Examageddon

Eleven exams and a third year of naturopathic medical school are over!

Congrats, First and Second Years!

...to all the first and second year CCNM students who finished their exams today!

Enjoy your summer! 

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Please come and visit the class of 2014 in the clinic when you return to school in September. 

I promise we'll take good care of you!

Baby Poo

Today is my Maternal and Newborn Care Exam. 

In celebration of finishing this course, let's chat about baby poo and digestion:

A baby's first stool (aka poo) is thick and black. It is known as meconium. This stool has been collecting in the baby's bowels since the 16th week of the pregnancy (crazy!). Meconium is made of bile fatty acids, mucous, and sloughed off epithelial cells.

Moving on, if a baby is breastfed, his or her stool will be liquidy, mustard-colored, and odorless. Babies who are fed formula will have harder, darker, and much smellier stools! The iron contained in formula can be constipating for babies, contributing to development of these hard, dark, and smelly stools.

The newborn baby's stomach can only hold 15 to 30 mL. That's only a tablespoon or two! Amazing. This is why newborns need to be feed all.the.time! And while we adults have gastric emptying and bowel movements every 8 to 24 hours, babies empty their bowels every 2 to 3 hours, which means there is a lot of poo. The glycogen stores of babies are also very small (note: we store fuel for between meals and sleep through glycogen), also contributing to their constant need for food.

Mothers know that they need to burp their babies after a meal and that "spit-up" is a common occurrence  Babies often get this regurgitation as their cardiac sphincter of their stomach is still weak and doesn't properly seal off the stomach, allowing some milk to come back up.

Source unknown; not my picture. 

In terms of newborn food, you've probably heard that "breast is best". However, we were taught that the terminology to use when promoting breast feedings is now "formula has risks". The problem with the former phrase was that moms thought that "sure breast is best, but formula is pretty good too!". This new caption is aimed at educating moms that there are risks involved with feeding a child formula!

Eleven

Eleven final exams and year three is done-and-done. 

Please bear with me over the next two weekn as I prep for and write my exams; I may not be blogging regularly. 

Good luck to all CCNM students writing exams! 

Bittersweet

I am about to begin the last.week.EVER.

That's right: this week is my last week of classes at CCNM! 

No more pencils, no more books, no more teachers' dirty looks... 

This post is titled Bittersweet for a reason, however.

While I am so, so excited to get out of the classroom and into the clinic, I'm a wee bit sad about ending almost two decades of classroom time. I like being a student, it's what I know! I love learning, I love taking notes, I love hearing from experts (my professors), I love seeing my classmates everyday, and I love routine. I know that the learning won't stop (my patients will become my new teachers!) and I'll still see my colleagues around the clinic, but it will be different. Good different, but still different. I'm sure the month of May will be pretty stressful as we all adjust to this new system of learning. But by Summer, I'm sure we'll have mastered the operations portion of our year four experience (charting, audits, case management files, the PAX booking software, taking out equipment, changing treatment rooms, monitoring modality numbers, ICD codes, and so much more). And once those headaches are out of the way, it'll be smooth sailing: we'll be back into a routine and our patients will dictate the course of last year of formal learning.

But in the meantime, I'm going to soak up this last week of being a student... a mere third-year... spending my days in the Lecture Theatre... comfortably seated, just one in the crowd... trying to take in as much good knowledge as I can...

...while waiting for the next bathroom break to chat and complain with my peers about the eleven exams that stand between us and clinic. Eek!

Life Updates

- I have roughly one month left of classes until I enter clinic! It's going to be the last month I set foot in a classroom in my life... after twenty years of classes. Crazy.
- I start learning vitamin B12 injections tomorrow.
- I've made this pizza twice now. Awesome!
- I have my official clinic schedule for next year! I'm super happy with the shifts I have AND the supervisors who I'll be working under. I'll talk more about my shifts, satellites, and supervisors in a later post.
- I had my OSCE 3 on Friday. Here is how it runs: enter clinic room, greet patient, take their history (i.e. ask them a ton of questions about their health complaint), rule out emergent conditions and red flags, perform physical exams, diagnose the patient, recommend further testing/labs, and recommend a treatment for their condition ...all in 18 minutes ...all the while being marked/evaluated by a clinic supervisor who is sitting in the corner of the room ...then repeat this whole process two more times with two new patients. It was an adrenalin-packed hour that's for sure!
- I celebrated completed OSCE 3 by checking out this place with friends. Fun times.
- I think my OSCE 3 went very well. I was proud of performance(s). I have to pass OSCE 3 in order to enter clinic. Here's hoping the evaluators thought I was competent!

