October 17, 2007

House MD predictions

I like this show. It has bad medicine. It features a doctor who is the antithesis of good medicine. He regularly commands underlings to break and enter peoples' homes to search for clues about their current disease. He says very rude and insensitive things to patients and their families. He's done outright illegal and unethical acts in the name of saving his patient. Well, I suppose its the thought that counts. He does care, after all.

I get my House fix over at Polite Dissent. There wasn't a new episode of House this week (much to my disappointment when I sat down to watch TV at 8pm) but Scott did put out a challenge to his readers: guess what diagnoses are going to be featured in future episodes!

Most of my studying is out of a hefty tome called "Robbin's Pathologic Basis of Disease." A lot of the random names that fly about in House episodes come straight from this book, so I'm glad to say that after just a year and a half of med school training, I can ID nearly 90% of the lingo from the show.

House has made it easier to remember some of these bizarre entities and ridiculous diseases because I can put a face and a story to many of them now. It's greatly added to the appeal of the show for me. I haven't ever nailed a diagnosis, but maybe someday I will.

Here's my list of predictions. I'll report back week after week about how I'm doing.
1) Bronchogenic carcinoma (some sort of paraneoplastic syndrome, myasthenia gravis, Trousseau)
2) Small cell carcinoma (w/ ACTH or SIADH) … just because I like the ddx of paraneoplastic syndromes, I wanted to toss this in
3) Neurofibromatosis -> acoustic neuroma
4) Cryptococcus infection (c’mon now. A disease you get from pigeons? They’ll use this at some point.)
5) Strep mutans -> subacute endocarditis -> weird stroke syndromes, etc. (i picked this because they’d get use the line “s/he died just from brushing his/her teeth!”)
6) McCune-Albright polyostostic fibrous dysplasia (w/ endocrinopathies GH, TSH, ACTH… might show up in #2’s ddx or vice versa w/ cafe au lait spots)
7) Lyme disease -> Neuroborreliosis (maybe concealed by something like psoriatic arthritis)
8) AVM (maybe concealed w/ something like a traumatic brain injury in a soldier from Iraq… shrapnel would prevent them from running an MRI, House’s favorite diagnostic test)
9) Systemic Progressive Sclerosis (the clinic case of the day of Peyronie’s disease could be the eureka moment for House’s diagnosis)
10) Syphilis -> neuro, cardio etc.

October 13, 2007

OLD AGE is bad for Gout

O besity & HTN
L ead poisoning --> saturnine gout (hits the knee preferentially)
D rugs (i.e. thiazides, furosemide, low dose ASA)
A ge
G enetics (partial HGPRT deficiency, etc.)
E tOH (beer > liquor > wine)
Gout is a disease of imbalanced production & excretion of a substance called uric acid.  Humans are unusual animals in that we do not break down our purine DNA metabolites beyond uric acid (into substances like allatoin.)  When uric acid accumulates in joints, it can spontaneously form into sharp needle-like crystals that cause inflammation and extreme pain, most commonly in the big toe (podagra.)
It can be avoided by reducing OLD AGE risk factors, especially through an appropriate diet of no alcohol and low-purine foods.  That means no beer, seafood or organ meats.


Lippincott's Biochem 2nd edition

Harrison's Internal Medicine

Robbins Pathologic Basis of Disease

Poor, G. Saturnine Gout. Baillieres Clin Rheumatol. 1989 Apr;3(1):51-61. I just used the abstract to figure out what made Pb-induced gout different.

Choi, Hyon. Pathogenesis of Gout. Ann Intern Med. 2005;143:499-516.

Golan's Principles of Pharmacology

October 12, 2007

On Loss

My Healer's Art class assignment for the week is to write an antry on loss or disappointment. Here's what I came up with. It has a lot of personal details that I didn't feel like stripping away. This is my life. This is who I am and what I think.

This story takes us back about two and a half years in time. I just finished my last round of interviews at medical schools and I was waiting to hear back from them. My classes were fairly easy; I was taking a music and an acting class to finish off my reqs for graduation and a microbio and embryo class to prep for med school. This waiting time was a big moment in my life... I knew that a good chunk of my life would be altered by the decisions of anonymous others.

