Now and Then . . .

So, I’ve been messing around this weekend out here in San Diego.  The weather was wonderful and I couldn’t have had a better time.  I was able to attend Prospect Avenue Baptist Church and meet a bunch of new people.  I always love fellowshipping with Christian around the world and how easily we can just sit and talk like we’ve known each other for years.  

Four years ago I took a personality test and retook it 2 years ago and then yesterday.  Each of the results show a difference in my personality as I progressed through medical school.  I’m not much more open but am more confident, extroverted, empathetic, trusting in others, feminine, spontaneous and stylish.  Yep, I am a more well rounded individual and medical school taught me much more then I could imagine.  Only one more month of medical school and then I have two months off until I graduate on Dec. 10th.  

Well, off to life again.

Memphis

I’ve been in Memphis for two weeks now finishing my last rotation at UT.  It is a strange but odd feeling. One might expect it to generally be filled with joy and excitement but in my case it is somewhat anti-climatic.  Similar to a made field-goal in football.  Filled with relief and satisfaction after a long and tense expectation of failure.

So, I’ve only two weeks left.  What am I doing with myself.  I will be studying radiology next week and then palliative care the following week.  I’ve settled on a specialty – Emergency Medicine.  It shouldn’t come as much of a surprise to those who have been following my blog for the past year.  After immersing myself in wilderness medicine and then finishing up an Emergency Medicine rotation two weeks ago I finally figured out that it fits me – or I fit it.  Either way, I had a blast in the Emergency Department and learned a bunch.  It fits best in my future career plans and allows for the greatest flexibility.  

So, how is the finger?  It is great.  Today is exactly 1 and 1/2 months after the accident.  I really think healing has been greatly accelerated by a new product I’ve been taking that help reduce inflammation and overall health.  It is distributed by a company called Max International.  I started taking it about 2 weeks before the accident and then after thought – well, I’ll learn a lot about it. It is a glutathione supplement and after taking it and seeing the results – my anecdotal evidence matches their scientific findings (warning it is a pdf).

Day 11So, only ten days after the accident, I had up to 50% mobility and by 14 days I was up to 75%.  As soon as I removed the bandage I was able to type and at 14 days I was able to play the piano and do most everything including pull-ups.  Only thing I haven’t tried is guitar again.  Because of the scar tissue I cannot flex much beyond 80% but I’m continuing to work at it.  I’ve included pictures chronicling the healing of my precious pinky and then some of the last few weeks.

Lately –

My pinkySometimes things happen that are best left to the imagination, food poisoning, C. Diff infections, major trama to an extremity.  Well, 12 days ago at 3:15pm my pinky, yes the smallest of my phalanges, was rendered useless to me for the next week and 1/2.  Yep, my pinky got smooshed.  It was a random collection of events (bad judgment, big part of lake, unseen wake) that ended with my pinky between two boats.  All things considered, however, I was very fortunate to sustain only soft tissue injury.  No broken bones, no loss of motion or sensation just a really nasty wound (more graphic pictures of my finger after the break).  As you can imagine – typing and other activities requiring a pinky have been rather difficult the past week or so.

Group BattleshipOtherwise, I’ve been hanging out with friends playing games, biking Cades Cove and doing a lot of working and reading.  I learned a new game, a group version of the classic battleship game.  Everyone is given a sheet of paper where you mark your ships and after everyone has placed their ships turns are taken lobbing bombs.  It is somewhat a bingo/battleship collage.  It was fun watching and learning.

Opthalmology humorAs to school, recently I did surgical subspecialties (last month) and am currently on Emergency Medicine.  Surgical subs consisted of ENT, Urology, Ortho and Ophthalmology (hence the pic).  I have to say I had expereinces in doctor’s offices I’ve never seen before or probably will never see again.  It was fun and I learned alot.    I’ve really been enjoying the ED or emergency department.  For the longest time I’ve considered doing Family Medicine and then doing a fellowship in Emergency Medicine, however, all the doctors I’ve spoken to have highly suggested I just do the Emergency Medicine residency if that is my interest.

Well, count this as your warning – graphic pictures after the break – and this time they are real.

OuchDay Three and 8 stitches

Today

WMS Elective Day 19 & 20

Cave beforeDay 19 —

Everyone split-up today and went different directions enjoying the beautiful weather.  Some went bordering, others hung-out at camp and enjoyed the sunshine while others went for a hike on Rainbow Trail almost getting to Mt. LeConte.  The snow became knee deep and thus they had to turn around but they really enjoyed the beautiful views.

