Wednesday, November 9, 2011

There's Never a Good Time to Get Sick

I came down with a cold yesterday and it's just in time for my test tomorrow in laboratory management. I'm actually not too worried about it because my grades in that class have been fairly solid and I would have to flunk it for it to have a significant impact. But nonetheless, despite our two big tests last Friday and on Monday, the study material is once again piling up.

For me, the worst part about having a cold is not the impact that it has on your health, but how the cold disables your normal functioning. This is only the second cold that I've gotten this year so I don't get sick often, but when I do it just saps all of my precious energy. Precious energy is what is needed for studying.

Yesterday, as I was walking home from school after studying late in the scope room, my whole body just felt so exhausted that once I arrived home I couldn't study anymore. Later that night my pharynx began to get sore and I knew by midday today that I was sick for sure. Thankfully, I don't have any cough. Today after school I tried to catch up in the scope room again what I wasn't able to complete yesterday, but I was just so exhausted from the cold that I couldn't concentrate. No matter how long I stared at the slides I couldn't connect the dots or recognize what I was supposed to see. So after about 15 minutes of sitting listless I decided to head home, call it a day and try again tomorrow.

In high school, when our class graduated, my friend received an award for "Most Likely to Make a Cure for the Common Cold." He's studying physics now, but I need to pester him to hurry up on that cure.

Friday, November 4, 2011

Fingers, Abuse and Blood, Oh My.

Despite the misleading and grisly title this entry has little to do with what you're probably thinking.

So we've finished a big endocrine system physiology test today on Friday just in time to study for another big microbiology test on Monday. But at least this short break has given me enough time to write a little today. I focused most of my efforts this week on studying for the endocrine test today and it paid off well, but to my detriment a huge 16 lecture microbiology test awaits me in just three days. So, I already know what I'll be doing this weekend. In a twisted way, one perk of being in graduate school is that you usually know your plans are for weekends. Studying.

In addition to our normal studying, we've been busy fulfilling the requirements for working next year in Pittsburgh. We had already done our fingerprint requirements and vaccinations before we entered into the program, but unfortunately those results aren't transferable to Pennsylvania. So we have the pleasure of doing it all over again. Our program has switched over to a third party this year who will store all of our information and release it to any organization that we authorize. That third party is "Certified Profile" and we scan and submit our required information to their website. I believe that the PA students for next year in January 2012 will be going through Certified Profile as well.

There are a number of things that are required before we can start our clinical rotations. The hospitals want to make sure that we aren't child molesting, disease carrying ex-convicts. One would think that being in a Master's Program would pretty much be proof enough that you have no major offenses (after all how would you have been admitted to the program in the first place?) but rules must be followed for the sake of rules it seems.
The four requirements are:
1) Pennsylvania State Background Check
2) FBI Finger Print Background Check
3) Pennsylvania Child Abuse History Check
4) Proof of Immunizations for:
     -Measles, Mumps, Rubella (MMR)
     -Varicella
     -Meningococcus
     -Tuberculosis Skin Test (two PPD step test)
     -Polio
     -Tetanus, Diptheria
     -Hepatitis B

Hence, the title of this post.

In between our studying and exams and classes we've been getting these requirements done one-by-one.

1) The Pennsylvania State Background Check was the easiest. It was just a simple matter of printing out a form, sending it in the mail, waiting for the reply in the mail, scanning it and uploading it.
2) For our FBI Background Check, we needed to get our fingerprints done at a place certified to carry them out. There are a number of places in Pennsylvania which will take our fingerprints, but the most convenient place for us was in Washington, PA. There's a place there called "Mail Boxes Plus More" and it's located in a renovated train station, so it's got an awesome historical feel to it. They were open on Saturday so that's the reason we decided to go there. Anyways, the finger scanning laser machine was having trouble for the first customers but once it warmed up we got ours done in about 7 minutes each. I didn't know it but there's a special rolling technique to having your fingerprint scanned. You've got to roll with the right force, at the right angle and at the right speed or you aren't rewarded by the satisfying beep of success. Finger rolling is certainly an undervalued art form and deserves further study.
3) The Child Abuse Form was easy to do, just like the State Background Check. We just filled out a form, sent it in the mail, waited a week or so to get our results, scanned the result and uploaded it to the certified profile site.
4) Immunizations were a pain to do, but I am happy to say that today I should be finally finished with all of them. Because the cost of these immunizations was prohibitively expensive here in Morgantown, we drove to Fairmont to the clinic to get them done. The clinic has some of the nicest staff that I've ever met and it was a pleasure to be there. It's located just across from Fairmont State University and is called Monongahela Valley Association of Health Centers. In addition to our immunizations, I had some blood work done at the laboratory there on Wednesday and got my results today.

