Last week was my last day at the Endocrine clinic. On the one side, I will really miss it because I have enjoyed seeing patients. I have learned a lot about Endocrine, including thyroid disease and growth hormone deficiencies. One of the classes I am taking now is all about hormones of the body so I am sure all that I have learned will come in handy soon.
My last day in clinic, my preceptor let me see my own patients. I was able to get the patient history, do the physical exam and then report to my preceptor for her to do the final wrap up. It was a great time to test what I had learned over the previous weeks. I knew the proper questions and what we were looking for with different diagnoses. I wasn't even nervous. I enjoyed talking to the patients and their families, and I look forward to the future when I can do this completely by myself.
Since then, life and school have been tough: 5 exams since last Friday and today was the dreaded exam. It took 3 hours...and it wasn't even a midterm, just an exam. We have one of these every month or so. It's a bear but I am learning a lot. Today's exam was all about how our bodies metabolize sugar and blood glucose regulation during fasting. I now understand insulin deficiency (Diabetes).
The other exams were: Women's Health, Neonatology, Physical Diagnosis and a group exam that requires talking through potential diagnoses for a particular set of symptoms. This time we talked about developmental delay in a child. There are so many possible causes including maternal illness during pregnancy. Did you know that a fetus can have a stroke? Many problems can be diagnosed before birth, including many kinds of heart defects which allows doctors to prepare for delivery.
I have really enjoyed Neonatology. We have been learning about fetal development and why the first trimester is the most critical for protecting the fetus against drugs or other harmful affects. One thing that I found interesting was that the nervous system isn’t completely developed until 4-5 years of age. This is why infantile illnesses can still dramatically affect a child’s overall health. Brain damage can occur after birth. For example, recent studies show the cerebral palsy is not usually from perinatal hypoxia (lack of oxygen during birth). Evidence shows that there is much more to it and CP can actually develop after birth as well.
One topic that has been hammered this semester is STDs – in almost every class. It is a topic I never really cared to learn about but I have learned so much about the reasons why STDs can be so detrimental to personal health, as well as future children. To protect a fetus from an STD, they will do a C-section because maternal illnesses can be transferred during birth.
Anyway, this is a very small taste of all I have been covering over the last few weeks. Hopefully I will retain a good portion of it for future use.
One more exam next week – Microbiology. I will be thankful for next weekend – a weekend without major studying to do! My on-campus Bible Study is having a retreat next weekend – a great weekend to meet new people, relax and have fun!
Friday, October 16, 2009
Tuesday, September 29, 2009
Clinic - 1st real patient
Today I saw my first real patient - by myself! I thought it was a run of the mill "follow-up" and it turned out pretty interesting! I tried to be very thorough, and I got to do the physical exam too! At the end, the doc came in and wrapped it all up. She said I can see more patients by myself next week! I am really excited about clinic next week...and a little sad too because it is my last day in clinic for the semester.
Days like today give me reinforcement that I am where God wants me to be. I really enjoy talking with patients, hearing their stories and trying to help. I love working with kids - even though he was so shy, he wouldn't talk to me :-) Medical providers ask some awkward questions like "Are you having any diarrhea or constipation?" What kid wants to tell a stranger about their bowel habits???? BUT it is our job and the information helps us diagnose!
On a positive note, I will get Tuesdays off for the second half of the semester so I can study, sleep, catch up on life...you know, the essentials!
Craziness is around the corner 5 exams in 8 days - I know I will survive and the program won't let me fail out...all very comforting :-)
Days like today give me reinforcement that I am where God wants me to be. I really enjoy talking with patients, hearing their stories and trying to help. I love working with kids - even though he was so shy, he wouldn't talk to me :-) Medical providers ask some awkward questions like "Are you having any diarrhea or constipation?" What kid wants to tell a stranger about their bowel habits???? BUT it is our job and the information helps us diagnose!
