Pulmonary lecturer: "If there's blood in the pleural space, obviously the lung can't expand there. Two bodies cannot occupy the same space at the same time...though, of course, it's fun to try."
Renal lecturer: "So if this woman has 6 liters of extra fluid on board but she doesn't have pitting edema, where did she put it?"
Student: "I don't know, in her hump?" (full disclosure, it was me.)
Professor: "What?"
Other student: "She's a camel!"
Other renal lecturer: "And if you had to guess which diuretic Peter Griffin from Family Guy is on, you would guess spironolactone. Because of the gynecomastia." (For those playing the home game, gynecomastia is when men develop hypertrophic breast tissue; in layman's terms, man-boobs).
Monday, September 21, 2009
Wednesday, September 16, 2009
Today's Lessons...
Not necessarily related to class--though some are.
1. No one ever has pheochromocytomas (tumors that produce excess adrenaline and noradrenaline), but lots of people have the symptoms. The symptoms are really common and vague--palpitations, flushing, jitteriness. As an intern, you will run lots of labs trying to track down a "pheo," imagining the 'House'-ready moment when you present your off-the-wall find to your attending and are crowned with laurels and fanned with palm leaves by the more junior medical students. One problem: you will not find them. They are the Easter Bunny, the end of the rainbow. Never there. Oh, and fun learning point: "Pheo" is a root meaning 'dusky.' Guess the tumors are dusky colored.
2. According to several people in my class, "Snickers are the healthiest candy bar. The most protein, the most fiber. No, seriously." I would say that if your eating habits have reached the point that you are SERIOUSLY considering the nutritional merits of Snickers bars, you have bigger problems than that extra 2 grams of fiber can address.
3. Not even the promise of cupcakes was sufficient to lure--I mean, encourage--more than 5 people to come to the Medical Students for Choice meeting. Why? Because another interest group was having a meeting and serving lunch. Since when does lunch beat cupcakes? Especially cupcakes with that layer of frosting that's so thick and firm you can pick it off the pastry and eat it by itself? Damn, now I'm all hungry.
4. In low-bloodflow situations, tissues (including the heart!) are capable of entering a 'hibernating' state where oxygen need is reduced and metabolism slows; upon reperfusion (ie the return of blood to the area) metabolism picks right up again, albeit with modifications--including modifications that are protective in the event of future ischemia! We are truly adaptable creatures.
5. I'm a soprano and all, but hitting a high A (as in, a ledger line above the staff) is...difficult.
6. When you're a medical student, you dissect the aorta and appreciate how thick it is, how muscular while still being elastic and distensible. When the aorta dissects itself--as in advanced syphilis or Marfan's syndrome--it's really, really bad. Rupture and exsanguinate (isn't that a great word? Better than 'bleed out,' in my opinion) in a matter of minutes bad.
7. Waiting for 45 minutes at the reproductive endocrinologist's office with only a People mazagine for company reinforced several things I already know about myself:
a) I think those over-sized sunglasses are a horrible, horrible trend, mostly because I associate them with Paris Hilton and Mary Kate Olsen. Also, they make people look like bugs.
b) I am a fundamentally impatient person. I have a need to be doing SOMEthing at all times. Maybe the Universe is teaching me to be more chill; I don't know.
c) I am out of touch with popular culture, and this does not bother me. I know who Jon and Kate are solely from check-out-stand magazines; I do not care about their family because I have other things to care about, and also because I am strangely immune to the 'cuteness rays' children emit. I spend evenings reading textbooks and writing sonnets rather than watching TV. Does this make me a better person than someone who watches Wheel of Fortune or streams cat videos on YouTube? Yes. Yes, it does.
d) There is no way to make a gyn exam not suck. There are, however, ways to make it suck less--and the rules for an easy exam are surprisingly similar to the rules for good sex. To the patient: relax. Speak up if something hurts. Breathe. For the doctor: Go slow. Explain what you'll be doing before you do it. Warm the speculum, or use a plastic one. Have lube handy. Don't be in a rush, but don't hang out in there forever.
1. No one ever has pheochromocytomas (tumors that produce excess adrenaline and noradrenaline), but lots of people have the symptoms. The symptoms are really common and vague--palpitations, flushing, jitteriness. As an intern, you will run lots of labs trying to track down a "pheo," imagining the 'House'-ready moment when you present your off-the-wall find to your attending and are crowned with laurels and fanned with palm leaves by the more junior medical students. One problem: you will not find them. They are the Easter Bunny, the end of the rainbow. Never there. Oh, and fun learning point: "Pheo" is a root meaning 'dusky.' Guess the tumors are dusky colored.
2. According to several people in my class, "Snickers are the healthiest candy bar. The most protein, the most fiber. No, seriously." I would say that if your eating habits have reached the point that you are SERIOUSLY considering the nutritional merits of Snickers bars, you have bigger problems than that extra 2 grams of fiber can address.