I've always had high cholesterol. Despite my slim BMI of ~18.5 my cholesterol has been over 200 for my entire life. Way back in early May I had my cholesterol done and didn't like my results.

                                                  normal
Total Cholesterol - 210 mg/dl     (<200)
Triglyceride -         163 mg/dl     (<150)
HDL Cholesterol - 35 mg/dl       (>40)
LDL Cholesterol -  143 mg/dl    (<130)

I was glad that my total cholesterol was down from around 230 earlier, but I still wasn't satisfied. I decided to eat less fattening foods, exercise more and take fish oil tablets. I'd eat more fish but it's just too expensive to eat a serving everyday, and although I love to eat tuna I don't want to introduce heavy metals (within reason) to my body. In addition, with the nuclear power plant in Fukushima continuing to spew radioactive cesium, iodine and even more harmful isotopes into the Pacific Ocean I'm even more wary of eating seafood. (I just hope that the fish oil tablets come from fresh water fish.) I had changed my daily regimen and it looks like it had a positive effect! My results that I got today are as follows:

                                                  normal

Total Cholesterol - 205 mg/dl     (<200)
Triglyceride -         85 mg/dl       (<150)
HDL Cholesterol - 46 mg/dl       (>40)
LDL Cholesterol -  142 mg/dl    (<130)

I can't be sure which change to my lifestyle brought about the most change, but I believe that the dramatic drop in triglycerides and slight rise in HDL are due mostly to taking the fish oil tablets.

BUT!

The physician who saw me had the foresight to order a variety of tests on my blood while I was getting my cholesterol checked and I found out that I have my first deficiency! (At least that I know of.) I don't know why I'm excited over it. It must be because I'm always looking to improve my health and now that I know about it I can do something about it.


It turns out I'm quite deficient in vitamin D (20.6 ng/ml, normal 32-100). We just covered vitamin D on our endocrine physiology test so I know quite a bit about it still. Vitamin D mainly comes from our skin when we're exposed to ultraviolet radiation, but it can also be found in fish, eggs and some meats. Well, I don't really get much sun exposure because when it's cold here (everyday in the Spring, Fall and Winter) I wear a sweater and pants. I also don't eat much fish (too expensive), eggs (too much cholesterol), or meat (too much other bad stuff).


My deficiency is such that I have a prescription for vitamin D now. I'll pick it up tomorrow in between my studying for microbiology.


Vitamin D deficiency is usually associated with impaired intestinal absorption and renal re-absorption of calcium and phosphate which are needed for your bones. I'm glad that it was caught before it developed over the course of many years and I suffered an unexpected fracture. In the end, I've got to thank having all of these extra requirements for going to Pittsburgh. There's a bright side to everything.


Monday, October 24, 2011

Brrrr.

This month the weather has taken a turn for the colder and with it my vigor to study hard has been sapped. I've always disliked the cold because it just paralyzes my muscles. It's bad when the weather is close to freezing and you want to go for a jog, but it's even worse when your hands are so cold you can't write with a pencil or type on a keyboard very well. So, I've moved my studying from my desk and into my bed.

Studying in bed is great and now I have an excuse to do so. My electric blanket keeps me comfy, my stretched out legs have plenty of room to move around and my bed isn't too cluttered because I'm on a queen sized mattress. At night I share my bed with my binders, textbooks and notebooks by my side. How very fitting for the life of a graduate student.

Tests are a constant presence in my mind. We have been having at least one per week and it seems that as soon as we finish one we barely have time to draw breath before turning our attention to the next test. Next year during our rotations we're only supposed to have one test per month, so it will give us more leeway to study what we'd really like to. For example, right now I'd like to review some anatomy that I learned during the spring semester and create some more digital flash cards. But I realize that if I turn my focus towards anatomy, it's not going to help me on my microbiology test in three or four days from now. It's like learning or relearning old material kicks out the new material  in my head. Wouldn't it be great if our minds had the storage capacity of a computer? As long as I wasn't stuck with a 1.4MB floppy disk for a brain, I'd be able to absorb and recall all of the information that I wanted to.

