Summer Utah Trip

There are not enough words to describe how nice it was to see my girls again, so I'll use pictures.

Abby puked all over the place not 5 minutes after this picture was taken.

Orem Library

Daddy-Daughter date

Daddy-Daughter date

Dimetrodon (incidentally, not a true dinosaur)

BYU Museum of Paleontology

Striking a pose.

A little PA school fun

So, the Harlem Shake is the new meme sweeping the interwebs.  Our class did one today and it was a blast.  Studying isn't the ONLY thing we do in PA school.

Comment, share, spread the word.  We want this to go viral!

Wow, it's been a while

Hey there.

Remember me?

I'm the guy that used to post stuff to this blog.

It's been a while huh? Well, I'm back. Not sure for how long, but I'm back.

2012 is over. Thank goodness. It was the hardest, worst, most traumatic year of my entire life.

However, it was punctuated by some really great things, like this:

Not too bad for 17 graduate level credits.

And this (I'll do a separate post for this):

Do you have any idea how hard it is to get a 4 yr old and a 1 yr old to look at a camera at the same time??

So, the year ended as well as it could. But best of all, it ended. I was thinking of trying to summarize how last semester turned out, but that just seemed too daunting a task.  So, just look at the report card above and know that I learned some stuff (feels forgotten already) and passed all my classes with flying colors.

Now, it's a new year and a new semester of this crazy thing called PA school.  We just finished the first week and here's what I'm already knee deep in:

PAS 5009: BEHAVIORAL & COMMUNITY MEDICINE – 2
The second course in the PAS 5005, 5009 sequence. A continuation of the study of the biopsychosocial model of health care and the study of the American health care system emphasizing the role of the PA on the health care team; patient education/preventive medicine/community health; medicolegal ethics.
PAS 5004: CLINICAL PROBLEM-SOLVING / DIFFERENTIAL DIAGNOSIS
An introduction to critical thinking in the development of the medical diagnosis and treatment plan.
PAS 5007C: CLINICAL PROCEDURES
The primary objective of the Clinical Procedures course is to help PA students develop an understanding of and basic competence in the skills needed to perform diagnostic and outpatient, in-house, and emergency procedures. It is not intended to be conclusive nor is this class meant to turn out “skilled professionals.” Basic skills and knowledge learned here will prepare the student to further refine these skills with more intense, personalized instruction in the clinical setting.
PAS 5027: EKG INTERPRETATION 
A study of the principles and practical applications of electrocardiography for the physician assistant. An overview of common laboratory studies frequently encountered in the clinical setting. Students will learn when to order and how to interpret a variety of laboratory studies.
PAS 5020: INTRODUCTION TO MEDICINE – 2
The second course in the sequence PAS 5010, 5020. Signs, symptoms, and pathophysiology of common diseases of all ages; special studies in differential diagnosis. Individual sections cover various specialties included in the coursePAS 5001: PATIENT EVALUATION AND HOSPITAL PRACTICUM
Utilizing the hospital setting, the student will obtain experience in performing and recording patient histories and physical examinations and presenting clinical data.

There is some really cool stuff going on this semester.  We are starting to learn a lot more practical/application type stuff and are getting to have a lot more hands-on experiences.  For instance, on Monday, I will be completing my first full patient history and physical exam on a real. live. patient.  The class has been split into groups of six and assigned a resident.  We met with ours yesterday and he was really cool.  He took us over to the VA hospital--where we will be doing our interviews--and showed us around.  This weekend he'll email us our patient assignments.  Kind of nervous and kind of excited at the same time.  I'm definitely ready to get out of the classroom and interact with patients again.  That is by far my favorite part of health care.  I love sitting and talking to people, getting to know their stories.

This semester we also get to learn how to do cool things like venipuncture, suturing (we'll practice on pigs' feet and fake skin), casting, and lumbar punctures.

It all seems so overwhelming.  Too overwhelming.  But, I've been told that I think that at the start of every semester, yet every semester it turns out OK.  So, I guess I have reason to believe this semester will turn out alright as well.

Bucket List

So, I promised you a little more excitement in this week's post, and I will deliver.  However, I want to tell you about this week's other happenings first.  So, here goes.

Monday, our intramural co-ed flag football team had its first game.  It was so much fun.  I never really had the chance to play intramurals at BYU, so this is kind of a new experience for me.  Let me tell you, the outcome of this game was so much better than it ever was during intramural basketball this summer.  We won 29-0!  They had to invoke the mercy rule.  Here we are after the game.

