everything you wanted to know about poop...and more. GI system quotes

“We are following where the food goes. It starts in the mouth and it goes out the..... tooshie...” - Pummy

“We promise none of these tapes will be shown to your future patients.” - Pummy

“Good morning everybody, I am sorry you have to see me again... I know most of you thought you were done with me after head and neck.” -Chew

“There’s two parts to the tongue, the oral part, which is moving around right now like crazy for me.... and the root of the tongue.” -Chew

“[The teeth] are lined by gingival mucosa... gingival mucosa is commonly known on the streets as...gums.” -May

“Generally when the dentist pulls the tooth, what they basically due is rip the PDL, of course at the same time you hear a pop, which is very reminiscent of opening a champagne bottle. If you like champagne you will like having your teeth extracted.” -May

“This is why individuals giving speeches may suffer from dry mouth... much as I am now...” -Wagner on sympathetic oral nerves causing secretion of mucinous saliva

“How many of you have had a tooth cleaning?” – Boehm
::One student raises their hand::
“Well I hope it is more than that” – Boehm
Poor Dr. Boehm… none of us could understand you =(

“Why would you give 2x daily PPI instead of 1x? Well it is very simple, because 1x daily isn’t working.” - Bahlodia on GERD treatment

“Well the parietal cells, their nucleus is located on the side... you see it looks like a pac-man. I used to play that game...” Al-tikriti finally let his true nerd shine through.

“I have to retract some thing I have said about the GI system being a dumb kidney.. because now I am working in the GI system...” -Barnes

“And in this way we can get more bang for our bile salt dollar.” Wagner on Enterohepatic circulation of bile and how much of the secretions are reabsorped.

“Aren’t you glad we don’t do surgery this way anymore. You can imagine being that patient.... all these people staring at you, no anesthesia, the nurse sort of holding your head... I was going to put a bottle of jack daniels in the patients hand, but I thought that might not be appropriate for class.” Barnes

“Mr. Belly Pain (spelled Belli Paine) came in for nausea and vomiting, hah ha ha.” Barnes

“Joseph why don’t you whip Ashlynn on the table and show us how to do the psoas sign... okay nevermind, we will have this naked lady show us how instead.” -Barnes

“He says he can feel the appendix on the rectal exam. He has long arms I guess...” -Barnes in response to a student describing what they would like to order next for our patient.

“Often times you find that the student goes in and gets a history and they get one story. You send your intern in and they come out with a different story, you send your resident in and they get a third story, then you go in and get a completely different story...” -Davis
“It’s called historical alternans.” -Barnes along with Davis on the difficulties on making a diagnosis in real life.

“What is concerning about this patient? Did someone say because she is a woman?” -Barnes
“No, I said its because she’s an old woman.” Emory
“I wouldn’t want to be you right now Emory...” -Barnes

“Anatomically the liver is probably one of the most boring organs you will find.” -Kheun
“I have never heard the liver called boring, maybe it is boring at the gross anatomy level, but I will try and make it interesting for you at the histological level… I think…” -May

“If I take a cut through here, and put it under the microscope… you are going to look at that and say boring! A new buzzword from Dr. Keuhn.” -May

“Hopefully you can appreciate the liver, it is not boring, it has got structure. It is boring until you get to the microscopic level.” -May

“What do you know about RNA viruses with respect to antigenicity? ::silence:: Anything?” -Thrush

“And sometimes Dr. May is like that…. You will have to contact him directly since he is loathe to put up his powerpoints on blackboard…” -Kheun
“And Dr. Kheun should know what Dr. May is like…” -Pummy

“It either cold in here, or I have a 24hr hepatitis that is going around…” Pummy

“Oh, only a few of you haven’t seen this interesting…’yeah I have them at home’ “-Pummy

“Are you guys just looking this up? Because I can also just read a list... It’s like kissing your sister.” - Pummy

“Let’s take a look at Dr. Khuen’s [quiz] question... he is no longer here to get any tomatoes thrown at him.” - Pummy

“Remember all bleeding stops.... eventually.... so let’s try and do that before the heart stops as well.” Pummy on how to manage esophogeal varices

“Where is the problem and why are we using spirinolactone? God that goes back to the fall
… that sucks...” - Pummy on treatment of cirrhosis with diuretics and a drug we learned about during endocrine.

“What lactulose does is it lowers the nitrogenous waste that is going into the portal system... you shit it out. That is a technical term for that.” -Pummy on managing a patient post TIPS procedure.

“Dr. Mehta do you need to be excused?’ -Pummy on Mehta raising her hand to get his attention
“It’s a hormone” - Mehta
“Oh yeah... vasopressin it is the anti-diuretic hormone” - Pummy

“My question is who boo’d after the quiz? Were you booing me in general or was it all of us up here? What’s that? You want to know which question I wrote and you’ll get back to me? Well, you will see later... Don’t worry we won’t boo you back.” -Barnes after another disasterous quiz.

