Cardiology and GI

Its been a while since Cardiology, its funny how the past 3 weeks feels like years ago. Most modules feel like this while in PA school, time seems to fly and last week feels like it happend sooo long ago. 

Cardiology was technically our first 3 week module, and it was a little weird to have two weekends to study instead of the typical one. I honestly think that allowed me and my classmates to be more relaxed during the first week of study... which is a good and bad thing! I felt like I didn't study as much as I should have at the beginning, but I got enough studying in the last 2 weeks to last me a while... Plus I feel that I had a major interest in cardiology and cardiothoracic surgery so it made it easier to retain the info. 

One skill we have been working on since we started the program is ECG interpretation, and I know SO much more than I did when I started... but let me tell you, it is not easy to pick up. It is a skill that gets mastered over time, and as one of our professors says: "you have to practice this skill over and over again in order to become and stay proficient". I really enjoy it, however, it will take me lots more practice until I feel comfortable interpreting them. 

Here is a bit-o-knowledge from Cardiology:
Auscultation (listening with the stethoscope) for cardiac murmurs and bruits is a skill that takes a lot of experience and practice. Of course its not always easy to hear pathology on fellow classmates who are all normal... 

Bruits (pronounced brew-ees) is a sound produced from non-laminar flow (disruption in normal blood flow). This can be due to plaque or a clot. Below is a typical presentation that can cause a bruit. 

Plaque that can cause a Carotid Artery bruit

A typical treatment for a carotid artery plaque (if it is severe enough, and a risk for emboli) is a carotid endarterectomy. As the photo shows, just cut the artery open, take out the plaque, and sew it back up. Some times a shunt will be placed around the plaque in the artery to continue blood flow while the plaque is removed. Clamping off the carotid for surgery can only be done for a short amount of time due to its effect on brain blood flow (that's kind of important!) 

GI Module

I never thought I would have such an "intimate" relationship with the colon and feces as I did during GI. I feel so much more comfortable with poop, bowel sounds, asking patients about their bowel habits, blood, hemorroides, and of course prolapsed rectums! 

One of our guest lecturers (a colorectal surgen) spoke about how "you can learn a lot about a patient by sticking your finger up their butt"... the whole class laughed a lot during that lecture. It was a really interesting module because this is something that will be addressed a LOT in practice. A lot of patients will present with  GI upset from drugs they take, or constipation. And because everyone needs to eat to live... i'd say there is a lot of things that can go wrong. Also there is a lot of people who like to do some weird things and get "items" stuck in their rectum, so they present to the ER for help. (Yep, we got to see pictures of that too!)

Endoscopic Retrograde cholangiopancreatography

 Interesting information regarding the GI tract: Most pathologies can be visually seen with an Endoscope or a colonoscope, making it much easier to diagnose patients without the inconvenience of invasive surgery (although a polypectomy or biopsy may be performed during an endoscopy/colonoscopy) it is hardly traumatic compared to other procedures. 

I also had the opportunity to do some dissection in the cadaver lab for the upcoming anatomy test involving the GI tract. It was really fun, and time really went by fast when I was dissecting. I spent a solid 5 hours in the lab dissecting and I hardly noticed it. I love working with my hands and I enjoy learning about the body hands on. It helped me to understand the anatomy so much better. 

For those wanting to attend Pacific... ask about the opportunity to do some dissections... you don't have to do them, but if you don't, you'll miss out on an amazing opportunity. The program doesn't set aside "scheduled time" for you to dissect, but there is time available during scheduled lab time where dissections can be performed. Plus you get to help dissect out what is going to be on the test, so you get a much better understanding of where the structures are on the cadavers. 

3 weeks of cardiology, and i'm still feeling it!

Cardiology... what can I say?! It was a lot of hard work and memorization, in fact I am positive it was the hardest test we have taken thus far. It included so much material it is really difficult to describe until you actually get to do it. 

I am only posting a brief little bit because I am in the middle of Gastroenterology and I have to study for the upcoming tests on Thursday and Friday... whew this semester is literally FLYING by! 

I just wanted to post a little 'teaser' to get everyone ready for the details of cardiology and Gastroenterology (which has been a lot of fun... there are so many jokes surrounding Gastroenterology... besides the typical "its a 'crappy' subject to study" joke, I think I've learned more about bowels and feces than I ever thought I would need to know!) So stay tuned! 