Among all of our classes this fall semester, I'd have to say that my favorite has been our microanatomy course. It's not easy and there's a lot of memorization, but looking through the microscope is like delving into another world. Histology is quite bizarre when comparing what's on a slide to what we see in our everyday life. Pathologists have quite the imagination when they say something like a cell pattern has a 'starry-sky' appearance or a nucleus has a 'Pince-Nez' appearance. (Usually they don't look anything like their descriptors. Perhaps these pathologists breathed one too many formalin fumes during the discovery process.) Anyways, this class is starting to affect my everyday life. Whenever I see something that has a strange pattern to it I'm reminded of all sorts of diseases. The wallpaper in my room looks hemorrhagic and papillary with nests of poorly demarcated cells surrounding capillaries. I'm surrounded on four sides by a huge inverted papilloma covering the walls of my room.

Sunday, October 9, 2011

Dress Code and Other Thoughts

I can't remember where but I learned a saying a long while back that goes something like, "The clothes that you wear are a reflection of your heart." Since then, I've tried to dress more appropriately for each situation. It's not a requirement at WVU that you dress formally, but my daily attire is usually a dress shirt with black slacks and black dress shoes. I probably dress more formally than other students here, but I've never felt the need to wear a tie as part of my daily routine. Many people here wear t-shirts, shorts or jeans to class, which is just fine with me. It's definitely more comfortable attire than what I wear. Students wearing scrubs or white lab coats are also commonly seen.

Friday we had two tests and tomorrow, Monday, we have another one. I'm about all studied out. It always seems that once you reach a threshold no amount of further studying is going to help you. I think of it as diminishing returns for each extra hour invested past your limit.

I never realized how big football here was until this summer. Walking around town on a game day is like entering another world. The sidewalks and parking lots become crowded with people dressed in blue and yellow and the smell of hot dogs permeates the air. Tailgating is almost like a religious ceremony here. I've never really been interested in watching sports or attending a sports game. My father follows sports intently, so I'm not sure why those genes weren't passed down onto me. Rather than watching other people play a sport, I'd rather just play the sport myself. I can't live my life vicariously through the players on the field. I enjoy my life too much to be concerned about whether a player can catch a ball 70 yards down the field with two opposing players trying to tackle him. Getting together with friends and family and enjoying watching a football game is perfectly fine. But I'd rather get together with friends and family and just have fun over a game of Texas hold'em, hearts or Egyptian War.

Thursday, September 29, 2011

Just School As Usual

It's been awhile since I've updated but you can all rest assured that everything is going as smoothly as things can go here in West Virginia. Last week we had quite a number of tests but this week has been more relaxing thus far.

Last week our online course on educational methodologies started and I was glad to quickly get our first assignment done and over with. Every laboratory has a procedure manual for how to do everything that needs to be done in the lab and it was our assignment to write a procedure for a specimen of our choice. As PAs, we may find ourselves in supervisory roles and it seems more and more that my feeling of responsibility is increasing. Which is good. It's also partly due to our class on laboratory management. Throughout my life many of the jobs that I've had were ones in which a person was frequently looking over my shoulder and I was following what ever they ordered me to do. It was simple and I didn't need to think very hard. It wasn't necessarily to my disliking because I like being able to focus on my work and to do a good job at it. My first job related taste of being in a position of leadership was during my time as an English teacher in Japan. It was more stressful having to 'make orders' than to 'follow orders' for me, but I did find satisfaction from my pupils looking up to me. I can only hope that acting in a leading role in the pathology laboratory will be just as rewarding.

I've said it before, but one advantage of studying pathology is that you can correlate a lot of what you learn with your own personal life. I'm always looking for ways to avoid getting cancer and other diseases. I had always wondered whether artificial sweeteners, like aspartame, are actually bad for you or not. My wanderings on the internet brought me across "The Carcinogenic Potency Project". They have a good section on 'Misconceptions about the Causes of Cancer'. After reading the article I realized that I too was guilty of some of them. If you've ever had questions such as whether eating 'organic' is really healthier or not, then you should find it an educational read. Bruce Ames, if you know who he is, also helped to write the article.

That reminds me. I need to go get some more fruits and vegetables the next time I'm at the supermarket.

Friday, September 16, 2011

How to Find an Apartment in Morgantown

This week we've had three tests and I'm glad that they are finally over with. I've been busy studying as usual, but so far this semester seems more easy going than the spring semester. I can't tell if it's because I've gotten used to living here or if the course material is actually easier to understand. This fall semester, on most days our classes finish at around 3PM, which is nice to get out early and head home for a little relaxation before studying.

I'd like to make a post about housing while studying in Morgantown. I am by no means a housing expert, so I'll just go off of the limited knowledge that I've gained over the past year. When I was first thinking about this post I was considering actually naming different housing complexes, but since I've never personally lived at those places I can't really give a good impression of them. I hope to instead give some resources on housing in general and things to consider just for Morgantown.

