Flat Line

Heart and Soul

2011-02-11T08:19:00.000-08:00

We are currently studying cardiovascular physiology in school, and my professor told an interesting story about compliance of blood vessels in relation to the ancient understanding of heart and soul.

So blood vessels such as veins are highly compliant vessels. This means that they are very distensible. In fact, most of our blood volume is stored in our veins- this can be considered as a reserve blood volume. When we exercise, then we can utilize this 'reserve' volume to increase our cardiac output.

Arteries, which carry the blood away from the heart, are less compliant. You can consider these vessels to be elastic since they are able to resist a high pressure of blood coming out of the heart.

Now, in the olden days when people died and physicians opened their bodies to make observations they noticed an interesting phenomenon. When one is dead, the heart is no longer acting as a pump. This means that it can no longer create a pressure difference to drive blood around the body and move from arteries to veins. As a result, the pressure in the system is quite low, say around 5mm/Hg. This causes most of the blood in the body to pool in the veins - the most compliant blood vessels in the body. Since the veins are able to distend to accommodate the volume of blood, there is nothing in the arteries. When the physicians saw this, they thought that the veins contained the blood of the heart. But then, they had to consider this seemingly completely different system-- the arteries. Here were these vessels, running throughout the body, devoid of any substance within. What could this be? They hypothesized that this system contained our ether or life force. Since the patient was dead, then the life force had left the body, so these vessels were empty.

So there you go- heart and soul related to physiology :)

HAPPY NEW YEAR

2011-01-15T09:14:00.000-08:00

One of my goals for 2011 is to be more consistent with my blogging.

Things to look forward to:

Reflections on my trip to India for a Medical Selective
Looking back on Term 1 of medical school
My Term 2 experiences
Perhaps a summary of my Cornell Days

2010 was a year of change for me. I graduated from Cornell University with my BSc in Communication. I said goodbye to my old friends of the last 4 years. Then I began medical school at St. George's University School of Medicine in Grenada. Making new friends and adjusting to the course load has been quite an experience.

To top it all off, over this winter break I took my first trip across the Atlantic. I visited London for the first time and did all the touristy things like see the Big Ben, Buckingham Palace, Westminster Abbey, Piccadilly Circus, the London Eye, Harrods and many more.

Then I left the cold and headed to India. Spent some time in Mumbai and Goa, but mostly at the Krishna Institute of Medical Sciences in Karad.

What a wild ride. I hope that 2011 brings experiences that are just as fulfilling. Here's to enjoying our youth!

Gummy Bear Anatomy

2010-10-14T16:15:00.000-07:00

Inflammation

2010-10-14T08:25:00.000-07:00

The 5 cardinal signs of ACUTE inflammation include:
Rubor, Calor, Tumor, Dolor and Functio laesa
That means:
1> Redness
2> Increased heat
3> Swelling
4> Pain
5> Loss of function

Happiness is Overrated

2010-10-11T15:13:00.000-07:00

I came across this article entitled Happiness is Overrated in the Harvard Business Review.

http://blogs.hbr.org/schwartz/2010/10/happiness-is-overrated.html

This phrase stood out to me, "pain and discomfort are critical to growth, and that achieving excellence depends on the capacity to delay gratification." This makes me understand and helps me come to terms with the fact that failure happens. Sometimes we don't do as well as we want to. Coming at a time when I just received my grades for the first midterms of medical school, I can relate to falling short of one's expectations for oneself. Feeling disappointed in the outcome of one's examination will cause pain and discomfort. But, it is what we do with this feeling that makes the difference. This is true in all arenas of life. I learned this lesson time and time again in my youth. As a competitive long-distance swimmer, if I was behind at the start of the race, I would use that disappointment to keep pressing on. This would help me to continue plugging away at and and eventually persevere. Even if I did not win the race, I would achieve my best time. This would only happen if I learned to embrace the failure and not be a quitter.

I feel like I have heard the sentiment that perseverance makes all the difference between someone who will succeed and another who will fall short. I will continue to strive for the best. If you're not trying to be the best that you can be, then why bother trying? No one likes someone to half-ass an assignment or a presentation, and no one likes a friend who's not all there when you need them. Being a true person makes the difference. I am still trying to learn how to overcome my fear of failure. As JK Rowling so wisely states, failure strips away all the inessential, and who you hot rock bottom you should use it as a solid foundation. I have been through this, after the first year of engineering at Cornell, I hit rock bottom. I approached medical school as a test to see how much I learned from that experience. It is obvious that I learned some, but there is much still to do.

When we're living fully, what we feel is engaged and immersed, challenged and focused, curious and passionate. Happiness — or more specifically, satisfaction — is something we mostly feel retrospectively, as a payoff on our investment. And then, before very long, we move on to the next challenge.

This statement is taken from the aforementioned HBR article. It explains why we sometimes feel demotivated or apathetic after the thrill of success is past. I know that I experience this sometimes. It is the challenge that makes life worth living. In the words of Miley Cyrus, "Its the Climb"

JK Rowling's Commencement Speech

2010-10-10T17:43:00.000-07:00

http://harvardmagazine.com/commencement/the-fringe-benefits-failure-the-importance-imagination

JK Rowling speaks about the fringe benefits of failure and the importance of imagination.
Her sentiments and morsels of wisdom struck a chord with me. I believe that some of her words and proclamations will resonate with me for a long time.

I wish she spoke at my commencement...

For most of my life JK Rowling's words have been my guide. She reached out to many through Harry Potter. I wish that one day I could be such an influential writer.

Until then, I will continue along the path of medical school. Here I have the assurance that one day my actions will at least help a few people.

Life

2010-10-09T19:21:00.001-07:00

Have you ever watched kids playing on a merry go round or listened to the rain lapping on the ground? Ever followed a butterfly's erratic flight or gazed at the sun into the fading night? Do you run through each day on the fly? When you ask 'How are you?' Do you hear the reply?

When the day is done, do you lie in your bed with the next hundred chores running through your head? Ever told your child, 'We'll do it tomorrow.' And in your haste, not see her sorrow? Ever lost touch? Let a good friendship die? Just call to say 'Hi'?

