Spring Break Update

First of all, let me apologize to anyone who has been following this blog for my lack of attention over the past few months. After winter break, school became brutal and the only person I was talking to regularly back home was Annie. Needless to say, a lot has happened since January, so let me try to get you all up to date.

Classes
So, last I left you, I had started a class called Cell Structure and Function. This class took over my life. This course had three main components: cell histology, metabolism and genetics. The histology (looks at tissues under a microscope) was not bad, and neither was the genetics. The metabolism, however, was evil. I don't even remember what happened during that time. It is all a blur. Here is an image which we basically had to memorize. You probably can't read the text, but I think you will get the idea.

So anyway, in the end I survived, which is all that really matters in medical school. I am now in the last quarter of the next course, which is called Systems, Processes and Homeostasis. It is a much more civil course and more conceptual. I actually think I am working harder at this course than the previous, nightmare course. But that might be because I find it innately more interesting.

Skype!
So the other big thing that I was doing over the past few months is a research project involving the videophone software, Skype. My group has a number of seniors who have agreed to let us set up videophones on their computers so they can call a designated family member or friend. The idea is that if we get them interacting more with people, that we can potentially improve their overall health. But before we could get started on the project, we had to work out the bugs with a test subject. My group decided that Annie would be the perfect candidate. If we could get Skype working for her, than we could get it working for anyone! So, I mailed out the camera to Annie and, after many hours of fighting with her computer from 3,000 miles away, we got it to work! Unfortunately, her computer has proven to be a bit unreliable, so we haven't been using it that much, but we were able to talk a few times and she was able to see Drac, which made her very happy.

Courtney
As some of you already know, Courtney has finally received an official diagnosis of what has been ailing her over the past few years. It seems that she has a disease (Ellers Danlos, Type III) that the collagen fibers in her body by making them super stretchy. While this may indeed mean she has super stretchy lips, the real effect is that she has hypermobile joints. As a result, she is consistently causing "microtraumas" in her joints by overextending them. So, she has to now work to redefine the limits of her mobility and strengthen her joints in order to avoid causing more injury and as a result up her energy levels. While it certainly sucks, it is better then some of the other options (i.e., Lupus) which would have some very serious effects down the road.

Drac
He is getting fat again. We weighed him last night and he is almost 15 lbs! When we moved out he was 12 lbs. He is going on a diet.

Hospital Stuff
After working with the urologist, I spent the winter working in the Emergency dept at OHSU. This was fun, but it was a very different experience than being at the ED at University of PA. OHSU is situated on the top of a hill, about 15 minutes drive from the city. As a result, the patients that come to the ED are very different. Also Portland is much less violent than Philly. Anyway, the patients we saw were often homeless, drug addicts/seekers, and people with very complex diseases that were already being treated by specialists at the hospital. I learned a lot, but I certainly did miss the action of Penn.

Now I am working with a rheumatologist, actually the same one that diagnosed Courtney! My work with him so far has been a welcome change of pace from the ED. I really like having the extra time with the patients to try to get to the bottom of a disorder. When you are working in the ED, the main concern is "How can I keep this patient alive" whereas in rheumatology you are more concerned with trying to either cure the patient (rarely possible) or at least manage their pain and symptoms. Because he is a specialist, he also gets some exotic cases which have stumped other doctors.

So, anyway, that is the summary. Hopefully I will have time to post again before I come back. I think that I am through the worst of first year and some projects of mine that have been ongoing will be wrapping up, so I should have less on my plate and more free time. I will hope that makes for more frequent and interesting blogging...but it remains to be seen!

lee

Christmas Update!

Happy Holidays everybody!

I am so sorry that I haven't been able to take the time to add a new blog here lately. I have been feeling a bit overwhelmed with school from the Thanksgiving through the winter break. All is well though, here is the update.

