another discovery!

I've begun studying for the boards, and at no other point in my life have I felt like I know so much and yet have so much more to learn. I believe this is well illustrated in a recent discovery: emboli and thrombi are not the same thing. Surprise! For most of last year, the distinction was never pertinent to doing well on exams (I presume). But now I know that they are different and I feel like a genius (which is sad because, well, I'm probably an idiot).

Emboli are traveling coagulopathic bundles of debris. Coagulopaths!

Thrombi stay put embedded in arterial walls. Lipitor!

I'm probably an idiot. 

Propofol? More like propolol...

I really am not enjoying the humor employed by First Aid. Also, since most of medical literature uses the term "African-americans", this publication's use of the word "blacks" seems a smidge too racist. Oh well. At least they call whites whites. I'll wait to see what they call asians....

More Good News Everyone!

Alcohol is good for you! But only in moderation. This fact is best illustrated by the J-curve, which suggests that not drinking at all and heavy daily intoxication are equally dangerous for you and your health. Suck it teetotalers (read: Utah)! Regardless, it appears that the range of 1-50 g/d is the healthiest for you, which is equal to 1-4 drinks per day. Even at my most debaucherous  I usually don't go 4+ drinks more than once or twice a month.

However, the most successful drinking plan involves lower levels of intoxication for a longer period of time. Which means you shouldn't drink more than 1 drink/hour. Which means! I get to drink for four hours! Every day! Good thing I start with dinner. 

C ut-Back

A nnoyed

G uilty

E ye-Opener

Questionnaire.

Good News: i'm not a heavy alcohol user.

I fall somewhere in between binge and heavy drinking. Thanks science!

State of the Union

"90% of our lawyers work within the beltway. And we wonder why we have problems."

-From our neurology professor

Borg Metaphor

So as the Borg are spreading across the Delta quadrant, they're behaving like prion proteins, taking similar proteins (humanoids) and converting them into a more Borg friendly model. 

Honestly, I don't think prion proteins are cubes, but such was the capricious nature of this powerpoint presentation and so I just spent the last ten minutes making this .gif. 

And That's Delirium!

Recently I found out that hypoglycemia can precipitate the mental state of delirium. As a well controlled diabetic, I have a lot of hypoglycemic events, so I am versed in the various physiological and psychological events that coincide with a drop in blood sugar. However, the number of times I've been delirious because of hypoglycemia? It's hard to say--I only just discovered what delirium is (thanks clinical neuroscience!)

But I'm going to say I've been completely incapacitated by delirium secondary to hypoglycemia twice: once in the central rain forests of Costa Rica, and once again in the sixth row of Finch Auditorium at Rosalind Franklin University.

The first time--in Costa Rica, was innocent enough. I had lost a lot of weight rather precipitously. The temperature was always in the low eighties and I had to hike about ten miles everyday under the weight of climbing harnesses, bio-tags, poorly prepared, non-Skippy peanut butter sandwiches, and gallons and gallons of water. Regardless, when I returned to the states briefly to take the MCAT, I sidetracked and took a shopping trip to the Gap, only to realize I was a size four, which means I probably weighed about one-hundred-and-forty-five-pounds, placing my BMI at 20. Although still in the normal range, when you consider my amazing, incapable-of-becoming-osteoporotic bones, a BMI of 20 is deadly. Or at least deadly for a diabetic since I didn't have any excess stores of glycogen in my liver. All hypoglycemic events had to be dealt with by myself--not the glucagon my diabetic body was still capable of making.

Essentially this just meant waking up with hypoglycemia frequently and having to drink more gatorade. But one morning, I woke up with a huge existential crisis hovering around my incapacitated body. I will never know how low my blood sugar was--all I remember is that my roommates had already left for breakfast and I found myself alone in the jungle, surrounded by the creaks and caws and chirps of forest dwellers and the hot and sticky and humid air of the tropics. Oh yes, and an existential crisis.

There was a journal by my bed. I wasn't really recording much in it: we had actual journals to take down actual data--like the types of epiphytes on the branches held up by the forty meter tall trees we climbed. I had a journal to take down various soil measurements (soil is so cool! But that is neither hither nor thither). But by my bed was a journal of just short little ditties--observations really, of a rainforest. Or at least, that was all that was in it--ditties--until my blood sugar was freakishly low and I somehow located a pen and started tearing at the pages with it. I was terrified, in that moment, of death, without knowing why. I had no idea my blood sugar was low, just knew that God was holding me in his hands at that very moment, pondering whether to keep me on the planet or toss me out, into the abyss of Hades.

And I was terrified. My mind flashed, somehow, and without anything more than incredibly tangential reason, to Cat Stevens, and how he had decided to dedicate his life to god and become a muslim after he had almost died swimming in the atlantic ocean and got caught up underneath a rip tide. So I wrote a prayer, a plea, and a mantra on the quadrille lined pages of my yellow journal, demanding that god forgive me for all that I had done and to allow me to live a little longer.