On a positive note, I will get Tuesdays off for the second half of the semester so I can study, sleep, catch up on life...you know, the essentials!
Craziness is around the corner 5 exams in 8 days - I know I will survive and the program won't let me fail out...all very comforting :-)
Saturday, September 26, 2009
Vaccinations
So my nephew told my sister that he just got immunized for "munkungacoyta". Well, there may have been some confusion on the name of the vaccine, but I think it reflects an overall confusion about vaccinations. By the way, he meant meningococcal vaccine.
Immunization recommendations are always changing. Recently changes have been made to the tetanus vaccination. Did you know that when you get a tetanus vaccine, it includes diphtheria? When you look at your records, you should see "Td" as the name of your tetanus vaccine every 10 years. In the last few years, they have added a new component to this vaccine - Pertussis (Whooping Cough). It used to be that your last Pertussis vaccination was ~ 10 years old, but there has been a concern about waning immunity so now when you get your tetanus shot, you should be getting a TDaP (Tetanus, Diphtheria, and acellular Pertussis). If you haven't had a tetanus shot in the last 2 years, you might want to ask your doctor about this TDaP vaccine.
Even if you don't fully break out with Pertussis, you could be a carrier to those important children in your life. Infants are particularly susceptible because they haven't been fully vaccinated yet. They don't even get their first shot until they are 2 months old, and it is a 3 series vaccine. Full immunity isn't expected until after the 3rd shot.
For those of you concerned that vaccinations may cause Autism or other developmental problems, there is no evidence that this is true. I have read many studies comparing children who got all the vaccines at once and those who didn't. There is no link. Also, without the vaccines, your children are at extreme risk for major illnesses. Whooping Cough in an infant can turn into serious pneumonia, requiring hospitalization. Meningitis can be deadly. It is important to protect your child from some of these critical illnesses.
If you have older children in school, they can be carriers for diseases, even if they have been vaccinated. I didn't realize that you could bring home illnesses, even if your immune system fought it off. Scary, huh?
No need to be paranoid though. Just get the recommended vaccines.
Immunization recommendations are always changing. Recently changes have been made to the tetanus vaccination. Did you know that when you get a tetanus vaccine, it includes diphtheria? When you look at your records, you should see "Td" as the name of your tetanus vaccine every 10 years. In the last few years, they have added a new component to this vaccine - Pertussis (Whooping Cough). It used to be that your last Pertussis vaccination was ~ 10 years old, but there has been a concern about waning immunity so now when you get your tetanus shot, you should be getting a TDaP (Tetanus, Diphtheria, and acellular Pertussis). If you haven't had a tetanus shot in the last 2 years, you might want to ask your doctor about this TDaP vaccine.
Even if you don't fully break out with Pertussis, you could be a carrier to those important children in your life. Infants are particularly susceptible because they haven't been fully vaccinated yet. They don't even get their first shot until they are 2 months old, and it is a 3 series vaccine. Full immunity isn't expected until after the 3rd shot.
For those of you concerned that vaccinations may cause Autism or other developmental problems, there is no evidence that this is true. I have read many studies comparing children who got all the vaccines at once and those who didn't. There is no link. Also, without the vaccines, your children are at extreme risk for major illnesses. Whooping Cough in an infant can turn into serious pneumonia, requiring hospitalization. Meningitis can be deadly. It is important to protect your child from some of these critical illnesses.
If you have older children in school, they can be carriers for diseases, even if they have been vaccinated. I didn't realize that you could bring home illnesses, even if your immune system fought it off. Scary, huh?
No need to be paranoid though. Just get the recommended vaccines.
Thursday, September 24, 2009
Difference between NP and PA
I have been asked more than once, "What is the difference between a Nurse Practitioner and a Physician Assistant?" I attended a lecture today on the history of the PA profession and the speaker gave a great chart comparing the 2 professions. I thought it would be helpful to share. This picture can be clicked to make it larger and easier to read:
Cool Clinic Tidbits
This week in clinic held a bunch of "firsts" for me. I heard my first heart murmur, first wheeze (lung auscultation), first visual of ambiguous genitalia, first spina bifida patient... If you aren't medically minded you might not realize how cool this is for me.