“Older people are at risk, because one of the genes poops out.” -Parsa describing the pathogenesis and risk factors for colorectal cancer.

“What do you want to do next for this patient? He is in the emergency room, he has bloody diarrhea... so calm him down... get him some diapers...” -Mehta on the workup for ulcerative colitis.

“What is it about this patient that concerns you? He’s crapping blood Byron says.. what else do you want to know about this crapping of the blood, since we are using this technical term.” -Barnes

“You want to ask these patients if they swallowed something, or if they put something? What do I mean by put something?” -Barnes on the differential for bloody diarrhea

“Are you guys going to share the joke?” Barnes
“Sorry I made a joke about pink eye” Student
“Wow, I am not going to touch that one. Alright well what would you be looking through the anoscope for, besides to develop pink eye.” Barnes

“This first lady comes to us all the way from the cardio system, she missed us so she is back in GI...” - Pummy

“Okay that one person, are you just trying to kid with us, you wanna make sure we go through this entire year without one 100%?” Pummy on the results of a class quiz question polling.

“What kind of situations outside of an outbreak would you expect to see viral enteritis?” - Pummy
“A carnival.” -Student
“Okay maybe if only one person went to it.” -Pummy

“That is why you always see me walking around with water bottles, because I am getting to be a granny.” Pummy on the complications of dehydration in the elderly.

“What are the other things we could do to slow this down?” Pummy
“A cork...” Student
“A cork? Well I wouldn’t go with that first...” Pummy

“You guys have your laptops... I am working off of my memory, which over 40 is plus or minus a few facts...” -pummy

“This case reminds me of the saying, that travel enriches the mind, and loosens the bowels.” -Pummy in regards to travelers diarrhea.

“Okay go for 100%...” -Pumy
::everyone clicks in on the question he has just given us an answer to, survery says 97% correct 3% incorrect::
“Okay who is the smart ass here that clicked false?” Pummy

“Now if you were a woman Casey... and I am not suggesting you are...what could antibiotics give you?” - Pummy answer = yeast infection and a baby...

“Now if you had a young patient, and that should cover almost everyone in this room except for Karoon....” - Pummy

“Salmonella... you gotta light some candles and give it some malox for it to come in and cause trouble. It has a relatively high infectious dose. Shigella.... it’s like rambo...” -Pummy on the virulence of different dysentary pathogens.

“This is the Bristol stool chart which was developed at the University of Bristol in the UK. You can use this chart to discuss this with your patients, [#2] looks like a challah.... Any questions about anything before we go into the cases?” - Pummy
“Which one is normal?” -Student
“Well we were going to have a live demonstration, but we decided not to... What is normal? It depends on what ones own body does” ::turns bright red:: -Pummy

“Many of you are probably at this point... you are feeling furious and vindictive, instead of just irritable...” -Pummy

“Another 70 year old patient.... you notice all of my patients are either 40 or 70.... I wonder what that means... probably nothing....” -Pummy speaking only to himself I can assume

“At this point I would like to propose the use of OMT in this patient according to the MOPSY study.” Casey Pyle begins to assert various proven benefits of OMT in this situation
::class erupts in applause::
“The what study??? oh yes the MOPSY study... and the control group was using peanut oil on the skin....What you don’t believe? Good point thank you for brining that up. Its always good to bring evidence based medicine into these sessions.” -Pummy

“Now the first problem here... is that this patient is using the ER as his primary care physician.” -Pummy

“Dr. Kuehn is going to do an anatomy review..nothing has changed unless you grew any new anatomical parts..”-Pummy
“Hey what can ya say, nothing has changed since the time of Galen.”-Kuehn

“Where’s Kiff Ewing? Dorothy? Chelsea Chung? Nolan? Bueler?” -Pummy attempting to call on anyone other than Casey Pyle

“What else is important?” -Pummy
“He’s got floaters?” -Student
“No that isn’t it, I mean he does have an oil spill in his toilet bowl...” -Pummy

“Did I hear Hep C? Okay... you can retract that if you want to...” -Pummy on an incorrect differential for giardia

“That’s very good and he did that without his laptop open.... What’s your name.... and are you a student here?” Pummy after Tommy’s awesome explanation of the Giardia life cycle.

“And Dr. Kathari is here right in time... she’s got a white shoe thing happening with a sweater....” -Pummy
“I got stuck in the traffic” - Dr. Kathari
“You know pathologists don’t get the appreciation for how they dress... because they are always down in the basement...” -Pummy
“It’s true!” Kathari

“This is like egophony, someone [in the audience] says no, and it comes over as yes.” -Pummy on how hard it is to hear us in the large group sessions. Don’t worry pummy, we feel the same way in a lot of those lectures...

