Discover's "Vital Signs" Podcast

One of my favorite sections of the Discover Magazine has always been "Vital Signs," in which a medical mystery was presented and solved in an articulate article. It's House, MD without the attitude.

I recently found the podcast version of these articles!

Healer's Art Part 1

I signed up for an elective course this semester on "Healers Art." I was really excited about it because I thought it would be the perfect opportunity to talk about my feelings on medicine and hear what other peoples' thought. Unfortunately, I found out that I was one of two people who had signed up for the course, which dramatically changed the group dynamic idea I had in mind.

I attempted to start up an ethics club last year with the same idea in mind, but there was a similar lack of interest from my fellow classmates.

The course was created by Rachel Naomi Remen and uses her book, Kitchen Table Wisdom, as the text.

We had our first session last week and I really liked it. I'm glad that I had an outlet (with people, face to face, unlike here) with whom I could share my thoughts on medicine. We talked about:

IDing, strengthening & cultivating the human dimensions of the practice of medicine
Recognize the commonality of personal concerns among peers
Discovering and nurturing our Wholeness

It sounds like real Chicken Soup for the Soul type of stuff... and I guess it is. I'm taking it with an open mind.

We drew pictures about what we wanted to change about ourselves by the time we graduate from medical school. It was very open-ended, but I didn't want to get too personal with the thing that I want to change most about myself (which is an attitude shift of reacting to negative things with anger --> reacting w/ constructive actions.)

Here's my pic:

It's about stories. More on that later.

Medicine is a man-whore

For you aspiring pre-meds out there, heed this advice:

-get the training over with while you're young; don't take breaks (or alternatively, wait until you're a bit older)

-keep it in perspective. You are not a saint because you are a doctor (don't be arrogant and think more highly of yourself than you should). It is not a calling. See it as a stable, respectable, secure, job. Your work is valuable, but not more valuable than yourself, or your family.

-know the drawbacks, and balance those with the benefits of becoming a doctor today.

-the money *does* matter (both the student loans, and the eventual salary).

-don't sacrifice having children, visiting aging parents, or other significant life events in lieu of becoming a doctor. It will not be worth that sacrifice.

-Choose your specialty with care. Chose based on your personality...not based on what is most prestigious, what other people want you to do. Your specialty will determine your potential work environments, your pay, your lifestyle, and the number of years you spend 'training.'

-Finally, don't work too many hours. If you do, you'll be more tired, less healthy, and more likely to experience dissatisfaction and fatigue.

EM Physician makes some really good points with a healthy dose of good humor. I'm worried about a few of these things myself... I've been more aware of maintaining balance recently and I am so much happier for it. However, I have been rather dependent on my student loans for sustenance and I'm sure that this will come back to bite me. :-\

It's an interesting point to say that you should treat medicine as a man-whore. A seductive, back-stabbing, all-consuming vacuum. Don't fall in love with it or it will hurt you.

I'll do my best to keep that in mind.

Kava drinking increases liver GGT levels

The Honolulu Advertiser had an article in the paper this morning about how Kava drinking creates a "liver anomaly."

"There's some evidence of something happening in the liver," said Dr. Janet Onopa, an assistant professor of medicine at the John A. Burns School of Medicine who analyzed the data and reviewed the lab reports. "But it doesn't seem like anything catastrophic."
....
The blood work revealed elevated levels of the liver enzyme GGT — or gamma-glutamyl transpeptidase — in 65 percent of the kava drinkers. The levels of GGT increased with increased kava consumption.
In the control group, high GGT levels were only seen in 26 percent of the non-drinkers.
"We don't know exactly what a high GGT in and of itself means," Onopa said. "It's possible that kava just induced that enzyme without doing any liver damage."

Kava is a traditional drink of Samoa and Fiji. The active ingredient, kavalactone, comes from the root of the plant Piper methysticum. It causes numbing of the lips and tongue when consumed and a mild intoxication of calming quality. Some ill-prepared concoctions still contain parts of the leaves and stem of the plant and this can cause severe liver damage and hepatotoxicity.

I've scoffed at Kava drinking before, but I had some last spring break as a part of a Hawaiian cultural experience. Despite its dirty brown yellow watery appearance and its strange numbing effect, it's not that bad. It's nothing that I would choose to drink, but I can see why many Polynesians drink it.

