Royal Wedding

I'm not ashamed to admit it - I was up at 5am to watch the Royal Wedding. I'm a sucker for love, I really am. What a beautiful way to celebrate love, by watching two people commit the rest of their lives to each other. The wedding was an elegant way to remind us of how important love is; it's one thing that every person on earth wants...which explains why nearly 1/3 of the world's population - 2 billion people - tuned in to see this ordinary, middle-class woman marry her Prince. I know as Americans, we can over-celebrate things...and this drives Mike crazy...but why not? What's wrong with celebrating something as beautiful and rare as true love?! There are extremists all over the world, killing others in the name of their religion or for a corrupt leader or for money; I can't think of anything better than to stop for a moment and have the whole world be reminded of the power of love. It's such a beautiful thing.

I've been looking through a lot of wedding magazines during the past 4 months, and I absolutely love the lace in a wedding dress. All of the ones that Mike and I both like have a bit of lace in it, and they have definitely more of a classic and elegant feel to me. My mom wore long sleeves made of lace with a lace bodice on her wedding day, and I am absolutely drawn to those dresses now; they are so elegant and timeless. Kate looked absolutely stunning in her dress; a perfect combination of elegant and sexy.

What a beautiful reminder of the one thing which is common to all of humanity - love.

Bright Eyes

I became a new patient for a Perrysburg eye doctor this week. Since I don't go home nearly as often as I did during my undergrad years, I finally decided to find an eye doctor up here...

You all have experienced the Glaucoma test before, right? Well the only one that I've ever had was the puff of air test and peripheral vision check..where you put your eyes into a microscope-looking thing and get a puff of air blown at you when you aren't expecting it. The doctor is assessing your eye's pressure with the puff test.

My new eye doctor does it a bit differently; maybe you can relate to this other test. 

First the nurse put a drop of an unnaturally yellow solution, called fluorescein, into each eye, and the purpose of its use is to examine my cornea for scratches or ulcers. 

After the nurse had a look at my eyes, she then put a drop of atropine (or some similar drug) into each eye. Atropine is a really well known drug; you may have heard of it in relation to its somewhat controversial use as an anticholinergic cardio drug. It works by competitively inhibiting the muscarinic acetylcholine receptors which are present in our parasympathetic nervous system. The use of it as an eye drop is to cause pupillary dilation by inhibiting the parasympathetics in the third cranial nerve (the oculomotor nerve). The antimuscarinic drug also blocks the parasympathetic-controlled lens accommodation (which allows us to focus our eyes when reading). By inhibiting the parasympathetic innervation to our eyes, the pupil dilates (because it is under unopposed sympathetic control), and the lens is relaxed. This allows the doctor to examine the retina more precisely, and to be able to be more accurate in deciding that your eyes truly are healthy.

I appreciate that my new doctor wanted to have a good long look at my optic disc and retina, but I was NOT a fan of waiting 4 hours for my lenses to be able to accommodate/my eyes to be able to focus on my studies!...But I guess it was a good excuse to take a night away from the books and spend it with Mike and Marley! :)

"Mydriasis": dilation of the pupil

...I just LOVE medicine; such amazingly fascinating stuff!!! :)

Farewell, HEB 110

I can't believe it; I just can't believe it! Am I seriously finished with the classroom?! I've sat in classes and listened to lectures nearly every weekday for the last 18 years of my life; Can it be true that those days are finally over?!?

Today, I sat in the last classroom lecture of my life. Sure, in the future there will be countless hours of continuing medical education, clerkship orientations, and pharmaceutical education during which I will sit in a classroom and listen, but today was my last lecture as a proper student. For the first time since my white coat ceremony (which was nearly 2 years ago), I feel like I am really truly on my way to becoming a physician. They may be tiny little baby steps most of the time, but today, after finishing my last fully didactic day of my medical school career, I feel like I am a real big leap closer to my MD!!!!

The view from my seat in HEB 110:

First year of Medical School included 657.5 hours spent in lecture in room HEB100.

Second year of Med School included 538.5 hours spent in lecture in room HEB110.

Farewell, HEB110!!! ahhhhh am I really nearly halfway through Medical School?!?!?!?! :) :) :)

And My First Clerkship will be...

At 1:30pm, UTCOM released the availability to schedule for our first MS3 clerkship. A little breakdown of what to expect in the third year:

10 weeks of surgery

10 weeks of internal medicine

5 weeks psychiatry/5 weeks neuroscience

5 weeks OB-GYN/5 weeks pediatrics

5 weeks family medicine/4 weeks elective

That equals up to 49 weeks of work; we get 1 week off for Christmas, 1 week off between third and fourth year (in June 2012), and 1 week off whenever we choose to do our elective clerkship (if we choose to take 1 week off at that time). I say work, I really mean high-cost education, as we are neither paid nor taught voluntarily, but instead actually pay a whole lot of money to be able to be on the wards. This is different than in England, where Junior Doctors are paid (I would say that an English Junior Doctor is about equivalent to a US 3rd year medical student). Saying that, I know I am lucky to be given this amazing opportunity to fulfill my dreams, and I am privileged to be doing what I do!