Someday I will need to identify the abnormal noises and if all you hear is normal, it might be hard to know what the abnormal noise is, when you hear it. Also, I want to work with kids and ambiguous genitalia occurs more frequently than you might think. Spina bifida also occurs frequently enough that I will treat patients with the medical complications from spina bifida.
Spina bifida is a congenital abnormality where the formation of the spine is not complete. It starts flat and then folds closed from the middle out. For these patients, it might connect in the middle but then not close on each end. Repair is not simple, even though it sounds like it might be. Paralysis is common due to damage to the nerves running the length of the spine.
I also learned in clinic this week that hives can signal a VARIETY of problems - including thyroid disease. So, if you ever have unexplained hives and your doctor wants to do a full blood panel on you, it's because it may not be an allergy or anything obvious. Hives CAN be simple but aren't always. The patient we had this week was referred from an Asthma and Allergy clinic.
This is just another example of why medicine is truly a PRACTICE - rarely are symptoms straightforward - but it also makes it fun, as long as you aren't the patient. For the medical provider, it is a puzzle that needs a new angle or some tweaking to figure out. It is also another reason why medical doctors are always learning and they may tell you they haven't heard of that "new study" you just read about. I heard today that medical science is new every 3-5 years. Scary, huh? By the time I graduate, almost everything will be obsolete, but you know what won't change? Patient care. No matter how the sciences change, human interaction and fact gathering is still the same. Treatment options may change but respect and compassion will always be the foundation.
Enough about that.
Sad to say only 2 more weeks in clinic for this semester - it also means the semester is almost half over. Wow!
Someday I will need to identify the abnormal noises and if all you hear is normal, it might be hard to know what the abnormal noise is, when you hear it. Also, I want to work with kids and ambiguous genitalia occurs more frequently than you might think. Spina bifida also occurs frequently enough that I will treat patients with the medical complications from spina bifida.
Spina bifida is a congenital abnormality where the formation of the spine is not complete. It starts flat and then folds closed from the middle out. For these patients, it might connect in the middle but then not close on each end. Repair is not simple, even though it sounds like it might be. Paralysis is common due to damage to the nerves running the length of the spine.
I also learned in clinic this week that hives can signal a VARIETY of problems - including thyroid disease. So, if you ever have unexplained hives and your doctor wants to do a full blood panel on you, it's because it may not be an allergy or anything obvious. Hives CAN be simple but aren't always. The patient we had this week was referred from an Asthma and Allergy clinic.
This is just another example of why medicine is truly a PRACTICE - rarely are symptoms straightforward - but it also makes it fun, as long as you aren't the patient. For the medical provider, it is a puzzle that needs a new angle or some tweaking to figure out. It is also another reason why medical doctors are always learning and they may tell you they haven't heard of that "new study" you just read about. I heard today that medical science is new every 3-5 years. Scary, huh? By the time I graduate, almost everything will be obsolete, but you know what won't change? Patient care. No matter how the sciences change, human interaction and fact gathering is still the same. Treatment options may change but respect and compassion will always be the foundation.
Enough about that.
Sad to say only 2 more weeks in clinic for this semester - it also means the semester is almost half over. Wow!
