What's in a name?

Not too much to report school-wise -- had a big Neuro exam on Friday and now I'm holeing myself up for the weekend to study for a big Physiology exam on Monday. This unit is all about the cardiovascular system; anything you can imagine is covered: the cardiac cycle, EKG readings, cardiac measures, blood pressure, peripheral circulation, hemodynamics, and how the system responds in exercise as well as various states of failures. There are 3 pages of mathematical formulas alone to measure. One thing about PA school -- you can never be caught up, you just do your best to prepare for the next big test. I think if all I had was Physiology, or say Neruoanatomy, I would feel really comfortable in any one area, but there is no way you can master it all when you have 8 classes.

I thought I'd go into names a little bit. How many of you have thought about your names, and what they mean? I happen to have a very common name, but it's one I'm rather proud of.

Let's start with my first name: Daniel. I was named after the Biblical Daniel, a prophet as well as an interpreter of dreams and known as a wise man (for clarification: wise man -- not wiseguy). In Hebrew, Daniel means "God is my judge." In the Bible, Daniel is perhaps most known for his courage in the "Lion's Den"













Did you know that Daniel is portrayed in Michaelangelo's famous painting on the Sistene Chapel? Needless to say, Daniel is a quite a popular name worldwide -- many young parents pick this name (and who could blame them?)

But just how common is it? It depends on the source, but here are some of the data I found:

In the U.S., Daniel is the 5th most common given name, overall. You can break it down further and look at states and years -- for example, in California in 2007, Daniel was the most popular given name, and I won't belabor you with all of my findings, though here is one curious one: according to the 2000 U.S. census, Daniel is also the 380th most common surname! Suffice it to say, there are a few of us Daniels around. Here are some links in case you want to research your own name: U.S. links or a more general site

Now let's look at my last name: Miller. As you probably know or would guess, this is incredibly common as well. According to the last U.S. census, it was the 6th most common surname, behind Smith, Johnson, Williams, Brown, and Jones. Another way to look at it: Millers account for about 0.5% of the U.S. population. Here are some links for last names: a nice NY Times scrolling chart and a whitepages.com breakdown.

And finally, my middle name: Ruben. My middle name came from my paternal grandfather, a man who I greatly love, admire, and respect and who I am proud to be named after. My grandfather, as my family well knows, has many legendary nicknames, though that is a tale for another day. Ruben, incidentally, is the 20th most common given name in Spain, and by its alternate spelling, makes for quite a tasty sandwich. To quote the great Miracle Max: "Sonny, true love is the greatest thing in the world. Except for a nice Reuben sandwich, where the corned beef in nice and lean, and the sauerkraut is fresh."

Hopefully I made you all think a little bit about your own names, if you've never been curious enough to do that in the past. I'd love to hear some comments so feel free to share some stories about your own names and any other interesting related trivia. I'll never forget the time my uncle David lived on a street where there were 2 other David Millers within a few miles. As you can imagine, their poor keystone-cop-like mailman never could get their mail sorted just right.

One more interesting Dan Miller bit: as some of you know, I'm a fan of all things martial arts, including the recent MMA movement. Well, there is an upcoming fighter from Jersey named Dan Miller, and of course, I am a huge fan. We Dan Millers have to stand up for each other, you know? He fights tonight at UFC 90 -- let's hope he does the rest of us Dan Millers proud. Apparently he is a pretty good grappler and submission artist, though I notice he still lacks a nickname. Which reminds me of a converstation I had with my friend Derek, where we tried to come up with possible nicknames for ourselves were we to become MMA fighters. Derek came up with "The Red Herring" which is even more fitting as he has red hair, and I figured that he should hail "from parts unknown." So any suggestions for a good nickname would be appreciated. Here is a link to his bio: Dan Miller's bio & professional record





















Carlin of the day:

The wisest man I ever knew taught me something I never forgot. And although I never forgot it, I never quite memorized it either. So what I'm left with is the memory of having learned something very wise that I can't quite remember.

Somehow I'm still afloat

Had quite an interesting experience on Monday -- had to perform a Well Woman exam on a standardized patient. This included a breast exam as well as a full pelvic exam, including using a speculum to visualize the cervix (I did not actually take a pap smear, though it would have been a simple thing at that point) and a bimanual exam to feel the uterus and ovaries. As you can imagine, this was a fairly nerve-wracking experience, especially for the guys in the class. Thankfully, the patient was very relaxed and helpful and they made the whole experience as non-threatening as possible. It ended up being a lot less stressful than I had anticipated, and hopefully I'll be more prepared now when my Women's Health rotation comes around next year. I won't go into any more detail about the experience (for all of your sakes) but it was probably the most invasive thing I'll have to do until my clinical year, and I'm glad they included it in the curriculum -- it's one of things you can't just read about but have to actually do to appreciate.

I'm keeping this one short as I have a big Neuro exam to study for.

In closing, let me present you with proof positive on something I have long suspected: Tom Cruise is indeed a Sith Lord:

I'm on a roll here ...