Caramel Apple Timbits

- I made these donuts yesterday (but since I didn't have a donut pan, I made "timbits" using a mini muffin tin).  They are pictured above.
- Anyone have nice Spring weather yet? While it's sunny out here, it is still cold.
- I walked into Bulk Barn this weekend: holy Easter candy overload! I forgot how sugar-laden this holiday is. However, seeing them all (an entire row of Eater candy only, by the way) brought make nostalgic memories. Malt chocolate eggs, foil wrapped chocolate eggs, jelly beans, gummy bunnies, mini eggs, caramel filled chocolate eggs... Om nom nom!
- I selected my clinic office for next year. I'm going to be sharing a room with two of my CCNM best buds. 

...and we're back!

...back to school, that is. 

After 2+ weeks of reading week and midterms, today was the first day back to school. It was busy being back to the grind, but I missed the hustle of bustle of daily school (however, some aspects were extremely stressful, so I hated those parts of today... more on that in another post). Also, now that it is March, things are busy again so I can't guarantee daily posts. I'll pop in as much as I can, but if I don't post, it's because life and school are really hectic!

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Check out this awesome Canadian health news! I've talked about dandelion root in the past as a good liver detoxifier and replacement for coffee, but who knew that it fights cancer? I'm actually having a cup of dandelion tea right now as I type! Here's my favorite brand, but you can also buy this one, or this one. Or, as explained in the news article, you can make your own by grinding dandelion roots!

Image taken from the Traditional Medicinals website. 

Phew, January is over!

Well, January is officially over.

It was the busiest month that I have ever had at CCNM. You can expect way more blog posts now that February is here because I will certainly now have more free-time. It was a month of challenges, being put on the spot, and testing my "doctor skills". Overall, despite being busy, it was a super fun month!

I am actually loving third-year. It is challenging and fast-paced, but it is very motivating and "real". No more learning the theory behind something... instead we are actually doing that something. When I first started third-year I absolutely dreaded the Winter semester (what I am going through now). However, as I was going through the worst of it (the month of January) I found myself really enjoying the process! I was rarely stressed or worried. I guess my confidence has been built up high enough that I am  actually feeling great about my abilities to "play doctor" and therefore I don't worry or fret about the times when I will have to perform what I've learned in a timed and tested environment. For example, OSCE 3 is coming up and I am not feeling the least bit worried. It is nothing more than another hurdle that I will have to get-over in order to becoming a ND.

January featured...

1) Performing three phlebotomies (aka blood draws from a vein)

2) Being Scribe in Primary Care for a disc hernation case

3) Being Doctor in Primary Care for a positive HIV patient case

4) Performed my first spinal adjustment (and have since done three adjustments a week on my partner)

5) Continued to see patients in Clinic while shadowing a fourth-year intern

6) Attended two pediatric appointments; during one I got to perform a physical exam on a 2-year old. So adorable!

7) Volunteered several times at a chocolate company here in Toronto and also at the naturopathic medicine-geared business class

8) Conducted another Chinese Medicine patient intake and provided treatment regarding my patient's TCM diagnosis

9) Finished 99% of the organizing for Women's Health Week (coming up in March!)

10) Worked on CCNM's formal committee (an annual formal-dress dance/dinner), keeping the volunteers in track and working on ticket sales (also in March!)
11) Performed my first gynelogical exam on a female patient
12) Performed my first genitourinary exam and digital rectal exam on a male patient
13) Spent a lot of time on my cookbook. Things are now moving along nicely!

 

Well, it's pretty much smooth sailing from now until the mid-March. Come mid-March I'll get super busy again due to Women's Health Week, formal, and our third and final OSCE exam!

How Romantic!

Did you know that since I started at CCNM in 2010 (September), that I have written SEVENTY exams? Wow, wow, and more wow!  Thanks to my classmate T for counting.

