December 26, 2010


In anatomy, spatial relationships are very important for pretty obvious reasons.  If you say an injury is on the front of a person, you have to understand what 'front' means.  So we attempt to avoid confusion by using very precise terminology.  One major relationship is dorsal versus ventral.  It seems obvious at first glance.  Dorsal is where the dorsal fin would go like on a dolphin or shark.  That would mean your back is dorsal and your chest is ventral.  But what do you do about parts of the body that move?  What's dorsal on your arm?  Or, your hand?  Furthermore, what's lateral on your hand?  It would depend on what position your hand is in.  Physicians (especially radiologists) get around that by establishing a concept dubbed Anatomical Position.  In the anatomical position, the body is standing facing forward with arms to the side and palms forward.  The legs are also straight with the feet pointed straight down.  What about the penis?  You'd think it'd be the state that is the most common, ie relaxed.  Nope.  It's when it's in an erect state.  So what the average person would call the front is really the dorsal (or back) portion.  Obviously whoever decided that had to be a male.

December 24, 2010

you mean I'm above average?

My last post on not studying probably came across a bit flippantly.  While I do enjoy writing, I'm no professional and I freely admit that sometimes concepts and writing ideas fall flat or just plain fail.  Despite my grumblings and shall we say, less than ideal study habits, I am actually right where I need to be in life.  It's a process and I'm trying to find the right path for me.  And despite my limitations, apparently, I'm not a complete idiot.  For the gross anatomy final, we took a national board style exam.  We just got the scores back and while I was a couple of points below the class average (damned overachievers), I'm in the top 75th percentile nationally.  Normally, on a standardized test, that'd be bad for me.  But considering the competition at this level, that ain't bad, especially given I am severely impaired when it comes to spatial relationships which is what anatomy is all about (seriously, I can get lost in a closet).  On biochem last year, I was in top 99% nationally.  I put those together and start to think that maybe, just maybe it's possible that I can do well on the board exams.

December 22, 2010


I'm a hard person to get to know.  No, that's an understatement.  It's damned near impossible to really get to know me.  So when a cadre of former colleauges presented me with this gift basket full of beer, chocolate and more meant a lot to me.  Two of them have had the misfortune of watching a loved one suffer through and ultimately succumb to cancer.  Nothing creates a mutual understanding like shared pain.  I can explicitly recall when one was going through it several years back.  I remember some long and difficult conversations in my office.  I tried to help in whatever small way I could.  Honestly, I didn't think I did much in comparison to the pain they were going through.  Now that the shoe is on the other foot, I know now that sometimes those small tokens of caring can make all the difference in the world.  Thank you!

December 19, 2010

finish line

I'm done.  I crawled across the finish line but I did cross.  I'm still waiting on some scores before I have my final grades.  Now I've got 2 weeks off.  I'm not sure what exactly I'm going to do with them.

December 15, 2010

never before has so much been studied so little

It's more than a bit ironic that when I would most need to be a good student, oh, say med school for example, would be when I somehow decide to be a pitiful student.  Last year, I was a decent student.  Not great, but not horrible either.  I got honors, high pass for the most part.  This year?  It disturbs me how little I studied this semester.  No honors but I still passed.  With this approach, I will still get to be a doctor.  It's a bit disconcerting, to be honest.  I can use the explanation that I've had a lot going on emotionally and certainly that's part of it but if I'm honest with myself, I admit it's not it.

I can't really understand it myself.  In hindsight, though, I can decide what to do with it.  Strapping on my psychiatrist persona, I think two things are going on.  I did this once before.  When I was an undergrad, I was a slacker during all the intro classes.  To put it simply, the classes bored me.  I didn't care and nothing anybody did or said could make me care.  My senior year when I was into the supposedly hard upper-level classes, I made straight A's.  I was friends with the professors.  I was even a teaching assistant because I found the stuff so cool.  I think the same thing is happening here.  When I relayed this to a friend and former colleague, in a sarcastic and dry, truthful manner told me, "you've got a bbaaddd attitude.  You need to hurry up and get into the clinic."  I think he's right.  This crap bores me to tears.  With every test, I feel like I vomit up a part of my soul and say, "see?  I proved I could memorize your crap yet again.  Can I please move on to the interesting stuff now?"

My subconscious, though, I think is also at work.  It's having me deliberately acting a slackass to prove a point.  It's telling me, "you can do this."  That may sound trivial, but to me, it's a very big deal.  I had (and to some extent still have) reservations about if I'm capable of doing this.  Down the road in my residency when all sanity has abandoned me and I have to study for my board specialization test, I hope I look back on this moment and tell myself this,  "You studied for a total of five, count'em five measly hours for your comprehensive developmental final.  You studied a semester's worth of material for a whole 4 hours the night before and 1 hour the morning of.  You passed the class.  Imagine the possibilities when you actually apply yourself."

Now, I should probably go study for my gross final.  But I only need to get a whopping 23 to pass the class.  You can see my dilemma...