We had our first exam in our new course right before Thanksgiving. It is called Cell Structure and Function and combines histology (looking at cells under the microscope) with biochemistry. It was brutal. The class average was a 75% (which is considered good for this class!) and, as has been my trend for medical school, I was right with the average. This was very disheartening for everybody in class. We felt like we had been hit by a Mac truck. On a more positive note, I got my grades back from my ongoing clinical medicine class and did really, really well. I am pretty ok with this since it is more likely that I will be dealing with patients in a clinical setting than looking at cells all day with a microscope. But anyway, the rough first exam set the stage for exam #2 which was on the 19th. I don't think I ever studied so hard for anything in my life.

However, it wasn't going to be that easy. Portland was hit with the worst snow it has seen in 30 years (basically your average, yearly bad snowstorm back east) and the city shutdown. The exam was on Friday and we started the week with Monday's classes cancelled (for 2 inches of snow!) Tuesday's classes went on, but the afternoon class on Wednesday was also cancelled. I actually skipped the am lecture that day (I rarely miss class) because I didn't want to risk getting stuck at school for a week! You see, my school is up on a hill overlooking the city. Windy roads lead up to the hill. Also, they are not allowed to use salt on the roads here (bad for the rivers) and they have to set the plows (which are about 30 years old) to two inches above the street in order to not damage the streets with their plowing. So, basically, all of their snow removal attempts are futile.

As the week went on, light snow continued to fall but the classes were not cancelled this time. The dean's office made contingency plans, which basically would have us taking this exam once we returned from winter break (our "vacation" would hardly be a vacation with this exam looming over our heads). Friday came around and we were able to take the exam! Relief all around. On top of that, the preliminary scores were posted and the average score jumped 10 points! Amazing. I was actually marginally above average, where I am quite happy thank you. There was much rejoicing that night! My friends and I (Courtney had work :( until late) went out to eat and ended up playing darts. Made me feel like I was back in Philly!

On Saturday, though, the real snow began to fall. Courtney had her winter dance recital out in Camas, WA that afternoon and I went with her to see it. The snow was really coming down hard and roads were being closed. By the time we got to Camas (a 25-minute drive from Portland that turned into an hour and a half drive) we had seen at least 4 trucks crashed into the side of the highway. People in trucks always seem to drive like fools in the snow, as if they are immune from accidents, while all of us in cars are afraid for our lives and drive cautiously. The result is predicable. The cars make it to their destination (or get stuck in the snow!) and the trucks wipe out.

When we got to her studio, we decided to drop off the costumes she worked on and turn right back around, which was really smart. The recital was cancelled an hour later and a foot of snow blanketed the region soon after. We were snowed in for days. Luckily, Courtney had made a grocery run so we were able to eat :) On Tuesday, there was a break in the weather and we needed to restock, as well as get dinner for xmas day and eve. Our car was still snowed into the carport and we knew the roads would be terrible, so we walked to the store. It was about 3/4 of a mile away. The walk was crazy. No one in Portland owns a shovel it seems, so there was no visible pavement to be seen. We were walking for most of the way on a snowpack that was 3 or 4 feet deep that had been plowed to the side of the road. Some people were getting around on cross country skis! Anyway, we made it to the grocery and it was a zoo. Everyone realized this was the time to get out, especially since the forecast was calling for more snow the next day. We bought everything in sight: meat, fish, vegetables, wine (you need something to do when stuck inside!) and then packed up our stuff in backpacks and cloth shopping bags to head home. We had spent over $200 and the groceries were heavy. Oh, and the walk was uphill. It was a nightmare. We stopped multiple times, Courtney had to use her inhaler, and I was sweating from the workout. We finally made it home and collapsed. Courtney had to take two muscle relaxers because her back was seizing up!

For xmas eve, we had a nice london broil and we exchanged our gifts. We both bought each other multiple sweaters...now we can actually be warm here! Today, on xmas morning it is snowing again and we miss all of our friends and family back east. Hope you are having a good holiday and we look forward to seeing you soon!!!

Thanksgiving

So today is the day after thanksgiving. It is a a really welcome break from all the madness that is medical school. I am so happy not to have to wake up at 6am in the morning everyday! Unfortunately, that is all coming to an end on Monday, but at least for the moment there is nothing for me to do or worry about.