Before I start, it's best to know what the layout of the area surrounding the campus looks like. I've made this small map here. I know, I know, my skills with paint are enviable.
I've taken this image from Google Maps and added a few notes. You'll see the Health Science Center (HSC) right in the middle. To the west, north and east, I've put three black circles. These areas are preferable when choosing an apartment. They are relatively close to the campus and are quiet neighborhoods. I've placed a red circle with an 'X' in it towards the south. These houses are where mostly the undergraduates stay. The housing there can be really cheap if you are strapped for money, but it will be hard to concentrate on Friday and Saturday nights. Also, this part of the campus is a bit isolated from the HSC and you may have trouble getting to classes in a timely manner.
I've also added a bar at the lower left. I left my car back in California so I walk everywhere I go. If you intend to walk to class I would recommend keeping within 25 minutes walking distance of the HSC.

From my experience, average housing costs in Morgantown will be $550-$600 monthly. This includes all utilities and trash service. Cable and internet are usually separate. I've seen some places go for as low as $350, but they are usually located downtown and you need to share the apartment with two or three other people. I currently pay $450 for my place that I found on Craigslist, although I am roommates with my landlord.

On-Campus Medical Center Apartments
http://housing.wvu.edu/graduate_student_faculty_and_staff_housing/mca
The first place I looked into before I moved to Morgantown was the on-campus Medical Center Apartments for graduate students. The location can't be beat because it's right next to the Health Science Center where nearly all of your classes will be held. You can get from your apartment to class in under 5 minutes. However, there are a few drawbacks to staying here. From what I understand, you need to be on a waiting list to get in. It might be 6 months before you know for sure whether or not you've gotten in. The other drawback is the higher than average cost, which ranges from $627 to $758 per month.

WVU Off-Campus Housing Resource
http://studentlife.wvu.edu/OffCampusHousing/roommateswanted.htm
The WVU website has an awesome bulletin for people who are looking for or advertising a room. Students who have a place but want to find roommates commonly post on here. The number of advertised places usually goes up during the end of the semester when students are graduating and need someone to take over their leases.

Google
Just go to Google and type in 'Morgantown Apartments'. You'll find a list of commonly advertised places such as 'The District', 'West Run' or 'The Ridge'. I personally don't know any specifics of these places. Look to see if they fall within the black circles on the map I made above and if they do, then compare their rates.

Craigslist
http://morgantown.craigslist.org/
You might be hesitant to try Craiglist, but it has worked for me so far. Well, I've had mixed success. As you may well know from reading this blog, the first place I went to had bedbugs. I expect that no matter where you go, there will always be undesirable things that landlords will not tell you about. I believe that my place was an anomaly and since none of my classmates had that problem, I assume that Morgantown is relatively bedbug free.
There are two places that you'll want to check out on Craigslist. Under 'Housing' you'll find a link for 'apts / housing' and 'rooms / shared'. Both will have plenty of places to choose from. As always, use your judgment and check the address to find out if the location is close to campus or not.


There are just a few other things to note while living in Morgantown.
-If you are bringing your car, you need to know that driving can be a harrowing experience in winter. The roads can get a thin layer of ice on them and people routinely crash or get fender benders. In addition, there are some major hills with steep inclines. In the winter, going up and going down those hills can get scary. Traffic during these times can come to a standstill.
-Roads can also become clogged during the morning rush hour and afternoon rush hour traffic.
-If you are walking to school, during the winter you'll need boots and a good windbreaker.
-Public transportation in Morgantown, while nice, is not always available or on time. I've used the bus system plenty of times. It's usually on time, but there have been times where I've waited at a stop for 45 minutes and the bus has never come. So, I would suggest that you not rely on the bus to commute to school. Using the bus is better for getting to the Morgantown Mall or the University Town Center.
http://www.busride.org/
-The Personal Rapid Transit (PRT) is useful for getting around to the different campuses, such as going from the HSC to Downtown, but it's not all that useful for commuting to and from school.
-Bicycling in Morgantown is tough. The various hills make it difficult unless you have legs of steel. The HSC is located on a giant hill and it's a monster to climb. I would say that it's better to bike for recreation than to integrate it as part of your commute.

That's all for now. If I think up of anything else I'll be sure to post it here. You'll need to use a variety of resources to find your ideal place. There is no 'magic' place that is going to be super cheap, close to campus, quiet and furnished like a king's throne room. None of my classmates nor I have had a terribly difficult time with our living conditions, so there's no reason to fret about finding the perfect place. Happy house hunting!

