Thursday, July 25, 2013

Your Surroundings

The day started out with the usual drag-yourself-out-of-bed routine which resulted in me almost missing breakfast, again. Fast forwarding to class time...

The class started with a lecture by Dr. Brandon Williams, who is a general surgeon. He talked to us about Bariatric surgery, which is a type of surgery that he performed a lot. Bariatric surgery is basically weight loss surgery that alters the stomach to help patients maintain a healthy weight.
There are three types of Bariatric surgery: The gastric band, which is an adjustable band placed around the top part of the stomach to limit the amount of food entering. There is also the Sleeve gastronomy, which is when part of the stomach is cut out so food goes through parts of the stomach then straight to the small intestine. This also helps control the patient's hunger because the part of the stomach that secrete most of the body's ghrelin, a hormone that is said to cause hunger, is removed. Last but not least there is the gastric bypass. This procedure rearranges the stomach so that the small intestine is directly connected to the upper stomach so technically you are not using your stomach at all. The stomach is left in the body to lower surgery risk and to reverse the procedure if there is a change of mind. The procedures are usually recommended for patients whose BMI is between 35-40. Dr. Williams said that this method is much more successful than just going on a diet and exercise plan. Patients who have had any of these procedures done to them not only looses weight but their diabetes is gone along with most of their other health problems. I thought that this method was really cool and helpful coming from Dr. Williams. I have always had negative thoughts again weight loss surgery but thanks to this lecture another ray of light has been shed. 

After the lecture we had our team based learning class. This time the topic revolved around how neighborhood environment and socioeconomic status affects diabetes and obesity. The articles show that neighborhood environment moderately affects DM (Diabetes Mellitus) and obesity while the socioeconomic status affects DM and obesity more. People who live in 'poor' neighborhood can't afford healthy food or lifestyle so they are more susceptible to DM and OBS. Following the reading we had our readiness assessment test which we must take individually and then as a group. I'm sure I did pretty well on my iRAT but I'm not sure since we didn't get it back. On the gRAT however, we made Jake proud by scoring a 90% beating the other groups. Then we moved on to the application part of TBL. Our case was a 48 year old Hispanic woman with two children. Her health is bordering bad, her kids are overweight and she just lost her job. As a group we decided to have her checked her fasting blood sugar since it was indicated in her paper that they were a bit high. We recommended that she exercise and work out a healthy diet for her family. After the practical questions were over with, we had to face the ethical question. So our patient broke down crying about how bad of a mother she is for not taking better care of her children. I decided to give her the cold truth but then reassure her that I would help her get through it. I felt that it is better to get pass the problem and head straight for the solution then to deny the problem and get nowhere. Like if I tell you to not think of a pink elephant then what are you gonna do? It doesn't matter what I say you will think of the pink elephant so I might as well as not argue with you. By the way, thank you to Mr. Bodwin, a biomedical science teacher at Pinole Valley High, for teaching me about the pink elephant. So back to the situation. After two weeks, the patient calls back to tell you that she has been making a little progress and whether or not she should move to a better neighborhood. While some people felt that it is not the business of a doctor to tell a patient whether or not they should move, I felt that it is because moving correlate to her well being. I decided to advise her to move because the benefits outweigh the trouble. She would have access to affordable healthy food, a park and there are no fast food restaurants around. This TBL session went really well and it wasn't as chaotic as the last one. We all pretty much agreed with each other on everything so it flowed by.

Our first afternoon lecture was by Dr. Jamie Dwyer, he talked to us about the kidneys. So you can have anywhere from 0 functioning kidneys to 4 kidneys. 0 is when you have kidney failure. 1 is a pretty common condition where the two kidneys are fused into one so technically you only have one. 2 is the normal number of kidneys that a person should have, 3 is when you have one kidney transplant and 4 is when you have two kidney transplants because your old kidney(s) are/is kept inside of you. The kidneys regulate blood pressure, remove toxin, makes urine and synthesize hormones. The kidneys turns about 320 liters of blood to 1 liters of urine each day. The kidneys claim 99% of the body's water or else it would turn to dust.

Next we had a psychologist named Dr. David Schlundt to tell us about food deserts. Food deserts are just places where the residents have no transportation and/or has to drive a distance to get food. Dr. Schlundt showed is various maps of Tennessee and how it relates to the obesity map. Areas where there are food deserts are also areas where the most obesity cases are at. The maps were ranged from city sized up to state wide. Of course there are well off neighborhood where they can just order their maids to go shopping for grocery and not have to worry. He also talked about a research project he did with his colleagues and a summer student. They used GPS devices to track their movement throughout the day for about 10 days. By looking at data on where and when someone had been and at what speed. He can figure out their lifestyle. Dr. Schlundt hopes to use this method on his patients someday to help them figure out their good and bad habits and improve on them. He told us all that from this day forward, we should not look at our (future) patients as a ball of symptoms but as a whole person and how they interact with their environment.  Twice in a day, light has been shed on the way I would look at the world.

Since all of our lectures were finished and we still had lots of time left, Jon decided to tell us about his summer research project. So he spends some time in Lwala, Kenya studying soil transmitted helminths, which is parasitic worms. He tested the stool samples of many of the villagers and came up with a list of risk factors of who is more likely to get infected. Afterward we watched a video of a 15 year old who discovered a more efficient, accurate, inexpensive and fast way of detecting pancreatic cancer. After watching the video I just thought about how doomed my life is.

Tonight was the night of the VSA talent show. Everyone here is so talented at everything, some sang like angels, some danced like ballerinas, and a few gave us hearty laughs. Since it is our second to last night, we proctors allowed us to have sleepovers in each others room. My roommate went to another room to sleep so I invited a few of my friends to come over. We all settled down, watched a movie and then fell asleep. Except for me, here I am writing my blogs while listening to their soft snoring. I can't wait for my OR time tomorrow but I'm saddened by what tomorrow is; our last full day at VSA.

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