I on the other-hand went home to do laundry and rested for most of the day.

Day 20 – 

On the way inToday we went to The Lost Sea and did the wild cave tour.  It was great fun.  Our guide, Shane, was really enjoyable and really tailored the tour for our group.  It was funny to hear him really enjoy having a tour of adults rather then children.  The lake in the cave is huge.  In the 70’s they went diving with sonar and couldn’t identify any walls or floor.  Thus the floor is deeper then 3500 ft and the back wall is farther then 3500 ft.  That is a huge cavern.

Small holeAfter finishing we went to a place call Joe’s for the best burgers in Sweatwater, TN.  The burgers were really good.  They were really good.

Well that’s all for now, enjoy the pics.

WMS Day 18 – Finale

Where we had all our lecturesAll good things must come to an end and certainly the lectures went out with a bang.  We had 3 lectures spanning from 8am to 4:30 pm with 3 breaks (one for lunch).  It was a marathon session but very interesting.  The lectures were over Space Medicine, Toxicology (i.e. venomous and poisonous animals) and making a Wilderness Medical Kit.  It became one of our first beautifully sunny days and during our few breaks we made sure to enjoy it.  All the pictures of us today were on the front porch of Tipton Lodge where we had all our lectures and was the headquarters of all our scenarios.

Enjoying the sunAll in all it was an interesting day.  All we have left for the remainder of the elective is the 4-day hike.  Unfortunately, one mentor had to drop out.  Because of this one group had to disband and join the other groups.  Fortunately everyone found a hike they were interested in hiking so everything worked out.  Now to rest and relax until Monday.  Here’s hoping for more good weather.  

As to the weekend, tomorrow some of us are going to the Lost Sea http://www.thelostsea.com/ for a Wild Cave Tour.  It should be fun.

Here are some interesting facts from yesterday –

  • Politics in NASA really hinders science
  • Medicine in space requires a completely different thought process.  
  • CPR in space is worthless due to taking to long to initiate
  • The most dangerous venomous animal is the Bee
  • Most use the term poisonous and venomous interchangeably but that is incorrect.  A Bee or a Rattlesnake is venomous but not poisonous (i.e. they will make you sick if they inject the venom but will not make you sick if you eat them).  Poisonous animals are like the Puffer fish.
  • Superglue, duck-tape, trash bags and safety pins are essential in a wilderness medical kit

WMS Day 16 & 17 – Random facts and the final scenarios

Long dayDay 16 was a day full of lectures as will be day 18.  Day 17 was our final day of scenarios.  The posts are a day late and a bit short in content because as a camp we exceeded the daily bandwidth allotment and I didn’t take time yesterday to write.  Yep, no internet yesterday so I couldn’t post anything about Day 16 or 17.  It made me lazy :).

On day 16 we had lectures for a bunch of different topics.  We learned about Dive Medicine, a recent medical trip to Haiti, preparing to lead a wilderness expedition, making a medical kit and lots of random facts.  Some of the most intriguing were from the dive medicine lectures.  Did you know:

Lots of lectures

  • 1 clo – the amount of insulation created by a Summer business suit in England during the 50s and 60s.
  • You can increase your total lung capacity via Lung Packing.
  • Record for a man holding his breath is 17:19 on pure Oxygen.  On room air it is 11:35.
  • Record depth for free diving (diving while holding breath without breathing apparatus)  is 702 ft for men and 525 ft for women (http://en.wikipedia.org/wiki/Free-ping).
  • When adjusting to a new timezone allow 1 day for the first 3 time-zones and 1 additional day for every additional time-zone.
  • FAST – Fatigue Avoidance Scheduling Tool.  It was used to determine the hours limits of medical residents and show the equivalent blood alcohol level to the fatigue level.  So someone with only 2 hours of sleep one night and works 18 hours the next day would have an equivalent  blood alcohol level of ~1.8.  Yep, basically drunk.
  • The abbreviation SHAG, Social Hand Grenade, is someone who has trouble making all social interactions cease when they appear.  