Yesterday we wrote our last exam, Radiology and Advanced Imaging Techniques, and boy, what a way to end an exam period! This was, by far, the funnest (not a real word, I know) exam that I have ever written at CCNM! We all sat in the pitch dark; the examination theatre's lights were turned off so that we could best see the images that were projected onto the screen in the front of the theatre. A series of eleven images were then shown on the screen, with each image pausing for four minutes before moving onto the next. This reel of images then cycled through once more. We were all given an exam sheet with exactly eleven pages; one page per image. Each page featured a series of short answer and multiple choice questions  that (for the most part) pertained to the corresponding image shown on the screen. Oh, and because the room was dark, we were each allowed to bring a light source to help us see our individual exam. It was quite the romantic exam: a pitch black room, filled with approximately one-hundred and forty glowing students. We were glowing thanks to our light-source of choice (candles, flashlights, mini lamps, and even a string of Xmas lights were used), but we were also likely glowing because we knew that relaxation, family, and fun were jjjuuuussstttt around the corner!

P.S. I didn't post last night because I was off celebrating the end of exams (and also my birthday gone by) by attending the opening night of the Nutcracker Ballet! It was absolutely lovely and I am so very lucky to have been able to attend it.

Ramblings and a Recipe

I'm.running.out.of.time! 

Come to mama!

...but let me be clear: I'm not running out of study time, but blogging time! Me-oh-my, where did this semester go?! I had SO MUCH to share on the blog about year 3, semester 1, but here I am, the eve before my final exam of the term, wondering where the time went. I think the problem with this semester was that I didn't have time to blog at school because the classes were actually super interesting. They weren't boring; when they are boring, I spend the class writing blog posts. They were captivating and interesting, which meant that I did my blogging late at night, often before bed, and thus when I was too tired to write out an epic post about *insert cool topic here*. Instead, my blog posts were quick and dirty (with spelling errors and missing references, oops!). Ah well, at least I managed to still blog daily despite the madness of year 3.

So, I've written 8 out of my 9 exams. One more and it's officially the holidays, wahoo!

By the way, my drug of choices during these exam: dark chocolate and tea! The darker the chocolate better. Today alone I ate about 50 grams of 90% dark chocolate (amazing!). Also, I've had so much herbal tea. Today I had three green teas (1 caffeinated, two decaf), two chai teas (both decaf), and a peppermint tea. Six cups a tea seems like a ton! No?

Oh, and my third DOC (drug of choice) during this period of exams: this gluten-free quick bread. So good, even without any toppings (but it was great with margarine and nut butter)! My next batch will replace half the apple sauce with mashed banana to make a banana bread quick bread. Might even through in some walnuts for good measure...

Blender Bread

Sorry no picture of this lovely bread because my camera was dead.  But it was a handsome bread!

3/4 cup buckwheat flour

3/4 cup rolled oats*

1/2 cup almond flour (or 1/4 cup almonds*, ground into flour)

1 tablespoon flax seeds*

Pinch of sea salt

1 teaspoon baking powder

1/2 teaspoon baking soda

1/2 cup water

3/4 cup unsweetened applesauce

2 tablespoons coconut oil

2 eggs*

Inspired by this bread. I call this blender bread because I threw all the ingredients into a blender and then blended until smooth, then poured it into a lined loaf pan (with parchment paper). If you don't follow the blender step, then you will need to grind your flax and oats in a coffee grinder, and whisk your eggs, before combining all of the ingredients a bowl. Stir well then transfer this mixture to a loaf pan. Bake at 350*F for 50-60 minutes. Let it cool fully before slicing! It slices super well if cool; if you cut it when warm, the bread will be fragile. Makes 12 slices.

Sleeping & Radiating

This week I have my Health Psychology and Radiology final exams. Here are two tidbits taken from my studying of these courses:

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We learned a bit about insomnia (inability to fall asleep or stay asleep) due to mental illness (anxiety, depression, bipolar disorder, etc) in Health Psychology this term. While treating the underlying mental illness is key in correcting the insomnia, as naturopathic doctors, we can also teach our patients about sleep hygiene. I've talked about sleep hygiene before on the blog, but in my Health Psyc notes, we learned some even stricter sleep hygiene principles that can be used to help get our patient sleeping at night! In addition to following those recommendations previously discussed on the blog (here and here), the patient should...