As for the effects of GGT, gamma-glutamyltransferase is a liver enzyme used like alkaline phosphatase (ALP) as a marker of liver damage. In conjunction with elevation in other liver enzymes like ALT and AST, an assessment of liver health is made.

I think it is irresponsible to imply that the elevated GGT levels signify something other than liver damage. If these enzymes that are normally in biliary liver cells are released into the blood stream in large amounts... to me, it means that they are dying off in larger amounts.

At least they end the article this way:

Even with the high GGT enzyme results of the UH study, the men said they aren't about to change their kava-drinking habits.

But Brown, the lead author of the study, said heavy kava drinkers might consider getting their liver functions tested.

"You want your liver profile to be normal," she said. "If something is causing that to be abnormal, then you should discuss it with your doctor and have your doctor run a liver profile. Then take your doctor's advice."

References:
Honolulu Advertiser, 9/22/07. "Hawaii kava study finds liver anomaly" http://the.honoluluadvertiser.com/article/2007/Sep/22/ln/hawaii709220345.html
Samoan Sensation. http://www.samoa.co.uk/drink.html
Wikipedia, “Kava.” 20067 http://en.wikipedia.org/wiki/Kava

Something I noticed

I summarized the slides of a long-winded & technical professor and I made this observation:

 

Research faculty are interested in rare and novel things, while clinical faculty are more interested in impact and applicability.  It makes sense after all... the sorts of people who are attracted to research are the ones who seek out unknown things and attempt to answer questions, while doctors are interested in how they can diagnose and treat a specific disease.

 

This certainly has an effect on how they approach their lecture teaching styles.  I've noticed myself sliding into the clinical role more and more.  When I'm faced with a fact, I have to make the brutal decision -- is this something important enough that I need to try and memorize it?  How will I use this fact in the future?  No longer is there the simple joy of learning something new... there's too many new and exciting things to learn!  I have to prioritize.

 

I'd like it if our professors could understand this and help us out with this process to spare us some of the pain-staking process of going to lecture, getting next to nothing from it, doing independent reading, synthesizing our knowledge, summarize it, share it with others and HOPE TO GODS that it is the right stuff we're focusing on.

Family Medicine Interest Group T-shirts

We've got a Family Medicine Interest Group t-shirt competition and I thought I'd try my hand at some art. Our president came up with a great idea for a shirt; the back has a bunch of organ systems with our name in the middle. His original design for the front was an "evolution" of man from baby to geezer. It reminded me of an old riddle:

What walks on four legs in the dawn, two legs at noon and three legs at dusk?
Answer: Man. (Or Family Medicine. ;)

I modified his design by removing the intermediary figures and tossing in a sun and a moon. I like it a lot. So inspired, I tried to come up with some other ideas.
I searched through a bunch of clip art pictures on OpenClipArt.org for something that I could utilize and I came up with the funny idea for this one. I doubt our advisor would approve. :)

My last idea is still undeveloped. I wanted to try something Hawaiian, so I thought I'd go with the word "Ohana" to substitute for Family. My initial thought was to do something with Stitch from Lilo and Stitch. I kept trying to quell that. I thought about what Ohana meant... Here's what wikipedia had to say:

ʻohana means family in an extended sense of the term including both blood-related or extended. It emphasizes that family and friends are bound together and members must cooperate and remember one another.
... The root word "ʻohā" refers to the root or corm of the kalo, or taro plant (the staple "staff of life" in Hawaii), which Kanaka Maoli consider to be their cosmological ancestor.

Well, that flopped. I still have to figure out how to incorporate the idea of taro into Family. And Medicine. Hrm.

Don't sacrifice personality for character.

This is just an bit of advice I've formulated today.


I'm probably over-analyzing this, but if there's any place to share it, I figure that this is the best.

What does that mean?
I think of Personality as those cute little quirks that make you uniquely you. They are the things that people do to imitate each other.

Character is the sort of thing that Calvin's dad would always evoke as a way of getting Calvin to do hard work. "Shoveling snow builds character." "Aww... I wanna play with Hobbes!" Character is the ideals of what you want to become.

