Canterbury Bells
(Image courtesy of http://www.flickriver.com)

I owe a few thank yous in regards to fundraising. Some recent. Some long overdue.

The first is to Dr. Kent DaVault of Central Washington University, who sent a donation about four years ago. I’m ashamed it’s taken me this long to acknowledge him in a post, but if you’re reading this, Dr. DaVault, know that over the past few years I’ve still remembered your kindness and generosity. Thank you.

The second is to Angel Garcia, a former graduate student here at UVM. I met him through the Graduate Intervarsity chapter here at UVM, and after I joked he should send a donation, he went ahead and sent one in. Angel, your classiness astounds me. As does your coffee.

The final thank you is to Dr. Larry Rudiger, who I gather is a lecturer here at UVM. His donation astonishes me because 1) I’ve never met him, so he must have randomly found my blog, and 2) he sent a donation in just recently, during a time when the blog was inactive. Wow.

In fact, “Wow” is a consistent reaction I’ve had through this blog experiment. When I started The Meager Med Student, I was primarily concerned about raising money to pay for my schooling, so that I could continue to do groundbreaking medical research to help patients without being encumbered by loans I normally wouldn’t have had. And while I have been receiving funds, I got so much more. I made numerous contacts and friends through this blog. Fellow med students inform me every year that they read it to learn about UVM and its lecturers. Christians have used it to find information about the Burlington area. People have sent me letters informing me that they’re praying for my ulcerative colitis. These are all gifts I don’t take lightly, and you know how I feel about gifts.

Muchas gracias.

Josh Pothen (UVM’s Meager Med Student)

***

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It is believed that President Kennedy had ulcerative colitis.

Note: I have not updated this blog in the past semester due to multiple bouts with ulcerative colitis. During the past few months, I wrote this post to help people understand what I go through. Some of my friends have already commented that this entry is both beautiful and disgusting. It must be if I’m to be honest.

When you’re diagnosed with ulcerative colitis, you will quickly become an expert on the disease. If you’re a medical student, you have an advantage because you already learned about it. You know it’s an autoimmune disease: your body’s immune system is attacking the inner two layers of your colon, starting at the rectum and then moving up through the rest of it. That’s why all the treatments are all designed to weaken your immune system just enough to control inflammation in your colon.

But why didn’t you get the disease before you were 24 years old? Why does it start at your rectum and spread upwards? Why doesn’t it affect all four layers? No one knows. But you keep up to date with the latest studies and findings. And maybe one day as a doctor you’ll figure it out.

You’ll need expensive amounts of medication. Your student insurance will only cover so much, leaving you to pay several hundreds of dollars each month. You’ll look at other health insurance options, but they’ll all be too expensive and offer little extra benefit. Thankfully, your parents graciously agree to cover half of the costs while you’re in school. You’re blessed. You wonder how other people do it.

When your friends and relatives learn you have ulcerative colitis, they will immediately give you advice about what you need to eat, do, etc. 99.9% of it will be bogus, like a plumber telling an astronaut how to operate a shuttle. Your religious friends who automatically favor homeopathic, holistic treatments over Western medicine without thinking will be the worst. They’ll insist you try all sorts of remedies, from probiotics to special diets to Eastern medications. They don’t understand their solutions are useless, as none of them deal with the underlying nature of your disease. Sometimes, they’re even harmful. You may try one or two of them and end up worse than before.

So when you get yet another piece of advice, you’ll nod politely, only correcting people when it’s appropriate or necessary (like when it’s your closest friends and immediate relatives.) You will still love them all, but you will encounter another type of friend. They’re humble enough to know they can’t fully understand your disease. They will ask lots of questions, but offer no solutions. They will simply support and pray for you. You will treasure them the most, for these are your real friends.

You and your doctor will inevitably disagree as to how to treat your disease. But you must remember the decision is ultimately yours. And if you have a GI relative who specializes in your disease and assures you that your case is controllable via different treatment options, you have all the more reason to hold your ground. Because while you can cure ulcerative colitis through a surgical colectomy, you don’t want to wear a colostomy bag for the rest of your life. You must make sure your treatment options won’t lead you there too quickly, or at all.

When you’re healthy, you can eat anything you want. Anything. But you’ll eat a healthy diet with lots of fiber. You’re blessed. Others with your disease can’t eat certain foods because they trigger flare-ups—periods where the immune system goes into overdrive in the colon.