- Avoid all screens after 7 PM. No television, cell phones, or computers. The back-light of these electronics stimulate our sympathetic nervous system, our 'flight or fight' heightened response.
- Avoid reading anything work related in the evening. It may be triggering stress! 
- Avoid evening exercise. Complete daily exercise in the afternoon or morning. Evening exercise may 'wind you up'. 
- Aim to accomplish one or two household tasks each day. It will get the 'nesting vibes' flowing, will output some energy (increasing bedtime fatigue), and will keep the house in tidier, potentially more relaxing space. 
- Complete a trial period without any coffee or caffeine. Because we all know caffeine keeps us awake...

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While studying Radiology this morning, I came across this nifty chart that shows some common causes of radiation. Ionizing radiation is the worst; in fact, we were given this chart to help us understand why X-rays (ionizing radiation) and other forms of imaging should only be performed when the patient's case and diagnostic guidelines warrant it.  Don't be X-raying your patients all willy nilly! There must be specific presentations and patient identifiers (gender, age, body type, etc) for these types of procedures. 

Brain Dump

Brain dump (noun): a blog post where all the things that have been lingering on the blogger's mind are dumped.

- Do you know what the number one industry in the world is? The pharmaceutical drug industry. And number two? The illegal drug industry. Why are we all hooked on drugs?!

- Remember my post on the book Your Brain on Nature? Well, here is an article written by the book's author. I really like the article's title: Two hours of pine forest and call me in the morning. Love it!

Source 

- I love, love, love all the brightly colored fashion hitting stores this season (see above). It's like a highlighter exploded all over the mall. I love super bright colors; they just radiate happiness!

- I'm over halfway done my final exams (5 out of 9 exams are done and done!). I celebrated by dining at Chipotle. Yum!

- This is a very creative recipe idea. No dairy, no soy, no junk... just plain old cashews, turned into cream cheese.

- Green tea is an anticancer agent because of its medicinal epigallocatechin gallate (EGCG) content. Naturopathic oncologists often prescribe concentrated EGCG to cancer patients due to its potent antioxidant effects. While the cancer dosage of EGCG is about 600 mg three times a day, you can easily get about 300 mg of EGCG in just one cup of green tea. Maybe this is why I drink green tea every morning: for its anticancer effects!

Avena Aveeno

I start (almost) everyday with Avena sativum.

Well, Botanical Medicine is officially over, but sadly it didn't end on a happy note. The exam was rough and tough. Oh well, moving on to other modalities/subjects...

But let's be clear: just because my Botanical Medicine learning is over, it doesn't mean that you won't see any more blog posts dedicated to plants/herbs. I love them too much to ignore them for the remainder of my time at CCNM!

Today I'm going to talk about a plant that you probably already eat in the form of cookies, loafs, and morning porridge: let's talk about Avena sativa, or as it is more commonly known as, the oat! 

Avena has many medicinal properties. It can be used to combat depression, anxiety, stress, nervousness, and headaches induced to stress as it is a sedative and nervine tonic. Also, it helps both diarrhea and constipation (due to its soluble fiber content) and removes bad cholesterol (lowering blood lipid levels).

Topically, Avena is especially beneficial for itchy skin, such as eczema. Have you heard of oatmeal baths? They are a combination of two naturopathic modalities: hydrotherapy and botanical medicine! I've never tried one, but apparently you just add a half of a cup of oatmeal to a bath and hop-in whenever your skin is feeling particularly itchy. Be careful getting in/out of these baths, however; the oats' gooey fiber will make the water and bathtub feel extra slippery!

Did you know that the cosmetic company Aveeno is named after Avena the oat? The company is named after oats because they claim to put real oats in their products. However, I doubt that there are enough oats in these products to achieve a proper therapeutic dose...

Setting Intentions & Giving Gratitude

More de-stressing and mood boosting mental exercises today. These are also courtesy of my clinic intern!

Exercise 1: Start your day off right by setting intentions

Set the tone of your day by setting your day's intentions when you wake up in the morning. Right when you wake up, while you are snoozing and procrastinating getting out of bed, think about what kind of day you want to have. Set your intentions by defining the type of day you want to have. Will it be an active day? A stress-less day? A fun-loving day? A motivated day? A family-focused day? Etc, etc...

