Internal Medicine Clinical Rotation

POP QUIZ: What is the only lipid-lowering medication class not contraindicated in pregnancy?

     For Internal Medicine, our program has two, four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I was at a Cardiology clinic for my 1st rotation, and I was at an out-patient primary care clinic for my 2nd rotation! I did not think I would enjoy primary care as much as I did, but I saw something new/interesting every day!

     As a provider at an out-patient internal medicine clinic, you are the patient's go-to for healthcare and also the "middle-man" between the patient's various doctors. If a patient has numerous medical conditions (i.e. congestive heart failure, chronic obstructive pulmonary disease, osteoarthritis), you are to ensure they are being referred to/seen and treated by their Cardiologist, Pulmonologist, Orthopedist, and so on. You also see the patient for annual physicals, acute illnesses, chronic medical problems, lab work, medication adjustments and so much more! 

     As a primary care provider, it's important to build a positive rapport with your patients. I noticed very quickly how much my physician's patients meant to him, and how well-respected he was by patients. He cared for each patient as an individual, helping them with medical problems as well as life in general. He has gone on mission trips with his patients, long-distance bike marathons with others, and even attended events/parties when his patients asked him to join. As a medical provider it's important to always remember that you are treating people; people with emotions, feelings, concerns, stressors, and anything else you can think of. Compassion is the best way to develop a positive rapport with patients. Studies actually show that patient overall health and disease outcomes are linked to a better patient-provider relationship.

     We had a couple of very interesting patients that came into the clinic...

• Female that was born with esophageal atresia and developed a fistula. For treatment, they took a portion of her jejunum and made a new esophagus that ran on top of her sternum. Looked WILD.
• Male patient with hypokalemia that says he drinks 2-3..... POTS of coffee each day. Does anyone else drink that much coffee!?
• Male that has debilitating headaches with orgasm, recent-onset.

     We have assignments that we do for the class portion of rotations, and one of those assignments is to type up a SOAP (subjective, objective, assessment, plan) note on a patient that we saw in clinic. For those interested in the male patient that has headaches with orgasm or if you want to see how a provider's clinic note is typically typed up, CLICK HERE (*please note: all HIPAA standards have been followed)

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the IM topic list is a unreal):

• IM Topic List
• IM Exam Blueprint

 Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just IM):

• Washington Manual Internal Medicine
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Bile Acid Sequestrants (cholestyramine, colestipol, and colesevelam)
- Be sure to monitor fat-soluble vitamin levels as these drugs may impede their absorption

Regret

QUESTION: What is your biggest regret?

     I hear so many people say, "I regret not doing this" or "I regret not doing that." How many people do you know regret something they they have done? I hear that so few times that I'd be lying if I said I could count on two hands. I'm personally of the mind set to trying everything. You want to try out for the local baseball team? Train, and try out. You want to become a doctor? Study, and apply to med school. You want to date that person you think is out of your league!? Ask, they just might feel the same way... Try everything! And even though you might not succeed initially, you CAN do it and you WILL do it if it's what you truly want to do.

• Bottom Line: Try Everything - Shakira

     There was a video I saw on YouTube where they had a giant chalkboard, and at the top "Write your Biggest Regret..." People began populating the wall with things their regrets; not pursuing their dream, not asking that girl/boy out, not taking that extra step to reach their goal, not applying to their dream school, not ______, you can fill in the blank. Not a single person wrote something on that wall that they regretted actually doing.

     My grandfather shared a quote with me... While humorous, it hits the nail on the head. "It's better to reach for the stars and land on the moon than to reach for the top of the haystack and land in the dirt." Pursue your dreams! You will regret it more if you don't try.

My Biggest Regret: The mental stress I placed on my family growing up. Love you guys!

Family Medicine Clinical Rotation

POP QUIZ: What's the most common cause of chest pain?

     For Family Medicine, our program has two four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I am at an Urgent Care clinic for my 1st rotation, and I'll be at a Family Practice Clinic for my 2nd rotation in the Spring semester.

     At the Urgent Care, you see a wide variety of age groups and complaints. From infants a month old to a 98-year-old woman (yes, you read that correctly) who's more active than I am!! It's much more fast-paced than traditional family medicine, and you don't get to focus much on the preventative side of medicine. A patient comes in with a complaint, you diagnose the complaint, and you treat the complaint. It's a "greet em, treat em & street em" way of  looking at medicine.

     Common complaints/diagnoses I saw while working:

• streptococcal pharyngitis (strep throat), influenza A&B, upper respiratory viruses, seasonal allergies, chronic bronchitis exacerbations, depression, cuts/scrapes, and orthopaedic injuries (my personal favorite!).