As your doctor and you experiment with maintenance medications that will prevent these, it’s inevitable you’ll have some flare-ups along the way. When you do, it will be awful. Naturally you will have bloody, watery diarrhea, and you’ll go to the bathroom several times a day. (Each time, you’ll scrub the toilet bowl within an inch of its life out of self-consciousness.)

But you’ll also have many seemingly unrelated symptoms. Headaches. Fevers. Aches and pains anywhere from your lower spine to a small spot on your arm. Night sweats where you soak your sheets every night. (This is when you’re especially grateful you’re single and sleep alone.)

You’ll become dumber when you’re sick. You didn’t know that was possible, but you’ll catch yourself making numerous mental mistakes you know wouldn’t normally make. You’ll become extremely sensitive to temperature. Even standing out in the wind for a few minutes can be hazardous to your health. You’ll lose lots of energy. Sometimes you won’t be able to walk your normal route without having to rest several times along the way. Push yourself too much and you might collapse.

You spend the mornings resting in bed, gathering just enough strength to get to work. When you come home, you’ll sit on your bed recovering the energy you lost. Naturally you’ll have to drop contact with the outside world as much as possible during this time. You’re grateful to have family and friends who understand.

You’ll need to adopt a different diet when you have a flare-up. Low-fat, low-fiber. (Fiber makes you move your bowels more often, which is exactly what you don’t want right now.) This means you’ll have to avoid many healthy foods, particularly raw vegetables, and eat lean meats instead. This will seem odd to your health-conscious friends, some of whom may judge you. They don’t know you long for the day you can eat a salad again. You’ll also have to avoid foods that make you even a tad gassy, like broccoli. And for reasons you don’t understand but know from experience, you’ll have to avoid alcohol and caffeine.

As you get better, your symptoms will slowly vanish. You’ll treasure the days you are completely healthy. You’ll have learned more about yourself and the people around you. And you’ll never be more grateful to see solid feces in the toilet bowl.

***

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(click on image for original source)

“…and I do declare that the sun is shining.”

When I last updated this blog in April 2010, I was fighting my way through Neural Science. Easy class for most of my classmates. Not for me. However, I not only passed, but ended the year on a very high note.

Since then I have:

• Found an advisor for my PhD
• Worked on a summer research project with my advisor
• Finished Foundations, i.e. finished all my basic science classes
• Begun helping out with the Care Net Pregnancy Center here in Burlington
• Been hospitalized and diagnosed with ulcerative colitis
• Worked to regain my strength, health and stamina  (see above)
• Taken two months off due to ulcerative colitis issues
• Completed my first rotation in the hospital: Internal Medicine
• Said goodbye to my med school classmates
• Begun my PhD
• Taken my boards
• Turned 26

I plan on doubling back to discuss most of these in depth. The ulcerative colitis in particular took a toll, and is a big part of the reason I haven’t blogged in so long. Let me assure you that not only am I back to normal and on minimal medications, but I can eat anything and am in better shape than I ever have been.

Now I am in grad school, doing a PhD in Bioengineering with Dr. Jason Bates, an Engineering professor tied to the Vermont Lung Center. What am I doing? For now, I can say that we are working on a computational model of what happens in the lung during an allergic asthma attack. More details in the future.

Doing this MD-PhD thing was one of the smartest decisions I’ve ever made.  After two years of the frenetic pace of medical school, the switch to grad school came at just the right time. It’s still busy in its own way, but it’s nowhere near as busy, affording me more free time. I know of one MD-PhD student at Johns Hopkins, Jimmy Lin, who’s using it to also get an MPH and a seminary degree. I’m nowhere near as ambitious, but I do have plans. Many, many, many plans.

Part of that plan involves The Meager Med Student. When I began it, I vowed I was going to walk my readers through all the details of med school life. But then I had to step away from blogging, and it gave me more time to reflect. I eventually realized that while the details of lectures and medical practice were interesting,  in the end I found my emotional journey through med school more fascinating.

So from now on, The Meager Med Student will switch back to a weekly post on med school life. There will still be details about classes and perhaps one or two funny stories. But now it will be more of my emotional responses to the events of med school and the issues of medicine. More fascinating. More insightful. And better written. Look for updates every Friday, the first being the Friday after next.

All that to say, this blog isn’t dead. It’s just begun. I’m back.

Josh Pothen (UVM’s Meager Med Student)

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(Jean-Martin Charcot. from en.wikipedia.org)

Today was…not the greatest day for lectures. Let’s just leave it at that. It doesn’t help that we have a readiness exam tomorrow morning.