Had a shorter day than usual at school -- in Neuro, we reviewed upper and lower motor lesions involving the vestibulospinal, reticulospinal, rubrospinal, corticospinal, and corticonuclear systems as well as discussed what is going on neurologically in decorticate and decerebrate postures that you might see in comatose patients. In Women's Health, we started the Obstetrics 1/2 of the class. Our teacher for this section is actually a OB-GYN D.O. who graduated from our school in 2004. I've found that quite a few of the PA faculty are past graduates. I think someday I would enjoy teaching a class here or there. Though first, I need to *pass* and complete the program. Then, get some years of experience under my belt (and hopefully pay off my sizable college loans in a decade's time.) Then, and only then, I will hopefully try my hands on the other side of academia.

In other news -- it's FINALLY cooling off here -- 72 tonight and the 1st night I've had the windows open at night. I shouldn't complain as I do like the heat for the most part and seeing the sun every day -- although I love a nice cool night with the breeze blowing in through the window screen.

I'm getting a rare break this week and going to see Bob Schneider play on Thursday night. Normally, I wouldn't even consider taking a night off (sounds absurd but sadly it's true), however I will have a brief reprieve following a big test on Wednesday and I'm seizing the opportunity as I may not have another opportunity until the semester ends. And when Bob comes to town, I help out by playing roadie or selling merch and so the show is free. Free is good when you have no real income.

I have a few quotes from Mark Twain for today:

Action speaks louder than words but not nearly as often.


Forgiveness is the fragrance that the violet sheds on the heel that has crushed it.


When we remember we are all mad, the mysteries disappear and life stands explained.

What's this? A new post?

And it only took me a month and a half. At this pace, I'm sure I've lost the interest of the few people who might actually check this blog out. However, I am compelled to push on and maybe if I get in the habit of posting something, *anything*, at least once a week, it will become habit and this blog will actually serve the purpose I set out to accomplish with it. At any rate, I'm starting to ramble, as I'm wont to do, and I know no one wants to suffer through that, so I digress...

As you can see, I changed the title of the blog. I'll probably keep the same address but tinker with the title to reflect my current mood. After a really tough week or more all-nighters than I've had in a while, I decided to switch to my new motto and one of my favorite Warren Zevon tunes (I know he didn't coin the phrase but his song is legendary to me).

One of the main purposes of this blog was to let everyone know what the experience of PA school is like. I still have to post about my 1st quarter -- the "breaking in" phase, if you will -- but I may as well talk about the current quarter.

A quick side-note for those of you not familiar with the structure of PA school: think of what 4 year medical school like, and divide by 2. The structure of PA school is in the medical model, so the 1st half is didactic (lectures, courses on campus) and the 2nd half is clinical (going out on various rotations.) In a lot of ways, I think PA school might be more intense than med school -- you don't learn everything a doctor does, but you also have half the time. And by the time I'm done, I'll be basically doing the same things a doctor does -- examining patients, ordering/interpreting lab and other diagnostic tests, writing treatment plans, prescribing medications, etc. It really is a unique profession that has come a long way in a short period, and is filling in the gap created by the current physician shortage and increasing demand for health care. One nice thing about my soon-to-be career: job security. There will always be a demand for it, and it's something that can never really be outsourced. Okay, I'm rambling again, back to this quarter ...

This is quarter number 2 (PA programs have quarters rather than semesters and you go straight through with no spring or summer break) and I have 8 classes. No, that wasn't a typo -- 8 classes! Here are each of them with a brief description:

Physical Diagonosis: This class, as the name implies, teaches us to perform a complete head-to-toe physical exam. We are taking this class with the podiatry students on campus -- it's neat to mingle with some of the other programs. There are lectures that talk about the technique and purpose of all the individual parts of the exam, as well as specialized tests and abnormal findings. A big component of this is learning how to use medical equipment such as a stethescope, otoscope, opthalmoscope, and vaious and sundry other instruments. There is also a lab section where we come in and practice the parts of the exam on each other. So far, I'm really enjoying this class as I'm really starting to feel like a clinician. Rather than just sitting in a lecture hall, we get to apply some of our knowledge. Our school has a set of clinical rooms set up just like your typical doctor's office room, complete with exam table and requisite "butcher paper" all the way down to the jar of long q-tips and tongue depressors. There are 2 sets of 3 rooms and in between these rooms there is a "monitoring area" where the faculty can watch all the rooms behind 2 way mirrors and even listen in via headphones when we do our tests. The tests are also videotaped and given to us on DVD so we can analyze ourselves performing the exams and see where our bedside manner, approach, and comfort/confidence can be improved. When it comes time for the exam, there are are standardized patients who come in and we perform the physical exam on them, with one of the faculty standing by and grading us. I just had the midterm exam and it consisted of the following sections: vital signs, skin, head, ears, eyes, nose, throat, neck, upper extremities, and pulmonary. We had 30 minutes to check over 70 individual items and had to work from memory, which was a little daunting, both in trying to remember the correct order and all of the various tests as well as being able to hustle and move quickly. However, you find that it tends to flow once you get over the nervousness. On the final lab exam, we will have an hour, but have to do everything on the midterm, as well as adding cardiac and lower extremities and adding other specialized tests such as a complete neurological exam and pelvic/breast exams. Basically, the final will be a complete and comprehensive physical exam.