Delirium had made me a sniveling religious fiend.

I eventually escaped such a fate when I--fortunately--started chewing on sugar tablets sitting next to my bed. I then made my way to a late breakfast, where my advisor berated me for my tardiness and my rather dulled affect. Oh, but if only I had known then what I know now: "I mean no disrespect, but unlike the rest of you, I just spent the last hour in delirium."

Anyway, the second delirious state happened literally an hour ago.

Having awoken five minutes before class started, I had no time to locate my test kit. But I had a headache, and I had gone to bed with a bowl of popcorn recently consumed, so I assumed that my blood sugar was the cause of the headache and thus I needed insulin. Well, within the next thirty minutes I realized that my blood sugar had probably been fine when I started feeling the chest tightening spasms of hypoglycemia. No matter! I had fruit snacks!

And thinking that I had avoided the ills of hypoglycemia, I settled in to taking notes on a lecture about epilepsy.

And here's where it gets interesting: Somewhere--about an hour and a half into lecture--I stopped being able to understand the slides I was reading on my computer. And then, shortly after that--the lecturer stopped making sense. I wanted to raise my hand at several points along the way--I wanted to clarify what he was saying because I was sure he was saying it wrong, but I didn't. Instead I just sat in awe that everyone else seemed to understand what was going on.

And then the madness truly sat in.

We switched to a new professor for a new class, and my head wouldn't stay straight on my shoulders, my neck wobbling side to side. I became obsessed with the fear that the professor would notice me in what would have looked like a sleeping position and that I'd be kicked out of class--or that I'd automatically get a 0% on my next exam. So I snapped my head up and sat up straight as possible. But it was useless, because inevitably my eyes would close and my head would fall forward and I'd look like I was sleeping again.

I tried to focus on my computer, on my notes, but they no longer made sense. I tried to play a little game on google+, Triple Town, to see if that would wake me up, but I was exhausted and I quickly closed the tab on my browser and was unable to pull up anything again. I was exhausted; not tired, just thoroughly incapable of movement or thought.

I soon became incredibly confused and scared. Didn't anyone else feel this way? Why did nothing make sense anymore. I could hear the words my professor was saying, but they didn't make any sense. I became preoccupied with a feeling that I didn't exist, or that if I did, I existed on a plane unlike the one everyone else seemed to belong to. Kind of like I was the only one who realized that this world was simply a matrix, and that I needed to find my way back to reality. But how to get there?

I needed help, but from whom?

I decided that I needed to go to either the counseling/health center at school--a five minute walk away from my current location--or to my mother, who I was beginning to doubt was actually my mom at all.

But at both locations I would have done the same thing: fallen on the ground and started yelling that this wasn't real and that someone needed to find out what was wrong with me. "Run all the tests!" I imagined yelling to anyone who would listen. There was something terribly wrong with me, I just didn't know what--but I needed to know. 

My daydreams kept escalating in preposterousness until I imagined grabbing a knife and stabbing myself in the heart to regain entry to the "real" world that was hanging just outside my grasp. The thought of stabbing myself terrified me. And that simple feeling--intense fear--called my logic to attention.

What if this was just hypoglycemia? So I formed a plan while my professor kept garbling through his lecture on... what was it? ... anticonvulsants?

Step 1: Get Food
Step 2: Wait to Feel Better
Step 3: Feel Better? If no, go to Mother
Step 4: Feel Better? If no, stab self in heart

Fortunately, after eating a snickers bar, a twix bar, one reese's peanut butter cup, and a can of coca-cola, the delirium surrounding me started to fizzle away. I was capable of speaking, although my tone and volume were way off when I asked one of my friends sitting in the row in front of me, nearly incoherently, where today's pathology quiz was going to be administered. But I was conscious, and the fear that I didn't exist or that I existed in a parallel universe or a mirror reality, quickly became nonsensical and strange. Shortly thereafter, I was conscious enough to begin writing this, an assessment of my mental status as it descended once again into a state I wouldn't recommend for anyone. And that's delirium for you.




(a little bit more for the intrepid reader):

so delirium can be caused by anything that wholly affects the brain. usually when i have just bad hypoglycemia (so not life threatening but unpleasant), i act like i have a frontal lobe lesion: poor planning, flat affect, avolition, etc. however, the two times i've become "delirious" from hypoglycemia, it's possible that I was under the spell of global cerebral ischemia (so involving the entire brain). And while it appears that to get global cerebral ischemia from hypoglycemia, low blood sugars have to occur chronically (i.e., insulinomas), I fully believe that an hour of really low blood glucose could knock a person delirious.

(the end)

What Constitutes a Mental Illness?

