WILTIMS #202: Shivers and smiles

Today was not a productive day. Well, it wasn't a productive day toward the goal of passing my upcoming exams, but I did do couple things. I started by giving a presentation on preventing lung cancer to a class of middle schoolers through our school's Cancer Education Awareness Program. It's always fun to scare some silence into a rambunctious class by pulling out my cancer souvenirs.

Then my team played our last flag football game of the season. It was 50-something degrees with 20+ mph winds and somewhere between drizzle and teeming rain. Ever since high school and rainy water polo games (yes, east coast people, we always played outdoors), I've thought rain makes any game more epic. But even though this was a playoff game, this just felt fun. The team we played was from our year and we all knew each other. Everyone was cold, drenched and just wanted to put in our hour on the field and go warm up at home.

But home is not where I went. Tonight was our weekly volunteer evening at the juvenile detention center. So I dug out a towel from the trunk of my car*, changed into drier clothes and headed over to the facility to spend some time with a very different set of kids than the ones I had taught this morning. Though I love giving my little cancer spiel for CEAP, playing games with the kids at the detention facility is probably more fun and possibly more rewarding for everyone involved.

TIL: (and I am literally looking this up right now so that I have something to show for the day, knowledgewise) Elephantiasis is caused by the parasite Wuchereria bancrofti. These roundworms are introduced into the bloodstream by a mosquito bite and then travel to lymph nodes to mature, mate and reproduce. After repeated cycles of reproduction, the dead remains of older generations of worms block the lymphatic drainage resulting in edema (swelling) of the lower extremities and scrotum (on persons with scrotums).

Also learned elephantiasis is called elephantiasis not elephantitis. Just now.

♒☆ The more you know! ♒☆

*This is one frood who always knows where his towel is.

WILTIMS #156: Sunshine and GBS

Today I volunteered with yet another campus organisation, our school's chapter of Project Sunshine. This is a group that goes to a local children's hospital to play and hang-out with long-term pediatric patients. Got my but kicked both on the Xbox 360 and the air hockey table. Yay for ALL the extracurriculars!

TIL: Guillain-Barré syndrome is a peripheral neuropathy caused by an autoimmune reaction that targets the myelin around peripheral nerves. This causes progressive numbness in the extremities that starts at the hands and feet, before advancing toward the torso where it quickly becomes life-threatening. In this way, progressive arm or leg weakness can be an omen of sudden respiratory failure. So, there's a nice fact for all you hypochondriacs out there!

WILTIMS #137: Oooo Doc's got game!

Amusingly, just two days ago I thought I had such a busy day that I would share my impressive schedule with you all. Everything, it seems, is relative. So here is a truly busy day:

• Give cancer awareness club presentation at local middle school
• Attend captains' meeting for a spring kickball league
• Sit on lunch panel for interviewees to our med school
• Don white coat and take part in a small group patient interview at the nearby behavioral health center
• with a real life patient!
• Play touch football for half an hour
• Play ultimate frisbee for two hours
• Volunteer at the juvenile detention facility
• which today turned out to be playing basketball
• Work on neuroscience presentation for tomorrow

The highlight? There are too many to choose. But one of the better moments was at the detention center. I volunteer there nearly every week and we usually play goofy mental games or do arts and crafts. Every once and a while, we spend the hour playing a sport like kickball or basketball in the gym. It's a lot of fun for everyone and the kids often kick our butts.

Knowing that we were playing basketball this week and that the kids are far better than our usual crew of med students, we brought in some ringers. We invited the best basketball players in our class and a good 6-7 of them actually came.

The kids were waiting in the gym for us with their basketball gear on. As the regular from the club stream in, they look very cocky - as they should be. But then the ringers come in. The looks on the kids' faces were priceless. And the last person through the door is a 6'5 tall guy who was a good foot taller than everyone on the home team.

The game was first to 21, win by two and it was a brutal. Fouls went uncalled and boy were there fouls. Med students barely won 22-20. Everyone had so much fun that, for the first time ever, the guards extended the kids' free time so that we could play a second game. The second game was a little less intense which meant we got some of the girls to play. Everyone had a blast, including our players from the med school. Several of them were interested in coming back to play basketball on their own with the kids.

I love that we get to make the kids' day a little more exciting and that they get to see role models as great as my colleagues.

TIL: A Chiari malformation is a defect of the brain whereby the cerebellum and brain stem are squished through the foramen magnum (literally: great hole) at the bottom of the skull. This can cause all sorts of problems including hydrocephalus and syringomyelia (increased cerebral spinal fluid around the brain or in the spinal cord, respectively).