Saturday, September 3, 2011

A Trip to the Pathology Laboratory / Gross Room Part 2

I've been wanting to post about my experience in the gross room this week and I've finally found the chance to do it. Each of us students are assigned a week in which we'll go to the gross room everyday from Monday to Friday. So, in addition to regular classes and studying (well, lack of studying really) I spent a total of 21 hours in the gross lab at Ruby Hospital this week. It was a busy week to say the least, but I really got a much better feel for grossing than what I had before.

Before this week, the only grossing experience I had was observing the pathology residents and the 2nd year PA students do grossing and dictation. It was great to finally get some hands on experience and try it for myself. By Friday, even though I was still going much slower than everyone else, I had gotten the pattern of dictating down in my head. Of course, I only worked on the most simple of cases, but it was still really satisfying to make those first baby steps.

The easiest and most common cases that I encountered were the GI (gastrointestinal) biopsies. This is when the doctor looks down into your throat or into your bowels for any polyps or growths, cuts them out (they are mostly smaller than the size of a bb) and sends them to the lab for you to gross them. Typically, you'll receive 2-4 small formalin filled containers with tiny pieces of tan tissue from either the esophagus, stomach, small intestine, large intestine or rectum. I'm proud to say that I encountered so many of these that I can now give a simple dictation off the top of my head! This is an example of how a simple dictation is done here at Ruby.

Let's say we got some GI biopsies from Mr. John Smith:

Part A is received in formalin, labeled "Smith, John" and "esophagus." It consists of a 0.3 x 0.2 x 0.1 cm tan-white irregular soft tissue which is submitted in toto in cassette A1.

Part B is received in formalin, labeled "Smith, John" and "duodenum." It consists of two tan irregular soft tissues measuring 0.3 x 0.1 x 0.1 cm and 0.4 x 0.3 x 0.2 cm which are submitted in toto in cassette B1.

Part C is received in formalin, labeled "Smith, John" and "rectum." It consists of seven tan irregular soft tissues ranging from 0.1 x 0.1 x 0.1 cm to 0.3 x 0.3 x 0.2 cm which are submitted in toto in cassettes C1-C2.

What's really interesting about dictating is that you aren't necessarily typing all of this on a keyboard. An experienced PA can both cut open specimens and speak about what they are seeing at the same time so they use a microphone to cut down on the time it takes to gross. Plus, when you're cutting open some specimens your gloved hands will get a bit... messy, and although it's not a problem to get the keyboard dirty I like to keep my workplace as clean as is reasonable.

So really, when you're speaking into the headset, what you're saying in the dictation is really this:

part a is received in formalin comma labeled open quote john comma smith close quote and open quote esophagus period close quote it consists of a zero point three by zero point two by zero point one centimeter tan hyphen white irregular soft tissue which is submitted in toto in cassette a one period

.....


Now we're getting into some foreign language skills! Learning to speak like this brought back some memories of when I was studying Japanese. It seemed awkward at first, and it was, but within a week I was able to get the hang of it and decrease my time by about half. Of course, the other more experienced PAs were still going twice as fast as I was, but it was good to finally be able to do it on my own.

In addition to GI biopsies, with the help of the other PAs and residents, I was able to work on skin biopsies, liver biopsies, bone biopsies and breast biopsies, but the biggest and most difficult one I worked on was the placenta. There are a lot of parts to the placenta that each need their own dictation. The parts that need to be looked at are the umbilical cord, the amnion, the fetal surface, the maternal surface and the parenchyma inside the placenta. It took a long time, but with the assistance of a PA working there I was able to gross it. Now, I can look back on it nostalgically and think, "Ahh, my first placenta."

So, that is how my week went. I didn't get a chance to do much studying, but I lucked out because this is a three-day weekend. I'll definitely be able to catch up thanks to Labor Day.

Also, I received an email back from the AAPA. Unfortunately, they said that I could not use any data from the job hotline, as it is exclusively for members only. So, I can't write a post about in which states are PA jobs opening up.

But, I do have other great news. Our program director, Cheryl, came back to the university after having attended a couple of conferences and at one of those places she met a representative from the place that I briefly shadowed at in Fresno/Clovis CA, called Pathology Associates. The representative was on the lookout for new PAs to hire and she did me the favor of mentioning me. Since I'm originally from Fresno/Clovis, it would be an ideal place to start working as a PA as soon as I graduate. Could it be that I'll already have a job lined up before I even finish my first year in PA school? I'm really excited for this great opportunity.

So, thanks to all of the PAs, residents and our program director, I've had a busy but awesome week. PA school is great! (Did I just say that?)