Waterfall rescueDay 17 was all about our final two scenarios.  The first one was all about two very difficult extractions.  The victims situated beneath a 50 ft waterfall (i.e in it) and since it was below freezing there was lots of ice.  I was on the medic team and was stationed at base camp.  Everything I hear was how great the teams did in their extractions.  I didn’t see anything until the victims were brought back when we re-evaluated them and repackaged them for transport to the hospital (i.e. once we were done let our classmates free to get changed).

The second scenario was two male four-wheelers accident victims.  They were both on a really steep slope demonstrated by the photos (rotate your laptop until the people are upright to see the angle of the slope).  The packaging and transport went really fast and we were off the slope and ready for dinner in about 1.5 hours.

Plunger used to stop a nasal bleedBetween the two scenarios we had a wilderness improvisation demonstration.  Each of us was required to demonstrate two improvisations using supplies we would have while in the wilderness.  These ranged from making air splints from bedding pads to snow goggles made of aluminum foil.  It was a great experience and many great ideas were shown.

The day ended at the Heritage Planetarium learning navigation through the night sky.  It was an incredible experience and one I would like repeating.  

Well, today we have a day of lectures starting with space medicine.

Gonna be a good day.

WMS Day 12 – Knoxville

LecturesAlmost a day of rest with no scenarios – but a day of constant activity.  We left camp at 8 am and drove to the University of Tennessee (UT) Medical Center in Knoxville (UTMCK).   We spent the morning in the Graduate School of Medicine Family Medicine conference room treated to donuts, orange juice and coffee.  We had three short lectures regarding group travel and emergency medicine finishing off with a visit to UT Lifestar helicopter.

All of us with the crew

After seeing Lifestar we went to RiverSports Inc. for a treat of a free 2-hour climb in their climbing gym.  It was great climbing for “real” for the first time.  I was really amazed watching some of the climbers.  Many of the holds were really difficult.  

Finally about half of us went over to my parents house for some good home cooking and to watch the Opening Ceremony of the Winter Olympics.  Another good day and looking forward to our days off.

WMS Elective Day 10 – Lectures and Scenarios

Neither rain, nor sleet, not snow . . .Quick plug for the official WMS Elective Blog for anyone interested in reading an official version of our daily activities.   Only thing I have on it is the pictures. 🙂  Mainly because I’m here and collecting all the photos for the elective DVD and not being able to send many due to limited internet connectivity.

For the first time since the elective started, my brain isn’t really ready to write anything.  I have this interesting collage of thoughts floating in my mind but refusing to come to any semblance of order. 

I will, however, make a shout out to my cousin in Philly, already has 27″ of snow and expecting 12-22″ more.  That is crazy.  I’m glad we only got the little bit (about 1 inch) this morning.  It made our afternoon scenarios much more interesting.  Oh, I forgot to mention we were able to do two scenarios this afternoon.  It was quite the learning experience.  Many problem-solving skills in use to perform the packaging and extrication.

The day started out with the completion of the frostbite lecture, moving on to Poison Ivy, then to Hypothermia, Sunburns, Blisters and Avalanches.  Busy morning and lots of learning.  From what I was told there is a great new products out for the treatment of Poison Ivy call Zanfel.  It is used to reduce the symptoms and duration through a topical application, which helps reduce the immune response.  I must make note I’ve not tried it nor endorse it but would be interested in hearing from anyone who has tried it.  

We also talked about sunscreens (cannot use the word sun-block anymore) and how often the SPF can be misleading due to only working for UVB but not UVA.  From what we were told sunscreens with Zinc Oxide or Titanium Dioxide are the best sunscreens out.  To get the best sunscreen look for something without preservatives and chemicals (like perfumes) because those are often what causes hypersensitivity to the lotions (allergies).  There is some cool stuff to do about surviving an Avalanche but mainly what we learned is to really understand it we need to take another class taught in the snow.  

In the afternoon we had two scenarios, one a snowboarding accident and another a chainsaw accident.  The student’s “wounds” were quite realistic (sorry for the lack of pictures) and made it easy to treat the scenario as a real situation.  The first scenario was ended once we packaged the patients for transport and the second required us to transport the patients up and back down the mountain to the main lodge for completion.

Both exercises were great learning experiences.  The first one was somewhat simple given it was our first scenario.  We had to package the patient and were done.  The second scenario, however, was much more challenging because the scenario had three victims of a tree falling on them.  