     I got to have a little fun at the office for college football opening day! Yes, I am based in Lexington at the University of Kentucky and do most of my rotations in Wildcat Country, but I will always be a Georgia Bulldawg at heart. I got some flak for wearing this to the clinic, but I was born in GA and went to undergrad there! I will always support the Kentucky Wildcats.....except when they play the Dawgs! #GoDawgs

     I did learn an interesting new technique for wound care, that I'd personally never seen before! It was actually for the 98-year-old mentioned earlier who injured herself while tending to her garden! When dealing with scrapes, try use as much of the patient's leftover skin to cover the wound. The BEST band-aid is your own skin, so we spent plenty of time trying to cover up the patient's wound with her own skin and then using steri-strips to hold it in place before dealing with the remaining open wound. This took plenty of patience as the scraped skin loves to roll up on itself! It's best with two sterile cotton swabs and some normal saline. Use one of the cotton swabs underneath the skin and twist the swab away from you to help unroll the skin before placing down to cover the wound. This ensures the most amount of skin possible is being used to cover the wound. It was definitely an interesting approach to wound care I'd never seen before, but it makes so much sense!! So if you have a big wound, try NOT picking off the skin before getting seen by a medical professional.

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the FM topic list is a beast):

• FM Topic List
• FM Exam Blueprint

     Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just FM):

• CURRENT Practice Guidelines in Primary Care
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Chest wall pain, AKA muscle soreness.

Characterized by at least 2 of the following: Localized muscle tension; Stinging pain; Pain is reproducible by palpation; Absence of cough.

The Optimist

CHALLENGE: When talking to friends/family, mention positive aspects about your day or life before mentioning what you do/did not like.

     For those who don't know me, I tend to complain about the countless little things that surround me. Basically, I speak before I think... A lifelong problem for me that my mom can attest to (I love you, Mom!). This may just be human nature, I know I can't be the only one! All these negative things that surround us seem to consume a larger portion of our minds/lives than the positive things. The unfortunate thing is that we are somewhat conditioned to allow these negative things to consume us. The media runs negative stories because we, as a society, tend to tune-in to negative stories more frequently than positive stories, so the networks get more views and more revenue. Negative posts on social media stir a reaction while positive posts seem quickly forgotten or simply scrolled past, but I always love me an adorable puppy post!

     I recently was overcome with stress from PA school. I looked at my life and realized I simply could not keep living this way, with so much weighing me down. With all the complaining, the negativity, the stress, I was near rock-bottom from a mental health standpoint. It was unhealthy, it was wearing me down, it was exhausting! So I challenged myself. I re-wired my mind to focus on things that would make me happy, more positive thoughts. Some advice I got from one of my professors was, "only focus on what you can control." While, I didn't make sense of my professor's advice initially, it later hit me following a mental breakdown after an extremely stressful week of tests, studying, and personal life struggles. How helpful those words of advice are now. We simply can't control everything around us, as much as I'd like to... So I changed my thought process, I switched to controlling what I could, and allowing the rest of the world to happen as it happens. 

     There was a video I was recommended regarding everything I discussed above, and it places a unique perspective on how we view the world and ways we can change our thought process...

     Following this, I have encouraged those around me to name off every positive aspect of their life before mentioning the negative. It's amazing how much their affect changes while talking about the positives of their day. So much so, that the negatives are either forgotten or don't seem quite so bad. Every time my girlfriend and I talk to each other on the phone, we are not allowed to say any negative things before something positive, and it is amazing to see how this little change can make our days seem so much better than we previously thought!

     Just from this minor change of communication, my stress has greatly reduced and I feel so much better than I did prior to this little "social experiment." I am happier, much less stressed, and I am better able to manage the countess responsibilities that pull me in every direction. Positive thoughts and only controlling what I can control!

New Health Challenge!

     So, this is somewhat an extension of my last post. Since PA school has begun at UK, I have been slacking off with diet and exercise. For those in the medical field or still in school, you know how much time and effort school, studying and clinic takes and the amount stress it causes! Due to that, I have put on about 7 lbs in 1.5 years, and lost considerable GAINZ... I have tried fad diets and had a couple health-related goals over this time-frame, but nothing really ever stuck or motivated me enough, until now....

     My friend Joe from undergrad at UGA and I have constructed a challenge. The goal is to lose a certain amount of body fat percentage over a few months. We will be utilizing a handheld bioelectric impedance device to track our results! The challenge started two weeks ago and will last until Dec 15th, when our Christmas breaks begin, as we would love to enjoy some good holiday meals with family!

• My Goal: to go from 19.2% body fat, down to 12% body fat
• Joe's Goal: to go from 17% body fat, down to 10% body fat

     If we both meet our goal, we will both "win." But, if one of us does not meet their goal, there will be punishment... What punishment you ask? The winner will get to post an embarrassing photo to the loser's Instagram. This can be an old photo, or it can be a new photo with a pose/outfit chosen by the winner. Yes, both of us can technically lose!

• To check the accuracy of handheld BIA devices: Handheld BIA vs. DEXA (PubMed)
• *These devices have an error range of +/- 3.5%, and ensure proper hydration and measuring results at the same time of day, under the same circumstances.*
• To purchase the handheld BIA device we are using: Handheld Body Fat Loss Monitor

I will not post many progress pics, but I will post the before pic (below; relaxed, flexed, side-relaxed) and and after pic once the challenge is complete! I will also post the Instagram photo if one of us does not meet our goal!!