***

Today we talk about how neurons and glial cells respond to injury, which gives us an idea of how the brain and the nervous systems respond to trauma. We also have a lecture on multiple sclerosis (MS), and we do an E-Learning Lab on neurohistology, which means we sit in the classroom and work through a powerpoint about how to read microscope slides of neurons. The TAs and lecturers stay around if we have any questions. (We can leave and do this on our own if we want.)

Among the tibdits we learn today:

• They Might Be Giants has a song called “Countrecoup”, which Dr. Jaworski plays for us. It refers to a term where a head injury occurs on the opposite site of where head trauma occurred. Not too surprisingly, the lyrics are scientifically correct.
• You cannot diagnose a concussion with an imaging study like an X-ray or CT scan. You can use them to find a contusion, however.
• Demyelinating diseases (i.e. diseases that cause neuronal degradation) are often caused by a viral infection, but they can also be caused by childbirth. “I’m not calling childbirth an infection.”
• The neurons of the central nervous system (i.e. brain and spinal cord) ARE in fact capable of regenerating. So why haven’t we found a cure for paralysis? Because the cellular environment of those neurons does not allow them to grow. If we were to give them the appropriate growth factors and remove the inhibiting factors, then maybe…
• According to Sigmund Freud, his mentor Dr. Jean-Martin Charcot kept a charlady who kept dropping plates and platters for several years. Why?  Apparently after she died, he autopsied her and to prove she had what we now know is MS.

***

Tuesdays mean MSLG. Today we had two patients with psychiatric conditions come in to tell us their stories. Wonderful timing considering we’re starting Neural Science.  

As I find myself writing so often, obviously I can’t divulge details. But what I can write is that in medicine right now, psychiatry gets a bad rap, due to notions that psychiatry is a “lesser” intellectual field and that people with mental conditions just need to fix themselves. As Dr. Forehand said yesterday, you don’t tell your pancreas to fix itself when there’s a problem. So why would you do that for your brain?

We asked the patients who visited us what advice they had for us. One noted that the best question her doctor ever asked her was, “What are you reading?” It turned out she was reading a book that was adding fuel to her depression, and so she was able to recognize that and stop reading it. But also, it indicated that her doctor had some interest in her whole life, not just for her condition. After all, people are more than the sum of their illnesses.

Josh Pothen (UVM’s Meager Med Student)

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(I will use this song to study. from http://www.amele.tv)

Spring break’s over. Neural Science begins. This 9 week course on the brain will be the last course in our first year of medical school.

***

Since today is the first day, it’s very basic. Dr. Forehand gives two lectures: one giving an overview of the central and peripheral nervous systems, and another describing the embryological development of the central nervous system.

At the beginning of the first lecture, she shows us this slide to indicate why understanding CNS diseases is so important.

The costs take into account both money spent on medication and money lost due to being unable to work.

Then she asks what one disease not shown on this table costs nearly the same as all of these combined. We all draw a blank.

“Substance abuse.” Again, we’re reminded that in medicine, cigarettes is a very common cause for diseases we study.

***

The other item on the agenda today is to go to the anatomy lab. Back in HSF, we removed the brains from our cadavers and put them away. Now we’ve brought them out to learn the anatomy of the brain.

Dr. Jean Szilva and Dr. Ellen Cornbrooks (i.e. Ellen the Magnificent) are back and help us with any questions we have. They’ve set up several lab stations, and so we start at one and rotate around. Today we’re studying brain sections and the different parts of the brain.  

Today I interact a lot with Jean. She reminds me a lot of Ms. Frizzle from those Magic School Bus books I read as a kid, in part because she’s always very peppy and gets particularly excited when you make a mental connection.

She also gives us a useful clinical vignette. Without going into too much detail, there are three layers that cover your brain: dura mater, arachnoid mater and pia mater, from outermost to innermost layer. Between the two hemispheres of your brain is a cavity (which we call a sinus) formed by the dura mater. Blood and cerebrospinal fluid (CSF)  goes through this space.

Where does the blood come from? Veins that run underneath the dura mater. If you have a head trauma, there’s a possibility you could damage these and get what’s called a epidural hematoma.

“This is what killed Natasha Richardson last year.”

What’s scary is that if you get one, you won’t notice that anything’s wrong for a while. It takes a little while for the fluid to build up pressure, but when it does, it will push on the brain, causing you to get a headache and then lapse into a coma.