Exercise 2: Sleep better after giving gratitude

You may improve your sleep if you make happy thoughts be the last thing you think about before falling asleep. Achieve these happy thoughts by giving gratitude while lying in bed at night. You can give gratitude by answering these questions: What made you smile? What are you thankful for? What  about today made you proud? What did you do well? Etc, etc...

Myotomes & Dermatomes

In preparation for my Physical Medicine practical exam next week, I've been practicing locating myotomes and dermatomes, and testing deep tendon reflexes (using Tony as a guinea pig; you will be happy to know that all of his myotomes, dermatomes, and reflexes are intact and functional).

Myotomes are muscles that are innervated by one nerve root of the spinal cord. We test myotomes to look for any signs of weakness in a group of muscles. If a particular group of muscles is weak, then it is likely that the spinal nerve responsible for innervating these muscles may be damaged. Spinal nerves may be damaged by trauma, spinal cord lesions/tumors, or by disc herniation. For example, if you have trouble flexing your elbow, but you can extend your wrist with no problems, then it is not a cranial nerve 6 problem, but a more local problem involving the elbow flexors. If it had been a spinal/cranial nerve problem, then when the cranial nerve 6 myotome was tested (by resisting elbow flexion and wrist extension (with the actions being resisted at the same time)), then both actions would have been weak. Still confusing? Yeah, it's hard to explain myotomes in a blog post... am I am realizing this now when I've almost completed writing this post. Doh!  Anyway, you can watch how mytomes are tested by watching this video posted here. It's a bit lengthy, but it's great for someone who needs to know how to test myotomes like me ;)

Dermatomes are areas of skin that are innervated by one nerve root of the spinal cord. While myotomes are test the motor functioning of a nerve, dermatomes test the sensory functioning. For instance, if you can't feel any sensation on your thumb but you can feel sensation on your index finger, than your cranial nerve 6 dermatome is still intact and healthy. Both areas would be affected if it were a spinal/cranial nerve problem. The lack of feeling in the thumb is likely due to a local cutaneous nerve injury and not due to a spinal cord/disc/nerve root problem. You can view the dermatomes in this pretty, visual video posted here. I love learning about dermatomes because all of the teaching material for them are so colorful!

Lastly, while searching for the videos linked above to help me better understand myotomes and dermatomes, I came across this creative dance video. Through the medium of dance, the girls in the video demonstrate the testing of both myotomes and dermatomes. You can view their dance here. Now, if only I could dance my way through my upcoming Physical Medicine exam...

Squared Breathing

Exams start Monday, yikes! I was feeling a bit anxious this week and so my intern at the school's teaching clinic recommended I try this squared breathing technique to calm myself whenever I'm feeling super anxious to calm myself down. By focusing on our breath, we take ourselves 'out of our mind' temporarily. Breathing exercises like this one have been shown to help people to acutely decrease their stress and anxiety.

Directions:

Imagine that you are tracing a square with your breath (see the drawing above for an exam). Breathe in/inhale over the course of 4 seconds, then hold the breath for 4 seconds, then breathe out/exhale over the course of 4 seconds, then hold for 4 seconds before taking the next breath in. Repeat as necessary. 

Supplementing, Part 1.

In honor of my Clinical Nutrition midterm exam today, let's chat about supplements!  Part 1 of 3. 

First of all, have you heard of Biochemical Individuality before? Everyone is different; we all have different genetic backgrounds, metabolisms, and biochemistries, thus we all have different, yet specific nutritional, needs for our own optimal well-being. The theory of biochemical individuality is that even though there are recommended dosages to follow when supplementing, these doses can vary from individual to individual.

So, why supplement at all? 

Problem 1 Food Quality: Why can't I get all I need from whole foods? Unfortunately, our food today is not what it used to be. Even whole foods purchased from the store that appear nutritious can be deficient in nutrients due to poor soil quality, genetic modification, pre-mature/un-ripe harvesting, and continent to continent transportation, to name a few. The vitamin and mineral content in the foods we eat today are not as high as they were fifty years ago.