One idle night, I was on Myspace and I stumbled across the profile of someone who had captured my interest. She had a picture of herself with a quirky smile and turtles in the background at sea life park. I messaged her, telling her that I felt 'compelled to contact her because I thought she had the coolest pic ever' and 'I wanted to get to know her better.' She messaged me back almost instantly; she was online at the same time. We ended up sending messages back and forth several times a day for a week. Our conversation shifted to instant messaging and then to the phone. We met each other for the first time two weeks later.

It was an exciting time for me. We shared some strange similarities. We both used to play the trombone. We both went to Portland, Oregon for a year of undergrad and loved it there. We clicked so well that I was rarely nervous and I felt as though I could talk about anything with her. I often did. Our best times together always involved just talking. We'd have a picnic in the park together and talk. We'd walk through Waikiki in swim trunks at midnight and talk. We'd go camping and stroll on the moonlit beach and talk. This was a new form of communication for me, to share what I was feeling fearlessly with someone. I'd even say I became addicted to it.

This was a time filled with some uncertainty. Would I have to choose between a love and a life of medicine? I didn't know what would happen in a few months, as the letters came in. Rejection. Rejection. On the waitlist. Rejection. Waitlisted. One night, we were at the park, tossing a frisbee around together and my parents called me.
"Your letter from the University of Hawaii came in! Should I open it?"
"Sure," I said somewhat disappointed. "It says something already that it's a letter and not a packet..."
*sounds of a tearing envelope*
"'Dear Clinton, we regret to inform you that the University of Hawaii will not be accepting your application at this time. We have had a record number of extremely talented and qualified applicants such as yourself...' Oh, I'm sorry, son. Are you Ok?"

To be honest, I don't think I was ever so happy to hear bad news in my life! Getting rejected from medical school was a blessing. It gave me the time to get to know this new and wonderful woman, who was genuine and goofy and adventurous and positive and communicative.

Two months later, we went on a road trip together for close to 8 weeks, up and down the West Coast. We started off in LA, went down to San Diego and Tijuana and then all the way up to Vancouver, B.C. We spent most of our time in Oregon, where we had both gone to undergrad. It was a strange and risky thing to do. After all, we had only known each other for 4 months or so and we were basically homeless, living together for 2 months in a trailer van! It was a great way to do what I loved most... just talking with her.

I tell you all of this to explain my love, so it in turn illustrates the depth of my loss. She is a woman I love with my heart and soul. I would have proposed to her a long time ago if she could have ever uttered three little words that meant so much to me -- "I love you."

She did, you know. It was evident by her joy being around me. However, she wanted to save those words for someone that she wanted to spend the rest of her life with. Someone that wasn't me.

The freedom I felt with her was a failing as well. As easily as I could share my joy with her, I shared my wrath. I was an angry person back then. Angry with myself, mostly. A lot of that sort of mulling self-hatred drove me to improve as I beat myself up mentally. My insecurities, my competitiveness, my self-hatred, all of these things came out because I was totally open with her. She might have liked it that I was so honest and open with her, but she did not like my flare-ups. It also made for a sometimes dysfunctional relationship when I had trouble accepting when I was wrong and she was right. She never rubbed in my face when this was the case. She never gloated. She never did anything passive-aggressive when it was the other way around. It took me a long time to realize that she was incapable of doing any of these sorts of hurtful things. I'm a sensitive guy. She definitely brought this out of me, intentionally or not. I don't really know if being sensitive is something I'd like to change about myself.

The ANGER though... that was her major turn-off. Eventually, it grew worse as our relationship grew longer. She got accepted to the JET program and she was planning on going to Japan. I got accepted to medical school and I was planning on staying in Hawaii. Bitterness grew as I realized more and more that her philosophy of anti-long-distance relationships would apply to us. And there wasn't anything I could do to change that. The helplessness I felt tainted our time together. It came out in bursts of depressive despair and grouchiness that left me wondering... why doesn't she just break up with me already? Why is she drawing this out for as long as possible? Those feelings would pass, swiftly forgotten in my fickle mind... but they would build in her like steam. She didn't like that feeling and often told me that I was too much of a rollercoaster for her.