We ask her what causes the symptoms. She explains that the pressure in the head pushes the brain down your skull.

Also, she tells us, this puts a strain on our oculomotor nerve, causing the pupils to dilate. This is why they shine a light in the eyes of an unconscious patient. They’re checking to see if the pupils are massively dilated, which would indicate that a subdural hematoma is present. 

Josh Pothen (UVM’s Meager Med Student)

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(from 123rf.com)

I wrote a guest post for jpothen.com today. Thankfully had the free time to do it now that I’m on spring break for the week. Check it out.

Josh Pothen (UVM’s Meager Med Student)

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Yes, my last post was an April Fool’s joke. I would have thought the idea of me wanting to become a clown was too ridiculous to believe. And while many people realized the truth, a few thought I was serious. I thought they were just trying to trick me, but no.

So below is the email I sent to my med school classmates the day after April Fool’s Day:

***

Just to clarify, yes, the email yesterday was just an April Fool’s joke, though I’m flattered if you thought I could be a clown. Med school’s always been my main dream.

And you all will still have me around next Monday and beyond. If I’d really been leaving, I’d have been upfront with all of you about why. 

The things I wrote in the shoutouts, however, are real. (Note: I wrote personalized messages to a couple of my classmates at the end, which I will not reprint here for privacy reasons.) And I’m touched by the lovely sentiments I received from many of you. I love you all.

Josh Pothen (UVM’s Meager still-Med Student)

(from http://www.torontoist.com)

I sent the following email to my classmates today, and I’m sharing it on this blog so you all also know what’s going on in my life.

***

Hi everyone,

Just wanted to give you the heads-up that I’m leaving med school.

I’ll be here the rest of the week to say goodbye to all of you and take care of some details, but next Monday, I’ll be home in Indiana.  

Don’t get worried. Nothing serious or bad has happened to me. In fact, quite the opposite. I’m super-stoked about what I’m about to tell you:

I’M GOING TO CLOWN SCHOOL!!!

Some of you may know this, but med school wasn’t my first career choice. I’m not one of those people who’s felt called to be a doctor ever since I could remember, or one of those people who had an intense surgical operation and decided to go into research to improve patient’s lives. 

No, I actually applied to clown school first. Didn’t get in anywhere. So I thought I’d give med school a shot. And while it’s been an honor and a privilege, let’s face it…is there anything better we can do than make people laugh?

I tried to suppress the image of me in the clown makeup, wacky hat, red rubber nose, striped shirts, giant shoes and baggy overalls, no matter how natural and obvious a fit it seemed. I tried say that was all in the past and that I’d chosen a better career.

But over winter break, I realized my true calling again when I was in Chicago and saw a clown in the street, bringing joy and happiness to everyone around him. All those secret longings to learn the ways of the random and wacky came rushing back stronger than ever.  So I tried again, and well, I made it!

The details: First, I’m going home to eat a lot of food and gain a lot of weight so I can look the part. Then I’m going to the New York Goofs Clown School, where I’ll participate in an intense two-week clowning class. From there, I’ll be heading to the University of Chicago, as part of a 3-year program through the 500 Clown Company to learn clown theater. This will enable me to work both on the stage, and off it at circuses or birthday parties. This should enable me to make a substantive (and lucrative!) living in Chicago for the rest of my life.  

Still, it’s not easy to say goodbye. Let’s enjoy the rest of the week we have together. Be sure you come and give me a goodbye hug.

And if you’re walking through downtown Chicago and you see someone in goofy clown makeup squirting people with water flowers and honking his red rubber nose, look carefully. It’ll probably be me.  

Josh aka “Jimbo Pantalone”

(HDL molecule. from http://www.lbl.gov)

Week 5 of NMGI. The day after Daylight Savings time ended. AND the Monday after the weekend when the UVM men and women’s basketball teams won their entries into the NCAA tournament.

So Dr. Tracy was pleasantly surprised when most of our class showed up for our 8 AM lecture. She told us she remembered having her kids wake up late for school on the day after we lost an hour, calling it the “worst day of the year”.

She also couldn’t hide her excitement for the upcoming sports events. “If any of you want to discuss March Madness, I am happy to do so.” Although, she later admitted, ”My favorite team is Syracuse.” I’m surprised she didn’t get booed.

***

Every year, the medical school measures the cholesterol of the current first-year class.  

