Whoa.

Bone Sawing + Open Chest Cavity + Stethoscope= Doctor.

Boniva

Those who watch an excessive amount of Lifetime or Food Network (which I would never ever do) probably have seen a commercial for Boniva. Boniva is an osteoporosis treatment whose claim to fame is that you only have to take it once a month, instead of once a week like all those other osteoporosis pills.

Now if you're anything like me, you're sitting there wondering who on earth is so lazy that it makes that much a difference to take a pill once a week or once a month. But it turns out that bisphosphonates like Boniva (which inhibit the resorption of bone by cells called osteoclasts, your bone's natural recyclers) also are very hard to absorb through the stomach. This means you have to take them on an empty stomach, which causes severe upset stomach, gastric reflux, and erosion of the esophagus. So APPARENTLY I should judge less, and all Boniva users are happy to only go through this once a month.

Prions: birth without life.

Days 2,3 of Med School.

So most people have heard of Mad Cow disease.  Caused a meat panic, made England kill a whole bunch of cows, and revealed some creepy practices about feeding cows other cows.  But what many people don't know is the really cool scientific discoveries that came from Mad Cow, and its less glamorous sheep cousin, Scrapie.

When Mad Cow and Scrapie started popping up big time, people were scrambling to identify the causative agent, since it was obviously transmittable from one animal to another.  But they found that beyond even identifying it, they couldn't even kill it.  Anti-bacterials, anti-biotics, anti-virals, extreme heat, everything that would kill any living organism or virus, wouldn't kill whatever was causing Mad Cow.

Eventually, they found that what did stop Mad Cow from spreading was protein denaturing chemicals.  This meant that the Mad Cow infectious agent wasn't a virus, wasn't a bacteria or a microscopic organism, but just a protein.  And not just a protein- a protein that is in everyone's body already.

So here's what happens.  The Prion protein is the protein involved in Mad Cow.  It is a normal protein that is produced in everyone, and is now thought to have some sort of a neuroprotective function.  But it's not a perfectly stable protein.  It can twist, and change its shape a bit.  After it changes its shape, it may bump into another perfectly normal Prion protein.  When it does, it causes that normal Prion to change shape as well.  And so on, in a cascading fashion until there are thousand of millions of misshapen Prions.  When a misshapen Prion from one animal is introduced into another animal, it acts as a seed, initiating this cascade of protein shape changes that causes Mad Cow disease.

It is unclear whether the misshapen Prions are actually poisonous in some way, or if the shape change simply inactivates the good Prions, which may cause a problem if normal Prions are very important in the body.  However, in an interesting twist, very recent research indicates that normal Prions may suppress Beta-secretase, whose action is key in creating the plaques that occur in Alzeheimer's disease.  The plot thickens.

WTF is Histology anyways?

Day 1 of Med School (for reals).

Histology is the study of microscopic anatomy.  Basically you look at cells under a microscope.  Why do you need to do this?  Imagine:  You are at the doctor's and have a lump.  Somewhere.  And the doctor, fearing this lump may be cancer, takes a biopsy.  So now the doctor has a chunk of your lump.  You go home, and tomorrow the doc tells you if you have cancer.  How does he know this?  Not magic.

The object of the game is to look at the lump (also known as tissue) under a microscope and see if it looks normal.  However, this is complicated.  Because microscopes basically have to shine light through something in order to work.  So the tissue has to be cut in thin strips (about 60 micrometers).  To do this, the tissue is first dehydrated in alcohol, and then has wax poured over it.  This wax gives stability so that the tissue can be cut into such thin layers without making it into something resembling cream of wheat.  Then, the layers are dunked into stains, which stick to certain cellular structures and make them show up in colors, because unstained lump basically looks like lots of vaguely pink mush.  Then, and only then can you look at stuff that looks like this:

http://path.upmc.edu/cases/case263/images/figure03.jpg

Which will apparently one day tell me lots of things about your lump.