So, what do I get to experience first in my third year? Drumroll please....

Surgery!!!!

I can't wait to start seeing patients! :) :) :)

...although, looking through my "week at a glance", I feel a little discouraged...

Goodbye Summer, Hello Surgery!

Putting the Pieces Together

For Mike's birthday, I bought him a Beatles Puzzle...Last year, we put together a black and white Beatles puzzle that we now have hanging in our bedroom. It's kind of fun, putting together the pieces and watching the puzzle slowly take form. The first puzzle looked like this:

It took us about a month to put it together, so I bought this next puzzle hoping that it would last us until we would fly to England. No such luck, it took us less than a week to put it together! But it was a lot of fun, hanging out together, celebrating each time a piece was placed, drinking wine and watching TV. And now we have another piece of Beatles décor to add to our bedroom!

Watch it all come together:

On the Run

I think spring has finally come to Toledo! On Sunday, the weather was absolutely brilliant - 80 degrees and sunny. Today we lucked out with another warm, sunny day, and I have officially begun my outdoor running season. Absolutely love the gorgeous sun, warm weather, and a nice long run - the runner's high afterwards is pretty great, too.

And Happy Birthday to my 4 year old nephew, Alex! Looking forward to celebrating his birthday this weekend!

Surprise! Spring Cleaning

I went to the organ systems' class this morning and then to ethics this afternoon. We covered neonatal ethical issues; I could never deal with the life-or-death decisions of premature babies on a daily basis, like a Neonatologist does. If a premature baby is born at or beyond 24 weeks of gestation, it is generally accepted to attempt life-saving, curative treatments. If a baby is born at or before 21 weeks of gestation, it is currently generally acceptable to give comfort care to the infant, as the likelihood of survival is dismal. However, in between the 21-24 weeks gestation, there is a "grey zone" in which about 50% of babies live, but nearly all of those who survive will suffer distinct morbidities, such as mental retardation. In the "grey zone", the parents are usually the ones to decide whether to attempt life saving treatments or to comfort and love the baby for the few hours of his life. Either choice seems to be devastating...so very sad. Pregnancy and delivery are meant to be some of the happiest days of a couple's life; I know I look forward to the day Mike and I make our family more complete. But to be put in such a terrible situation, it just seems so incredibly sad. This is the worst part of medicine - not being able to save everyone. I'm already dreading the losses I will see during my career...
To give to March Of Dimes, a worthy cause involving the care of premature babies, please click here.

I was starting to feel really down after ethics - the stress of typical med school life compounded by the sadness of premature babies really knocked me down today. So I stopped by my sister's house and she made me feel much better. :) Then Mike sent me this text when I was about to head home for the night, to begin an evening full of studying and playing catch up on my work. This is what it said:

Not knowing what kind of surprise Mike had up his sleeve, I walked in the door and was face-to-face with what I was to spend the rest of my evening with: a carpet cleaner.

Surprise! Spring Cleaning! Not at all what I had planned today, especially since this is now the 3rd spring cleaning I've given our apartment this year (I'm sort of a clean freak!), but the carpets are clean and our apartment smells great - totally successful day. 

OH and Liverpool beat Man City 3-0 today, another completely unexpected surprise! ;)

Starting the Last Unit of MS2

Today we start the last unit of our pre-clinical years. Only 1 more exam stands between me and the end of my second year of med school! Then its one big board to pass before I start seeing patients in July; I am so excited! :)

This last unit of Organ Systems covers the Reproductive System, Skin & Connective Tissues, and a few miscellaneous lectures on things like aging, formulating new drugs, and clinical labs.

Yesterday, I completed my second-to-last exam of the year, which covered the GI system and the Endocrine System. I feel very confident on how I performed in regards to pathology and even pharmacology, but I am a little nervous about the physiology portions. Some of the questions  were tricky. For the physiology questions, I always have to go through all of the answer choices and literally decide which ones are obviously not true, which ones are sort of true, and finally choose the answer which is the most true (so-called "most correct answer"). That is to say that there can be, and often are, more than one correct answer; the tricky part is knowing which one is the most correct. For example, one of the simpler questions asked: which is most associated with cancer of the gallbladder? obesity, gallstones, male gender, ulcerative colitis, or old age. Of those choices, only 1 is truly false - male gender. All of the rest actually are risk factors: obesity, gallstones, old age, and even Ulcerative colitis - it has even been weakly-linked with gallbladder cancer, so technically that may be correct also. But the "most correct" answer is Gallstones, as they are the highest risk factor for GallBladder cancer. The silly thing is gallstones are really common, and gallbladder cancer is quite rare; that is to say, most people with gallstones won't develop cancer. And another thing, only about 75% of patients that have gallbladder cancer ever had gallstones. So I'm not sure how strong of a link there really is between the two.  Anyway, that's just a little taste of what the 108 question, two-and-a-half hour exam was like.