WILTIMS #100: Doctoring

Centennial post! Thank you to all of my readers. I love writing this blog (though I do forget this sometimes at 2am) and I'm constantly amazed that anyone would come back on a semi-regular basis to read my ramblings. This was the last day before a big week of tests, so I will probably not post anything for a little while. I have to stay in medical school to keep writing about it!

Today we had a midterm in Fundamentals of Clinical Medicine at 8am(!!!). How younger me ever managed to go to school at such an unsavory hour I do not know. We then continued into three straight hours of medical physiology, which was surprisingly intelligible for once. I then ditched the one hour of class in the afternoon - gasp! - to give a presentation at a local middle school about lung cancer and smoking.

Me getting a radiation treatment

As I mentioned in a post eons ago, I am on the executive board of the Cancer Awareness Education Program student club on campus. Our mission is to go to local middle and high schools and give presentations to kids about the dangers of lung cancer and smoking. At the same time, we are conducting research on the effectiveness of such presentations. Unlike D.A.R.E. programs which focus on peer pressure, "just say no!", and the like, our goal is to teach the science behind anti-smoking claims so that kids can decide for themselves not to smoke rather than just being told not to. Of course, we also add a solid dose of scare tactics, via gross pictures, to hammer the message home (my radiation mask and personal cancer stories do wonders too). Here are some of the highlights for your reference:

My mask

• Cancer is the second largest cause of death in the US and lung cancer is far and away the biggest killer of all cancers.
• Even though slightly more people are diagnosed with prostate and breast cancer each year, lung cancer kills more people than prostate, breast, colon and pancreatic cancers combined.
• Over 90% of these lung cancer deaths (and most oral and throat cancers too) are directly caused by smoking.
• Lung cancer is an especially nasty cancer prone to metastasis and has awful, relatively ineffective treatments.
• Smoking, even if it doesn't cause cancer in an individual, always reduces lung function. 
• Whereas healthy lungs will last well over 100 years, a lifelong smoker will start to have difficulty breathing by their 50s and their lungs will start to fail by 75. 
• But by stopping smoking, even after decades, the lungs will return to a normal rate of decay, prolonging the time that they'll work well.
• So don't start, but if you do, it is never too late to quit!

I love doing outreach like this - sharing the wonders of science and medicine with the uninitiated public. I firmly believe that regardless of education or interests, everyone should have a healthily inquisitive mind. And one of the biggest mysteries that everyone confronts on a daily basis is how their own body works. Part of the reason I write this blog and why I wanted to go into medicine in the first place is to share the knowledge that am lucky enough to learn in medical school with my friends, family and someday my patients. It's your body and it's amazing and you should know that!

The word "doctor" is literally Latin for teacher

TIL: The diving reflex is a physiological response to submersion of the face in cold water causing the lowering of the heart rate and vasoconstriction of peripheral circulation. This reflex allows people, especially young children, to survive for an extended time underwater without breathing.

WILTIMS #54: Eye spy

Today we explored the orbit (socket) of the eye, both in lecture and in lab. The eye is incredible both as a complex sensory organ and as a clinical tool. The movement of the eye is controlled by six muscles which are innervated by three distinct cranial nerves. This apparent inefficiency is a great diagnostic tool for classifying nerve or brain damage and the reason for those seemingly bizarre "follow my finger" eye tests.

In lab, we skinned the eyelids and explored the tear glands and ducts. We then turned to the space behind the eye, which was only accessible by breaking through the roof of the orbit with a chisel. The complexity of the eye was finally exposed after nearly an hour of meticulously clearing out all of the fat that cushions the eye and associated muscles, nerves and blood vessels.

TIL: The superior rectus muscle of the eye is innervated by the same nerve as the superior levator palpebrae, the upshot of which is that you can't look up without pulling the upper eyelids up as well.

The superior oblique muscle (the topmost muscle in the accompanying diagram) actually uses a naturally formed pulley system. In order to exert more force on the eye, the muscle passes from its attachment on the eye through a tendinous loop called a trochlea (literally: pulley wheel), before finally travelly to the back of the eye socket.

Tarsal glands are located on the edges of the eyelids and secrete an oil that both keeps the eyelids from sticking together as you blink and acts as a hydrophobic barrier, keeping the tears within the eye.

