Charlie goes to Medical School

We here at Charlie Med School send our best to Lee Corso who had a minor stroke.  They are expecting no permanent damage and he is planning to make it back for the start of the season.  Here’s to a speedy recovery.

If you suspect someone is having a stroke, here’s a mnemonic device to help you remember first aid.  FAST.

Face - Ask the individual to smile.  Look for drooping.

Arms - Ask the individual to raise both arms.  Look for drifting downward.

Speech - Ask the individual to repeat a sentance.  Can they repeat it?  Is there slurring?  Is there confusion?

Time - Act quickly.  Call 911 if the person is showing any symptoms.  Immediate medical assistance is imperative. Think Fast.

F-A-S-T.  Fast.  There are a number of other symptoms (list on wikipedia).  On thing to look out for is that strokes usually act on one side of the brain and therefore act on one side of the body, but if you are concerned you should seek immediate medical attention regardless.

A stroke is the loss of brain function due to a disruption of blood flow in the brain.  Because of the nature of nerve cells, a constant supply of oxygen and glucose is necessary to maintain homeostasis (there is no ready reserve such as in muscle cells).  Strokes can occur because of blockage from an infarction (ischemic stroke) or from the loss of blood from circulation in the brain (hemorrhagic stroke).  The disruption of blood supply to part of the brain will lead to tissue death in a matter of minutes, so time is of the essence when dealing with a stroke.

And a speedy recovery for Lee Corso.  I’m sure that I will be disagreeing with the things that he says on Saturday mornings soon enough.

J Griffin, C Calderwood, MD, S Helgerson, MD, K Johnson, DVM, PhD, B Barnard, MPH, C Rupprecht, VMD, PhD, E Kennedy, DVM, K Robertson, DVM, EIS officers, CDC.  2009.  Human Exposures to a Rabid Bat — Montana, 2008.  CDC MMWR 58(20):557-561.

Okay, there aren’t a whole lot of ways to say this.  I’m going to try one that doesn’t make me sound like a jerk.  If you find a dead animal in your home, please find use precautions when removing it.  I’m not going to go into a whole thing about it, so here is the first Google result when you search on “dead bat“.

Of course, I’ve just taken Microbiology, so I happen to know that the vast majority of emerging diseases happen to occur via zoonotic transmission, i.e. from animals. Transmission occurs primary through contact with bodily fluids, specifically (but not limited to) saliva.  This is why animal bites and contact with dead animals are taken so seriously.  Human to human contact is rare…except on CSI.

Symptoms start out as being “flu-like” progressing to neurological in 2-12 months as the virus starts to attack the brain.  The production of large amounts of saliva coupled with the paralysis of the throat and jaw present as an anxiety about swallowing liquids, or hydrophobia.

Diagnosis is made using PCR on brain tissue postmortem or samples from the skin before death.  Additionally, inclusion bodies in the brain show up 20% of the time and can be used to diagnose the disease during autopsy.

Treatment is with PEP (post-exposure prophylaxis), the rabies vaccine.  Prevention is primarily through avoiding contact with wild animals, quarentining animals suspected of having the disease, and proper disposal of animals known to have the disease.

One point of note, I’m a little shocked that the family in the report was allowed to keep the cat for observation at home given that they thought the dead bat was appropriate for show and tell…and touch.  Although, I’m personally hoping that it occurred with the cat in a cage after the family had learned their lesson.

If you do wind up having a dead animal show up that you are concerned about, contact your local health department or poison control.  I would personally recommend using some kind of disposable glove for handling the animal.  Place the animal inside a sealed bag (or two) and then put it in the freezer or drive immediately to where ever the good folks on the end of the afore mentioned phone call direct you.

If you are bitten by a suspect animal (an animal whose immunization status you are unsure of), wash the wound with soap and water or at least alcohol and then seek medical attention immediately.  If possible restrain the animal for testing or contact animal control or the police.

As far as your pets, keep them vaccinated.  You also want to prevent or limit their contact with wild animals as much as possible, although my cat book offers no real suggestion about preventing hunting behaviors.  I would also recommend taking funny pictures of your cat and putting in some funny caption that makes the whole thing ridiculously silly.

O hai.

So, there really is no lesson here.  Please just use common sense when coming across suspect animals.  Most people know a lot of this stuff already.  I don’t want to be harsh towards the family because bats are cool, and interest in these things at such a young age is where a lot of our prominant biologists come from.  While pursuing my studies, I met one gentlemen who got interested in microbiology because of a piece of roadkill which he took into his parasitology lab.  I also have a close friend who will gladly accept any frozen bird given to him.  Just make sure that you take proper precautions and limit exposure to animals.

Gross L (2009).  A Broken Trust: Lessons from the Vaccine–Autism Wars. PLoS Biol 7(5)

I just got pointed to this article by a post on Ars Technica.  This isn’t an article debating the virtues of vaccines but rather takes a look at how the antivaccination movement got started.