When you worry and hurry through your day, it is like an unopened gift....Thrown away.... Life is not a race. Take it slower. Hear the music before the song is over.

Primum non nocere

2010-09-20T11:17:00.000-07:00

First and foremost, do no harm.

The Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

http://www.pbs.org/wgbh/nova/doctors/oath_classical.html

Grenada Folklore

2010-08-12T07:25:00.000-07:00

I'm at St. Georges University in Grenada for medical school. One of the first sessions we had involved learning about the history and culture of Grenada.

Here are some of the more interesting superstitions.

Loupgarou (Male) and Soucoyuant (Female) are vampires. They fly as a ball of fire at night in search of their victims. Their victims are asleep and dreaming, but they can't wake up while the vampire is there. The vampire sucks their blood with a long pipe, and in the morning when the victim wakes up they usually have a big black and blue mark. So people here would see your bruise and ask "Loupgarou suck yuh last night?" The vampires are said to put houses on fire after they are done there.

La Diablesse/ Jab jab. Pronouced la-jah-bless. This is the Devil's Wife. She is a very pretty lady who wears a long white dress and a white hat. The long dress conceals her feet, as she has one human foot and one cow hoof. She lures married/attached men up a steep hill and pushes them off it, claiming another soul for her husband, the Devil. It is said that this folk lore was created to stop men from going out at night without their counterparts, and thus increase fidelity.

Mama Maladie is a lady that makes people sick. So if she is passing through a village and making a lot of noise, everyone who looks outside to see what is going on will get sick.

Dealers are the devil's disciples. They make deals under the silk cotton tree.

It is said that these folklore were all designed to scare people, and so prevent them from going out at night. In fact, that is because people wanted to steal cocoa off the trees in the plantations at night. So if you're out and you come across a coffin in the middle of the road, you should get scared and run away. Then the cocoa thief will come and lug away his coffin full of cocoa pods!

So visitors beware... lol

Imagination

2010-08-05T06:11:00.001-07:00

"All the breaks you need in life wait within your imagination, Imagination is the workshop of your mind, capable of turning mind energy into accomplishment and wealth."

- Napoleon Hill

The Female of the Species

2010-08-01T13:03:00.000-07:00

When the Himalayan peasant meets the he-bear in his pride,
He shouts to scare the monster who will often turn aside.
But the she-bear thus accosted rends the peasant tooth and nail,
For the female of the species is more deadly than the male.

When Nag, the wayside cobra, hears the careless foot of man,
He will sometimes wriggle sideways and avoid it if he can,
But his mate makes no such motion where she camps beside the trail -
For the female of the species is more deadly than the male.

When the early Jesuit fathers preached to Hurons and Choctaws,
They prayed to be delivered from the vengeance of the squaws -
'Twas the women, not the warriors, turned those stark enthusiasts pale -
For the female of the species is more deadly than the male.

Man's timid heart is bursting with the things he must not say,
For the Woman that God gave him isn't his to give away;
But when hunter meets with husband, each confirms the others tale -
The female of the species is more deadly than the male.

Man, a bear in most relations, worm and savage otherwise,
Man propounds negotiations, Man accepts the compromise;
Very rarely will he squarely push the logic of a fact
To its ultimate conclusion in unmitigated act.

Fear, or foolishness, impels him, ere he lay the wicked low,
To concede some form of trial even to his fiercest foe.
Mirth obscene diverts his anger; Doubt and Pity oft perplex
Him in dealing with an issue - to the scandal of the Sex!

But the Woman that God gave him, every fibre of her frame
Proves her launched for one sole issue, armed and engined for the same,
And to serve that single issue, lest the generations fail,
The female of the species must be deadlier than the male.

She who faces Death by torture for each life beneath her breast
May not deal in doubt or pity - must not swerve for fact or jest.
These be purely male diversions - not in these her honor dwells -
She, the Other Law we live by, is that Law and nothing else!

She can bring no more to living than the powers that make her great
As the Mother of the Infant and the Mistress of the Mate;
And when Babe and Man are lacking and she strides unclaimed to claim
Her right as femme (and baron), her equipment is the same.

She is wedded to convictions - in default of grosser ties;
Her contentions are her children, Heaven help him, who denies!
He will meet no cool discussion, but the instant, white-hot wild
Wakened female of the species warring as for spouse and child.

Unprovoked and awful charges - even so the she-bear fights;
Speech that drips, corrodes and poisons - even so the cobra bites;
Scientific vivisection of one nerve till it is raw,
And the victim writhes with anguish - like the Jesuit with the squaw!

So it comes that Man, the coward, when he gathers to confer
With his fellow-braves in council, dare not leave a place for her
Where, at war with Life and Conscience, he uplifts his erring hands
To some God of abstract justice - which no woman understands.

And Man knows it! Knows, moreover, that the Woman that God gave him
Must command but may not govern; shall enthrall but not enslave him.
And She knows, because She warns him and Her instincts never fail,
That the female of Her species is more deadly than the male!

A Ballad of China

2010-08-01T12:50:00.000-07:00

A Ballad Of China
Laura E. Richards

Her Name was Dilliki Dolliki Dinah;
Niece she was to the Empress of China;
Fair she was as a morning in May, when Hy Kokolorum stole her away.

Hy was a wizard, I'd have you know;
Wixked as weasels and black as a crow;
Lived in castle a-top a hill;
Had a panther who's name was Bill;

Used to ride him around and around,
creeping and peeping close to the ground;
Working mischief wherever he could;
Nothing about him in anyway good!

Saw the maiden one midsummer morn,
(sweetest creature that ever was born!),
Creeped and peeped in his wizardly way,
Catched her and snatched her and stole her away!

All through China arose a cry:
"Some one has stolen out Dilliki Di!"
People gathered in every Forum,
Crying, "it must be Hy Kokolorum!"

All the Barons in China land,
Ling the lofty and Bing the Bland,
Kong the Kingly and Bond the brave,
Vowed a vow to find and save

Darling Dilliki Dolliki Dinah
(niece you know to the empress of china;
Fair you know as a morning in May),
Whom Hy Kokolorum had stolen away.

