Long gap in my posting.
Just started my 7th rotation as a neurology intern. 'Family Medicine'. What a joke. They have a pretty rough time with all the random ass shit they encounter, but this rotation is 'tarded. At least I get the holidays off, right?
My zeal for learning and dedication to doing neurology readings has all but halted. Lots of things going on in my life (new baby: Adalyn, New lifting crew, Family issues, etc.). And reading has just not been too high on my list of things to do.
Medicine:
I'm disenchanted with modern medicine for the most part. The litigious atmosphere is bullshit. I've noticed a lot of what my attendings do is based on 'not getting sued' rather than what is best for the patient. "Oh, the patient has a headache? Better get a CT, CTA, MRI, and prep them for a 4 vessel angio... Normal neuro exam? Can't be too cautious, ya know."
Example: We come upon our HIV patient who has PCP (PJC?) pneumonia. He's completely encephalopathic, agitated and lashing out. My attending, being fearful of intubating this patient because of the overall risk of death of intubating a patient with PCP PNA, delayed intubation. What he failed to understand is the risk of death is in tubing a patient BECAUSE of PCP PNA, not because they are unable to adequately protect their airway. The patient had sats dipping into the 70's, not responding to any intervention they tried. This persisted far too long, until I got an Istat that showed PO2 in the low 50's and an O2 sat in the low 80's. At this point I had to take it upon myself to call anesthesia to get the patient tubed, and the critical care unit for a transfer.
It is unacceptable to have a situation deteriorate in this manner with someone who, fearful of the outcome of one intervention, withholds all interventions and puts the patient at an even more immediate, grave risk.
Sometimes a little knowledge is dangerous... especially when it paralyses you and interferes with your judgement.
Lifting:
Found a new couple of guys to lift with. One is on my level as far as strength goes, the other is a bit stronger than I am ( and 70lbs lighter.)
We have been doing "The Cube Method" for the past couple months. LOTS of volume, (bench, squat, and deadlift sets in the 10-20 rep range.) It's pretty intense, and I already have felt my strength get considerably increased.
Recently:
Did reverse band bench press with ~30-45lbs off at the chest, did 395, and had a bit more in my tank. 3 board presses with 275x11+ and other ridiculous exercises were done as well.
Squats have been lacking because of a nagging back injury. These guys do a lot of Safety squat/Yoke bar training with squats, which is a new experience. Sets of 10 with 225 is pretty rough, where sets of 365 for 10 were doable with a standard bar... I maxed at just under 500 a couple weeks ago, but once again, I think technique is the problem, not strength... I keep collapsing forward... and I can only goodmorning so much weight...
Deadlifting has been pretty good. Most notably getting a 505 conventional pull last week was pretty good for me... considering it was after some snatch grip deadlifts ( 3 sets of 15 at 315, and one set of 11 at 405)... Speaking of Snatch grip DL's... These light up the glutes like you would not believe.
--I look forward to making some gains with these new guys... as Long as my schedule will let me lift with em... Lucky bastards are able to work and lift at the same place, so their schedule doesn't always mesh with mine... Schade.
--Hope to update this a bit more often nowadays.
---Merry Christmas, all!
--Darktide
25 December 2012
14 April 2012
Medicine :
Med school is coming to a close. Next week is my last week of my last rotation as a med student. 3 work days separate me from freedom for at least a couple months. Things are coming together, medical license application in, contracts signed and returned, etc. I even received the 'unfinalized' schedule of my intern year. First rotation- ICU. "Out of the frying pan and into the fire." fits the situation.
These last two months of Neuro-Ophthalmology have taught me vast amounts about neurology and management of Neuro-op patients. Aside from getting a crash-course in the ophthalmalogic exam (something that isn't taught in med school), I've had to really apply myself to learn vast amounts about an extremely difficult subspecialty. My attendings place a premium on knowing and understanding physiological pathways associated with Neuro-op. Their mantra seems to always revolve around "Localize, before you generate a differential". I've been told this through all of my neurology and related rotations. Though never really embracing this previously, I am now understanding the how and why they were so insistent about this.
Diplopia, for example, has only 6 localized causes, starting distally: Neuromuscular junction, Extraocular muscles, Nerves to these muscles, Extraocular muscle nuclei supplying these nerves, Interconnections between these nuclei, and higher order functions that provide input to the nuclei (supranuclear). Once broken down into such categories, you can generate a differential based on which of these categories appear in and are relevant to your physical exam.
Thankfully this method of approaching a neurological patient is salient and applicable almost universally across medicine.
Gym:
Squat: Did some suit work. 405x2 raw, suit on: 585 for a single. Went up fast and easy. I think I could get mid to high 6's pretty easily. Maybe I'll try in a month or so.
Floor Press: 315 for a couple doubles. Got pinned by 335 after that. I'm going to stick with FP for a cycle or two and see how it helps my bench press. I'm quick off my chest, but stick mid position, which FP seems to hammer hard
Overhead Press (OHP): I'm feeling the effect of increasing my conditioning work. 205x3 reps (should have been 5).