It’s very frustrating trying to look for some answer to the public’s distrust of the scientific community.  Vaccination is a very important part of maintaining public health.  It is proven to protect against diseases, and we are starting to see reemergence of infectious diseases in pockets where vaccination rates have fallen below target thresholds.  At the same time, the medical and scientific communities as well as the government continue to look at the safety of vaccines.  Mercury containing preservatives were pulled out of vaccines in 2001 as a precautionary measure which started by a study requested in congressional legislation.

I’m trying my best not to be inflammatory here, but unfortunately this is a topic which people aren’t going to take any other way.  I’m sure this is a topic that I will wind up dealing with if I wind up going into primary care…one that I don’t really look forward to.  However, the benefits of vaccination far outweigh the risks of complication.  Not only do vaccines protect the individual, but herd immunity is used to protect the community as a whole, including people who have not yet or cannot be immunized.

Again, the article focuses on the events that led up to the current discussion about vaccines, and expands a little further as it discusses concepts such as the public’s trust in medical and scientific experts.  This issue of trust is obviously a very, very important for a doctor to understand, especially when you consider where concepts like informed concent actually came from.

Anyway, I don’t have any good wrap up for this.  We are either going to see some initiative by the scientific and medical community to educate the public more about vaccines and gain a little more of the public’s trust, or we are going to wind up seeing some pretty severe outbreaks of what are essentially preventable diseases.

In the meantime, please consider the sources of whatever information you are getting when making decisions about your health.

Title says it all:  DailyBurn

…or is it The Daily Burn

In any case, if you write a post about a website, they will change their name to something else four days later…obviously.  This wasn’t an acquisition or anything.  They said that the name change was to help out potential site visitors by making the name easier to spell as well as being a little more result oriented.

Good deal.

The Human Torso...Toy

Human Body Anatomy Model

The first present that I received after starting my post-bacc career was a five inch tall puzzle/anatomy model.  This was clearly meant as a light-hearted present, but it is always nice when friends show their support for major decisions.  The detail is not the best, but I still broke it out from time to time to look at where things go and how they connect while taking Anatomy and Physiology.

The link goes to an amazon item which is virtually the same.  There are tons of these little models which unfortunately can vary in accuracy and precision.  When I was a kid, I used to really like these toys (not something I would brag about on the playground).  I remember at one point I had a plastic skeleton that was pretty good.  However, there was some problem with the ribcage…the clavicles broke or something.  Now every time I wander through the toy section of a store or something like that, I wind up being disappointed at how meager the educational toy selection is. However, you can always go online to places like amazon to see what is available.

One thing I have noticed, the major models like the whole body “muscle man” tend to be a little complicated for a toy to get right, but the models of one organ such as the brain, the eye, or the heart tend to be simple enough that the toy will get most of the detail correct.  I wouldn’t buy it for a study aid, but still…

Anyway, I hope this post has met today’s edutainment needs.

So, I’ve been trying out a couple of the websites that were recommended by Lifehacker.

MapMyRun is a useful google maps integration to map running routes as most map websites don’t handle the same start and end location that well.  However, it only includes roads, and misses the nice long running path along a park in my neighborhood.  Plus, Google Maps can now do waypoints, making the ability to map out a loop a little easier with out all the bulk of the MapMyRun site.  Free and pay versions available.

RunKeeper for the iPhone won the Lifehacker high five.  I have no idea what it is like as I have no iPhone.  Free and pay versions available.

My personal pick: Gyminee

I actually can’t believe that I like this now.  I spent a while disliking this site when I was signing up for it.  It bugs you about your account profile being incomplete (inviting people isn’t part of completing your profile).  It isn’t exactly intuitive.  It took me a while to figure out the workouts and the exercises (or rather to figure out not to search through their workouts).

This site has a very simple interface for tracking weight and other statistics.  I basically skipped making a complicated workout schedule and set up a daily workout with every activity that I might do.  Then it is very simple to input your daily activities to track your exercises.

Again, it isn’t very intuitive so it may take you a while to figure out the quick way to do everything.  But, the second time I did anything on this site it took practically no time at all.

What blows me away is that after forcing myself to go there twice, I am now using it with out even thinking about it.  I have found myself wanting to go there and fill stuff in which is great for getting myself down to the gym, so the fact that I’ll use it is a big plus.  If I keep up at this, Gyminee will find its way onto my bookmark toolbar.

But again, this is a personal pick.  Individual experiences may vary.  Free and pay versions available.

Also: WiiFit

I’m still using this thing after a year…although off and on.  I usually don’t feel like swapping discs so I can do some push ups.  However, the WiiFit channel on the Wii main menu is always there for a daily check in.  This thing has fully replaced my bathroom scale.

No Tobacco Day - May 31 ...and Every Day

WHO – World No Tobacco Day

May 31 is world no tobacco day.  WHO’s theme for this year is Tobacco Health Warnings, which means that they have artwork on the page that will make you cringe.

I’m not sure if I think that this is the best approach to an anti-smoking campaign.  It has long been established as a deterent to prevent tobacco use, but I would suggest that this probably works best for those who never started the habit.

For those who do smoke, the CDC has a best practices document which focuses on evidence-based programs and supporting nonsmoking behaviors for both prevention and reducing the habit.  Make goals and keep track of progress to ensure success.

And it is one of the worst smelling habits.