So, Courtney and I had a very good holiday, probably as good as it could be considering we are 3,000 miles from our family on the #1 family holiday of the year. I spent the morning completing some surprisingly long computer based training so I can begin working at the VA Hospital next month. Once Courtney and Drac finally roused from their night's slept, Courtney and I went to the Ronald McDonald House to volunteer for the 1st part of the afternoon. We helped cook dinner for the 16 or so families that are staying there this holiday because they have a sick child at the hospital. We were in charge of the mashed potatoes :) We didn't get to meet many of the families, it turns out that the zoo was giving free admission on Thanksgiving so most of the families were taking advantage of the distraction. However, we did get to see some rambunctious kids running around and it felt nice to do something for someone else on the holiday.

After making the dinner, and coming home briefly to decompress, we went out to dinner at a restaurant around the corner called 3 Square Grill. It was absolutely delicious! We had our turkey, of course, but we also had two different stuffings (corn bread and oyster) as well as delicious potatoes, cranberry relish and a wonderful ginger cake for desert. Courtney said she never ate so much in her life! Well, she paid for it later with a tummy ache that is still hanging on today. Oh well, I guess that is the price you have to pay sometimes.

Anyway, hope that your holidays went well. I am steeling myself for the last few weeks of school before holiday break. The new class is brutal. Just had an exam on Wednesday, and the class average was a 75. That is where I was (I seem to always get the class average!) after studying for it for 5 days. Just doesn't seem right, no? Anyway, we have another exam in this class before xmas break and that is it for a while. I have to start keeping a journal again starting next week, so be on the lookout for some more "healthcare themed" blogs coming your way.

Random Thoughts

I just got back from a conference in Vegas. Honestly, I don't think I ever thought I would attend a conference in Vegas, but there I was! Anyway, it was very good. I represented OHSU at an information session and also took part in a pharmfree conference. It was fun and energizing, although I personally have no taste for Vegas. It feels like a soulless place to me.

We have our first test in our new course, Cell Structure and Function, this Wednesday...the day before Thanksgiving. I am not sure how I will handle integrating this week's lectures before the exam, but I guess I have no choice. I am looking forward to the mini-vacation that will follow the exam.

That's all. It is late and I need my rest. All free time is dedicated to studying until Wednesday's test is over (except for brief mind recovery periods, like this one, so I can be more efficient.) I will post something next weekend that is a bit more fleshed out, I promise!

Stem Cells

We are learning about stem cells in class right now. From what I understand, it looks like you could take a person, plop them into a vat of some solvent so that all of their cells melt away, and leave their connective tissue behind. Then, if you just added some of their stem cells you had saved, VIOLA! You have a brand new version of the same person! Perhaps that is a bit of an oversimplification, but that is what it seems like.

Healthcare Reform

Barrack won! Now we will all be able to afford our healthcare right? Maybe not.

Do we all get universal coverage? Not so fast. Beyond the obvious labeling of our government socialist by people who are in opposition, just take a second to think about the ramifications. According to data we saw in class the other day, about 25% (give or take) of your hospital bill is spent on administrative fees, that means this money is going to someone. Medicare has a much lower overhead, somewhere south of 10%. So if 25-10=15, than that 15 has to go somewhere (and not just into some rich CEO's pocket.) That extra 15% is going to support people who work at Blue Cross/Blue Shield, Aetna, etc. It is also going towards keeping the extra administrative staff at the hospital and doctor's office employed. So, the biggest ramification of socializing the system is that it would have the immediate effect of putting a whole bunch of people out of work. That is not such a good idea, especially in the middle of a recession.