Why am I bringing this up?
I feel as though I've traded out part of my Personality for Character. When I came to school today, I got multiple comments about my appearance. It wasn't any particularly special day for me; I was just dressed in an aloha shirt and some slacks for Project HOME in the evening. Even at HOME, where everyone was wearing aloha-formal-attire, they were impressed.

"You look like a doctor!" A classmate remarked. "You could march around and people would say 'Hey doc, we need you to save this patient!'" Really? That's cool. I've captured the respectable & conservative aura so soon. I'll admit, it's been the main reason why I'd never get a tattoo or a piercing. I'd lose that sort of asian doc credibility.

So what's the problem?
I only play Doctor at school. It's just a Character I slip into. It's all about professionalism, respect, integrity, compassion and humanity. However, school has taken over my life, slowly and surely. It's hard for me to make a distinction about when I need to behave and when I can relax and be myself again. Can I screw around and study at school after hours? I do sometimes, but I think the impression that a lot of people get is that I'm all work, no play. School is school, to me.

Sure, it's easy to say "be yourself all the time," but I don't really want to get into trouble all the time. It's easier to channel just parts of myself... but it makes me more bland.

I've been hanging out with a new group of people at school recently and I really like their company. They are doing research, so they are as dorky as my med school friends. I went out to out to eat and sing Karaoke with them on friday. How surprising it must have been for them to see me as a funny/wacky karaoker, singing myself hoarse. How unusually fun-loving.

Another thing that reminded me of this recently is that my friends like to do imitations of our classmates. I've wondered if they do one of me... but I think that they don't. It's as though I've washed out those characteristics right out. A few nights ago, we had an executive officer meeting, but I wasn't invited. It was as though I were totally forgotten on the invite list! (BTW, if lynn reads this, she'd feel totally guilty. that's not my intent here.) it was funny to me, because i wondered -- am I that forgettable?

Gods, I hope not.

Thinking back, this is not a new conflict for me. I will always be struggling to maintain balance between my school life and personal life, my Character and Personality. Who I am and who I want to become.

Reflection on a reflection

I wrote an email out to the med school classes to recruit for a mentorship program. It was interesting, because I wrote as if you, my blog readers, were my main audience and apparently it was well-received. When I came to school today, two of my classmates came up to me and said "I read your email last night!"

They seemed excited about that for some reason. "Yeah, it was like a bedtime story for me..." one woman said. Whoa! Bedside tales by Yours Truly. "It was inspirational," said another. I was flattered. I didn't really expect that it would recruit more people to join the club; I just wanted to share my reasons for why I joined. I think that is my approach to a lot of things in life.

I thought I'd share it with you as well.

I had my first musculoskeletal CSP (clinical skills preceptorship) today and I was just thinking about what it means to be a preceptor. These doctors take time out of their busy schedules to help train us to become great doctors! They probably remember bumbling through the questions in the history and getting confused during the physical exam. All in all, having access to helpful preceptors so early in
our careers helps to ease us into our roles as confident providers.

Teaching is a great skill to have! You don't have to wait until you get your M.D. degree to make a difference in the training of future doctors. Mentoring is a skill that the Medical Student Mentorship Program fosters. With that in mind, I just wanted to remind you about MSMP's upcoming Mingler! This event will be taking place this Friday 9/7/07 at My University's Center 5:30-8pm. If you are curious, please come on down.

Your parking passes are valid on campus after 4pm!
If you need a ride, I'd be more than happy to take you there. Check out our website for contact info.

Mingler details: First we will meet in the meeting rooms on the third floor for some icebreakers to introduce the mentors to the potential mentees. Then we will adjourn to the Gameroom on the lowest floor for some pizza, salad and billiards/games.
Please RSVP if you are interested in attending. Also, we would like you to submit an
online MENTOR application by Saturday, 9/8/07 so we can have the mentor/mentee
matchups finished by Sunday.

Cheers,
Not My Second Opinion, MS-II, MSMP board



P.S. I know that this has been "club week" at school and there has been a lot of activity. You might be wondering why you should join yet another club. MSMP is unique among the interest groups because it extends beyond the medical school community and it is worthwhile! After all, it made a difference for me, since I'm a med student today. :-)