A day in my life as a PA student.

I had a request to share what a typical day is like for me being in PA school, so here it goes...

7:00am-wake up get ready for school

8:35am-catch train headed for school

8:50am-arrive at school, prepare for class starting

9:00am-class starts (usually lecture) 15min breaks between each hour of lecture. 

12:00pm-break for lunch (depending on the day, get 15-20 min of reading and reviewing morning lecture

1:00pm-lecture starts again, 15min breaks between each hour of lecture. 

5:00pm- class ends for the day, catch train home.

5:30pm- Workout for 30 min and eat dinner, relax by possibly watching some TV shows. (again depending on impending exams... this can change dramatically!)

7:30pm- stay at home and study in office, or go back to school and study in a group. 

9:50pm- (if at school) catch the train home.

11:00pm- get ready for bed

11:30pm- sleep

This is a typical day, however the schedule is always changing, and each module is significantly different. Activities happen in the afternoons sometimes which breaks up the constant lecturing, but those depend on the module and the amount of info we need to cover. 

Most modules we have time set appart to learn the physical exam skills for the specific organ system. 

 The time set aside for skills during class is usually not long enough to memorize the entire physical exam and have it down for the test, so part of my evening study time involves practicing with classmates. 

Funny Story... So picture a classmate and me practicing our cardiac exam just yesterday evening... I was feeling for his PMI (Point of Maximal Impulse) for the gentle tapping of the apex of his heart. 

It involved him laying on his left side, lifting his shirt up and me pressing the palm of my hand just under his peck pressing firmly to feel for the soft pulse. The table was tall and it was difficult to get my hand over him and in the right place, so I got on the exam table on my knees and honestly- it looked like I was wrapping my arms around him... ha ha. 

It made me think think that it takes some really manly men to be able practice on each other in these awkward positions... not only that, but I could just imagine someone walking in on us and wondering what we were doing! ha ha 

I'm deep in cardiology and will give an update on how the module wen't after I (hopefully) pass the exam... wish me luck!

Nephrology... "when good beans go bad"

Alright so Nephrology is over and yes of course after every module I explain how this module was the hardest one so far... I don't want to make a habit of doing that, however... the kidneys are SO complex. If anything this module has given me respect for those nephrologists out there who do this everyday. Acid/base balance is NOT easy, and neither is all the conditions that have almost the same symptoms. The exam seemed to have the same symptoms for almost every case! 

Lets see... Patient presents with: Flank pain, dysuria, hematuria, proteinurea, oliguria, azotemia. What is the most-likely diagnosis? 

Ok so it wasn't that way for every question, but it really seamed that way. Acute Kidney Injury (aka failure) can manifest itself quickly and in so many ways, even in patients who are being seen for a different condition involving another organ system! 

Here is a pretty interesting disease we learned about... Polycystic Kidney Disease. If this dosen't get your attention than nothing will! 

Polycystic Kidney Disease

The next module is Cardiology, and although it is easily one of my favorite topics of medicine, it scares the crap out of me! ECG is something that takes a lot of patience and practice to learn, and its really not easy. Plus all the thousands of diseases of the heart and what is affected by it just seems overwhelming! Oh and to add to the intensity, instead of the usual 2 week module this one is 3 weeks (one week in our module system is seriously like a normal semester's worth of information!) It's like getting butterflies before going on a crazy-huge roller coaster... here goes nothing!

Hematology/Oncology finished and onto Nephrology...

So I was lucky enough to squeeze by Hematology/Oncology and not have to retake the test again... and its a good thing too, that was a REALLY hard test. 

I am slowly finding out that due to the limited time we have in PA school, every second counts... The balance of material studied is so important. It is so important to learn to balance where you will spend the most significant amount of time studying, and memorizing. I am still learning this skill, and i'm guessing that when I get it figured out... I'll be moving on to my second year! Then of course when I get that figured out... i'll graduate! But that's what life is all about!