The lacrimal caruncle (literally: teary meaty lump) on the nasal side of the eye surrounds a duct which siphons excess tear fluid into the nasal cavity. Ever notice that when a person gets misty eyed, they start sniffling? Turns out the bulk of  fluid that ends up in their tissue is tears, not snot. The tears are secreted from the outer upper part of the eye socket, flow over the surface of the eye, are held within the socket by the oil on the eyelids, collect near the meaty lumps and drain into the inferior nasal meatus of the nose.

During embryonic development we form remnants of gill slits that we inherited from our common ancestor with the jawless lamprey eel. The tissue between these slits eventual develop into the jaw, hyoid bone, and the cartilaginous structures of the pharynx and trachea. Bony fish evolved a covering over their gill slits and, sure enough, embryologically you can see the analogous human structure that forms from this covering: the external structures of the ear.

WILTIMS #46: Motivation

[ Sorry, this is a long one but it's important to me ]

Today I Remembered: ...why I'm doing all of this work.

In our small group session this afternoon, we had a guest instructor and we were asked to introduce ourselves and briefly say why we decided to be doctors. This prompt elicited a hearty mix of chuckles and groans from my classmates and myself because we had to answer this question ad nauseum during the application process, and hoped we were done with it for good.

As the circle approached my end of the room and everyone sheepishly said the same tried and true response ("I love science and want to help people."), I started to think. You know what? We aren't applying anymore, so we can say whatever we want. We're like retired politicians that can finally speak from the heart instead of from party lines. If I'm honest, what is my motivation?

My classmates moved too quickly for me to come up with a succinct response, so I barfed up some barely coherent line about my family and how the profession can be selfless. I'm still not sure where I was going with that. The class moved on and I put that thought on the backburner while I self-destructively criticized my inability to speak (normally not a weakness of mine).

My big activity for the day was way outside my comfort zone and I had been nervously looking forward to it all week. I signed up as part of GHHS NYMC Cares Week to volunteer at the nearby homeless shelter. A group of ~8 medical students would go give a presentation on diabetes and hypertension to the residents of the shelter. I was the only first-year to sign up for this activity and would be working with 2nd and 4th year students who, might I add, had already taken physiology, pathology and pharmacology and were thus much more reliable sources of health information than myself.

The older students turned out to be incredibly welcoming. They loved to reminisce about their first years and give tips on how to survive mine. When we got there we found that we wouldn't be able to use our Powerpoint presentation and would instead print out the slides to pass out to the residents. While we waited for the printer, we mingled in the activity room. Residents started to assemble and quickly grew restless waiting for something to start. As much as I like talking with the immeasurably cool 4th years, I felt more and more awkward ignoring the people we had come to (theoretically) help, so I went over and introduced myself to a particularly antsy older man.

We casually started talking and had a great conversation. It turned out that he was a cancer patient (like myself, for a time) but that he had refused to continue treatment after 10 years of chemo. I told him that I could understand his choice, and we commiserated for a while about nasty diseases, nasty doctors and nastier hospital food. By this point the rest of the medical students had followed my lead and dispersed amongst the residents and were engulfed in animated discussion.

The presentation began once the printouts arrived and almost immediately we began fielding questions. It seemed everyone in the audience had diabetes, hypertension or both - and the few who had neither were hypochondriacal enough to have questions anyway. And you know what? We answered every one of their questions. I could actually help real live people (and not just my mom over the phone)! True, I knew the least of all the students, but I still could chime in to clarify things and share the little I did know.

The highlight of the day for me was prefaced by an awkward moment where two residents asked questions at the same time. The more deferential of the two waited and was eventually forgotten amongst the continued discussion. After the presentation was over, I went immediately to that man and explained that I had not forgotten his question and that it was actually a really good one. He had originally asked if potassium was good to take for the cramps he developed in his legs while exercising (we confirmed this during the main Q&A), but had also heard that salt could help too. The sodium in salt is actually physiologically paired with potassium throughout the body. The only thing is, unlike with potassium which banana-haters might actually run low on, as unhealthy Americans we are never deficient in sodium thanks to our over-consumption of salty foods.

So, could sodium deficiency cause the cramps? Yes. Is that likely? Not really. Try a banana and some more water first. The man was incredibly thankful for both our time in general and for my extra effort to answer his question (and he told me so!). It was the first time I got to go out of the way for a patient - the first time I made a connection and established a professional trust with someone.

This is why I went into medicine. If I had to sum it up in a sentence, I might fall back on the application staple ("I love science and want to help people."), but it's something more than that. Something harder to describe but exceedingly more beautiful.