To track my calorie intake, I use My Fitness Pal, (MyFitnessPal). This just helps hold me accountable for what I am eating, I would hate to have to log an unhealthy meal or snack and have that staring at me in the face! It's more motivating than you realize! And, the key to weight loss is caloric deficit (calories in - calories out = <0) I do not use the paid version of MyFitnessPal. I am also planning on exercising regularly and even adding cardio into my normal workout routine... I know, gross!

• If you would like me to post my normal workout routine/schedule, just let me know!

Macro Goals:

• Total Calories: 2,300 kcal
• Carbohydrates: 259 g
• Protein: 173 g
• Fat: 64 g

Pediatrics Clinical Rotation

POP QUIZ: What pediatric condition is characterized by 3-4 days of a high fever (>103.5F), an abrupt cessation of fever, followed by a non-pruritic maculopapular rash on the neck & trunk?

     I recently finished up my pediatric rotation, and I LOVED every moment of it! For some reason, children in healthcare are so much more enjoyable to work with and treat than adults... I spent the rotation at two different clinics with two different patient populations. I was at an Adolescent Clinic and a General Peds Clinic. I spent 3 days/week at the adolescent clinic seeing patients 10-23 years old and 2 days/week at the general peds clinic seeing patients 1 day old through 4 years old.

Adolescent Clinic:

• Well-child checks, immunizations, sport's physicals, birth control, STI's

General Peds Clinic:

• Well-child checks, acute illnesses, rashes, fevers, education/counseling for feeding & growth/development

     Both locations were phenomenal and my preceptors consisted of MD's, DO's and PA-C's. Each had their own unique way of approaching the patient with the same end goal of total patient health and prevention of disease. I enjoy pediatrics because it is a different approach to typical healthcare. Pediatrics is largely focused on disease prevention or primary prevention while most adult medicine is focused on disease treatment or tertiary prevention. 

     Helpful Information for the Pediatric Rotation:

• Developmental Milestones
• Immunization Schedule

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for:

• Peds Topic List
• Peds Exam Blueprint

     Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just pediatrics but give a good summary of common pediatric conditions):

• Nelson Essentials of Pediatrics
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Roseola (“Roseola Infantum”)

Diet & Exercise

     Let me begin with a little background about myself before discussing this topic. I grew up in sports. Baseball, football, soccer, weightlifting, gymnastics, swimming... if there was a sport that existed, I was going to try it as I grew up! As I entered high school, I stuck with baseball, football and weightlifting because I was a bit overweight, making me less competitive in other sports. By the time high school was over, I was close to 260 lbs, and I hadn't realized how unhealthy I'd become. I was strong and a great weightlifter, but that didn't matter much anymore because I chose not to pursue college athletics. Needless to say, things needed to change.

     Then, college began and my weight fluctuated for the first few years with fad diets and intermittent exercise, but I actually LOST the "freshman 15!" But by the end of my junior year, I was holding steady at around 235 lbs, but was still not satisfied. I was an Exercise and Sport Science major and had some access to a DEXA scan to measure my body fat percentage. Let's just say that was a wake up call, it was much higher than I thought it would be...

     I met a good friend, who eventually became my roommate, who wanted to compete in a "mini" triathlon. I was never really into cardio, and I was scared when he asked if I wanted to join. I said yes, and we began training at the gym. I'm not saying this is the fix-all for everyone, but this is how I lost that stubborn weight... a LOT of motivation and hard work with the help of a dear friend!

• If you want me to share our workout plan, just comment down below, I'd be happy to. Just keep in mind that we had access to a lot of equipment, at UGA's gym.

     By the end of my Junior year, I was sitting just under 200 lbs, and stronger than I'd ever been. I did not get a change to compete in the mini triathlon we signed up for because I attended the wedding of a dear friend, which was far more important. Three years separate the pictures above, it takes time. I finally felt confident, I finally felt healthy. This friend has no idea the impact he had on my life, but I am forever grateful to him. Today, I struggle trying to balance life, school, work, and health... But, that's another topic for another day! The key: find balance, but don't neglect health whether it's mental or physical!

     The short story is, the secret to my success was surrounding myself with those who wanted me to succeed, those who helped me succeed and pushed me when I felt like giving up. Through constant motivation and competition, I was able to lose weight, improve my mental health, and feel healthier overall. There are so many diets/exercises that exist, but you MUST find support in those around you, and find what works for you. The diet that works for John Doe may not work for you!

Patience

We could all use a little patience sometimes. I'm currently on clinical rotations and my preceptor shared this quote with me. I didn't realize I needed this wisdom until later that night... I hope it can shed light on something you're going through.

"Patience with family is love

Patience with others is respect

Patience with yourself is confidence 

Patience with God is faith" 

A Growing Love

A girl so amazing, so beautiful

A girl that has stolen my heart

A girl whose kisses make me delusional

A girl who is driven, who is smart

A moment more precious than a sunset

A moment so wonderful, so grand

A moment that I won’t ever forget

The moment I asked you to take my hand

A relationship built upon trust

A relationship filled with competition

A relationship where wine is a must

A relationship supporting each other’s ambition

A future full of laughter and love

A future with us on the same team

A future I can’t wait to be a part of

The future I see as I dream