 I heard a quote today... yes its from extreme makeover weightloss edition (don't judge me, It inspires me to want to work out hard and work harder in school, ha ha) anyway here it is: 
             

"life starts at the end of you're comfort zone"

Yes, PA school is a lot of reaching the end of your comfort zone and stepping off into the wild unknown! It's hard, its fun, its scary... it's life! 

So today we had our first cadaver lab, and it was really a lot of fun. Putting what I saw in pictures and drawings into a 3-D image, then being able to hold it my hands just helped to put two and two together. Interesting fact: I didn't expect the lungs to feel so cool... its a weird spongy feeling that is hard to explain. You'll know what I mean when you get them in your hands. 

Off to digest everything renal... wish me luck!

studying my Friday night away...

Yes... I should be studying, but instead I am making an excuse by updating the blog. Before I started PA school, I would read other blogs of PA students doing this exact thing and thought to myself "I would never do that, studying will always come first"... boy was I off! It really takes a lot of dedication and stamina to keep up with all the hard work of PA school... Of course it will be rewarding in the end, however now, i'm just trying to muscle my way through it. 

One of our professors this morning mentioned a disease or some physiology we learned during the summer semester... and I was really scared to discover that I didn't remember it at all! 

There is so much information!! 

I keep hearing... trust the system, just get through it, you'll be surprised at how much you remember when you're out on rotations. And while I can recall a lot of info... its going to take a lot more exposure to get it stuck in my brain... everything is just flying by so quickly. I am loving the school process, yet every once in a while I have moments of frustration wondering if i'm really going to remember all of this stuff.

Ah the joys of PA school... surviving learning one disease at a time.

By the way, for this module "Hematology/Oncology" I feel like I have about 1000 new terms and acronyms to learn just to understand what is being discussed... but one day at a time...

back to the books... 

Derm, eye, ENT and Pulmonary modules...done!

             If you are anything like me and have ever thought to yourself "I can't wait to get into PA school, I wonder what it'll be like"... well here is a good comparison: grab a few rocks (the bigger and bulkier the better) lay them on the ground in an uneven pattern, and then lay on them for a while... then hours later get up and enjoy how GREAT it feels to not be in that extremely uncomfortable position anymore!

While I do feel lots of knots in my back from the stress... it is such a great feeling to pass modules and know that all of my studying paid off! One of the great things of PA school... you get a giant obstacle in front of you and then you climb it and feel way better about yourself! (until you look at the rest of the mountain you have to climb... ha ha but thats another story) right now i'm enjoying looking down at how far i've come and soaking in the days off, and small breaks I get to enjoy. 

The BIG derm, eye, ENT test I had been studying for is over...  and I was lucky enough to pass! I also finished the Pulmonary module which of course, was really hard also! Here are a few pictures of derm...

Actinic Keratosis 

Bullous Pemphigoid

 The Pulmonary medicine module was a lot more work than I originally thought. It took a lot of time to remember the different conditions that are obstructive and restrictive and how they would typically be treated. The most difficult part was that almost every condition had the same signs and symptoms! "Pt presents with  cough and dyspnea (difficulty breathing)" 

I learned how important it was to get a good thorough medical history in order to get a good idea of what could be causing the symptoms. Otherwise you end up with 50 different diseases on your differential diagnosis with none rising to the top! 

A few highlights of pulmonary...

Clubbing from chronic hypoxia

Tension Pneumothorax
(notice the clear/transparent right lung, it is air pushing the lung towards the middle)

Pleural effusion
(All the white in the lower left lung is fluid... it is a LOT of fluid, possible 2 liters worth)

For the pulmonary module we were able to do our physical exam skills test on Standardized patients! Which was scary and exciting at the same time. 

We practice on each other, and for our exam in Derm, eye, ENT we were tested on each other... but in pulmonary it was fun to have a patient that we had never seen previously, it made it seem like a real patient (besides having a professor sitting in there grading you). 

For those of you waiting to get into PA school, it is worth the wait, it is worth the time you sacrifice, it is worth all the obstacles you will encounter. The work is hard, the learning can be frustrating, but these experiences are amazing, and it is shaping me to be the best provider possible. Pacific University is an amazing PA school, and for those who are applying... for what its worth, it comes highly recommended by me. 

Next week is onto my next module and adventure... Hematology/Oncology. 