Now in a kingly, ringly row,
Round and about the hill they go,
Ling the lofty, Bing the bland,
Kong and Bong, and there they stand,

Weaving a weird and spinning a spell,
All with intent to quash and quell
Hy kokolorum, worker of woe,
Wicked as weasels and black as a crow.

Dilliki Dinah was weeping her fill,
When stepped up softly the panther Bill;
Whispered," if you will give me a kiss,
I'll turn your sorow into bubbling bliss!"

she, to animals always kind,
Said," No! Really? Well, i dont mind!"
Dropped a kiss on his nose so pink,
And-goodness gracious! what do you think?

He turned inot a beautiful Golden King,
Crown and sceptre and everything!
Ran the old wizard through and through,
Saying, " now there is an end of you!"

Caught the maiden up in his arms,
Broke through the net of spells and charms,
Cried to the barons Bold and Brave,
"I've had the honor to find and save

Darling Dilliki Dolliki Dinah
Neice (i learn) to the Empress of china,
Fair (i swear) as a morning in May
And she is my queen to this very day!"

__________________

Time for a re-vamp!

2010-04-02T13:13:00.000-07:00

This is the first post for 2010! Hard to believe how quickly time has passed. I am 57 days away from graduating and leaving my mark on this fine institution, Cornell University. Much has happened in my senior year that is worthy of discussion and contemplation. However, given the limited time I have left here, I'll be out there experiencing my last 2 months on the hill.
I will try to update periodically.

Success

2009-07-09T09:25:00.001-07:00

For success, attitude is equally as important as ability.

Sir Walter Scott (1771-1832)

Swine Flu, Bird Flu, ah... Influenza!

2009-04-26T08:44:00.000-07:00

Today, swine flu is one of the trending topics on Twitter. Yesterday, the WHO warned of possible pandemic as Mexico tries to contain swine flu. There have been mixed attitudes toward the confirmation of severe cases in Mexico, Texas and California. Dr. Anne Schuchat, the U.S Centers for Disease Control and Prevention's Interim Deputy Director for Science and Public Health Program, says that the virus is already "beyond containment" because of how far the virus has already spread. Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine, said the current outbreak was unlikely to become a pandemic. He states that although the virus is spread human-to-human, "that's a far cry from becoming a pandemic."

It is possible that this is not the approach the public should take when dealing with this new swine flu. Viruses like swine flu, bird flu, and just the flu in general are a big deal. Already, 2 antiviral medications (amantadine and rimantadine) are obsolete in the US. Although there are 2 others (Tamiflu and Relenza) that can be used it is important to remember that it is possible that these may not always be effective. Swine flu, like bird flu and the dreadful Spanish influenza can cause phenomenal mortality rates because they also affect normal and otherwise healthy individuals. (* For Twilight fans: the Spanish influenza in 1918 is what caused Edward Cullen to be dying when he was found by Carlisle and turned into a vampire*)

Medicine meets Communication

2009-04-24T19:20:00.000-07:00

This article from CNNhealth.com entitled "Brain-Twitter Project offers Hope to Paralyzed Patients," reports that Adam Wilson, a doctoral student in biomedical engineering, is working on tweeting using brain waves.

His lab has developed a way to post messages on Twitter using electrical impulses generated by thought. That's right, no keyboards, just a red cap fitted with electrodes that monitor brain activity, hooked up to a computer flashing letters on a screen. Wilson sent the messages by concentrating on the letters he wanted to "type," then focusing on the word "twit" at the bottom of the screen to post the message.

There is much speculation about how this technology could possibly be used both in the medical field and commercially. The immediate use for this development could be to enable communication with those suffering from "locked-in syndrome" in which the brain functions normally although the body is unable to communicate with the brain so the patients cannot speak or move. It is these little steps in technology that will develop drastically in the next 5-10 years or less. Perhaps soon we would not even need to touch the screen to communicate with others. Ah, the power of the brain... crave the brain waves :)

Microblog of House M.D. Season 4, Episode 14: Living the Life

2009-04-18T14:36:00.000-07:00

4:51pm: Who cares what he was allergic to as long as the treatment worked to get him out of the coma? Well, House wouldn’t be House unless he got to the bottom of it. Quinine allergy! What’s the point of drinking tonic water anyway if you don’t even put real gin in it? Uh, lame.

4:47pm: Oh no! He’s not allergic to flora, this actor is definitely dead.

4:45pm: Ah protocol. Do what those in authority deem to be appropriate whether or not your own expert opinion violates these protocol. There are some cases where protocol is stupid, but that’s politics.

4:41pm: Funny how a patient’s living or dying can change one’s outlook on life. The smallest of events can make someone question the future of their job or the certainty with which they joined the profession. It is strange how just one death out of hundreds could risk one’s career.

4:38pm: Aren’t we all waiting for that illuminating moment? The small, seemingly insignificant event that can trigger brain waves and help things gel together. The coincidence of looking at a sunflower pattern on a pillow and somehow having the thought process or brain wave of a different diagnosis…gotta love TV medical dramas =)

4:35pm: Living the life… we all are afraid of change. Why remain in a job that you hate if it makes you that unhappy. So what if it makes you popular, famous and rich? We all need to find courage to do what’s right for ourselves. Yeah, dying could definitely change our perspective on the state of our life.

4:30pm: The struggle between politics and getting to give optimal care of a patient. Such pointless arguing among doctors about who did what tests as opposed to trying to find the root of the problem with the patient. In the end, it seems that patients are not always the top priority of the doctors. People need to stop romanticizing doctors as superheroes. Being a doctor is a job too, and with the profession comes all the drama and group dynamics as any other job… its just that the stakes are sometimes higher and people’s lives can be lost.

4:25pm: Working in a team is so hard. So much deception- people do tests behind their team leader’s back. Medicine is sometimes guess work.

4:20pm: Wisdom about dealing with women from House MD… awesome! Yes House geeks: Get what the girl wants; even if she tells you that it is your choice.

4:15pm: This actor guy is right- his soap opera sucks. He behaves like a total loser- so what if he’s depressed? He is richer and more famous than most doctors. I still think Kutner is smarter.