Cyborg Technologies You Can Implant Now (io9)

So, you got me.  I like science fiction.  I read a science fiction blog.  Not only that, but I love science.  It is part of why I want to be a doctor.  It can be purely tangential to medicine at times, but still relevant.

I think my favorite example of this was a professor in post-bacc who wondered aloud if any of the students in our class knew about a lunar eclipse that occurred the night before.  Astronomy had nothing to do with the course, but robotics didn’t have much to do with medicine in the 1920s.

Now we have replacement parts for humans based that are increasing in complexity.

The first example that pops into my head is the iron lung.  In the earlier part of last century, Polio was the great equalizer.  There were few things that struck fear into both the rich and the poor segments of society like the Polio virus.  In some cases, the disease would spread into the nervous system including those nerves that innervate the muscles responsible for breathing.

To replace this functionality, an individual was placed in a metal drum with the head sticking out of one end through a foam or rubber collar.  The original iron lung used a mechanical motor and a rubber diaphragm on the foot end of the device to create negative pressure pulling air into the individual’s lungs.

The iron lung is still used in some cases for neuromuscular disorders that affect breathing.  Portable versions such as cuirass and jacket ventilators create a shell around only the torso to provide the same functionality and provide a little more freedom for people who need the device.

In the 1920s robotics didn’t have much to do with medicine, but later in that decade the first negative pressure ventilators were developed to replace the function of the pleural cavity and diaphragm in the body.  An eclipse of the moon may never have anything to do with medicine, but the results of research into astrophysics may one day benefit the field of medicine.

And if not, it is still worth it to know what humans can do and can understand.

Sorry for the missed day yesterday.  Between now and when med school starts, I’ll be needing to take a bit of time here or there for personal reasons.  The wife and I have a few trips and personal occurances in the meantime, and I won’t be stressing just to get things posted every day during my time off.

Yesterday was one of those personal occurances, but was also compounded by the fact that I couldn’t sleep the night before.  My sleep schedule has been a little off since school ended which was skewed late anyway since I started my post-bacc.  Exercising hasn’t helped as I seem to need more sleep every night than my body will allow as I get used to the new exercise routine.  Needless to say, I will have to work on the sleep schedule a bit.

The blog wasn’t the only thing that took an off day yesterday, I didn’t do any major exercise yesterday as my foot was still a little tweaked from running on Sunday.  I’ll be needing to get back on the run today.

Other than all that.  I’m trying to take it easy.  I’m in a holding pattern for most of the logistical stuff that I need to worry about waiting to see exactly how things go, so I’m trying to make use of the down time.

Oh.  Every now and then, I still have that moment:  I’m going to medical school.  Wow.

Does this look like a chair or a boat to you?

In the downtime between post-bacc and med school, I want to spend some time discussing the required coursework that is necessary for entry into medical school.  To do this, I am going to skip past some of the standard coursework that is required of every college graduate (just about everyone needs a certain amount of English and other humanities coursework) and focus on those courses that not every student would have.

Photo by ARTS

The basic requirements for entry into medical school are going to be a year each of General Chemistry, General Biology and Organic Chemistry, each with lab.  Additionally, I am not sure if this is required by the AAMC or any other governing body, but practically every school also requires a year of General Physics and a large number of schools require a year of Calculus.  I didn’t familiarize myself with the calc and physics requirements too much as I had credit for those courses previously and didn’t plan on retaking them.  As well, Biochemistry isn’t required, but you should plan on taking Biochemistry I if you plan on applying to medical school.  If you are applying to medical school, you should plan on having taken (or received credit for) each of these.

Additionally, there are a number of other courses which a lot of schools will strongly suggest.  Most of these are going to be upper level biology courses and include things like Microbiology, Cell Biology, Genetics, Physiology, Neurology, Immunology, Embryology and a host of other courses.  I would also suggest thinking about taking a freshman level Anatomy & Physiology course which is the only option which includes anatomy at the undergraduate level.  When I first saw a suggested list on a medical school site, I immediately went into panic mode thinking that each of those courses were basically required.  However, the approach that I wound up taking was that these were the courses that I used to fill in my schedule during my float year.

Actually, let’s come up with a better term for that: Application Year.  You should plan on at least getting all the way through Chemistry, Biology, Physics and Organic Chemistry before taking the MCAT (it will cover topics from all of these).  This means you will have a whole year while you are applying to schools to take additional courses like Biochem and the other suggested courses.  Most schools will expect that unless you have already graduated that you are continuing to prepare yourself for medical school, at least part time, and the suggested higher-level courses are a good place to start.

I’d also like to point out that for a number of these, medical schools will want to see that you’ve taken these courses within five years of matriculation.  While I got around retaking some of these requirements (it has been about 10 years for calc and physics for me), I did retake biology and chemistry.  If you are going to try to get around the five year suggestion, schools will expect that you will be spending some time focusing on higher level courses in relevant fields.  However, I suggest that you retake classes like Gen Chem and Gen Bio (and even though I didn’t, Physics) as they are covered on the MCAT.

So there you have the overall view of prerequisite coursework for medical school.  I’ll take some time to look at a few of these classes to give an idea of what each covers.