3. Not even the promise of cupcakes was sufficient to lure--I mean, encourage--more than 5 people to come to the Medical Students for Choice meeting. Why? Because another interest group was having a meeting and serving lunch. Since when does lunch beat cupcakes? Especially cupcakes with that layer of frosting that's so thick and firm you can pick it off the pastry and eat it by itself? Damn, now I'm all hungry.
4. In low-bloodflow situations, tissues (including the heart!) are capable of entering a 'hibernating' state where oxygen need is reduced and metabolism slows; upon reperfusion (ie the return of blood to the area) metabolism picks right up again, albeit with modifications--including modifications that are protective in the event of future ischemia! We are truly adaptable creatures.
5. I'm a soprano and all, but hitting a high A (as in, a ledger line above the staff) is...difficult.
6. When you're a medical student, you dissect the aorta and appreciate how thick it is, how muscular while still being elastic and distensible. When the aorta dissects itself--as in advanced syphilis or Marfan's syndrome--it's really, really bad. Rupture and exsanguinate (isn't that a great word? Better than 'bleed out,' in my opinion) in a matter of minutes bad.
7. Waiting for 45 minutes at the reproductive endocrinologist's office with only a People mazagine for company reinforced several things I already know about myself:
a) I think those over-sized sunglasses are a horrible, horrible trend, mostly because I associate them with Paris Hilton and Mary Kate Olsen. Also, they make people look like bugs.
b) I am a fundamentally impatient person. I have a need to be doing SOMEthing at all times. Maybe the Universe is teaching me to be more chill; I don't know.
c) I am out of touch with popular culture, and this does not bother me. I know who Jon and Kate are solely from check-out-stand magazines; I do not care about their family because I have other things to care about, and also because I am strangely immune to the 'cuteness rays' children emit. I spend evenings reading textbooks and writing sonnets rather than watching TV. Does this make me a better person than someone who watches Wheel of Fortune or streams cat videos on YouTube? Yes. Yes, it does.
d) There is no way to make a gyn exam not suck. There are, however, ways to make it suck less--and the rules for an easy exam are surprisingly similar to the rules for good sex. To the patient: relax. Speak up if something hurts. Breathe. For the doctor: Go slow. Explain what you'll be doing before you do it. Warm the speculum, or use a plastic one. Have lube handy. Don't be in a rush, but don't hang out in there forever.
Tuesday, September 8, 2009
More on Fat Acceptance...
Great article on eating disorders in the Fat Acceptance movement from my absolute favorite magazine, Bitch: Feminist Response to Pop Culture.
An article which begs the question, what exactly makes an eating disorder? Obviously it's a subjective diagnosis, whether you're talking about anorexia or binge eating disorder (yes, there are 'physical,' objective indicators of eating disorder status...a BMI below 17.5, or amenorrhea for more than 3 months for anorexia, for example) but then again, even the DSM-IV includes "overvaluation" of weight as a symptom of EDs. Think about that. In 2009, in the United States, one could reasonably argue that most women 'overvalue' their weight. Not because we're stupid or shallow or have a diagnosable eating disorder, but rather because that's what we're trained to do from elementary school on. Despite the positive spate of articles in teen-oriented magazines like Seventeen, there are still 'Summer Tone-Up Specials' published every May, showing 13 year olds that the best (and perhaps only) way to be a real woman is to watch those calories and do 100 crunches a day.
We have a slew of television shows like 'Bulging Brides' (I almost fell off the treadmill at the gym when I saw that title a few days ago) and 'The Biggest Loser' that focus exclusively on weight loss. Magazines at the check-out stand offer ways to drop 20 pounds in a month--assuming that every woman wants or needs to lose the equivalent of a small child--then, in another article a few pages later, exhort women to love themselves whatever their shape. Then, in the 'Health' column, another admonition that a body fat percentage over 20 means you're headed for an early, deep-fried grave. The whole mess is--well, a mess.
The primary point is that eating disorders occur in people of all shapes and sizes--something that most people would benefit from knowing. Officially, anorexia requires a certain percentage of weight be lost--yet I've known 'normal' and overweight people who followed profoundly restrictive diets. For a period during college, I was running ten miles a day and eating 600 calories--but it wasn't until my weight plummeted past 100 lbs that I was 'officially' anorexic. Bulimics can be any weight. Someone can binge-eat and weight 80 pounds, or 380. The fat acceptance movement is right on in encouraging people to care for their bodies--but an eating disorder, whether manifest in starving or bingeing, is profoundly unloving. For a woman attempting to heal that damage to be rejected by the very movement that purports to champion body-love is both counterproductive and disappointing. Exclusion and derision hurt, no matter what the 'political' motivations.
An article which begs the question, what exactly makes an eating disorder? Obviously it's a subjective diagnosis, whether you're talking about anorexia or binge eating disorder (yes, there are 'physical,' objective indicators of eating disorder status...a BMI below 17.5, or amenorrhea for more than 3 months for anorexia, for example) but then again, even the DSM-IV includes "overvaluation" of weight as a symptom of EDs. Think about that. In 2009, in the United States, one could reasonably argue that most women 'overvalue' their weight. Not because we're stupid or shallow or have a diagnosable eating disorder, but rather because that's what we're trained to do from elementary school on. Despite the positive spate of articles in teen-oriented magazines like Seventeen, there are still 'Summer Tone-Up Specials' published every May, showing 13 year olds that the best (and perhaps only) way to be a real woman is to watch those calories and do 100 crunches a day.