Naughty Bears

On Tuesday, we had our first Pharmacology exam.  It covered pharmacokinetics, pharmacodynamics, and Antibacterial drugs.  I wasn't too sure how I would do one, but it turned out just fine.  I got a 91%.
We also started our Hematology/Oncology section in Clinical Medicine.  This is proving to be the most difficult section yet.  There's about a hundred different kinds of anemia.  Then there's the whole coagulation cascade, which is a fairly complex biochemical chain reaction whose end goal is to clot off your blood so you don't bleed to death when you get a cut.
On Thursday, we had our ENT exam and, unfortunately, this was my lowest grade yet.  Barring any favorable point adjustments, I scored somewhere in the high 80s.  (Official scores should be posted tomorrow).
Then on Friday, we had to endure the WORST lecture since school began.  I think it was a combination of factors that made it so terrible.

1. It was the last lecture of a very long week. 
2. It was a 2 hour lecture  
3. The lecturer was incredibly boring AND talked way over our heads
4. The material was complicated...or at least he made it complicated

I mean, if anybody can decipher this diagram, let me know.

OK, now that that's out of the way, let's talk about the awesome stuff.  I was able to check two things off my bucket list this weekend!  The first one is kinda nerdy, but I don't care.  I have wanted to learn how to fence for a long time now.  It's just a really elegant sport that requires calculation and quick reflexes.  Shane, a member of my ward has been fencing for about 5 years and is now the co-owner of a fencing club here in Gainesville.  So, he brought a bunch of equipment to the church on Friday night for an Elders Quorum activity.  He taught us about the history of the sport and how that influences the three different styles (foil, epee, and sabre).  Then he showed us some simple footwork and how to lunge.  Since there wasn't enough gear to go around, half of us suited up and the other half learned how to poke us with swords.  After being a pincushion for a few minutes, we switched sides and I got to do the stabbing.  Then, he would officiate while two people dueled (or whatever they call it).  It was a ton of fun and a great work out for your legs and butt.

Me acting the pincushion.

My turn to do the stabbing.

Look at that form.

My first point...right in the throat.

This is me scoring a point.  The first shot got him in the shoulder, which doesn't count.  But, the next shot is picture perfect.  I won 5 to 3.  Shane actually asked me if I had fenced before.  Not too bad for my first time, huh?

Then, on Saturday, I was able to do something that I have wanted to do even longer than I have wanted to learn to fence.  This wish began when I was really little.  I would have these fairly regular dreams that I could fly.  Not like a bird, but like Peter Pan.  But, my dreams were as close as I ever got to flying.  Then yesterday, I actually got to fly in real life...well, kinda.  I went SKYDIVING!

My friend from class, Laura Beth, is a member of the UF Adventure Club and they were going skydiving this month.  She invited anybody that wanted to to come along.  Well, I had been putting it off for years for various reasons.  The time wasn't necessarily "right," but I didn't see it ever being perfect, so I took her up on her offer.  I was not disappointed.

We left Gainesville at about 20 to noon to make the 50 minute drive out to Palatka.

Sorry, these first couple are out of order. We took these on our way out.

We got there just in time for our 1:00 appointment.  Turns out that whole "appointment" thing is a load-a-poo.  We had to wait 5 HOURS before we got to jump.  I guess they had just sold their big plane a few weeks ago, so they were using these 2 little tiny planes that could only hold 4 people max.  Well, when you do a tandem jump and have a photographer, that means that only one paying customer can go up at a time every 20 mins.  There was another group ahead of us plus a bunch of regulars that, for some reason, got to go in front of us.  It was a bit frustrating but totally worth the wait.

Laura Beth and me

Next up!

Getting strapped in.

Jairo trying to proposition me.

Yeah, it's my middle name.

Kinda surprised this tiny, rickety, old thing made it to 10,500.

Both feet back on the ground.

 It was seriously one of the most amazing experiences I've ever had.  You spend 20 mins cramped up in this tiny little plane.  Then they open the door at 10,000 feet.  There's this blast of cool air (but I barely registered the temperature...my mind was elsewhere) when they open the door.  The camera man climbs out, then you and your tandem instructor scoot toward the door.  That's when your brain starts screaming at you that jumping out of an airplane will lead to your certain doom.  But, you're strapped on to somebody else, and once you step out on that step, there's no turning back.  After rocking forwards, then backwards, we launched ourselves out into nothingness.  Back on the ground, I had asked Jairo if we could do some extra flips on the way out, and he didn't disappoint.  We got a good 3 or 4 in before flattening out.  I cannot describe to you how loud it is.  It was like nothing I had ever experienced before.  I was kicking myself for forgetting my earplugs.  The free fall only lasts about 50 seconds, but it seems more like 5.  It's all over so quick, then you're under canopy.  But floating down under your chute is almost better than the free fall.  Once he pulls the cord, everything goes silent and you can see for miles around.  Jairo was cool enough to point out landmarks as we were coming down.  He then gave me the toggles for the chute and totally let me control the turns.  I was a little tentative at first, but he reassured me that I wouldn't break it and told me to really give it a tug.  I sent us into some great turns...at least they felt pretty awesome to me.  Then after a couple minutes, we were back on planet earth and it was all over.  I wanted to get right back on the airplane and do it again.  It was such an amazing experience.  I got video taken, so when the DVD arrives, I'll be sure and post it.  Someday, when I've got the cash, I'll definitely do it again.