Rural health care track for Pacific's PA program

Pacific University school of Physician Assistant studies now offers Rural Health Track for PA students! Pacific was awarded a $1 million grant to provide this track for 5 students each year. This is really exciting!

It provides a certificate for students after they graduate on top of their PA completion certificate and Masters degree. Students in the track may also qualify for help with funding their clinical rotations! It's worth mentioning, so I thought I would post an extra little bit about it.

Click here to read more about it

White Coat Ceremony and Summer Break!

Finally got the white coat!! I wont lie it felt really cool to finally be donned with the white coat, and have the graduating class, and the class before us congratulating us on making it here. It really feels good to make it here after all my hard work, even though I know there is still a LOT more work ahead... It still feels great to celebrate little victories, I guess thats a little tip about surviving PA school.

Getting my white coat!               

Pacific's white coat patch

             

So with all of the hard-studying that came with my first semester in PA school... I get a short week (of course much needed and appreciated) of hard-playing! My wife and I have been enjoying all that Portland and the surrounding area has to offer. Its really has surprised me at how much there is to do here! (Another reason why I have LOVED being at Pacific University!)  

Punch-bowl falls 

Punch-bowl falls 

alotto gelato in Portland

I saw this in downtown Portland, thought it was cool

Multnomah Falls

                 

Multnomah Falls

Multnomah Falls

Multnomah Falls

My wife and me at Multnomah Falls

This is the Alpine Slide at SkiBowl on Mt. Hood 

My wife just finishing up her ride on the Slide

The view from the lift

My first time wakeboarding!

Fall semester starts next week, and we are finally getting into the meat of everything! Ear, Nose, and Throat and Dermatology is our first module, and while its going to be a lot of work, its very exciting to get out of fundamentals and onto more in depth material. We also get to use the sim lab for this module as well, this will be our first experience with the sim lab to date and it is really exciting. I'll be sure to tell all about it. 

Infectious disease and Health Clinic visit

So this last few weeks have been quite the adventure! Infectious disease was my last course and it was the most draining class that we have had yet! It was a big dump of information and proved to be the most demanding module yet. 

One of the best things I love about Pacific's PA program is the built-in weekend "breaks" after modules. I am now enjoying my friday afternoon-monday afternoon break with little to no studying. I had a classmate explain it as "coming up for air" from our deep swimming in all of the curriculum. What a great explanation!

It was interesting to look at everyone after the individual and group test... it was like looking at zombies, everyone had tired written all over their faces with red and droopy eyes. It was apparent everyone was ready for a much needed break to rejuvenate. 

The night before the exam, it has been a habit of mine and a few of my classmates to review all of the material from the past module. However I was able to go to a free Health Clinic with a few of my professors to get some experience.

 I was able to look in a few ears (my first time using an otoscope) and I saw a Cholesteatoma. It was pretty cool, since my professor had only seen a few of them in her career. I also got to see a patient with an H. Pylori infection and practice my antibiotic knowledge and prescription writing skills. I was also able to practice and prepare for my next module with interviewing patients. It was a very enjoyable experience and helped to remind me of the reason why I want to be a PA! 


Our first semester is almost over, and it has gone by SO fast! At times it feels like it has been at least 6 months that I have been in school, just because of the amount of material. We have patient interviewing this upcoming week and i'm told it is a lot of fun. Our white coat ceremony is approaching soon and will also be an exciting event. Expect pictures of that too! 

First big course and Vice President

So... I have found myself VERY busy for the past month! I cannot believe how quickly things have flown by. After two big tests, my first course, Fundamentals of Clinical Medicine is now complete! It was so much information and I ended up having lecture 8 hours a day, then studying for another 4 or 5 hours afterword til about 10:00 every night (when the building closed). I have really enjoyed all the information and the challenge of learning medicine. It has, no doubt, been a lot of work and will continue to get harder as next semester approaches, but I can't wait until we get to do a little more 'hands on' with physical exams and working with patients. 


I do get the opportunity in two weeks to volunteer at the health clinic down the street from the school for an evening. It will basically be shadowing and following one of our professors around, doing a few things here and there. I will give the update on how that goes, it should be a lot of fun.