4:11pm: House is crazy! Why does he care so much about some stupid actor? Cuddy is such a tolerant woman. I love her: so powerful, beautiful and smart. Girl power!

4:05pm: Whoa, this seems like some skanky medical drama. Oh wait! The strange kidnapper was House. I wondered for a second whether I had gotten the wrong show after I unlocked the episode from some sketchy website after spending time taking strange surveys.

Insurance doesn't cover cancer pills!

2009-04-14T19:30:00.001-07:00

Today, this New York Times article entitled: Insurance Lags as Cancer Care comes in a Pill revealed the communication gap between patients, doctors, technology and insurance companies.

With oral cancer drugs, “the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion,” said Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, a consulting firm.

Cancer pills provide a convenient alternative to IV chemotherapy since it reduces the number of visits that patients need to make to the hospital. However, most insurance companies do not cover these pills even though alternative therapies are covered. This makes the cost of this treatment weigh heavily in the pockets of the patients. Additionally, there may be problems with controlling dosage quantities and interpreting side effects. This new wave of cancer therapy still has a long way to go before becoming mainstream as doctors, patients and society learn to deal with the challenges that arise.

Part II: Where are Microbes?

2009-04-12T17:34:00.000-07:00

In February the inside of a dormitory microwave was swabbed with a RODAC plate. This was for BIOMI 2911 laboratory at Cornell University. For more details see: Part I: Where are Microbes? After incubating the plate for a few days at ~30C a variety of different colonies were observed. There were 4 small round bright yellow colonies, 2 small round light pink colonies, 2 large white colonies with concentration in the center, 2 white round colonies and 1 very tiny round bright pink colony. This diversity of organisms inside a microwave was surprising since it seems that the microwave radiation should be enough to get inhibit growth of microbes.

I decided to isolate and purify the small round light pink colonies since they seemed to be the most interesting. This colony of bacteria contained Gram (-), oxidase positive, catalase positive non-motile rod- shaped bacteria. The bacteria perform aerobic respiration only according to the results of a BCP-glucose shake, which remained purple and had turbity (growth) at the top only. It was postulated that the bacteria belonged to the Pseudomonas genera. However, upon PCR, electrophoresis and BLAST sequencing it deduced that the bacteria was 96% similar to Roseomonas terpenica. Roseomonas is a new genus established in the 1980s that is associated with bacteriemia and other human infections. It seems that it is also radiation resistant since it lives in a microwave... better watch out when microwaving food!

Diabetes insipidus

2009-04-11T17:42:00.000-07:00

Unlike the name suggests, diabetes insipidus is not a subtype nor in any way related to the more common sugar diabetes (diabetes mellitus). In fact, diabetes insipidus is a metabolic disorder involving the pituitary gland and the kidneys. The pituitary gland secretes ADH, anti-diuretic hormone, that allows causes aquaporins to open in the collecting duct of the nephon in the kidney. If there is no ADH, then water cannot be reabsored into the bloodstream from the kidney, so one would produce vast amounts of dilute urine. A consequence of this extraordinarily high level of urine production is the never-ending thirst of someone with this condition.

Diabetes insipidus was addressed in the TV series House MD- Season 3, Episode 16- when a young woman came in believing that she was OCD because she drank water all the time. It was deduced that she was not OCD but rather had diabetes insipidus attributed to an accident on a balance beam. How could a simple accident cause such a condition? It is possible that head trauma could damage the posterior pituitary gland where ADH is produced. If ADH production or function is inhibited or disrupted then the body will be unable to regulate its osmolarity or water concentration. This is why diabetes insipidus is characterized by excessive thirst and the production of large amounts of dilute urine. This condition can be easily misdiagnosed as portrayed in the House MD episode.

The sad story of Medicare

2009-04-03T19:52:00.000-07:00

Medicare is a federally administered system of health insurance available to persons aged 65 and over. On Wednesday, the New York Times discussed the alarming reality that more and more doctors are not accepting Medicare in Finding a Doctor Who Accepts Medicare Isn't Easy.
The article reports that as folks become eligible for Medicare they realize that this safety net or support network no longer holds because doctors are not willing to accept Medicare. Why are doctors such as internists, psychiatrists, gynecologists and other specialists opting out of this insurance system? The paperwork. Doctors spent many years getting to where they are so that they can practice medicine. Not so they can fill out files and files of paperwork.

As insurance systems like Medicare proliferate, the returns on being a doctor like an internist decreases. More time is spent dealing with the payment hassles, and less with the patient discussing relevant health issues. Moreover, the doctor gets paid less as a result of low reimbursement rates. Such systems devalue the doctors of this country. This is why doctors do not want to enter the internal medicine specialty... too much grunt work, too little return: financially and psychologically. The New York Times articles cites 2 converging trends: decreasing internists, and increasing numbers of internists that do not accept Medicare. This leaves the patient in a very tight situation.

Medical Tourism

2009-03-29T06:48:00.000-07:00

"Medical Tourism" is defined as the practice of journeying outside one's native land for medical treatment.

On Friday 27th, March CNNhealth.com posted an article entitled Lower Costs Lure US patients abroad for treatment. US and Canadian patients are opting to go abroad for medical treatment (the exorbitantly expensive ones like heart surgery or even plastic surgery) simply because it is cheaper. In fact, such procedures can be up to 10% of the cost that one would pay in the US.
Another reason that some go abroad for procedures is the lengthy wait before they can get a date for surgery.

Dispelling the fear of shoddy procedures or lax sanitation, some private hospitals in India market themselves as having upscale accommodations, Western-trained surgeons and state-of-the-art medical equipment.

The article goes on the report that next year alone, an estimated 6 million Americans will travel abroad for surgery, according to a 2008 Deloitte study. "Medical care in countries such as India, Thailand and Singapore can cost as little as 10 percent of the cost of comparable care in the United States," the report found.

Some of the hottest destination for medial tourism include:

Brazil
Singapore
Central America
South Africa
South Korea
Malaysia
Hungary
India

Soon, more and more people may opt for surgery and site seeing in one reasonably priced trip.

