The Funny Current

is actually a current controlling heart rate.

Month: November, 2012

A Short Interview with Gail Emrick, MPH

A short interview with Gail Emrick, MPH, after her presentation “A 25 year journey in International health Care” where she talked on her experiences with border health, service learning, and her work in Central America.

Gail Emrick studied at Columbia University, obtaining a dual degree in a Masters of Public Health and International Affairs with a focus on Latin American Economical and Political Development. She was most recently in El Salvador for 10 years.  During that time she served as the Project Director in a regional food security initiative with nonprofit Project Concern International, based in San Diego, California she worked at the United Nations World Food Program with Public Relations and Marketing.

The responses written in this interview have been paraphrased from the original transcript.

Do you think “service learning” is an essential experience in any health-related profession? Do you think this is something that can be integrated into medical school curricula?

It should be. With service learning, you make a connection with the people you’re helping. It puts a human face on topics like “illegal immigration”. It is an introduction to complexities surrounding what a clinician would only see the symptoms of. These things include educational level, economic challenges, and the cultural environment.

There’s a big difference between immersion and a classroom experience. There’s a lot of mention of “cultural competence”, which isn’t teachable or something you can just read about —it’s a heart-mind connection.

I definitely think there’s ways to integrate this into medical school curriculum. Unfortunately, clinicians are pressured to do more procedures, which don’t necessarily make better clinicians.

 

Do you think anyone who goes to these places (underdeveloped or border areas) can return as the same person? There are a lot of similar short-term trips that are organized to give students “hands-on volunteer experiences” but don’t seem to have the same profound effect on participants.

No, that’s the point [that you do change].

Service learning is an intentional environment, which is the critical difference.

You do readings to prepare, analyze in groups and independently. You do critiques and reflections in group. Being in a group is important because it helps to channel what you’ve seen and what’s difficult to process alone. It took me 25 years to be able to talk openly about my personal experience with disappeared people.

By doing this, you see and understand environmental causes and impacts.

 

What do you think of the religious component of humanitarian aid? You mentioned Catholic missionaries.

I’m a spiritual person. I believe there is a spiritual connectedness, a human connection.

Spirituality is something all cultures share. The Catholic Church happened to be the Church offering humanitarian aid and accompaniment during Central Americas conflicts of the 80’s.

 

What are your thoughts on going abroad to places like these versus staying here in the United States where there is also need?

Most Americans are politically naïve about the effect that U.S. policies have on other countries. If you have a chance, go abroad and think about what you’ve seen. You can’t understand your own culture until you go outside and look in.

 

Do you think political measures are needed or just more health personnel to ameliorate the condition of people in these border areas?

A combination of both.

Everyone has a role. Like I talked about in my presentation today, the priest from El Salvador told me to go back to my privileged country and share their story (of the violence, poverty, human compassion, etc).  In the U.S., people talk about the 99% vs 1%, but actually we are the 1% by virtue of being from in the US. We are privileged. As health professionals, it’s our responsibility to advocate. We can’t ignore economic and political realities. My message is to use the blessings you’ve been given wisely.

A Surefire Way to Shorten Your Day

In my defense, the kid was obviously one of those overly-jittery ones. He also ended up throwing (literally) a temper tantrum when we had to leave because we had to take back a prop from him.

So… when I put the fluoride on his teeth, I missed and swabbed his gums real good. He started screaming and all my hard work cooing and making the audience of preschoolers feel at-ease with the dreaded “dentist” went down the drain. It’s a shame that the episode scared off 5 kids since Tim did a pretty theatrical scream, just sitting there calmly and going “AHHHHHHHHHHHHHHHHHHHHHHHHH!” And with some coaxing I actually finished up with him.

But the damage was done, and we had a few run away.

I’ve found almost nothing regarding this burning or tingling sensation a few of the kids tell me about. It makes me wonder if it’s really as bad as they say it is. I have noticed though, it happens when I paint their gums by accident instead of their teeth. I blame their cute little jaws.

Sigh, I pity anyone who pursues the dentistry field because their name will forever be intertwined with inexplicable horror.

NMS?

This woman is one of the saddest people I’ve seen. She’s pretty young and had suffered some sort of seizure or was experiencing neuroleptic malignant syndrome due to a change in the dosage of her anti-psychotic drug fluphenzine.

Another doctor commented on how she had a good Doll’s Eye sign, which in context is a great thing. It means that her brainstem is intact. As you turn her head away from you, her eyes go in the opposite direction.

