Second Year Analysis

Being a second year is pretty crazy. In the two first weeks, I went through 3 pens, an entire 70 page college rule notebook, and half a pack of loose leaf notebook paper. And I learned everything I need to know about lungs. Three weeks later, I had mastered the kidneys. A week after that and I am half way through the cardiovascular system.

I definitely liked Physiology in college. Learning how organs work. Pretty fascinating. But now, as a second year medical student, we don't just cover the basics. We really have to understand the who, where, what, when, how, how likely, in what order, what dose, what color, and any other question you could ask regarding physiology and pathology of the body systems. And we have to understand these concepts in 2-4 weeks per system. I have been getting pretty frustrated. I can't type fast enough, can't focus my attention long enough, can't learn as thoroughly as I would like. I keep thinking about my future in rotations, maybe in residency, maybe as a practicing who-knows-what-kind-of physician. I meet a patient with any one of the hundreds of pathologies we have learned, and I blank. Bad news for my patient, and I sure look like an idiot. All because I didn't learn it second year.

Except that's just my imagination getting the best of me. Medical school is alllll about repetition. We have already repeated certain important concepts dozens of times, and in rotations/residency I will see them again and again and again before I ever see patients on my own. With time, these abstract and ridiculous concepts will be drilled into my head and my future hypothetical patients won't end up with me looking back with a blank face. Also - doctors don't actually have to remember all of the lab values and formulas and concepts and medications. There are apps for that...

So really after thinking about it, second year is just the first run through for each system. Every out of breath patient, every patient on dialysis, every patient with heart disease will drill in the concepts that I obsessively pour over until my fingers are black from ink and numb from writing/typing. Maybe I just need to remind myself to take a chill pill and learn what I can when I can. Which means adios to my blog and back to learning about EKGs.

*Because of my lack of fun medical facts, here is a scary pic of what sudden cardiac death looks like on EKG (v-tac, v-tac, v-fib, a-systole). Let's hope I don't see this too often in my patients.

Kidney Facts and Doodles

I have been bad and haven't posted yet during our renal (kidney) block. The test is tomorrow, so I guess I have to post today!

The past three weeks have been kidneylicious. Normal kidneys look like, well, kidney beans. But pathologic kidneys can be pretty funky. Autosomal dominant polycystic kidney disease (ADPKD) is especially horrific. The kidneys can get bigger than your head, and they have gross balls of fluid in them that the pathologist decided to pull out and display on the table and squish around for emphasis. Gross. See the ADPKD pictures below....YUCK!

My favorite thing about kidneys is that they seem to make no sense until you really really understand everything. For example, the volume of water in your body depends on salt intake / output, not how much water you're drinking. And the amount of salt you have depends on how much water you drink. So to the kidneys, water = salt and salt = water. I promise it makes sense once you understand all of the hormones and transporters (a nice and simplified diagram of the transporters can be seen below, along with kidney doodles).

Fun fact - although Weight Watchers and famous TV hosts say that we should drink eight glasses of water a day - it IS NOT TRUE. At least according to the nephrologists (Kidney Doctors). They say you know when you need water because your brain (anterior hypothalamus) senses that you are water low (hypernatremic), causing your brain to make you thirsty / retain water (side note: the hormone that does this comes from the same place as OXYTOCIN!). So drink when you are thirsty and you should be fine. I asked if drinking water helps with weight loss. The nephrologist didn't really know (or seem to care). Too busy to research that, but your kidneys do not need eight glasses of water a day! I always hated having to pee all the time from all that healthy water. Turns out, I was wasting my time peeing. 

For my excersizers out there - DON'T TAKE NSAIDS (anti-inflammatories - like aspirin/ ibuprofen / naproxen) before strenuous exercise (like a marathon). NSAIDS inhibit prostaglandins which help keep your kidneys moving during low volumes (AKA when you are dehydrated from your exercise). Also, drinking too much water during a marathon can also cause you trouble. Basically marathons are dangerous.

Kidney Doodlings

Yes, this is simplified...

Hypertension (high blood pressure) depends a heck of a lot on the kidneys. And I finally understand how to treat it thanks to an AMAZING lecture by our course director. There are tons of meds for hypertension, but it really doesn't matter what you take (unless you have other diseases or specific side effects), and apparently thiazide diuretics are a good choic first anti-hypertensives. Also, if you are hypertensive, just keep your blood pressure as near to 140/90 as you can (again, unless you have other diseases - like diabetes - then keep it close to 130/80) because below that you don't have much lower mortality. Also, your meds won't help you unless you actually stop eating so much dang salt.

So tomorrow I can say Goodbye Kidney (no cute graphic for that one)... or at least until I encounter my next hypertensive patient.