Chill Out

2009-03-25T10:54:00.000-07:00

As the temperatures begin to climb it is important to maintain healthy food storage habits.

The USDA Food Safety and Inspection Service website provides useful information and tips for reducing bacterial growth and thus spoilage of food. Freezing and refrigerating food is a method of food preservation based on reducing the rate of bacterial growth in the food. At lower temperatures, bacteria tend to grow at a slower rate. This is because growth is regulated by enzymes, and the work of enzymes is temperature (and pH) dependent.

In BioMI 2911 at Cornell University, we investigated the growth rate of E. coli at different temperatures. It was found that the growth rate (per minute) was 0.0005 at 22C, 0.011 at 30C, 0.048 at 37C, 0.012 at 45C and ~0 at 55C. The most rapid growth occurred near body temperature, and the slowest growth occured at temperatures below (22C) and far above (55C) room/body temperature. This is consistent with some of our practices of food preservation: freezing and cooking.

So, in the warm weather ahead don't forget to refrigerate leftovers!

Diabetes

2009-03-24T19:04:00.000-07:00

The American Diabetes Association (ADA) defines Diabetes as a disease in which the body does not properly produce or use insulin. (Insulin is a hormone made in the pancreas that allows cells to use glucose for energy.) 23.6 million people in the United States, or 8% of the population, have diabetes.

The most common diabetes is Type 2 Diabetes according to Pollock of EzineArticles.com. Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). The major complications of diabetes mellitus are both acute and chronic.

In BioAP 311, Prof. Baustian of Cornell University claimed that in the past people could diagnose diabetes by tasting the sweetness in the urine. This is because diabetics are unable to absorb all the glucose into their cells so some of it passes out of their system via the urine.

Diabetes may seem like a disease that just means that one has to regulate weight by cutting down on sugar consumption and resisting the temptation of dessets and carbohydrates. At least, that's what I thought when I was younger. Now I realize that diabetes left uncontrolled is a serious disease that can dramatically affect one's way of life. This disease can lead to blindness and loss of limbs because of poor circulation and thus slower healing.
Diabetes can complicate any complaint, thus making simple things like a wound life threatening. In fact, the ADA reported that diabetes contributed to 224,092 deaths in 2002.

Alzeihmer's Disease and Prions

2009-03-20T04:29:00.000-07:00

Scientific American cited a study in the journal Nature which found that prions can team up with amyloid beta, the protein that forms the big plaques in Alzheimer's, to make the condition much worse. Another article in Science news claims "Prions Complicit in Alzheimer's Disease" and calls the findings "sensational" although the research is still in its early stages.

What are prions?

Proteinaceous infectious particles- or PRIONS- are infectious self-reproducing protein structures2. Prions cause a number of degenerative brain diseases: scrapie (a fatal disease in sheep and goats), mad cow disease, Creutzfeldt-Jacob disease, fatal familial insomnia and others1. MedicineNet.com defines a prion as a disease-causing agent that is neither bacterial nor fungal nor viral and contains no genetic material1. A prion is a protein that is harmless in its normally occurring form, but when it folds into an aberrant shape it turns into a rouge agent. It then causes other normal prions to become rouge prions.

How do they replicate?

Prions replicate within the cell by converting other normal cell proteins into other prions3. This method of replication is unique to prions since other agents-like viruses- that cause disease contain genetic material which is necessary for the to spread themselves through the victim5. Since prions do not have genetic material this method is irrelevant. Instead, the prion corrupts a perfectly normal protein, PrP, which usually sits on the external surface of brain cells5.
In general, healthy prion protein that does not cause disease is made of alpha helices. The infectious prion protein is mainly made of beta-pleated sheets4. The infectious prion has a changed structural form dominated by conversion of protein helix structure into flat sheets, even though the amino acid sequence is identical in both strains6. The mechanism for the conversion of the α-helices by infectious ß-pleated sheet prion is not exactly known. Experiments have shown that normal protein interacts with the beta sheet prion form and then changes its structure4.

References:

1. Definition of Prion. 1/22/2004. MedicineNet.com 02/01/2009. http://www.medterms.com/script/main/art.asp?articlekey=5047
2. Prion. Bio-Medicine. http://www.bio-medicine.org/biology-definition/Prion/
3. Pall Medical. http://www.pall.com/pdf/prions-QandA.pdf
4. SFN. How does a prion reproduce? http://www.scienceforums.net/forum/showthread.php?t=18577
5. The prion: simply mad. BBC News. 5/19/1998. http://news.bbc.co.uk/1/hi/health/background_briefings/bse/82972.stm
6. Another hazard: prions and mad cow disease. http://peer.tamu.edu/curriculum_modules/cell_Biology/module_5/hazards3.htm

Women's Health

2009-03-19T08:01:00.000-07:00

The Mayo Clinic released this article outlining the 10 top threats to women's health and suggesting preventative methods. According to the web site the top 10 threats are:

Heart Disease
Cancer
Stroke
COPD
Alzheimer's Disease
Injuries
Type II diabetes
Flu
Kidney Disease
Blood poisoning (sepsis)

Essentially, it was suggested that avoiding behaviors such as smoking. Maintain a healthy diet and weight, in addition to regulation of consumption of alcoholic beverages. Many of the tips seemed like common sense, such as "do not drive while sleepy."

It seems that the key to leading a healthy life is not a secret.

To go under the knife or not?

2009-03-18T10:50:00.000-07:00

This article from the New York Times about the effect of the economy on people's decision to have surgery or hold out puts the financial state of the nation in perspective.
Some choose to have their surgery sooner rather than later for fear of losing their insurance coverage with their job. Others sacrifice having surgery that could relieve pain or prevent further complications because of a tight budget. This leaves hospitals in a quandry, doesn't it?
Are doctors and surgeons really in control of their patients well-being? It seems in this system that the patient has the power to make decisions that can be detrimental to their well-being. When there is such economic strain, it seems that the patient is in the driver's seat.

All that is gold does not glitter...

2009-03-08T07:20:00.000-07:00

This post is not about gold, rather it is about glittering and sparkling. (More about gold later)

What glitters and sparkles and catches the eye of many girls and women? DIAMONDS of course!

