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?