Problem 2 Absorption Issues: We don't absorb food as well as we used to. Why all the absorption issues? Because we eat too much sugar, throwing off our whole digestion and metabolism; because we eat on the run, we don't "rest and digest", not giving our body the time and atmosphere in order to fully digestion; we eat the wrong foods, confusing and degrading our bodies; we at the wrong times and even when our body doesn't even want food (i.e. boredom hunger).

Much more to come, stay tuned for Parts 2 and 3! 

Third Time's a Charm?

I'm currently completing my third-year midterms.  Wait, didn't this semester just start?  How are we at the midterm mark already?!  Oh wait, I know why: assignments. We've all been so busy completing assignments that this semester is flying by (thank you weekly Post Encounter Probes (PEPs), Homeopathy case reports, Men's & Women's Health research paper, Radiology presentation, Health Psychology portfolio, etc).

So here we are, in midterm week, year three.  You'd think that they'd be easy by now (third time's a charm, right?), but nope, they are still tricky and require lots of studying.  Oh well, I really can't complain because there is only one more to go, this week, and then only one more midterm exam period to complete ever (February, 2013)!

Midterms, Year 3, Snapshot 1: On Monday, after our brutal Botanical Medicine exam, our student government treated students to gluten-free, dairy-free, oatmeal cookies for a nice moral boost. Super yum!

Midterms, Year 3, Snapshot 2: Physical Medicine studying last night, complete with chamomile tea! I learned a bunch of exercise-like to test to determine if the patient has nerve impingement or injury, ligament and tendon tears, facet joint pathologies, or nerve tumors (neuromas), to name a few.  I learned a lot studying this material; it was actually---dare I say it---really fun to study Phys Med!

Some Lovers...

Remember wayyy back when (in 2010!) I talked about the wrist bones (aka the carpal bones)? I'm thinkin' probably not... so here's a refresher (this time with a picture, yay!):

We have eight bones in the wrist and one way to remember their names and positions in the hand/wrist region is to use the following medical mnemonic device: Some Lovers Try Positions That They Can't Handle ...or Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate.

Using the Some Lovers... phrase, you are able to remember the names of the bones by referring to the first letter in each of the words in the phrase, and you are also able to remember the positioning of the bones based on their ordering in the phrase. For instance, Some Lovers Try Positions refers to the proximal (closer to the elbow) row of bones, moving lateral to medial (or in the thumb to pinky direction), while That They Can't Handle refers to the distal (closer to the fingers) row of bones, also moving lateral to medial (or in the thumb to pinky direction).

Confusing when written in words? Probably. Here's a picture instead:

The Carpal Bones. Drawn by Becca.

NPLEX Randomness.

Awesome joke, Nora!

I wrote my NPLEX Basic Sciences exam yesterday. Phew, glad that's over.

The joke pictured above was created by my classmate and pretty much sums up how we all feel about the exam.  All that studying I did in July?  I'm not sure if it all paid off (thankfully I learned a lot this Summer, but did it help me ace NPLEX, probably not because it was such a random exam).  Was it was I expected? Not at all. Like I said, it was quite random.

NPLEX was one of the silliest exams I have ever written.  I am shocked at how ridiculous the question choices were.  When you only have 200 questions to evaluate how knowledgeable a future doctor is within the realm of basic sciences, you think you'd test them on X, Y, and Z, and leave by the wayside those minor less-relevant-to-a-doctor details.  Seriously, with only 200 questions you decide to ask about that? There were several questions evaluating my understanding of high school-level Biology (odd), lots of questions regarding the shapes of bacteria (hmm, don't know how often in my clinic I'll be observing bacteria under a microscope... I'm guessing not very often), and many concepts were repeated on the exam (you already asked four questions about the kidney, and now you want to ask me four more!). I don't know, but I feel like I would have divided up the 200 questions a bit better.  You know, feature more pathologies and test more medically-relevant concepts.

Anywho, enough complaining.  Hope I don't sound like a sore loser or anything, because that wasn't the goal of this post. In fact, I think I prepared super-well for the exam (well, as much as you can prepare for a random exam like NPLEX, ha ha). I'm very proud of my effort overall, regardless of what the NPLEX examiners say*  :)

*Note: exam results aren't published until about October, so I won't know what they'll 'say' for a long while.