We had our blood drawn for fasting lipid counts about two weeks ago. We were also interested in the results, because apparently each incoming class had better cholesterol measurements than the ones before them.

And yes, part of it is because we’ve been trying to outcompete the classes before us, whether it’s in test scores or on the field.

So in the afternoon, Dr. Martha Seagrave (of Family Medicine) presents our class results. They look good. Most of us have total cholesterol in the desirable range  (< 200 mg/dL), LDL in the optimal (<100 mg/dL) or near optimal range  (<130 mg/dL), and HDL (‘the good cholesterol”) higher than 60 mg/dL.

Then they compare us against the other classes with various graphs, with each class having a different color (except for 2008 to 2010, which are combined together).

And well, we don’t stand out. Don’t get me wrong. Most of us are obviously very healthy. But let’s just say 2011 had some amazingly healthy people, and a few outliers that have to be genetic.

So finally a student asks the question on everyone’s mind: “So did we win?”

You know you’re in trouble when this is your reply:

“Well, it depends on what we’re measuring. If we’re going by which of you has the prettiest color [on the graph], then I’d say you won, since you’re the orange.”

*** 

Another student asks the other obvious question: Do they measure the cholesterol level of each class when they’re 4th years, and compare it to the data from when they were 1st years?

No, Dr. Seagrave tells us, but she thinks it’s an excellent idea, and polls our class if we’d want to participate. Most of us do. That’ll depend on getting funding from Dean Jeffries, she tells us. Start petitioning…

***

Lectures today included Dr. Tracy’s talks on how cholesterol is synthesized and broken down, as well as dyslipidemias–diseases where there’s an error in the synthesis, processing or degradation of cholesterol.

You know all those pathways that we’ve learned in today’s first lecture? Basically, an error in any one of the step can give you a dyslipidemia. We’re guaranteed to see one of these in our medical careers, Dr. Tracy tells us.

We also learn about dietary management of cholesterol levels from Ms. Johansen. Obviously we learn about avoiding saturated fats and trans fats. I won’t dwell too much on the obvious.

But among the interesting tidbits: 

• Even if your total cholesterol is low, your risk of serious disease is still very high if your HDL level is also low.
• Nuts are great for lowering your risk of heart disease, although they’re high in calories.
• Apparently the jury’s out on the effectiveness of soy. We know certain parts of soy are linked to benefits, but we don’t know the correlation between the magnitude of the effect and the amount of soy eaten. Sorry, tofu lovers.
• Weight loss actually causes your HDL cholesterol levels to decrease at first, but if you sustain the weight loss, your HDL levels will increase. For every 7 pounds of weight you lose, you gain 1 mg/dL in HDL levels…as long as you maintain the loss.
• And in a very interesting experiment, people who drank half a bottle of wine every day for six months had their HDL levels increase by 7 mg/dL! Let’s see if our class we’ll try that one…

***

We also get a Heart Healthy lunch today! Not sure why today of all days, but it’s a nice little break. It’s about 90% heart healthy, according to Dr. Tracy: water, salad and whole grain rolls. The missing 10%? Cookies, some meat and probably the salad dressings. 

Hey, I’ll take it. But perhaps not everyone. This is the only time I’ve seen a faculty member walk back in the room and encourage people to take seconds.

Don’t worry. We cleaned it all off. Eventually. I think.

Josh Pothen (UVM’s Meager Med Student)

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(A Byzantine form of the Hippocratic Oath. from en.wikipedia.org)

Here is the oath we’ve sworn at our White Coat Ceremony. It is not the Hippocratic Oath, but an updated, modern version. (Who developed it, I don’t know.)

I swear to fulfill, to the best of my ability, this covenant:

I will respect the scientific gains of those physicians and scientists in whose steps I will walk, and gladly share such knowledge as is mine with those who are to follow.

I will remember that there is both art and science to medicine.

I  will pursue the expansion of my knowledge throughout my life for the benefit of my patients.

I will practice medicine with conscience and dignity.

I will respect the privacy of my patients and not judge them.

I will prevent disease whenever I can; for prevention is preferable to cure.

Most especially I will treat with care in matters of life and death. If it be merely within my abilities to help ease suffering at the end of a life, may I face this awesome responsibility with humility and awareness of my own frailty.

I vow always to act to preserve the finest traditions of my calling, and may I long experience the joy of healing those who seek my help.

Josh Pothen (UVM’s Meager Med Student)

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