Ever wonder why diamonds sparkle?

In order to understand this, one must first understand that light bends when it goes from one medium to another providing these media have a different refractive index (n). When light goes from a medium of low refractive index to one of high refractive index, it bends into the normal so that θ, the angle between light and the normal, decreases. The opposite happens when light moves from a medium with high refractive index to one of low refractive index: θ increases.
This relationship is described by Snell's Law. n1sinθ1= n2sinθ2

To understand why diamonds sparkle, we must realize that this occurs when Snell's Law does NOT apply. (This is how fiber optics cables work too)

Say the refractive index of a materials is 2 (and for diamonds it it 2.42):
And n= 1 for air
(2) sinθ1= (1)sinθ2 [Assume that the light is entering the surface at 90 degrees]
sin θ1 = 1/2 sin (90)
sin θ1 = 1/2
=> θ1= 30 degrees

What happens to the light when it strikes the surface at an angle greater than 30 degrees?
It goes back into the substance! This is known as total internal reflection. (This phenomena also occurs when we see a rainbow)

Back to diamonds: the refractive index of diamonds is 2.42, so this means that light that strikes the surface at an angle more than perhaps 25 degrees gets reflected back into the material. As a result, when Snell's law doesn't apply light gets trapped inside the medium. While in the material, the light disperses. This means that white light splits up into the colors of the spectrum: Red, Orange, Green, Yellow, Blue, Indigo and Violet. Each color has a slightly different wavelength. n is inversely proportional to wavelength and as a result the light separates or there is dispersion of light.

If the light stays trapped in the medium long enough, there is a time when there is enough dispersion that the human eye can detect it. Now you know why diamonds sparkle:

Light is trapped in the material as there is total internal reflection because of the high refractive index of the diamond
Light then disperses in the diamond, and this is what we observe.

Acetone Breath

2009-03-07T06:06:00.000-08:00

In reading my Organic Chemistry text by Paula Bruice I discovered the condition called ketosis. This is a pathological condition that can occur in people with diabetes.

Acetone breath describes a characteristic “fruity” or acetone breath odor that occurs with a life-threatening condition of diabetic ketoacidosis.

Ketosis can be recognized by the smell of acetone (or ethanone according to IUPAC standards for naming organic compounds) on a person's breath. How does acetone come to be in the body?

In this disease, the body produces more acetoacetate than can be metabolized. This occurs when the body uses fat instead of glucose (sugar) for energy. This can be indicative of the inability of the body to use insulin effectively to burn glucose for energy.
The excess acetoacetate breaks down to acetone (a ketone) and carbon dioxide. Acetone normally passes into the urine, however, only a certian amount can be excreted in this way. Since acetone is highly volatile (think of smelling nail polish remover in a large room) it can be excreted in the breath in person's with a high concentration/excess of acetone in the body.

Got Staph?

2009-03-06T14:43:00.000-08:00

Staphylococcus is a genus of 33 species of bacteria. Often, one associates Staph with the species Staphylococcus aureus, which causes disease in humans. While this particular strain causes hassle and can be life threatening as its effects range from mere pimples to pneumonia, other Staphylococci reside normally on our skin and on mucous membranes of other organisms.

Yesterday, the area around the nose was swabbed and placed in a 7% NaCl broth and sealed with mineral oil to prevent the entry of oxygen. This treatment should enrich for Staphylococcus since most of these are salt tolerant bacteria. You may be wondering why the enrichment is under anaerobic conditions when Staphylococcus live on our skin, where there is definitely oxygen. Well, Staphylococcus are facultative anaerobes. This means that they respire both aerobically (in the presence of O2) and anaerobically (without O2). In order to enrich for Staphylococcus it was necessary to remove oxygen from the system to prevent growth of Micrococcus which is a strict aerobe.

Next week we will see what grows. After a isolating the bacteria and then performing tests on the pure culture it will be possible to identify the strain of bacteria isolated. This will be done using a simple dichotomous tree which includes only the most commonly found species. More on this later!

Pickles are evil cucumbers...

2009-03-04T09:50:00.001-08:00

My little sister thinks that pickles are terrible. However, many other people, including me, love pickles. I feel that burgers without pickles lack some flavor.

In my microbiology lab, we actually made pickles using lactic acid bacteria (LABs).

We found that LABs inhibit the growth of other microorganisms because they produce acid by-products. The lowered pH of the environment is too harsh for the sustenance of other microbial life. This demonstrates that LABs work by competitive exclusion. In the pickle jar containing LABs, the only colony isolated was a small, white round colony grown on a PCA agar plate.

A few brave souls decided to try the pickles that we made. Funny for us, but not so funny for them. Since we didn't add any agents to maintain freshness, the pickles weren't quite as crunchy as one would like.

Stress and Health

2009-02-28T12:57:00.000-08:00

As prelims and deadlines loom before us for the next 2 weeks before spring break controlling our stress level is of utmost importance. This Health feature from WebMD does a good job listing some strategies to keep debilitating stress at bay. Taking care of yourself physically, mentally and emotionally can go a long way in increasing stamina and focus. When these things are in place it seems that goals are more easily attainable.

Staying positive is a major factor in reducing levels of stress. Strangely, this point was not mentioned in the article. However, I believe that having the right attitude toward tasks can reduce mental load and affect our demeanor for the better.

Where are microbes?

2009-02-25T19:02:00.000-08:00

Do you think there are bacteria in your microwave?

I just swabbed the inside of a microwave and I hope to incubate an agar plate with the sample. Then, I'll be able to see what grows in a microwave! I have no idea what to expect. I wonder if any microorganisms even survive in a microwave.

For my microbiology lab, members of my group are going to swab different areas where we eat/where food is in order to determine which area would have the greatest diversity of microorganisms. The others are swabbing:

A stove top
Plate
Inside a refrigerator
The dining table
Top of an ice cream cooler
Inside a microwave (me)

We'll just have to wait and see what grows...