I knew our relationship was terminal when she would start saying things like "someday, you'll meet someone who will make you very happy" during my bouts of despair. Of course, I was thinking to myself that I already HAD met the person of my dreams... what were the chances of finding that again? Especially if it meant letting her go?

My white-coat ceremony was a bittersweet affair. She was flying off to Japan to teach English the day after I would set foot on the path of medicine. We parted on good terms and the promise to always remain good friends.

For a long time, I was filled with regret. Of all the relationships I've had, this breakup was the hardest by far. I was selfish. I didn't understand how someone couldn't love the oh-so-perfect-Me. I definitely made the relationship strained towards the end because of my unwillingness to accept failure. Looking back, it was always so childish and so ridiculous. I am embarrassed that I acted so terribly on a few occasions with the person who I cared about the most... and even worse, I chased her away because of it.

I visited her in Japan a few times since then. More and more, I've changed to the point where I don't think she'd recognize me. She only knows the old, flashpan angry clinton. After a long discussion with her recently, she sent me a clip from an audio file she was recording to help a student for a English Speech festival. It was particularly pertinent to our talk.
One day, someone came into my life and changed my thinking. He is someone very special. He said "do you think people grow more when they meet someone or when they say goodbye? Saying goodbye can be hard, but we realize the good things about them. At the same time, we start to feel regretful. By remembering those regreful moments, we're able to stop making the same mistakes and start improving ourselves. Saying goodbye gives us a chance to grow.

The big loss I speak of here is not so much the loss of my love, since she still swoops into my life from time to time. It's a loss of a part of me. That is a loss that I can celebrate now, thanks to her kind lesson. :) Thank you, Y!

October 11, 2007

Midterms and Midnight

So I took my midterm on Tuesday.

I had a close friend come to visit from Japan and I wanted to spend as much time with her as possible before she left, so I had to really schedule my study time out in advance. I like having these sorts of "planned distractions" because they really make me focus.

Ok, you've got to quit fooling around and get to work! I tell myself. And it's a good thing too -- the midterm was challenging, but I felt prepared for it. There were only a few questions I was thrown by... and they were the "duh, you should know this already" type of questions. Talking with my fellow classmates, I got the sense that a lot of people were flooded with anxiety after the exam.

What, me worry? I did good enough. That's the WORST possible feeling to have after a midterm, I feel. In some ways, I should have studied less so I'd feel worse about the test and that would motivate me to study even HARDER for the final.

This brings up the pressing point of the night.
I slacked off yesterday. I decided to watch House on TV, take two naps and then go to sleep early.

Because of that ill-advised decision, I had to stay up until *checks watch* 4:15am today!!! It turns out that the limbic system is very confusing and difficult to understand. Hopefully I have a good enough grasp on it tomorrow to be able to present it in a clearer manner than I received it.

At least I have my motivation back. I also had some good lazy naptimes. Now it's back to business!