So there you have it.  All-in-all, it was a pretty amazing week.

ALL DONE!

With my first semester that is :)  I can't believe it's been more than a week since I last posted.  I guess I've been caught up in getting ready for today.  Lots of time spent in the anatomy lab and library.

I've got to catch you up though before I talk about today.

First, only one person took my CT diagnosis challenge.  I must say that I'm disappointed in you nurses.  I thought I would get at least a couple more attempts. :)



Here are the answers...
Thick white: Epidural bleed
Thick black: Subdural bleed
Thin black: Subarachnoid bleed
Thin white: Intraparenchymal bleed

Basically, there is a bleed at every level within the cranium.  So, by my count, Kaitlin, you were 2 for 4.  Yeah, there is huge midline shift, but it's secondary to the bleeds.  Ventricles are still clear, no blood there.  As for the etiology, I'm not sure.  We weren't told what caused all this, but it was most likely severe trauma of some sort.  If I could switch to bone windows, I would be able to tell if there were any fractures as well.  Anyways, the rules of the contest clearly stipulated that all 4 had to be correctly identified to win the illustrious prize.  Sorry Kaitlin :)


Last Thursday, I was able to volunteer at the Equal Access Clinic.

 
Equal Access is a completely student run free clinic here in Gainesville.  They just opened up this brand new building last month.  It's super nice.  There are residents there and (typically) at least one attending physician, but it's the med and PA students that do the bulk of the patient interviews and exams, along with proposing a diagnosis and formulating a treatment plan.  Since it was my first night and all I really know how to do is conduct a patient history interview, I was assigned to a 3rd year med student.  Together, we went to see our patient, who had a whole host of problems.  I asked about half the interview questions and then the med student did the physical exam.  Then we went and presented the case to the resident.  Then he asked us what we thought was wrong with the patient.  I told him what I thought and he agreed with me!  And I haven't even studied physical diagnosis yet.  Then he asked what meds we should prescribe.  I gave him my idea and he said that the med I suggested is, "unfortunately, probably the most underused antibiotic out there"...as in, I got the right answer again!  And I haven't even taken pharmacology.  It was really cool.  I felt bad for our patient though.  She had all sorts of heart problems that we couldn't do anything about because we lacked the resources.  It broke my heart to send somebody away without being able to address their biggest concerns.  But, let me say that it was very cool to be in an actual clinic setting treating a real patient.  I felt totally at ease.

Oh yeah, I was also elected Webmaster for my class.  I kinda wanted to be Secretary, but somebody else wanted to do it, so I kinda withdrew myself from that election.  So, I'll be managing our FB page, updating the class officer page on the PA website, and generally taking care of any webby-type concerns the class may have.

OK, fast forward to this week.

Radiology
We took our Radiology final on Monday.  It didn't go as well as I thought/hoped it would.  None of us really gave it much thought, since we were all gearing up for the Anatomy final.  I got an 80%, giving me an 83% for Radiology.  It's no biggie though, because Radiology only makes up 20% of our total Anatomy grade.

Anatomy
Well, I passed!  And, if my calculations are correct, I not only passed, but got a 90% in the course.  Here are my scores on the exams today...

The first score is out of 85 points and the second is out of 35, for a combined score of 93.8%.  I made a few dumb errors on the written test, but I am not complaining one bit.

I can't believe the term is over.  The last six weeks has gone by so quickly.  Next semester is going to be a killer, but I'm really excited to be learning what I will be learning.  Somebody please remind me of that come October...which is lovingly termed Sucktober by the 2nd year students.

Well, I'm off to Utah for the break.  Not sure if I'll update from there.  If not, I'll post sometime at the start of next semester.  Take care y'all.

Heart, lungs and posterior mediastinum

Before I tell you about today, let me just say that I am disappointed in Google/the internet.  There are basically no good pictures of human lungs out there.  Most of what's out there are poor CG images of lungs.  And I thought the internet had everything.

Anyway, this is one of the better pictures I found...and it's not even that realistic.