Each “victim” they were placed around a downed tree and had “fake” wound accordingly.  We had to extricate them and prepare them for transport, which took about 30 minutes for each.  We were split up into three teams so it went quickly but since we didn’t bring the litter baskets one team was split up to retrieve them and help transport two of the patients back (our teams were not big enough to transport three back).  So, one patient ended up helping carry the others back.  How funny.  

Well, probably should get up to Sunset lodge.  That is where all the guys are staying and everyone hangs out in the evenings.  We are going to have more scenarios in the morning so probably need to get ready for them.  Hope you enjoy the pics.  It is taking to long to label them all so I’m just gonna upload them for now and let you imagine the captions.

How to keep someone warm in the wildernessThe day started out with the completion of the frostbite lecture, moving on to Poison Ivy, then to Hypothermia, Sunburns, Blisters and Avalanches.  Busy morning and lots of learning.  From what I was told there is a great new products out for the treatment of Poison Ivy call Zanfel.  It is used to reduce the symptoms and duration through a topical application, which helps reduce the immune response.  I must make note I’ve not tried it nor endorse it but would be interested in hearing from anyone who has tried it.  

We also talked about sunscreens (cannot use the word sun-block anymore) and how often the SPF can be misleading due to only working for UVB but not UVA.  From what we were told sunscreens with Zinc Oxide or Titanium Dioxide are the best sunscreens out.  To get the best sunscreen look for something without preservatives and chemicals (like perfumes) because those are often what causes hypersensitivity to the lotions (allergies).  There is some cool stuff to do about surviving an Avalanche but mainly what we learned is to really understand it we need to take another class taught in the snow.  

ExtricationIn the afternoon we had two scenarios, one a snowboarding accident and another a chainsaw accident.  The student’s “wounds” were quite realistic (sorry for the lack of pictures) and made it easy to treat the scenario as a real situation.  The first scenario was ended once we packaged the patients for transport and the second required us to transport the patients up and back down the mountain to the main lodge for completion.
Both exercises were great learning experiences.  The first one was somewhat simple given it was our first scenario.  We had to package the patient and were done.  The second scenario, however, was much more challenging because the scenario had three victims of a tree falling on them.  

Each “victim” they were placed around a downed tree and had “fake” wound accordingly.  We had to extricate them and prepare them for transport, which took about 30 minutes for each.  We were split up into three teams so it went quickly but since we didn’t bring the litter baskets one team was split up to retrieve them and help transport two of the patients back (our teams were not big enough to transport three back).  So, one patient ended up helping carry the others back.  How funny.  

Well, probably should get up to Sunset lodge.  That is where all the guys are staying and everyone hangs out in the evenings.  We are going to have more scenarios in the morning so probably need to get ready for them.  Hope you enjoy the pics.  It is taking to long to label them all so I’m just gonna upload them for now and let you imagine the captions.

WMS Elective Day 9 – Lectures

From my years of practice I have discovered testosterone and alcohol are a failed combination. – TK

LecturesI think this quote is a great summary of our day.  It was a day of many lectures imparting lots of wisdom, some student lectures and a little hands on demonstrations.  Our day consisted of lectures about High Altitude illnesses, Cold injuries, Facial Trauma, a talk from a Chiropractor and ending with a lecture about orbital injuries.

We started with lectures about high altitude medicine and cold injuries but were unable to complete the cold injuries lecture.  It will be completing it later and I am looking forward to it.  After stopping, we had several student lectures learning about methods to start fires in the wilderness, wilderness improvisation and two wilderness survivor lectures (one of our classmates has been a Survivor contestant).  

Some take away points from the morning lectures –
   • Ambien and beer is a bad combination
   • Fire is hard to start
   • Too much coconut can act as a laxative
   • Poke a bear in the eyes
   • Cold, numb, loss of motor coordination, burning pain after rapid rewarming are signs of cold injury or a level of frostbite.

Replacing a fillingAfter lunch some Oral and Maxillary Facial Surgeons from UT Medical Center spoke to us about facial tram and allowed us to try our hand at making fillings and attaching replacement crowns using Intermediate Restorative Material (IRM).  It is available from your local pharmacy in a premixed form from what I understand and looks very useful for long expeditions.

We ended the day with a lecture about orbital injuries (eyeball injuries) and the treatment in the field.  It was a somewhat disgusting lecture given the trauma displayed in the pictures (one showed a nail sticking through the orbit).  It was a long day.  Tomorrow afternoon we have our “first” scenario so we’ll see what happens.

Thanks to Gabe and John for the pics again.