One interesting learning point is that prolactin levels are high in the first 10-20 minutes post seizure. It would be abnormal to find it spiking otherwise since it’s a hormone that helps milk production.

One of my worst nightmares to be in this kind of condition, where your body is in terrible shape and you can’t control it but your mind is working. The only saving grace is that she probably isn’t aware of what’s going on around her (she slept in the middle of a lumbar puncture). The doctors tried to get some kind of reaction from her as they came in and left, calling her name and rubbing her shoulder, but nothing happened. She just lay there with her head leaning in the left, staring out and trembling slightly.

 

Antigone Bookstore

Sometimes I just need to read a book in its physical glory.

And then I go to the bookstore and it’s $16 for something I know I’ll finish in 4 hours.

I’m sad to admit that it’s just not worth it.

But the conversation I overheard there is good enough to go into “Overheard in NY”:

Little Boy: (pointing to a cutout of Obama) Why did they color him in?

Dad: They didn’t, that’s the color he is.

Little Boy: Is that the color he likes?

Dad: That’s the color God gave him (looks embarrassed at me and shoos boy outside)

Ulcers in a Past Drug User

Because I am a genius, I threw out the notes I had taken while doing rounds with the Family Medicine residents. So I’ll have to rely on memory to write this up.

One of the more interesting people we saw was a woman in her thirties who came to the hospital because of recurring ulcers that were becoming very painful. She actually had these sores for the past 3 years, mostly on the upper body, but they hadn’t bothered her enough until recently.

She had several open sores on both of her legs, the largest being around 2 inches wide. They weren’t actively bleeding, but they had some pus and had a red inflamed border. She some more on her arms and ears, and told us they were also starting to develop on her chest. She also complained of painful genital ulcers.

The team had spoken to her before and found that she had a past (questionably) history of cocaine use. Lab tests showed that she was positive for a Naficillin-sensitive Staph. Aureus infection and syphilis.

She had no fever. No rash. No HIV or any other STDs.

Levamisole

The doctors seemed baffled by the sores. When we sat to discuss our differentials, the attending looked to the pharmacist for some advice. The neat thing about this system is that it takes pressure off the MDs to know the drugs inside and out. She brought out a paper which was titled something along the lines of Levamisole-Cocaine dermatological effects. I actually came across the same one as I was doing some searches on my phone for clues to what was afflicting the patient.

Levamisole is an anti-helminthic (anti-worm medication) which is now being used to cut cocaine. Ingestion is causing ulcers and rashes to come up. Starting from around this past summer, it seems to be a “popular” agent to cut the drugs with and has been cropping up case reports from many hospitals.

The pictures seem to follow this trend of deep purple bruising patterns and some ulceration (but not much from what I can see). I don’t think that’s what the patient has, and I don’t think her CBC reflected the changes that these reports are saying: lowered white blood cell count with autoantibodies.

Syphilis

She did acknowledge that she had gotten syphilis a while back and said she got a penicillin shot for it, but now we’re not sure how long she’s had the current infection since the tests for syphilis are based on antibodies and can’t tell us about re-infections.

Syphilis is my favorite STD.

It gets this title because it’s smart. It causes painless lesions which go away and eventually causes neurodegenerative disease. If you want to stay inside your host, you shouldn’t cause it too much trouble!

It has a unique pathogenesis, going through 3 stages:

Primary: a single, painless skin ulceration commonly found in the cervix, penis, or anus. Adenopathy around the site.

Secondary: 4-10 weeks after primary infection, a maculopapular/pustular (flat and bubbly) rash on the trunk, palms, and soles.

Tertiary: Years down the line, you can get “gummas”, tumor-like grows, or neurosyphilis, causing neurodegeneration. The effects of this range from paralysis or loss of sensation in some areas to Argyll Robertson pupils (don’t constrict in light).

The End

She probably has a whole slew of problems, maybe a chancroid (to explain the painful genital ulcers), with preexisting syphilis, and neutropenia because of chronic cocaine use. I’ll be skimming through some of these other articles which discuss atypical presentations of syphilitic ulcers, and who knows, that could be part of her problem.

I’m requesting an article through the library on ulcer presentations and maybe that’ll be useful, but by that time I’m sure the woman will be released with steroids or antibiotics.