Exciting news everyone! My previous post concerning personal ambivalence towards diagnosing, labeling, and medicating mental disorders has gained some validation. Below is the reading--from an actual publication--describing the "confusion" in dictating what constitutes mental illness.

BRAIN AND BEHAVIOR

Descriptive Psychopathology: The Signs and Symptoms of Behavioral Disorders by Nutan Atre Vaidya and Michael Alan Taylor:

The DSM conceptualizes a “disorder” as a condition that is clinically significant and that causes distress or disability. This definition fails because it is overinclusive, incorporating as disorders non-illness such as demoralization, jealousy and revenge, and criminality. By the definition, normal pregnancy might be considered a disorder. Others have argued that a more precise definition of illness is: a condition that causes harm and that derives from dysfunction. Harmful dysfunction involves “something going wrong with the functioning of some internal mechanism, so that the mechanism is not performing one of the functions for which it was „designed‟ by natural selection.”

This conceptualization works for most presently recognized psychiatric disorders, but may fall short for some of the personality disorders.

Confusion also arises from the fact that persons who appropriately receive classification labels are by definition deviant, but deviance has several fathers. Brain structural and physiological lesions (genetic and acquired), maturational variation, and indoctrination at odds with the cultural context cause deviation. Further roiling the conceptual waters is the fact that some deviation is advantageous (e.g. high intelligence, talent).

Going Over

This is awesome.

This is also terrible.

But still kinda awesome.

Child psychopathology is actually super fascinating. Unfortunately, lecture has gone over by 24 minutes. This might be a record.

Regardless, usually I wouldn't care. I love it when classes go long--if they're interesting. But today something else is amiss. My blood sugar is low (it's 55 mg/dL). And I need to go get a Coca-Cola.

OH! Class just broke. Great!

On the problems of the DSM-IV-TR

Seems about right...

Aphemia

I love medical words. I can't pronounce many of them, but I still love them. Like aphemia. It's a form of mutism seen in catatonic patients. But if you separate it into its parts, (aph)asic and -emia, you get:

Lack of language within your blood.

or

Loss of words from your vasculature.

Really, just poetic.

Cheap Medicine

"Don't be the ones who order labs because by the time you practice we won't be able to afford the labs."

-Psychiatrist Professor

Empowered

So thanks to my involvement in Step Up (a tutoring/mentoring program at NCCHS) and AMWA, I feel like I can do anything. Or at least, I can try to do anything. I have the resources and the know how. I feel as though I can affect change in my surroundings--and what could make anyone feel more powerful? Regardless:

The American Medical Women’s Association (AMWA) at my school is really awesome. I’m not just saying that because I’m on the board, but that fact helps a lot.

Regardless, last year was the first time we put together an event called the “High Heel-Athon” which was designed to raise money for a domestic abuse shelter in Chicago. It was a good event in that we raised a lot of money—over $500. It was not good in the turnout. We got about 14 people, including board members, which was depressing, at least to me, a lowly M1 who had yet to realize that medical students are flooded with apathy.

So this year, the president, the ambitious and awe-inspiring Alice Lee , and I, decided to tone it back a little bit, and have a High Heel Gala instead. We were going to get a speaker to give a speech, pertaining to domestic violence and what we as medical students should know, and how we should aspire to deal with the situation when we became practicing physicians. We wanted to not only raise awareness, but we also wanted to help our peers become better physicians.

Unfortunately, we couldn’t find a speaker, so instead my mother (a professor at the school) suggested we give the presentation ourselves. So we did! And not only was it really nerve-wracking, it turned out totally amazing. Alice Lee and I are both creative types, so the presentation looked pretty. Alice Lee talked loudly and authoritatively, and I rambled somewhat less than usual (I suck at preparing speeches; “I’ll do it live!”)

Even better, more than twenty people, not including board members, showed up and many of them said they enjoyed the presentation. So below, for your benefit dear reader, I’ve posted some of the more informative slides:

Compliance & Threats

Currently I am in Clinical Neuroscience. We are being lectured to about sleep disorders, specifically sleep apnea. The guest lecturer appears to be in the range of 40-60 years of age.

Concerning sleep apnea, there is a fairly successful treatment: continuous positive airway therapy (CPAP). Unfortunately, compliance with CPAP is pretty low. Only 46% of patients use the therapy, and of these persons, only 70% use it on a regular basis.

The lecturer urged us to tell our patients: "You're going to die in the most horrific way imaginable then list all the complications of uncontrolled sleep apnea."

This was one of my major complaints for my previous endocrinologist: vague threats. I can understand why doctors would want to do this--it is really frustrating when you're trying to help someone when they're not trying to help themselves. But I wonder if there isn't a better way to tell someone that they're killing themselves. Would this involve asking them about their life goals and how non-compliance will negatively affect these goals? I think it does.

Regardless,

I suppose doctors are among the few people that can tell you--in disturbing and exact details--how you're going to die without you freaking out and calling the cops.