“Okay lets say that the patient does not get better after treatment and they still have giardia... what happened?” -Pummy
“The patient is living with a beaver?” Student
“Ok, well anything is possible...” -Pummy

“Tenesmus... where is that occuring? The rectum... damn near killed em.” -Pummy

another test weekend looms ahead...

Via facebook:

Laura: oooweee here we go again..cram, crush, compact, repeat.

Kelsea: Til Monday high noon. Then hit the eject button.

haven't written in a while....no big changes in school. here is a recap
1) we are in the gastrointestinal system, lots of diarrhea and bloody poop stories
2) i have a mild panic attack daily thinking about how close my board exams are
3) i went to vegas last weekend for a bachelorette party and while in the elevator with 10 of my gorgeous friends, 2 men walked in. they smiled and said how lucky they were to share an elevator with us...and i confidently added "yeah, and you know what the best part is? we are all going to be doctors" [i never get sick of saying that]
4) only 9.5 weeks of class until we are done with our second year [granted i pass all my classes]
5) dad's 60th birthday is this Friday!!!!!

:)

"Sometimes we are more focused on the destination than the journey when it is the journey that makes up most of our lives."

unfortunately 'are we there yet' is all i can ask myself these days

Today we learned how to suture in ECM [essentials of clinical medicine] and it was a lot harder than imagined. not only are there a ton of different knots and suture types, but the tools are pretty hard to get used to. we started off with rope and learned how to tie different suture knots. then we stepped it up a notch and each of us got a pig's foot, suture thread with needle and of course, gloves [some of em were a lil bloody at the end but it was a pretty clean set-up dont worry]. im gonna need a LOT more practice before i do that on real people!

The white coat doesn't feel like a costume anymore!

Just got home from another clinic night at Montclair and had to recap the night. It was gooooood. I saw 3 patients and managed to flawlessly finish my patient's chart's first along with impressing the resident in charge. :)

The night started off at 5pm and first we ran through all the basics for the first years that were new to the clinic and shadowing us for the night. Then at 5:30, the first patients starting rolling in. My first pt was a 45yo female to check on her labs. She had hypothyroidism and hyperlipidemia for which she was on meds for. She then started to complain about sinus pressure. I felt very confident in asking all the appropriate questions that I needed to and then moved on to my physical exam where i checked her ears, mouth, palpated her sinus', etc to rule out any infection. After listening to her heart and lungs I went back and presented to the resident. We ended up giving her amoxicillin.

Ok, so that patient wasn't too exciting but the next one was. She was a 54yo female presenting with peripheral neuropathy [google it if you need to]. She had these symptoms for a while now and was waiting for a neurology consult and since she didn't have insurance, she had to wait for a while. So, she was instructed to come in every month to get checked on until she got this consult. It was an overwhelming case because not only did this woman have a million symptoms from the neuropathy [like loss of sensation, dizziness, blurry vision, shooting pain down her leg, etc] she was also on 10 drugs to control her hypertension, hyperlipidemia, rheumatoid arthritis, back pain, etc etc. Though a pleasant women, she was a walking disaster. So, I did a full neurological exam, listened to her heart and lungs, and then went to present to the resident. After discussing things with him we decided there really was nothing we could do until the neuro consult was done. At this point we were thinking multiple sclerosis [again, google if needed...] but we were also thinking she was a a bit of a hypochondriac. Either way, it was great practice for me to perfect my clinical skills!

The last patient was a hypertensive in for a BP check, blah blah, boring stuff. The cool part of the night came when I got complemented on my perfect chart notes. Both the resident and clinic coordinator said they were clear, concise and very well written notes and that i should be very proud of them. Actually, i believe the resident actually said, "beautiful." I realize this may sound like a very odd thing to be excited about but considering I have spent the last year and a half learning and fine-tuning the art of writing a well written history, physical, and assessment/plan on a patient, I am very excited to hear that things are finally making sense.

It is these kinds of experiences that reassure me I will be a great doctor and that I have the ability to kick ass on my rotations. I didnt get nervous at all tonight, I knew exactly what I wanted to ask to rule-out certain diseases, I knew what I was doing when I took their vitals, checked their ears, heat, etc., and I did all this while I got to know the patient and make them feel at east. The student I was working with had to be impressed because I didnt hesitate with anything, I just worked through things like I was already doing this everyday....I was CONFIDENT!

Yeah grades and board scores are important, but having confidence in your clinical skills and writing a good work-up in a patient's chart are vital in doing well on rotations and eventually getting into a great residency program! I am even more excited now then ever to start rotations and to come home everyday and reflect on the fact that I am learning how to cure people and save lives. How cool is that?!

i could not agree more...

"makes his bed only when he wants a sense of control of his life."
-Mike