I have also been selected to be class Vice President! Its such a great opportunity to do a lot of good for my class, and get some more great leadership experience. I'm not exactly sure what is in store for me in this position, however I will give it my best effort and put all that I can into helping our class to succeed. 


The next upcoming course is Infectious Disease and Immunology, and this is technically our first Clinical Module. It will be a lot of work, just like everything i've done so far, but will be important for my clinical foundation. The end of the semester is soon approaching (the beginning of August) then we will have our white coat ceremony. Which should be a lot of fun too! Just starting my journey, and so much to look forward to! 

First few weeks of school, iPad update!

Alright so the first few weeks of PA school have passed and all I can say is it has gone by very fast. The first week was Intro to Anatomy, and it was a LOT of work. I was at the school pretty much all day from 9:00 until 10:00pm when the campus closed. We had 3 days to remember/memorize all the bones and boney landmarks of the skeletal system. Besides all the other anatomy that we had to know/memorize. We started on Tuesday and had our test on Friday. It was pretty intese to say the least. 

Then we had a week of Genetics, and we just finished Topics in the PA profession. We are also in the middle of Evidence Based Medicine which is every Thursday morning. 


This upcoming week we are starting the meat and potatos of PA school: Intro to Clinical Medicine. It includes a lot of pharmacology, physiology and pathophysiology for all body systems. I am really excited, however I am also scared out of my mind. Our professors assured us that if we are not panicked by the amount of work, then we are abnormal! So it looks like i'll be studying all day long, but I am expecting that.


iPad update!
OK, so for those who were wondering what I think of my iPad to take notes on for class... I really like it a lot! Its so much easier than printing out powerpoint slides and writing on them, and it keeps all of my classes/powerpoints organized and easy to access. I also just ordered a bluetooth keyboard that I think will be very helpful if I want to type in some sections instead of writing (not everyone needs or wants this). I suggest the iPad for everyone in PA school... so if you are debating, just get it you wont regret it.

A look at the keyboard I ordered for my iPad. 

Also, in other news, I got a job! I know... they say don't get a job when your in PA school, but this job is for the school. When the IT guys came and gave us an intro to how to connect to the internet, and how to print ect... they said that they select one person from each class to be a" technology representative" and its a work study position. So I interviewed and got the job! and I work 5 hours/week and get a little extra money each month! Most of these hours are me helping to fix/diagnose problems with peoples Macs and PCs, and at times with the audio/visual equipment in class. (and since im in class all day, i don't really have to go anywhere for work) So its a great opportunity for me to lower my final PA school debt... even if it is just a little bit. 

Study group!

We were assigned study groups/test taking groups at the beginning of class and here is mine. We had fun this week working on assignments together. Yes we take tests together, we already took and passed our first test last week. 

Orientation

This is my last week of freedom before all the hard work starts. Orientation was a blast, it was procedures and policies for some, but we had a good introduction to what PA school will be like for the next 2 years. We also got fitted for our white coats and got our medical equipment package. I honestly feel so cool with all this equipment, even though I don't know how to fully use all of it yet...

My wife and I also got a chance to ride a tram this week that gave us a birds eye view of portland. It was a lot of fun, and it only cost us $4 so we couldn't complain.

During orientation we went over our schedule and all I can say is that it will be VERY full. This first week we are starting off with an Anatomy overview. Class is from 9am-12pm and 1pm-5pm. I'll keep everyone updated on how everything turns out, I can't wait to get started!

The fun before the storm.

So this week has been full of my wife and I enjoying Portland, and getting used to our surroundings. I also went on a hike with about 16 of my fellow classmates as a 'get to know you' type of gathering, which was a lot of fun. The weather in Portland has been sunny and nice for the first few weeks here in portland, it has since become rainy and cloudy the last few days, but i'm enjoying it all. 

Shopping for school furniture

Riding my bike on the light rail

I was intrigued by the name, I had to try one

Honestly SOOO good, not the healthiest of course... but still awesome!

Beautiful rose at the International Rose Test garden

China Town

A good view of Portland

Of course Voodoo Donut a famous donut shop

This is the line we had to wait in for some donuts... about 30-40 min

Of course I had to get a picture of this sign...

School orientation starts tomorrow... today I meet at the main campus to review immunization records and I can honestly say I am 
excited, scared, and ready to get things moving forward!