Deadlifting: I'm feeling pretty weak in the deadlift. Between doing Kettlebell/dumbell swings, my numbers suffered this week. 405 for a couple sets of 5. 465 for a double. I've decided to add power-shrugs in place of power-cleans. Worked up to 365x20.
Med school is coming to a close. Next week is my last week of my last rotation as a med student. 3 work days separate me from freedom for at least a couple months. Things are coming together, medical license application in, contracts signed and returned, etc. I even received the 'unfinalized' schedule of my intern year. First rotation- ICU. "Out of the frying pan and into the fire." fits the situation.
These last two months of Neuro-Ophthalmology have taught me vast amounts about neurology and management of Neuro-op patients. Aside from getting a crash-course in the ophthalmalogic exam (something that isn't taught in med school), I've had to really apply myself to learn vast amounts about an extremely difficult subspecialty. My attendings place a premium on knowing and understanding physiological pathways associated with Neuro-op. Their mantra seems to always revolve around "Localize, before you generate a differential". I've been told this through all of my neurology and related rotations. Though never really embracing this previously, I am now understanding the how and why they were so insistent about this.
Diplopia, for example, has only 6 localized causes, starting distally: Neuromuscular junction, Extraocular muscles, Nerves to these muscles, Extraocular muscle nuclei supplying these nerves, Interconnections between these nuclei, and higher order functions that provide input to the nuclei (supranuclear). Once broken down into such categories, you can generate a differential based on which of these categories appear in and are relevant to your physical exam.
Thankfully this method of approaching a neurological patient is salient and applicable almost universally across medicine.
Gym:
Squat: Did some suit work. 405x2 raw, suit on: 585 for a single. Went up fast and easy. I think I could get mid to high 6's pretty easily. Maybe I'll try in a month or so.
Floor Press: 315 for a couple doubles. Got pinned by 335 after that. I'm going to stick with FP for a cycle or two and see how it helps my bench press. I'm quick off my chest, but stick mid position, which FP seems to hammer hard
Overhead Press (OHP): I'm feeling the effect of increasing my conditioning work. 205x3 reps (should have been 5).
Deadlifting: I'm feeling pretty weak in the deadlift. Between doing Kettlebell/dumbell swings, my numbers suffered this week. 405 for a couple sets of 5. 465 for a double. I've decided to add power-shrugs in place of power-cleans. Worked up to 365x20.
08 April 2012
I decided to start this blog while lying on the floor of the gym unable to move today after a 'conditioning' session... I'll try to get this thing up to date as far as my life is concerned as time permits...
Workout: 20min of sprints on the recomb bike, followed by 15 minutes of KettleBell swing intervals (@~50lbs? only heavy KB my gym has...)
This is the first time I've done KB swings in roughly 5 years, so it was quite the experience... I'm always reluctant to do 'conditioning' days as they always seem to diminish my number for the upcoming strength workouts. I've always been a thick guy, and I see conditioning as a necessary evil to keep me from becoming a wad of lard... but I do absolutely hate it. Absolutely. I rate conditioning right up there with getting my thumb smashed with a hammer, or stapling my nutsack.
Academic-wise: I've submitted my second draft of an article on nystagmus that is to be published in Nov 2012 (Current Opinions in Ophthalmology) to my attending (AKA: The supreme overlord of all things eye-movement related). I'm fully expecting to get it back looking as if it were dunked in a bucket of red ink... Oh well.
2 more weeks of Neuro-ophthalmology left until I'm done as a medical student forever... I graduate on May 3rd; then internship starts in July. Awesome. That 2 months off will be paramount, as my girlfriend and I just signed on a house; and we should be moving within the next month and a half or so... Loads of stuff left to do...
Workout: 20min of sprints on the recomb bike, followed by 15 minutes of KettleBell swing intervals (@~50lbs? only heavy KB my gym has...)
This is the first time I've done KB swings in roughly 5 years, so it was quite the experience... I'm always reluctant to do 'conditioning' days as they always seem to diminish my number for the upcoming strength workouts. I've always been a thick guy, and I see conditioning as a necessary evil to keep me from becoming a wad of lard... but I do absolutely hate it. Absolutely. I rate conditioning right up there with getting my thumb smashed with a hammer, or stapling my nutsack.
Academic-wise: I've submitted my second draft of an article on nystagmus that is to be published in Nov 2012 (Current Opinions in Ophthalmology) to my attending (AKA: The supreme overlord of all things eye-movement related). I'm fully expecting to get it back looking as if it were dunked in a bucket of red ink... Oh well.
2 more weeks of Neuro-ophthalmology left until I'm done as a medical student forever... I graduate on May 3rd; then internship starts in July. Awesome. That 2 months off will be paramount, as my girlfriend and I just signed on a house; and we should be moving within the next month and a half or so... Loads of stuff left to do...
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