But that's the boring stuff.  The cool stuff is when you use Scanning Electron Microscopy.  Instead of those big bulky lightwaves, you use itty bitty electrons.  And instead of all that slicing and staining, you just dunk the thing in heavy metals, and that gives you a sweet 3-D image of really really tiny things:

(blood cells)

http://upload.wikimedia.org/wikipedia/commons/8/82/SEM_blood_cells.jpg

(gills of a mudskipper)

http://www.vcbio.science.ru.nl/images/TechniqueFig3B_Zoom.jpg

(ant)

http://upload.wikimedia.org/wikipedia/commons/c/ca/Ant_SEM.jpg

Seriously the prettiest thing science has come up with for a while.  But aside from making pretty pictures, Scanning Electron Microscopy (SEM) is the only way to visually identify viruses.  SARS?  

http://www.sciencedaily.com/images/2009/03/090313150254-large.jpg

ID'ed by SEM.  Useful.

Busy lives make it hard to post.

Med School Day 3,4,5 (Kinda)

Last Day of Orientation, White Coat Ceremony, Saturday

• White Coats are cool
• Swipe cards are even cooler
• Check out Ovid because it's so much better than Pubmed
• Parents make life busy
• Always have balance in your life, so go to the zoo often

Some things never change.

Med School Day 2 (kinda)

Second Day of Orientation

Today, mixed in with the usual orientation bureaucracy and being informed that we have 8 (count 'em, 8) different passwords, we had our first real class.  Med students today don't take the real hippocratic oath, because it's 2500 years old and that may mean it's a bit outdated.  Instead, most schools use some revised version encompassing the main ideas of the oath, and here we get to write our own each year!  Really, this just means that each class looks at last year's oath and changes a couple words to make themselves feel warm and fuzzy inside, but anyways.

So, the school sent home a bunch of example oaths and ethics papers, so everyone could read them over the summer to develop their own ideas of what a Physician's oath might entail.  Then today we met in small groups to discuss.

And there we are, 10 of the "best medical students in the country", as we have been told all week, sitting with one of the school's foremost experts in Medical Ethics.  And...the silence descends.  It really is comforting to know that for all the overachievers and geniuses that are supposed to be in this class, it still takes pulling teeth to get anyone to speak up in class.

Eventually, we came to the conclusion that no one really cared if our oath was different than last year's oath, so we looked at the real hippocratic oath.  Some of the pledges ancient Greek Physicians made are definitely no longer held true:

I will provide medical education free of charge.

I will financially support my teacher in times of need.

Some are still the foundation of today's oaths:

I will only seek to benefit my patients, and not do harm.

I will speak of nothing that I learn inside a household, whether learned during treatment or not.

I will not have sex with my patients.

And the most interesting are the "no" statements.  Today's oaths largely do not have any negative statements.  They say what the physician will try to do, but do not say what the physician will refuse to do.  Probably because they were trying to avoid the controversy of:

I will not give a deadly medicine to anyone, even if I am asked.  Apparently scholars are unsure if this means no euthanasia or assisted suicide, as it is often interpreted, or is more directed at not supplying assassins.  Since we are told that there was plenty of euthanasia in Ancient Greece, either a bunch of Physicians weren't good at following instructions, or it really meant the latter.

I will not give a woman a harmful pessary.  A pessary, in my understanding, is when a sharp metal instrument is poked into the uterus to initiate an abortion.  Many people interpret this as no abortions.  However, the pessary METHOD of abortion had a ridiculously high death rate, because you just poked sharp metal things into soft tissue.  So, since again there were plenty of abortions performed in Ancient Greece, many scholars believe that this was outlawing only this method of abortion, not abortions in general.

And now you know.

My monthly payments are going to be WHAT now? And other things you did not want to learn.

Med School Day 1 (kinda)

First Day of Orientation

56% percent of America's graduating physicians in 2008 had debt greater than $150,000.  We are told this to emphasize that we are not alone.  Over half of your class is probably scared shitless as well.  Of course, my school is very proud to announce that their average student indebtedness is 20 grand lower than the nation's average.  But considering 20% of the class is MSTP (aka no debt), and this is the largest percentage in the US, the fact that they're only 20 grand lower doesn't comfort me.  But anyways, we're going to try not to think of this, and pray that the financial aid team didn't screw up and think that sister is still in school, cause otherwise bye bye all aid.

OTHERWISE... we learned:

We have a cool library (duh).

We have an IT department (duh).

We have a class picture (duh).

We have to pay tuition (damn).

We have individual study carrels (cool).

Its impossible to get any work done in said carrels (oh well).

The second years say if you study outside of exam week in first year you're working too much (...yay?).

We have a school tab at the bar tonight (SWEET).