Experiments

2009-02-24T05:35:00.000-08:00

Sometimes, things don't work out as planned. For example, last week my Microbiology lab set up an experiment to test whether sulfa drugs work by competitive or non-competitive inhibition of a crucial enzyme. The hypothesis was that sulfa drugs work by competitive inhibition, and previous experiments have been run to show this mechanism of inhibition. Unfortunately, no one obtained the expected results. Now what?

I always thought that doing the successful experiment was the hard part of research. However, now I realize that the most difficult thing sometimes is to figure out exactly what went wrong. Why did the scheme that you set up not work according to plan? This takes the most effort and introspection.

Can smelling peanut butter make you have an allergic reaction?

2009-02-22T09:26:00.000-08:00

While sitting in lecture and taking notes, I smell the tangy odor of someone peeling an orange. I looked across the aisle and I was amazed that I could smell that orange so strongly. After the person consumed the orange, a jar of peanut butter was brought out. As a banana coated with peanut butter was eaten, it just blew my mind that I could smell the peanut butter from so far away!

Then I started to wonder whether smelling peanut butter, or any peanut containing product could be fatal or at least very uncomfortable for someone with a peanut allergy. In order to smell something, some particles must enter your body... Could this not irritate a person's immune system and cause an allergic reaction?

According to MayoClinic.com, it is possible for an allergy to be caused by inhalation of a peanut containing product. I suppose that merely smelling the the peanut smell means that the peanut particles entering your body are minimal, or at least in too low a concentration to cause a reaction. That's pretty lucky.

Uncertainty

2009-02-19T19:40:00.000-08:00

It feels disconcerting to not know for sure what the future holds. Will I be a doctor? Will I get into a medical school of my choice? When will everything fit together?

One thing I know for sure is that my life is going to be changing constantly for a number of years in the future. Looking back on it all will be interesting as only then will I be able to see that perhaps it was the little things I did, the seemingly insignificant choices I made that truly shaped my life circumstances.

Until then, one must have faith and hope that things will work out, somehow, in the end.

Sulfa Drugs: Miracle making a comeback?

2009-02-15T10:53:00.000-08:00

Today in my Microbiology lab we set up an experiment to test the hypothesis that sulfa drugs work by competitive inhibition of an enzyme crucial for synthesis of folic acid, which is a precursor for amino acids and nucleic acids, in bacteria.

Sulfa drugs were discovered by Gerhard Dormagk, a German pathologist and bacteriologist around the time of World War II.
At this time, people were dying not from the wounds they sustained during the war, but from the bacterial infection that festered in these wounds. These were the times before penicillin.

Dormagk ran structured tests to see what drug would work against these bacteria and he finally discovered these sulfa drugs- more commonly- sulfonamide or sulfanilimide.

These drugs work by competitive inhibition at the active site of the DHPS enzyme that catalyzes the formation of p-amino benzoic acid (PABA) to folic acid, which is a precursor for biosynthesis of amino acids and nucleic acids. Essentially, the drug prevents the bacteria from making folic acid and so the bacteria cannot thrive. Fortunately, humans do not make folic acid (we have to ingest it) so this drug does not affect us.

Before the drug was available on the market, Dormagk's daughter became ill with strep. She was not responding to the treatment available at that time, so he decided to give this drug to her. She recovered, and this was instant proof for the viability of these drugs for widespread use.

During the war, soldiers would have pouches filled with some of this drug in powdered form. The use of sulfanilimide greatly reduced the fatalities due to bacterial infection of wounds during this time.

Eventually, when penicillin and other antibiotics were discovered, sulfa drugs began to lose favor. However, today with the prevalence of HIV/AIDS and antibiotic resistance, these drugs are beginning to make a comeback.

Got sniffles?

2009-02-15T07:51:00.000-08:00

I came across this article on the New York Times website that investigates the claim that you should NOT blow your nose if you have a cold.
Imagine that! Not blowing your nose when you feel all congested and stuffy. It seems very counter intuitive. Are we supposed to walk around with mucous streaming out of our noses when we have a cold. When one feels all wretched because of a cold, I doubt that one would want others to be appalled at them.

However, the article states that blowing the nose results in excess buildup of pressure in the sinuses, in addition to compounding the disease by propelling bacteria and viruses into the sinuses possibly causing further infection.

The conclusion: Blow your nose one nostril at a time and take decongestants according to Dr. Anil Kumar Lalwani, chairman of the department of otolaryngology at the New York Un iversity Langone Medical Center.

Essentially, your nose is not a trumpet! Go easy when you blow it :P

Koch's Postulates

2009-02-14T13:51:00.001-08:00

So far this semester, I have learned that Robert Koch was instrumental in proving that bacteria cause disease.

This German physician was successful in isolating Bacillus anthracis in 1877, Mycobacterium tuberculosis (MBT) in 1882 and Vibrio cholera in 1883.
He was awarded a Nobel Prize in 1905 for his isolation of the Mycobacterium tuerculosis and other tuberculosis findings.

Becasue Koch proved that bacteria cause disease we were able to create drugs to cure disease by attacking the pathogenic bacteria that infect our bodies.

Koch postulated that:

Microorganisms that cause disease can be isolated from diseased tissue.
This isolated bacteria can be grown as a pure culture and identified using various characteristic tests and observations.
If this pure culture of bcateria was injected into a healthy organism, the same disease symptoms would appear.
The same bacteria can be isolated from the now diseased organism.

In my Microbiology lab, we started an experiment to see if we could prove Koch's postulates.
The plants that we used had a disease that caused red-purple swellings/tumors on their stems. These tumors had white, hair-like protrusions. After observing the disease conditions the tumor was removed and ground so we could isolate the bacteria within.

Last week we isolated bacteria from this tumor in the plant, and we grew a pure culture of this bacteria. I used a colony from this pure culture to infect a healthy plant. This actually turned out to be harder than I expected as the first healthy plant I tried to infect actually broke... ooops! The toothpick that I was trying to use to make a hole in the stem actually was too big and severed the stem most of the way through! Fortunately I was able to get another healthy plant. This time I used a smaller toothpick and punctured the stem. Then I used that same toothpick to pick up some cells from a colony and use these cells to plug the hole I just formed.

