would style the pieces. So excited that they sent me dress pants that actually fit (length and hip size!) I will definitely find a good use for those. I did not end up keeping every piece (you get 20% off if you do) just because I am a little picky about fit but had a lot of fun trying out new styles. I have scheduled a delivery every 3 months, but I loved the choices this month that I may decide to do every other month. Honestly, this is a really great option if you are lazy like me.

If you would like to check it out, please use my referral link here

 

Boards boards boards.

This week marks the last few days (18 days to be exact) before a very big day for me, and that is the USMLE Step 1 Exam. A few days later will be my COMLEX. Like any medical student will tell you, it takes a lot of work, discipline, and reminders that there is a light at the end of this tunnel. Netflix gets replaced with Sketchy and Pathoma videos. Car rides become time to listen to Goljan audio files. UWorld is more visited than Facebook.

I have been studying for this thing for months now. It started off casually, and then really picked up and became all I do during “free time”. My second year of medical school flew by. It’s hard to believe I am halfway to an osteopathic medicine degree. As time winds down for me, I am starting to realize the importance of mental health during these periods of high stress. I never studied this hard for any test before!

That is partly why I decided to start a blog. I figured that a creative outlet would be very therapeutic for me. A lot of exciting things are ahead (like clinical rotations!), and I would love to share the journey and save the memories.

Everything you have ever wanted, is sitting on the other side of fear.