Today we got to actually cut out and remove the lungs from our cadavers.  (We did the heart yesterday).  It is difficult to really understand the beauty and efficiency of these extremely complex organs until you see them up close and personal.
In many ways, the human body is pretty resilient.  I mean, it's a downright miracle that all of what we are (physically) came from 2 "half-cells" coming together into one cell and differentiating a trillion times into tissues and organs.  Then, the fact that all of these highly specialized organs and systems work together so perfectly (or at least so functionally) is mind-boggling.  Even in very sick people, the body has redundancy systems that compensate for deficiencies.
Yet, at the same time, it's humbling to realize how fragile it all can be.  Our little lady had a collapsed left lung.  Instead of being full, firm, and healthy, it's this little, shriveled, wrinkly thing.  Another cadaver had suffered lung cancer.  His lung was dang near unrecognizable for what it was.  And it is alarming that with a few well placed swipes of a scalpel, our lady's heart and lungs were taken from her body.
But to hold these organs in your hands, to open them up, to see with your own eyes just how amazing they are, is something I wish everybody could experience.  It sure gives you appreciation for what God has created.

Moving on.

So, we got to take out the lungs and examine the trachea, primary and secondary bronchial branches, and where all the major blood vessels enter.  Once the lungs and heart were removed, we could (with a little work) see many of the blood vessels (azygos, accessory, and hemiazygos veins; the neuro-vascular bundles of the intercostal (between the ribs) spaces, the descending aorta with its many branches, as well as the thoracic duct of the lymphatic system and the sympathetic trunk of the nervous system.  There are about a hundred other structures I have to know, but I won't bore you with them.  Today completed our look at the thorax.  Tomorrow we'll move below the diaphragm and into the abdomen.

I also wanted to say that I am really appreciating a lot more the already prosected cadavers we worked with at BYU.  I can't tell you how much of the inside of our bodies is just fat and connective tissue.  Most of our lab time is spent clearing this crap out of the way so that we can see actual structures.  I don't know how many hours were spent by students and professors at BYU to get a cadaver cleaned and ready for the lab, but it must have been a ton.

Lastly, I got this email as I was sitting in class today.

EVMS was the only school that I hadn't heard back from yet.  For some reason, their program starts in January whereas everybody else starts in either Summer or Fall, which I think is silly.  That's why their email came so late.  I just thought it was funny, because there I was, sitting in class at what I think is the best Physician Assistant school in the nation, and in pops this rejection letter.  Oh well, their loss, not mine. :)

Today's cool stuff

Amazing things I got to do today in Anatomy.

1) Cut through ribs and retract rib cage/sternum to expose the pleural cavity.

2) Hold a human heart in my hands...Like so

Actually, it was more like this...

I wish I could take actual pictures of me in the lab, but they don't allow that for obvious reasons.

3) Saw a partially collapsed lung.

4) Saw and felt a cancerous lung.  Instead of a nice spongy texture, it was like a balloon full of mud.  Moral of the story...don't smoke.  Ever.  It's gross and it will kill you.

All in all, it was a pretty cool day.

July the 4th

Ah the 4th of July.  Typically one of my favorite holidays.  This year was a bit different.  Being in a new place far away from friends and family makes it a little more difficult to get into the spirit of things.  And honestly, no place does Independence Day like Provo.  That place knows how to be patriotic.

Gainesville actually did their celebration last night.  Maybe it was so people didn't have to go to work the next day.  Who knows.

A buddy from school invited me to bike it up to campus with his wife and him to take in the festivities.  We made it up there in time to catch a few songs from the Gainesville Community Band before the fireworks began.

It was a descent show.  Not Stadium of Fire but not bad either.  It was hard to get into it though.  The fireworks brought back a lot of memories of people and places and things I was missing out on this year.








So, because I kinda celebrated yesterday, I spent most of the day on campus in the Anatomy lab going over the Brachial Plexus and the Axillary artery with it's important branches.  There were actually quite a few of us up there, so I didn't feel like such a loser.  After lab, we sat around and reviewed some terminology for one of our quizzes tomorrow.  It's nice to finally be making friends again.  Then I came home and did my readings.  By 9 I had had enough of studying and was craving ice cream for some reason.  So, I walked on down to Cold Stone and bought a highly overpriced but delicious cup of ice cream.  Cheesecake Fantasy.  Mmmm, cheesecake.

It turns out my roommate has had a whole load of firecrackers stashed in his room since last year.  So we spent 15 mins or so throwing firecrackers off our balcony and in front of our neighbors' doors.  Real adult of us, I know.  But hey, it made us laugh pretty hard.