We have a slew of television shows like 'Bulging Brides' (I almost fell off the treadmill at the gym when I saw that title a few days ago) and 'The Biggest Loser' that focus exclusively on weight loss. Magazines at the check-out stand offer ways to drop 20 pounds in a month--assuming that every woman wants or needs to lose the equivalent of a small child--then, in another article a few pages later, exhort women to love themselves whatever their shape. Then, in the 'Health' column, another admonition that a body fat percentage over 20 means you're headed for an early, deep-fried grave. The whole mess is--well, a mess.
The primary point is that eating disorders occur in people of all shapes and sizes--something that most people would benefit from knowing. Officially, anorexia requires a certain percentage of weight be lost--yet I've known 'normal' and overweight people who followed profoundly restrictive diets. For a period during college, I was running ten miles a day and eating 600 calories--but it wasn't until my weight plummeted past 100 lbs that I was 'officially' anorexic. Bulimics can be any weight. Someone can binge-eat and weight 80 pounds, or 380. The fat acceptance movement is right on in encouraging people to care for their bodies--but an eating disorder, whether manifest in starving or bingeing, is profoundly unloving. For a woman attempting to heal that damage to be rejected by the very movement that purports to champion body-love is both counterproductive and disappointing. Exclusion and derision hurt, no matter what the 'political' motivations.
Saturday, September 5, 2009
Cool stuff learned in class this week
1. If you have 2 boys, roughly 13 years of age, show up together in the ER with symptoms of atropine poisoning (anticholinergic or antimuscarinic poisoning): Odds are good--ie, 90%--they heard from someone--like a 14 year old boy--that it's possible to get high by smoking a plant called Jimson Weed. The bad news is, it contains alkaloids related to those found in Atropa belladonna (otherwise known as deadly nightshade) that will make your mucous membranes dry, make you unable to pee, cause hyperthermia (ie, high temperature, but not mediated by the cellular messengers that usually cause fever), and make you kind of delirious and crazy. It's a high, sure, but it's not the nice sort of high you get from a Purple Haze or a White Widow (names, apparently, of carefully cultivated and very expensive varietals of Cannabis sativa. Ahem. Seriously, I read about it in a New Yorker article. And then learned about 'Afternoon Delight' from Arrested Development. Aside: I really don't know why marijuana isn't legal. It's exponentially safer than cigarettes, alcohol--or, for that matter, aspirin).
2. Two teen girls who show up together will probably exhibit an anticholinergic toxidrome related to motion-sickness meds (hey, if you take enough Benadryl or scopolamine you can get high!) or a sympathomimetic toxidrome (ie, be speedy, with pounding hearts and anxiety) related to drugs like amphetamines taken for weight loss.
3. There is a drug called Narcan which exists to bring people out of heroin-induced comas, but according to the lecturer, "People are usually pretty pissed off when they wake up, because you've undone the nice high they paid for."
4. There is a drug called Flumenazil that exists to undo benzodiazepine toxicity, too, but it's used much less often, and for good reason. If someone's been abusing (or even just taking regularly, as one might for insomnia or anxiety disorders) benzos, they'll be kicked into withdrawal, one sign of which is seizure. And what's the first-line treatment for seizure? Benzos, only know you can't use them, because you've blocked the receptor. Oh shit.
5. Despite having to memorize lots of drugs and mechanisms, pharmacology is pretty damn cool.
6. Pediatric neck masses are almost never cancer. In older adults, they almost always are.
7. If someone says they feel like they're 'spinning,' 90% of the time they have an inner ear problem.
2. Two teen girls who show up together will probably exhibit an anticholinergic toxidrome related to motion-sickness meds (hey, if you take enough Benadryl or scopolamine you can get high!) or a sympathomimetic toxidrome (ie, be speedy, with pounding hearts and anxiety) related to drugs like amphetamines taken for weight loss.
3. There is a drug called Narcan which exists to bring people out of heroin-induced comas, but according to the lecturer, "People are usually pretty pissed off when they wake up, because you've undone the nice high they paid for."
4. There is a drug called Flumenazil that exists to undo benzodiazepine toxicity, too, but it's used much less often, and for good reason. If someone's been abusing (or even just taking regularly, as one might for insomnia or anxiety disorders) benzos, they'll be kicked into withdrawal, one sign of which is seizure. And what's the first-line treatment for seizure? Benzos, only know you can't use them, because you've blocked the receptor. Oh shit.
5. Despite having to memorize lots of drugs and mechanisms, pharmacology is pretty damn cool.
6. Pediatric neck masses are almost never cancer. In older adults, they almost always are.
7. If someone says they feel like they're 'spinning,' 90% of the time they have an inner ear problem.
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