Rough seas ahead?

It should have been simple: finish the first year, get the house ready for sale, and concomitantly buy a house close to the university. The plan emerged literally 2 days before the last exam. My wife and I decided that it would be much easier if we lived in the same house when I worked my way through the second year. So for three weeks we feverishly worked on cleaning up the house and improving the property, to bring the whole thing to a sellable condition. And two-and-a-half weeks ago we finally put the house on the market. Yet the right house near the university has eluded us. We decided to withdraw our offer on what was supposed to be the 11th-hour house that would have closed right as the kids were ready to go to school. The house was in no condition to move in as I realized yesterday, so it became a no-go. Now we're staring the prospect of potentially moving in the middle of winter, when the kids finish their first semesters along with me.

Other than real-estate hell, though, it's been a decent vacation, if one could call it that. Early in June I visited Chicago for an AMA conference. It was an eye-opening chance to see politics of a large organization in action. Much of the student section's work was devoted to debating and voting on proposals that were to be later taken up by the doctors' sections.

No research for the summer. I was planning to get together with a radiologist in town to do a paper study that would have likely yielded a publication, but the family life won out in the end. I wanted to spend some time with the kids and do some studying. And I had a chance to do both. There is also a chance to do some research at the university once things start back up again. I'm counting on 2nd and 4th years to attempt the research, since I hear year 3 is jam-packed.

The time away from school has also given me some opportunity for reflection on my future role as a doctor, on medicine, and on that most precious thing that is health. In coming days I'd like to comment on a few things; hopefully there will be time to do a bit of writing.

$20,000 Words

Medical jargon, as it should be expected, is hardly limited to obscure conditions or highly technical procedures. While some of it has permeated into the common parlance, there are conditions that retain their common names, and only doctors end up knowing the 20-dollar words for such mundane things as hair loss. Seeing that our annual tuition hovers around the $20,000 mark, I call them the 20,000-dollar words. Alopecia (baldness), pruritis (itching), or exanthema (rash) are just few such examples. It's always fun to throw out a medical term for something common and watch for response. I suppose it's the geeky thing to do...

Econ 101 @ Med School

eBay or any large auction site is a great tool for learning the principles of supply and demand. The review books for USMLE 1 (part 1 of the board exams) are now in a price spike because the summertime boards are coming up. Naturally the most recent editions are fetching the highest prices, but even the 3-4 year old sets do pretty well. I look mostly at the tried and true Kaplan review materials, (worked well for the MCAT) though by the time my turn comes, I may have amassed a pile of books taller than me. But there is a way to circumvent the brutal market forces--4th year students. Right now most of them are moving out to their residencies and getting rid of everything. Furniture, TV's, and review books. Often at a price much lower than eBay's. So for now, I'm keeping my eyes peeled for good bargains. At worst, I can try eBay after Step 1 has been administered.

http://www.ttuhsc.edu/som/studentaffairs/documents/Step_1_Prep_Book.pdf

The other PETA

For a brief second I thought that there was some kind of joke. The site was dedicated to physical examination of a patient, yet it directed me to "Online PETA." As we all know, the People for Ethical Treatment of Animals oppose medical research on grounds that it is essentially animal cruelty. The organization's extreme methods of liberating research labs and pouring paint on fur coats have gained them enough notoriety, that most of us normal folk steer clear of them, which would include any of their websites. I clicked the link, just in case this was yet another instance of a famous acronym having a completely different meaning. Sure enough, PETA stands for Physical Exam Teaching Assistant. It's a nice site that I wish I had found about a month ago, though it's pretty obvious it'll be handy in the future. From the little that I've learned in medical school, one thing is quite obvious--no matter what you'll be doing, the physical exam will be a part of your daily routine. You'd better get it right sooner than later.

Link to Online PETA here.

Quiz Time

Coming fast on the heels of Monday's practical exam is today's "quiz." Feels more like a bona-fide exam, since it'll be a 25-question lecture-hall affair. But it's only worth 10% of the grade, which makes it that much more of a dry run before the single high-stakes exam we have at the end of this (musculoskeletal) module. We'll have 45 minutes do complete it, which is "twice as much as you'll get on the Boards." How generous...

After all this: 3 hours of lecture, a trip back home to meet an uncle who's visiting for one day, and then back to it on Thursday.

Transplant Trivia

The renal module is all wrapped up, but a few nagging thoughts remain. Transplantation in lay media, especially when it comes to kidneys, is seen as a fix-it-all procedure. "Yup, that brand spankin' new kidney there will make it all better. It's like poppin' in a new battery, and you won't need a new one for a 100 years." Just as I used to debunk bad science in movies (as my friends rolled their eyes and munched on the popcorn anyway), I suppose it's time to let the pocket protector ride again and point out bad medicine at the cinema.

One common preconception is at least true. You only need one kidney. Two kidneys filter around 180 L of blood each day, so cutting that in half still isn't too bad considering we only have 5-6 L of blood.

The transplant does not replace the original. It is instead placed somewhere below one of the existing kidneys. Reason? Higher morbidity.

Who does the transplants? A urologist. I was surprised to find this out, especially seeing that urologists usually do small procedures on the urinary tracts.

Who's the best donor? Related or not, a living one. Cadaveric donors, while still good, don't match the 5-year survival rates that the living donor kidneys do.

Transplants can be rejected, in a dazzling variety of ways. From hyperacute rejection which takes minutes--the kidney literally turns black as it's being sawed up, to chronic rejection which takes years. Once rejected, it's back to dialysis for the patient.

The transplant is good for about 10 to 15 years, though the recipient is permanently on a regiment of immunosuppressive drugs.

Appreciate your health, comrades!

Today is May Day, which in many countries is a day off, as it is the workers' holiday. During the heady years of the Soviet Union it was the day of missile parades in the Red Square. That's all gone, though maybe Cuba or China still let the workers know in a rather festive way who's in charge of those missiles. In the US, May 1st has morphed into "Illegal Immigrant Day" which our dutifully ignorant journalists routinely forget (or intentionally omit, who knows?) to associate with its origins.

Although Thanksgiving is really the holiday I should be talking about today, I'll take May Day. The more I learn about what can go wrong with the organs, the more grateful I am for being healthy. Kidneys alone, though we have two of them, can fail in many ways. Many diseases and conditions revolving around the kidneys or ones unrelated like type II diabetes, lead to the destruction of the organs. This is called ESRD--End Stage Kidney Disease, and it usually results from chronic conditions or genetic abnormalities. Oddly enough, acute conditions are often quite reversible if properly diagnosed and treated, and in the disease lottery, you want to draw their lot and hopefully have a competent physician nearby. In any case, life without kidneys plain sucks. While you do find out that ESRD is one condition that makes you automatically eligible for Medicare, being on dialysis 3 times a week is not fun. A surgeon makes you a fistula, which is a slight rerouting of an artery into a vein (in the arm) to create a blood vessel hospitable enough for large bore needles 6 times a week. Fistula takes a while to develop, but once there, it's good for several years. Dialysis takes 4-5h per session, so you're pretty much tied to that center. And the survival rates aren't necessarily all that hot, so if you meet all the criteria, you're placed on the transplant waiting list. Transplant itself is not fun either--immunosuppresive drugs keep that kidney from getting chewed up by the immune system, but cancer will go hogwild in such a body. So here's to our kidneys, comrades!