Friday, September 18, 2009
Week of 1st Exams
So this week existed of 2 first exams - Microbiology and Physiology. Microbiology wasn't too bad. I have been sick this week and wondered if I would hold up long enough to finish studying for both exams. The Micro exam was mostly about Strep and Staph infections. Did you know that the same Strep bug that causes Strep throat can also cause Rheumatic Fever and Scarlet Fever? In clinic on Tuesday, I also learned that both of those illnesses still occur in the US. I never hear about them so I thought they were like the measles or rubella - guess not. :-)
Physiology is very complex. If you ever wanted to know how you can be dehydrated and still have to go to the bathroom, this is the class to take. It is very interesting and, at first, I was having a hard time pulling all the pieces together, but yesterday a lot of the pieces started falling together. The exam was all short answer with a few multiple choice. A note on the multiple choice though - these questions had more than one answer so the questions was really - "circle any of the following options". You can't even narrow down your options with that! :-) The exam was hard but I felt I understood the material. I learned from this test that I need to prepare a little differently for the next exam. Live and learn, right?
Tonight I start playing on an indoor soccer team. I haven't played in YEARS - 4 or so - tonight will be interesting. Thankfully there are enough players to have a couple subs so I won't have to play the whole time. I fully expect to be sore tomorrow and maybe regret the decision to play :-)
Thankful for the weekend - ahhhh.
Physiology is very complex. If you ever wanted to know how you can be dehydrated and still have to go to the bathroom, this is the class to take. It is very interesting and, at first, I was having a hard time pulling all the pieces together, but yesterday a lot of the pieces started falling together. The exam was all short answer with a few multiple choice. A note on the multiple choice though - these questions had more than one answer so the questions was really - "circle any of the following options". You can't even narrow down your options with that! :-) The exam was hard but I felt I understood the material. I learned from this test that I need to prepare a little differently for the next exam. Live and learn, right?
Tonight I start playing on an indoor soccer team. I haven't played in YEARS - 4 or so - tonight will be interesting. Thankfully there are enough players to have a couple subs so I won't have to play the whole time. I fully expect to be sore tomorrow and maybe regret the decision to play :-)
Thankful for the weekend - ahhhh.
Tuesday, September 15, 2009
Interesting Clinic Thoughts
Today was another day of Endocrine clinic and there were a lot of interesting cases today. Yeah, we had a lot of the typical growth hormone cases but today was also the day my preceptor had hospital rounds. We saw 2 patients in the hospital this morning. The first patient is part of a research study. Neonates are screened for a lot of illnesses and genetic markers that predispose them for other illnesses. If an infant tests positive for some of these markers, the parents can choose to enter their child into a research study that monitors those particular levels throughout their lives. This child is currently healthy but because the patient tested positive for some of the indicators for serious illnesses, blood tests are done on a regular basis to catch any problems early on.
The second hospital case of the day was a complex case that started out with a large blood clot and ended up with pneumothorax (air between the lung and the chest wall that inhibits full lung expansion), surgery and a month+ hospital stay. The current tests indicate hormone deficiencies that lead to the blood clot and because it wasn't caught right away, there was a ripple effect causing the other health problems.
During the office clinic, a patient reported that their 2 children regularly get Scarlet Fever and Rheumatic Fever which I thought was interesting. I have a microbiology exam tomorrow and I was just learning about Streptococcus and how the pyogenes species can cause both of those things. I thought they were eliminated a long time ago -like the measles - because I never hear about them, but I now know that isn't true.
I love seeing how my classes parallel with my clinic experiences. It makes the textbook information more interesting and relevant.
The second hospital case of the day was a complex case that started out with a large blood clot and ended up with pneumothorax (air between the lung and the chest wall that inhibits full lung expansion), surgery and a month+ hospital stay. The current tests indicate hormone deficiencies that lead to the blood clot and because it wasn't caught right away, there was a ripple effect causing the other health problems.
During the office clinic, a patient reported that their 2 children regularly get Scarlet Fever and Rheumatic Fever which I thought was interesting. I have a microbiology exam tomorrow and I was just learning about Streptococcus and how the pyogenes species can cause both of those things. I thought they were eliminated a long time ago -like the measles - because I never hear about them, but I now know that isn't true.
I love seeing how my classes parallel with my clinic experiences. It makes the textbook information more interesting and relevant.
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