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I found this forum a couple months ago and now read it daily. Thanks to all the students/residents/ and attendings who post, its a great resource. Im a third year medical student in South Dakota(dont ask just find it on a atlas). I came into third year not really sure what i wanted to do, and now halfway through im 90% gas and 10% IM. The gap is distancing every day( except for when my attending let me do flex-sigs or colonoscopies, 20+ years a video gaming really has really paid off, I can navigate the colon like fighter pilot) IM clinic and rounds usually pushes the pendulum way back to Gas. I love the amount of Knowledge required to be good at IM, it seems like IM and the diagnosis aspect of surgery(acute abd.for example), are the real meat and potatoes of medicine. I love how gas combines the depth of knowledge for pharm, CV and pulmonary physiology, CCM, with aspects of acute care, hands on procedures, and intense responsibility for a patient's life. After my surgery rotation I knew I wanted to do something procedural and KNEW I could never be a surgeon. My attending my last month(also Chief of Surgery) really gave me some freedom to spend more time in pre-op with the anesthesia providers. amazing right 😀 I loved it.
Anyway thanks for all the info, when your trying to figure out your life it really helps to hear the thoughts and opinions of people farther downt the road from you.
I wanted to start my first thread about some amazing stuff that happened during some time of your training. A time when you really came through or hell, just got lucky. Times like this really solidify for me that I made the right choice to pursue medicine and give me energy to learn more. Plus everyone likes to brag a little. 🙂 heres mine from a couple of months ago.
For my continuity of care clinic which we have all year every Tues. I had a 42 year old white male come in with a CC of cramps. He went to a doc-in-abox, they did a CBC and Lights all normal. His only lab abnromality the first round was elevated CPK. they then sent him to us. Guy works a job where he walks a lot, he is very active doing a lot of hiking etc. He mainly get a cramping sensation in his thighs, but can get it in his arms, fingers, etc...if he uses them a lot. He takes nothing for relief but water and the cramps only occur during or after physical activity. He states he make a serious effort to stay hydrated. The rest of the routine questioning was what you would expect for cramping. NO PMH whatsoever, this guy was in great shape. No Meds. No allergies. NO neurological signs, Physical exam was normal. Heres where being a student comes inhandy(having time in the office to really do a thorough H&P). Any FH of Diabetes, heart disease, HTN, etc?.... he answers no. Any FH of any medical problems?? he says "well my brother, dad, and grandfather have varying degrees of cramping too." Now where getting somewhere. We do all types of testing short of muscle biopsy, we'll get to that later. Tests for muscular dystrophy, all forms of myositis, autoimmune disorders, come back negative.
Here iswhere 1st Year BIOchem comes in handy, So my attending says I'm running out of ideas,what do you think? After a second or two of blank staring and trying not to pee in my pants I throw up the crap answer of " Well there are some glycogen storage diseases that cause cramping, but I think they are really rare." She looks a little puzzeled and says research it and we schedule this guy for a f/u next week.
Why did i think of this rare pearl for BIOCHEM. I got it wrong on a test. McArdle's glycogen storage disease presents in usually the second or third decade of life with cramping. It is usually autosomal dominant, but can be sex linked. On a matching question I confused McArdles, Pompe's GS disease, Von Gierks and got 3 wrong on a test and got a B. At the time I was pissed, I thought what a waste of information/who cares. I talk to my attending show her some info and she says lets go talk to him. So I talk to the guy next week with my attending tell him that if he does a have a GS disease, there is no cure and to diagnosis it we would have to do a muscle biopsy. He understood, but he really wanted to know for sure, it had affected him for over 20 years. Anyway the biopsy came back positive for a defieciency in muscle phosporylase, which is defficient in McArdles. He felt better knowing what was really going on with his body and actually responded to treatment with quinine. He then informed his family and they all now know why they get cramps.
The point of the story is not that im really smart(in fact I probably wouldnt remember that stuff if i didnt get it wrong on the test and subsequently so mad.) But that all the crap you learn those first two years of hell, is really important and can affect peoples lives. That experienc really renergized me to keep learning and I think we all need that from time-to-time. Any way thats my story, Lets hear some of yours. 😱
Anyway thanks for all the info, when your trying to figure out your life it really helps to hear the thoughts and opinions of people farther downt the road from you.
I wanted to start my first thread about some amazing stuff that happened during some time of your training. A time when you really came through or hell, just got lucky. Times like this really solidify for me that I made the right choice to pursue medicine and give me energy to learn more. Plus everyone likes to brag a little. 🙂 heres mine from a couple of months ago.
For my continuity of care clinic which we have all year every Tues. I had a 42 year old white male come in with a CC of cramps. He went to a doc-in-abox, they did a CBC and Lights all normal. His only lab abnromality the first round was elevated CPK. they then sent him to us. Guy works a job where he walks a lot, he is very active doing a lot of hiking etc. He mainly get a cramping sensation in his thighs, but can get it in his arms, fingers, etc...if he uses them a lot. He takes nothing for relief but water and the cramps only occur during or after physical activity. He states he make a serious effort to stay hydrated. The rest of the routine questioning was what you would expect for cramping. NO PMH whatsoever, this guy was in great shape. No Meds. No allergies. NO neurological signs, Physical exam was normal. Heres where being a student comes inhandy(having time in the office to really do a thorough H&P). Any FH of Diabetes, heart disease, HTN, etc?.... he answers no. Any FH of any medical problems?? he says "well my brother, dad, and grandfather have varying degrees of cramping too." Now where getting somewhere. We do all types of testing short of muscle biopsy, we'll get to that later. Tests for muscular dystrophy, all forms of myositis, autoimmune disorders, come back negative.
Here iswhere 1st Year BIOchem comes in handy, So my attending says I'm running out of ideas,what do you think? After a second or two of blank staring and trying not to pee in my pants I throw up the crap answer of " Well there are some glycogen storage diseases that cause cramping, but I think they are really rare." She looks a little puzzeled and says research it and we schedule this guy for a f/u next week.
Why did i think of this rare pearl for BIOCHEM. I got it wrong on a test. McArdle's glycogen storage disease presents in usually the second or third decade of life with cramping. It is usually autosomal dominant, but can be sex linked. On a matching question I confused McArdles, Pompe's GS disease, Von Gierks and got 3 wrong on a test and got a B. At the time I was pissed, I thought what a waste of information/who cares. I talk to my attending show her some info and she says lets go talk to him. So I talk to the guy next week with my attending tell him that if he does a have a GS disease, there is no cure and to diagnosis it we would have to do a muscle biopsy. He understood, but he really wanted to know for sure, it had affected him for over 20 years. Anyway the biopsy came back positive for a defieciency in muscle phosporylase, which is defficient in McArdles. He felt better knowing what was really going on with his body and actually responded to treatment with quinine. He then informed his family and they all now know why they get cramps.
The point of the story is not that im really smart(in fact I probably wouldnt remember that stuff if i didnt get it wrong on the test and subsequently so mad.) But that all the crap you learn those first two years of hell, is really important and can affect peoples lives. That experienc really renergized me to keep learning and I think we all need that from time-to-time. Any way thats my story, Lets hear some of yours. 😱