December 11, 2010


     There's a popular university northwest of here that's really more of a cult.  The graduates drive maroon trucks, wear maroon clothes, and say 'whoop!' at damned near everything (I've heard a grad say it during the hell did that person get into med school?).  I'm pretty sure their blood even turns maroon once they graduate and receive initiating into the high church.  Like I said, it's a cult that demands complete allegiance in everything.  I think I may have been subversively assimilated. 
    Let me back up to explain how.  A few weeks back, I started getting sinusitis and ran to my family doc.  Quite expectedly, my bp was less than desirable as I was throwing down sudafed with regularity.  I blew off my doc's concern saying that it'll return back to normal after this is all done.  To prove my point, I started measuring my bp once I recovered.  Ahhhh, crap.  It didn't come down so much.  The top number was consistently running 135-142 which puts me on the verge of Stage I hypertension.  The bottom number was 77-81 which places me in that same range.  Having done a wee bit of hypertension drug discovery, I couldn't help but pick up a bit of knowledge along the way.  I know full well that prehypertensive is really just a polite way of saying, "you're not hypertensive...YET, but you will be in short time.  Let's get you medicated."  Short of making some decent lifestyle alterations, pretty much everyone in that prehypertensive group inevitably progresses to full blown hypertension.  It's just a matter of time.
     Losing weight is one of the reliable methods but that takes time.  Strike one.  Hypertension also runs in my family on one side.  Strike two.  I wanted to do something in the interim until I could shed some pounds.  Enter the color maroon.  There were a couple of fascinating papers outlining the effects of beet juice on blood pressure.  It's just a couple of papers but they look convincing because in it, they outline the mechanism.  Anytime someone has A) observed a phenomenon and B) explained said phenomenon with proper controls, it starts to gain credibility in my book.
     The group observed two things.  First, they established that supplementing with a pill of nitrate similar in dose to the amount found in a glass of beet juice lowered bp.  Second, they established that the reduction in bp is due to the conversion of nitrate to nitrite by bacteria in our body.  How did they do that?  They had subjects drink the beet juice but then spit out their saliva once they swallowed the drink.  Let me reiterate.  They drink AND swallow the juice.  The juice is in the stomach and gets absorbed.  After that, they begin to spit out their saliva.  That blocks the bp lowering effects.  By spitting out your spit, you remove that recirculation of nitrate in your saliva to allow bacteria to do their thing.  It turns out that bacteria in our body (saliva) convert the nitrate to nitrite.  That nitrite is then converted to that nobel prize winning compound nitric oxide.  Nitric oxide has a rather large reputation in the cardiovascular field.  I'm sure you've even heard about it, or at least its effects on the blood vessels (think of nitrates for a person with angina which improves coronary blood flow or viagra/levitra/cialis which improves penile blood flow, both through the production of nitric oxide).  That's right, it dilates your arteries and lowers blood pressure.  (You gotta love the fact that with thousands of publications and a nobel prize, the best we can do is a drug to improve erections.  Drug development is really about stumbling in the dark hoping to get lucky.)
     The beet juice (250 ml drank twice a day) was shown to decrease bp by just the amount I need.  I'm not about to start eating beets ad nauseum (it'd require three beets a day) and the juice itself is cost prohibitive so I got some freeze dried powder hoping it'd do the same thing.  After just three doses (mix a teaspoon in a small glass of water), my systolic came down to 124 and diastolic down to 70.  Perfect.  And it's about the same monthly cost as a generic antihypertensive would cost for my crappy insurance.  People in alternative medicine always like to tout 'natural' rememdies as being without consequence or side effects unlike evil pharmaceuticals.  Ain't true.  The stuff tastes horrid.  Swallowing an ACE inhibitor would be SO much easier.  I despise beets so I guess if you like beets, then it'd be great.  But I think they taste like crap.  And speaking of crap, it turns it maroon.  Whoop!  I must be becoming an aggie.  If my feces are maroon, I might as well go all in and get a maroon truck and start growing maroon bluebonnets.

Do some more reading (shouldn't I be studying for finals???) and find that it can also improve exercise tolerance.  I gotta believe given the mechanism, it should help beat erectile dysfunction but no papers on that.

December 7, 2010


Goodbye Mr. 62-year old male, colorectal cancer with metastases to the liver.  I took my last gross practical test last night which means I am DONE with cadavers (short of any surgical rotations down the road).  The whole class was a blur and I'm not sure that dissecting is the most effecient way to learn anatomy but I do feel that it was important.  Ultimately, it's a rite of passage.  There's something to be said for digging your hands into a body cavity, seeing what cancer does to organs, holding a human heart in your hands, or seeing the effect of a penile pump for that matter.  It's both awe inspiring and immensely humbling.  Maybe I learned more anatomy than I realize (I passed after all) but more important to me is that I'll take away the experience of reducing the human body down to its most simple elemental terms and carry that appreciation with me the rest of my life.  So I thank you Mr. Cadaver.

For anyone considering willing their body to medical training, here's a website.