Sources

Levamisole-Adulterated Cocaine: A Case Series. Journal of the American Board of Family Medicine. 

Dancing

Exhaustion in Medical School and Beyond

There are a lot of relationship-jokes when it comes to medical students. They usually run along, “You’re never as important as the next exam”. It’s funny because it’s true. Education can be grueling, especially for premedical students who need the perfect or near perfect GPA to even be considered for medical school. After classes and studying, there’s sometimes just no time or energy to spend with a significant other. I thought it would get better as you went further along, but residents work 6-7 days a week with hours like 6 AM to 6 PM. With electronic medical records, I think it’s also possible to end up bringing some paperwork home if you can’t get it done in the hospital. It doesn’t matter if it wasn’t a particularly busy day, just having to be at attention all day and really using your brain makes you tired. I got back from just shadowing and I spent the last drop of energy keeping my eyes open on the bus because I had never taken the route before. Coming home, I had a nice cup of black Starbucks coffee then went to sleep, then got up a little later to do some work.

Where does this leave a partner (if you have one)?

Almost all the residents I’ve seen are already married, so they must have figured something out. But I wouldn’t be able to sustain being cheery and accommodating or wanting to go out and do something almost everyday. Is it a contradiction to say, “I love you but this is more important. I can’t do this right now?” Is it too little quality time spent together if you only spend maybe 1-2 days dedicated to that other person alone?

Oh Fox News:

How to Date a Med Student

Noooooooo!

Why Arizona, why?! The red shirt that was compulsory for the football game turned all of my white clothes pink! Thank God my white coat wasn’t in there.

The Elusive Peanut-Allergic Sports Lovers

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I busily cracked peanut shells with my hands, following everyone else’s example of tossing them on the ground as I kept my eyes on the game. The wind began to pick up, whipping dust storms of nut wrappings and half-empty bags of peanuts. I sat there, squinting into the sun, thinking, “I’m surprised no one is keeling over right now”.

Peanut allergies are notorious for causing anaphylactic shock–that sudden gasping and choking maneuver you often see in television shows. People with nut allergies are incredibly sensitive to the slightest amount of peanuts, so they fastidiously check candy wrappers. You may even see schools and restaurants with signs declaring that they are “peanut free” zones. A classmate of mine said to her mother, a nurse, that she wanted to bring some Halloween candy to her high school tutees. Her mother didn’t let the thought go further, “Who knows if one of them has a peanut allergy? Then you’ll have a lawsuit on your hands”.

People are usually careful when it comes to food allergies, which is why I’m baffled as to how allergic people either avoid going to a game or there are none who like football.

A study in 2009 to 2010 done on infants to 18 year olds by The American Academy of Allergy, Asthma, and Immunology reports that about 8% have a food allergy. The most prevalent of allergens being peanuts.

Considering that watching sports is often a family activity, it seems especially important to make a stadium a nut-free arena. An adult might be carrying an epi pen with them, a child is more likely to get into trouble and has to be with well-informed parents.

It seems that my surprise isn’t unwarranted, and the New York Post reports that Yankee Stadium only recently (since 2011) started offering “peanut-controlled suites” but in 2012 are only offering these seats based on demand. The Mets are also in their second year of offering peanut-free seats but with a waiver since there are peanuts elsewhere in the stadium. At the time the article was published, these tickets were selling for $93 dollars each. I hope you and your child really love baseball.

Sadly, there appear to be very few peanut-free stadiums. Americans can’t let go of silly traditions, like being able to carelessly shell peanuts at a game. People can argue that banning nuts oversteps our personal liberties, but in a world where everything is sterilized and allergies are on the rise, keep in mind it could be your child or grandchild who has to keep a wide berth from cherished spots.

Sources

Allergy Statistics

We Shell Overcome! New York Post

Additional Resources

Free to Enjoy Baseball (and more). List of peanut-free events in US and Canada

Football

I went to my first football game every today. While the experience was fun, I doubt I’ll ever repeat it again.

I can’t believe there are this many people in one place, ignited by such a fervor over sports that they go out in droves to buy the “right” color shirt for the day.

halftime

Kristene got the tickets for us through a really nice couple who work in her lab. Then we hung around for a while around campus and got to eat some greasy burgers at a neighborhood joint “Lindy’s”.

Don’t you think the world would be so much better if it were a tradition to go and workout after a game instead of celebrating by drinking and eating the worst food in existence? Humans…our intelligence still has a long way to go.