One of the other big problems we have is cost. By now, most people have heard that most of medical expenses are spent on critical care during the last two years of life. So, what would the option be? Deny grandma an medical treatment once a doctor deems that she is not worth it? You can just imagine the uproar. But perhaps that is too harsh of an assessment. Maybe grandma doesn't really need to see so many specialists at her age. There was a landmark study done by Dartmouth a couple of years back comparing outcomes at top teaching hospitals in the US. It looked at what they spent on the last two years of a person's life. There were some big differences between Mayo Clinic and Mass General, specifically. They were on the order of hundreds of thousands of dollars per patient. To top it off, the outcomes were no better at Mass General (who spent much more) than at Mayo.

Personally, I feel like I am seeing this in action right now as I work with my urologist out in Oregon. He is very sensitive to the practical considerations of whether it is advisable to treat a patient given their age. If someone is 85 years old and appears with prostate cancer, it is not something he is concerned about. That might sound cold, but the reality is that they are not likely to die from that disease until the are about 105. Would other doctors treat this patient? I am almost positive they would. Should they?

Finally, the last part of this problem that is on my mind is the purpose of the healthcare system in the US. A lecturer we had discussed the "mission statement" of the US healthcare system. He went on to say that if the mission is to generate profit, than we are succeeding marvelously. However, if it is meant to provide for the public health, than it is an utter disaster. I think that this is a discussion that needs to happen. For comparison, we don't have for-profit fire fighters. We used to. If you go to look around olde city in Philadelphia, you will notice that there are some placards on the front of the townhouses. These placards were purchased from local fire companies and, if your house was on fire, they looked for the placard. If there was no placard, they let your house burn down. This is how the healthcare system is working today. If you have a raging inferno, than they will treat you in the Emergency Room, but they might bankrupt you as a result. If you have a slow fire burning, say a cancer, they are not forced to treat you at all. Addressing this mindset is key to reforming healthcare in the US in my opinion.

So basically, there needs to be: a solid plan in place to prevent not send millions of people to unemployment, a serious study of various health systems (both in the US and internationally) to learn how to handle costs, and some hard discussions about idealology and purpose. If these things actually happen, then I will be hopeful.

Sex for Octagenarians

**disclaimer, this is not an actual patient account, but a collage of various experiences with names and specifics changed to protect health information.

As many of you know, I have been spending the past two months working with an urologist here at school. This has been a surprisingly rewarding experience for me, and I am a bit sad that it is coming to an end soon. Most of our cases that come to the office involve urinary tract infections, kidney stones, prostate and bladder cancer, or various "itises" that are only inflammations but are presenting themselves as if they maybe a more serious affair. In addition to these cases, we also get our fair share of erectile dysfunction. Now, it is one thing when the patient presenting with erectile dysfunction in their fifties, however, when they are well into their eighties, it is pretty amazing to me.

There is so much in the news today about therapies, pills and exercise programs that we can do in order to live longer lives. However, when I see a many of these older patients, it becomes crystal clear to me that a longer life is not better than a quality life. After a day of seeing a number of elderly patients in poor health, the urologist I work with asked me, "So, how old do you want to live to be?"

You see, most of the people who show up at the office who are in their eighties are not thinking about having sex with their husbands or wives (or girlfriends/boyfriends, for that matter!) These people are generally concerned with trying to be generally free of pain and discomfort, or are really just trying to stay alive. Some people, when asked about their sex life, haven't had one for years, even though they are still married. In addition, a good percentage of these patients are not as sharp mentally as they used to be, so the physicians are really just trying to patch things together and trying not to make a bad situation worse. Now, to be almost ninety, be of pretty sound mind and body, and to have erectile dysfunction as your chief complaint? That is something that many of us can only hope for.

And that is where the 80-something year old guy comes in, let's call him Mr. Jones. My hat is off to him. Mr. Jones is basically of both sound mind and body (more or less). On top of that, he is still able to maintain an intimate relationship with his spouse (in this case, a re-marriage going on twenty years). What a life! His quote to me? "Sometimes the wife still likes to play around." It is a cute way to say it, but I feel like it was very sweet. Maybe like the x-rated version of the feeling you get when you see the older couple going for a walk and still holding hands.

My answer to the urologist about how long I wanted to live? To live as long, but also as well, as Mr. Jones. That is clearly the way to go.