3 weeks left until Step 1 prep takes over my life! And only 3 weeks left of my pre-clinical years, wooooooohooooooo!! :)

Birthdayyy!

Yesterday was my fiancé's 24th birthday!!! I am so thankful to have him in my life; he is so understanding and kind-hearted, and he makes me try, every day, to be a better person. He believes in me even when I don't, he thinks I'm the smartest girl in the world, he tells me I'm beautiful even without any make-up on, he is always there as a shoulder to cry on, a best friend to lean on, an ear to listen to my frustrations, to lend a hand, to quiz me before exams, to celebrate with me after each step towards becoming a doctor, to cook me food when I forget I need to eat, to take a walk when I need to relieve stress, to watch a movie when I need to relax, to play games when I need to have fun, to drink a beer when I need to unwind...there are literally a million little reasons why I love him so much, but the one big reason I love him so much is because he makes my life complete, and without him, I know that I would get nowhere. It's only through his endless encouragement, patience, and understanding that I am able to be where I am right now, and I know that if it weren't for him, I would never be able to fulfill my lifelong dream of becoming a doctor. He believes in me unconditionally, and he makes me strive to be the very best person that I can be. He is truly an amazing man, and every day I thank my lucky stars that he came into my life and made me the happiest girl in the world. So my lovey, happy birthday to you. I promise when we're old and have money to throw about, your birthday presents will be top notch. But for now, I hope a whole lot of love will do. 

Lack of Lynch Info

As I am revising the GI system, I keep feeling a bit irritated by the lack of information we were given in regards to HNPCC, or Lynch Syndrome. Normally, the less info I need to shove into my brain, the happier I am, but we were literally only told to remember a few things about Lynch Syndrome. It's caused by a mismatch repair gene dysfunction, and it is associated with colon cancer. That's it. Having done my entire Senior Thesis project on HNPCC, I feel like the pathology associated with HNPCC should be presented more in depth. But I suppose I am a bit biased...

Lynch Syndrome is, in essence, the reason I decided to become a doctor. The kindest, most compassionate, and most giving person I had ever met passed away because of colon cancer. She was my aunt, and she was young. My grandmother passed on because of colon cancer the same year that my parents were married; my uncle has recovered from colon cancer, my 28-year old cousin is battling against colon cancer, and another aunt of mine is now battling this cancer for a third time. I've even had an 11-year old cousin diagnosed with Medulloblastoma (which can be associated with Lynch Syndrome). Clearly, colon cancer is strong in my family, and because of that (according to the Amsterdam criteria), we are categorized as a Lynch Family. As such, there are many cancers to which we are predisposed, including the obvious colon cancer, but also endometrial, ovary, stomach, small intestine, brain, urinary tract, and skin cancers. This also means that we need to visit several doctors annually to check for any possible malignancies...including annual colonoscopies starting at the age of 18. The frustrating part is the fact that there have been several doctors that I have come across that don't know much about Lynch Syndrome, and certainly don't know the associated increased cancer risks. In fact, my dad went to a dermatologist who knew nothing about what to look for in a Lynch patient. Hellooo, derm is one of the most difficult specialties to get into, and he doesn't even know that Lynch syndrome can predispose you to skin cancer!? There must be something wrong with our education...

So what are the things that I wish all doctors knew about HNPCC/Lynch Syndrome? Many doctors need to be able to assess these patients' risks, because there are many links to cancer, not just of the colon (Gastroenterologist), but also of the endometrium and ovary (OB-GYN), stomach and small intestine (Gastroenterologist), brain (neurologist), urinary tract (nephrologist), and skin (dermatologist). It's an autosomal dominant defect in mismatch repair, with a mechanism of action as a two-hit occurrence. In a patient with the Lynch genetic predisposition, there is a 90% chance that he/she will develop cancer during his/her lifetime, and it is likely to happen at an earlier age than the general population. They need to have annual screenings, and they need each of their doctors to know what to specifically screen for. If an OB-GYN, take an endometrial biopsy during each annual visit; as a dermatologist, specifically screen for skin cancer (and do a thorough check) and remind the patient to check his/her skin monthly; as a GP, get a urinalysis check for abnormal cytology that may indicate urinary tract cancer and also monitor for any neurologic changes which might suggest a malignancy in the brain.

I guess a big reason why I'm such an advocate on educating fellow future-physicians is because I had an adenomatous polyp removed during my last colonoscopy (in March), located in the right side of my colon. While I can't say conclusively that I have the defective mismatch repair gene, I do know that my risk of developing colon cancer is real. Adenomatous polyps are precancerous lesions. It was removed and biopsied, so it didn't have the chance to grow into a malignant lesion this time.

While you can't distinguish between an adenomatous (precancerous) polyp and a hyperplastic (noncancerous) polyp on gross visualization, this is what my little polyp looked like from the endoscope's point of view:
(The polyp is the little bump in the bottom right picture):

Nasty little shit, isn't it?! ;)

I hope you all learned a little bit more about HNPCC/Lynch Syndrome and how to better serve your future patients!