October 05, 2007

Chatting with a friend

This is something that I'd like to come back to later on. The AIM names have been changed to protect the innocent. ;-)
NotMySecondOpinion (11:34:22 PM): are you going to join the air force?
religiousfriend (11:34:37 PM): I'm not sure
religiousfriend (11:34:43 PM): they need leaders in the air force
religiousfriend (11:34:50 PM): I don't have much leadership experience
NotMySecondOpinion (11:36:27 PM): i think it would be good for you to join, but at the same time, i wouldn't want you to go
religiousfriend (11:36:37 PM): ah
religiousfriend (11:36:40 PM): why do you think so?
NotMySecondOpinion (11:37:16 PM): the military would give you discipline and direction
religiousfriend (11:37:27 PM): that's true
religiousfriend (11:37:36 PM): I don't know about direction
NotMySecondOpinion (11:37:38 PM): but its dangerous, even in the air force
religiousfriend (11:37:40 PM): but discipline, yes
NotMySecondOpinion (11:37:55 PM): and you'd become a part of the military culture, which i dislike
religiousfriend (11:39:29 PM): I don't care for military culture
religiousfriend (11:39:45 PM): I don't want to become a further drain on taxpayer resources
religiousfriend (11:39:56 PM): besides which, the AF is scaling down its officer corps
NotMySecondOpinion (11:42:37 PM): what do your other plans comprise of?
religiousfriend (11:43:27 PM): I'm thinking of entering a monastery
religiousfriend (11:43:40 PM): other than that, law school/grad school
NotMySecondOpinion (11:45:04 PM): is there any incident you can think of that prompted your religiosity?
religiousfriend (11:45:20 PM): a realization of my own finitude
NotMySecondOpinion (11:46:12 PM): thats rather abstract.
religiousfriend (11:46:23 PM): When I was ten, I remember thinknig
NotMySecondOpinion (11:46:31 PM): was it from reading something or doing something?
religiousfriend (11:46:31 PM): "ah, I've lived through one eighth of my life"
religiousfriend (11:46:49 PM): I've read a lot of things
religiousfriend (11:46:54 PM): I've done a lot of things
religiousfriend (11:47:18 PM): but faith is something from God. You can't get it by your own efforts
NotMySecondOpinion (12:02:28 AM): how do you define faith?
religiousfriend (12:02:41 AM): I'm still working on that one
religiousfriend (12:02:54 AM): But ultimately Faith is personal
NotMySecondOpinion (12:04:05 AM): i'm just wondering why you think it comes from God
religiousfriend (12:04:37 AM): Well, from the Materialist side people could say it comes from all kinds of chemical reactions
religiousfriend (12:05:27 AM): but at any rate, I don't have enough faith to faithfully answer your question
NotMySecondOpinion (12:06:18 AM): I disagree with the statement that it comes from all kinds of chemicals
NotMySecondOpinion (12:08:09 AM): I think Faith comes from a strong desire/belief in the connections you make with others and the world around you. Those connections are immaterial, but they might be represented by chemical reactions that take place concordantly or disconcordantly, depending on whether or not your Faith is misplaced
religiousfriend (12:10:54 AM): that's a bit over my head
NotMySecondOpinion (12:14:43 AM): i didn't know what faith meant until i loved someone. i could never really know if they loved me back. that's when i had to decide whether or not I could step back and relinquish control of ... almost everything and just have faith.
religiousfriend (12:15:36 AM): I think you're getting close
religiousfriend (12:15:56 AM): but I don't have much faith, so what can I say
NotMySecondOpinion (12:16:02 AM): yeah, i don't know where God fits in there.
NotMySecondOpinion (12:16:20 AM): thats what i was hoping you could help me with
religiousfriend (12:16:35 AM): mmm, it's hard for me to give what I don't really have
religiousfriend (12:16:42 AM): It's important to be humble, first of all
religiousfriend (12:17:06 AM): Hell is full of people who think they're too good for Heaven
NotMySecondOpinion (12:18:31 AM): what does that mean?
religiousfriend (12:19:16 AM): Well, according to the Faith, Hell and Heaven are the same place
religiousfriend (12:19:34 AM): Think of Gollum
religiousfriend (12:19:44 AM): and how he hated the Lembas bread
religiousfriend (12:20:04 AM): and other elvish things
religiousfriend (12:20:39 AM): Those "in Hell" experience the glory of God in the same manner
religiousfriend (12:20:57 AM): because their hearts are too prideful
NotMySecondOpinion (12:21:31 AM): we make our own heaven, then.
religiousfriend (12:21:57 AM): We don't really "make" it
religiousfriend (12:22:00 AM): we accept it
religiousfriend (12:22:12 AM): but yes, ultimately Faith is a matter of the heart
religiousfriend (12:26:40 AM): http://fatherstephen.wordpress.com/ anyway, this site is much more articulate than me in expressing this sort of thing
religiousfriend (12:26:51 AM): I suggest you add it to your google reader
religiousfriend (12:28:09 AM): http://fatherstephen.wordpress.com/christianity-in-a-one-storey-universe/ this might be of interest to you
NotMySecondOpinion (12:29:20 AM): he spells story weird
religiousfriend (12:30:48 AM): that's to distinguish storey as in a building with story as in a book
NotMySecondOpinion (12:35:07 AM): ah
NotMySecondOpinion (12:52:59 AM): i'll definitely have to read more of that later
NotMySecondOpinion (12:53:10 AM): for now, i'm off to do more work. ttyl!