Clinical Medicine: If Physical Diagnosis is part of the nuts-and-bolts of medicine, this is your bread-and-butter. This class is similiar to Pathophysiology, so you go system to system and study disease processes and abnormalities, but with the addition of treatment. We learn how to diagnose various disorders and also the medications and standart course of treatment with each. There is a small group breakout in this class where we are presented with a case and have to come up with the probable diagnosis & differential diagnoses (what else it could be) and then come up with a treatment plan. With each case, we do a full write-up as if we had just seen that patient in our office, and even write out their prescriptions on sample prescription pads.

Here is a sample of the content from our last test (which was this morning):

• Hematologic conditions (all the various macro and microcytic anemias)
• Oncology: Leukemias, Lymphoma, and Multiple Myeloma
• Musculoskeletal/Rheumatology: Arthritis, Orthapedic Radiology, Gout, SLE

Obviously this is just a general idea of how we cover broad areas -- each section has many many more conditions than what I listed. Earlier in the year we covered Dermatology, Immune Disorders, Vision Loss and other eye conditions, ear infections, allergies, oral lesions, upper respiratory conditions, and more.

Physiology: This is tought over 2 quarters and is the natural extension after you make it through the juggernaut that is Gross Anatomy. In anatomy, you mainly just learn what and where all the various body structer are, and in Physiology you learn how they work. We started with some basic cellular stuff -- osmolarity, diffusion, equilibrium potential, the nervous sytem (action potentials, graded potentials, synaptic transmission) and such -- and moved on to the muscular system (one my faves -- the sliding filament theory) and now we are on a big cardiac unit where we study the cardiac cycle, EKG readings (what they mean and what abnormalities look like), circulation, blood pressure regulation, etc.

Neuroanatomy: Another extension of Gross Anatomy, this class focuses on the brain, spinal cord, and peripheral nerves with a focus on how various lesions present clinically. Very focused class as you might imagine -- so far we have covered a more comprehensive look at the anatomy of various brain regions -- medulla, pons, cerebellum, forebrain, cranial nerve nuclei, etc. and are now moving into systems: somatosensory (pain, touch, proprioception), visual, auditory, taste, olfaction, and upper and lower motor neurons and reflexes.

Women's Health: Somewhat of a challenging course for me -- I've been told on many occasions that I don't understand women, so I suppose I really need this class (though I'm convinced I'll never truly understand them lol). I won't go into great depth on this one -- the 1st half of the class covers gynecology -- we study the menstrual cycle and hormonal changes and disorders (amenorrhea, dysmenorrhea), birth control, sexually transmitted infections, ovarian, breast, and cervical cancer, pelvic organ prolapse, etc. Then 2nd half of the class will focus on obstetrics.

Epidmeology: This class looks at various ways to study and track disease processes and how to read and interpret various test measures. It's very heavy on statistics and calculations, but with a very practical focus, which I really appreciate. For example, if a woman tests positive on their pap smear, what is the chance they have cervical cancer? And what do you do next?

Evidence-based medicine: This is actually part of my Master's track and meets on Friday afternoons. In this course, we learn how to apply evidence-based medicine. The focus is on how to evaluate studies and research papers and use the current literature in our practice. The major "assignment" of this class is to come up with a clincial question, find all the current and relevant studies on your topic, and write up a review of the studies and disorder you are focusing on. The idea is that our final project will be suitable and ready to submit for publishing.

Interdisciplinary Core class: Finally, a class with no homework or tests! This is a very informal course that is designed to familiarize all of the students as to what each part of the health care team does. Each week, a different program comes up and presents on their profession. There are quite a few specialty programs here -- the dental school just started this year, and there are D.O.s, podiatrists, physician assistants, pharmacists, occupational therapists, nurse anesthetists, cardiac perfusionists, and other medical subspecialties. While this is basically a sit-back and relax class, there is a requirement to do community service as part of the course. The school runs a clinic and also does volunteer work at a few local homeless shelters, they periodically will do school physicals, and assist with fundraising events like the various walks/runs for various causes, so there really is a myriad of opportunity.

Well, in a nutshell, that is my current quarter. As you can see, I've been just a tad busy. Although I wouldn't trade it for anything -- there have been big groups of students already interviewing for next year, and the numbers keep growing and growing -- our school has had almost 1000 applicants already for only 80-odd seats, so I am truly grateful to have such an amazing opportunity and I do truly love it, even though I often feel overwhelmed and stressed. It's all part of the process -- and when else in my life am I going to be able to take 2 years and just learn...

Okay, if you're still with me after that massive diatribe, pat yourself on the back. I will do my best to post more frequently, and rest assured most of my posts won't be so long-winded and require you to schedule a 30-minute block into your day planners.

I'll end with a picture and a quote. The picture is a macrophage about to engulf a cancer cell:













And I'm not sure of the source of this quote, I just remember it from a plaque at my old kung-fu school in Michigan:

If we don't try, we won't do.
And if we don't do, then what are we on Earth for?