Next week in lab, we'll see whether the same type of tumor forms in this healthy plant.

Spice up your life!

2009-02-13T20:44:00.000-08:00

Ever wonder why people in the tropics or in other warm weather climate use so many spices? Perhaps it could be because herbs and spices make food last longer by preventing the growth of bacteria!

In order to test this hypothesis, my microbiology lab section contaminated 4 tubes of enriched glucose broth with E. coli and then added different herbs or spices to one tube. In order to compare the effectiveness of the herbs at inhibiting bacterial growth we performed pasteurization on a second tube. The other 2 tubes were control tubes.

~ In all cases pasteurization was effective at inhibiting bacterial growth.
~We found that certain herbs and spices actually did inhibit bacterial growth:

Oregano
Clove bud
Cinnamon
'Imitation' cinnamon (extract taken from a leaf that was meant to imitate cinnamon)

However, ginger extract did not inhibit bacterial growth. E. coli proliferated within these tubes.

I was surprised by this result, and I found it very intriguing. It seems that life (non-microbial, of course) is just a little more fun with some spice! :)

2009-02-10T13:19:00.000-08:00

Peanut butter making you nuts?

2009-02-07T07:04:00.000-08:00

The salmonella outbreak in peanut butter has many people worried, and some sick or even dead. Peanut lovers are called to exercise caution up to the point of removing peanut butter and other peanut products from their diet.

Here is a complete list of the recalled peanut products.

Professor Ghiorse of Cornell University discussed this outbreak in one of his Microbiology lectures, and he announced that it is safe to eat brands such as Peter Pan and Skippy peanut butter.
I was relieved by this since I have been eating Peter Pan peanut butter every week or so since this semester began.

In BioMI 2910, a course in experimental microbiology at Cornell University, Professor Sue Merkel began one of her lectures discussing this salmonella outbreak. She mentioned that one of the most unnerving things about having this outbreak in peanut butter is that these products generally don't go bad. In fact, the peanut plant in question tested positive for salmonella twelve times over the past 2 years. They just kept retesting until they got the results that were negative. This means peanut products produced over the last two years may be tainted. Peanuts from one plant end up widely distributed-another factor that increases the reach of this outbreak.

More than 500 cases of salmonella have been reported, and even more remain unreported. Fortunately, salmonella is not fatal. If one does not have a compromised immune system, the symptoms may be nothing more than a mild tummy ache. On the other end of the spectrum, there could be high fevers and even deaths as a result of salmonella poisoning.

It is so interesting how such small organisms can cause such great problems for humans. The more I think about it, the more I agree with Prof. Ghiorse's statement that, "MICROBES RULE THE WORLD!"

Dreams can come true!

2009-02-05T18:28:00.000-08:00

In my most recent post I mentioned that it would be amazing if a professor, employer or other superior offered to do a letter of recommendation when mentioned in passing conversation.
Well... IT HAPPENED!

At 2:43pm on February 4th, 2009 I experienced this seemingly miraculous phenomenon: a professor, in an almost offhand manner, offered to do a letter of recommendation for me in order to fulfill the requirements of a prospective employer.

It seems that making a good impression on people in addition to establishing rapport during conversations can go a long way in making life easier. I learned from my childhood reading of Enid Blyton that one good turn deserves another, and I believe that this is true. Events like this make me aspire to be a caring and compassionate leader when I am established in my profession.

Recommendation

2009-02-04T09:44:00.000-08:00

Asking people for letters of recommendation can be a very tricky process.
The palms sweat and the mind buzzes with thoughts like:

I hope this person likes me enough to write a good recommendation
I hope he/she remembers my name...
Maybe I should ask someone else
How should I approach the person without being too awkward... yet without outright demanding the letter?
This person can write well... right? Yea... I'm sure they can
Whoa, I hope they say yes in the first place because if they don't I'm going to have to try to find someone else

And so it goes.

For the more self-assured, perhaps the fact that they are applying to medical school and need a stellar letter of recommendation can be casually mentioned in conversation with the superior. Then, in an ideal world said person offers to be the author of the letter with such enthusiasm that it would be crazy to tell them no.

One can dream :)

Diagnosis

2009-01-31T19:11:00.000-08:00

I came across this Diagnosis column on the New York Times online.

It is interesting to see how seemingly harmless family traditions- such as preparing pork for an annual luau- can result in near tragedy. How often we take chances with our health... but one cannot live in fear of all the possible conditions that can affect one's life. It would be ridiculous for us to avoid all the foods that studies have attributed to increased incidence of cancer, hypertension or diabetes. It seems that finding a 'happy medium' may be the key to lowering the anxiety surrounding such reports.

HCEC

2009-01-29T06:18:00.000-08:00

Yesterday was the deadline for registration with the Health Career Evaluation Committee (HCEC).

In an effort to have the most efficient registration of the majority of the pre-medical students at Cornell, the HCEC decided to limit the times for registration from 5:00pm-7:00pm on the 27th and 28th of January. This logistical decision was rationalized because "this is the time between which we find students have the most flexibility." Perhaps this is true.

As I sauntered up the Barnes hall at 4:54pm, I was displeased but not too surprised to find that the lobby was packed full with early-birds waiting to hand in their package, and get moving with step 2 of the registration process. Ah, the 'neurotic pre-med' student. How I often get annoyed with that stereotype with which we are labeled. But that's an issue for a later post.

The HCEC offers a valuable service to the medical schools and students. The prospective medical student presents the committee with 3 letters of recommendation from professors, faculty or employers, in addition to transcripts and forms that detail all extracurricular activities. The committee then interviews the candidate, and puts all these things together to produce a letter from the university describing and endorsing that candidate. All 4 letters are sent to medical schools where the student wishes to apply. It is said that medical school admissions officers hold these university letters in high regard when it comes to evaluating the candidate. Needless to say, getting the ball rolling on this process is not a trivial task.

Introduction

2009-01-27T19:17:00.001-08:00

Welcome to my blog!

This is a place where I reflect on and discuss things related to the medical field.
Since I am currently a pre-medical student, occasional references to the application process to medical school will be made.