There was a point in time when I was very comfortable programming. I had finished my engineering degree and I had co-op and project experience in embedded and network programming. Next, I went to Microsoft and worked on the VB compiler there for a year. It was amazing how much more I learned about programming working at that company and more importantly, working with the people there. Being around a group of co-workers that were fanatically passionate about their work meant that I was exposed to new techniques, tools, and ideas that made me a much more efficient and talented programmer.
When I left Microsoft for medical school, I told myself that I would program on a semi-regular basis to make sure I retained what I had learned and stayed on top of the latest developments in the software industry. I was not under the delusion that I would have the time or energy to program regularly and become better, I just thought I could prevent regression.
After the first term of my first year, I threw together a very simple physics engine and created an incredibly basic simulation of the human immune system. This was a hacky project at best, but it was really the most I could do considering I actually wanted to take a break during my vacation.
Then in the summer after first year, I was using Excel to analyze data for a research project. I was able to dramatically reduce analysis time by writing VBA scripts to automate a lot of the grunt work. Again, this wasn't really programming, this was just scripting.
Now, as I'm looking at some of the most recent posts on programming blogs and forums, I realize that in two years there has been a lot of development in programming and the tools programmers use. Some of these changes are just fads or modified ideology (read: the flavour of the month), but many of them are true developments in the evolution of programming. Even though I currently feel like my programming knowledge is not up to date, I'm sure I can catch up if I dedicate some solid time to actually coding, but programming isn't really the most important skill for me to develop at this point in my career. With CaRMS (residency matching) coming around the corner, I should probably dedicate the time I would spend coding on, y'know, learning how to be a better doctor. It seems like the reality is that by the time programming will be a useful skill for me to have (in residency when I'm doing research is my best guess), I will probably have to re-learn a great deal of it. Fortunately, the most important skill a programmer can have is an analytical thought process...and that is something that doesn't degenerate (unless you have dementia).
The reality is...if you want to be a coder...you should code. Taking a break can be rejuvenating, but don't take it for too long because the industry will have moved along rapidly without you...
Thursday, June 3, 2010
Tuesday, June 1, 2010
Multiple sclerosis breakthrough as researcher saves wife
Dr. Paolo Zamboni has been in the news several times in the past twelve months for his breakthrough discovery. He claims that patients with multiple sclerosis (MS) have been found to have clogged veins that are responsible for the symptoms of their disease. He bases this claim on his finding that most patients with MS have clogged veins, but their symptoms stop progressing and often become better after the veins have been unclogged. This is a breakthrough because currently we have been treating MS with immunosuppresive drugs that have had mixed results.
The article makes an error when it claims that Dr. Zamboni's findings contradict the current understanding that MS is an autoimmune disease. Hypothetically, the clogged veins prevent drainage of toxins which causes an inflammatory response in the brain. This inflammatory response causes the blood brain barrier to become permeable to immune cells, which is normally a good thing because it allows immune cells to enter the brain and attack the toxins or infection causing the inflammation. However, when these immune cells enter the brain constantly they may may instead wreak havoc on the myelin of the nerves (the current supported pathogenetic mechanism of MS is that the immune cells attack the myelin of the nerves). This theory, which is also mentioned in the article (so it really doesn't make sense that the article claims the findings oppose the belief that MS is an autoimmune disease), allows both the current understanding of MS and Dr. Zamboni's findings to co-exist peacefully.
An interesting subplot in this story is that Dr. Zamboni was motivated to perform this research because his wife was suffering from MS. He studied the current research on MS thoroughly and realized that patients consistently had increased iron deposits around the veins that drain blood from the brain. Most physicians and researchers attributed this to the constant autoimmune reactions associated with MS, but Dr. Zamboni thought that it might be more significant. After measuring the blood flow of the venous drainage of MS patients and realizing that they were significantly lower than healthy people...he developed his new therapy...
I bet that he won't be yelled at if he forgets to put his clothes in the hamper, at least not for a couple of months...
The article makes an error when it claims that Dr. Zamboni's findings contradict the current understanding that MS is an autoimmune disease. Hypothetically, the clogged veins prevent drainage of toxins which causes an inflammatory response in the brain. This inflammatory response causes the blood brain barrier to become permeable to immune cells, which is normally a good thing because it allows immune cells to enter the brain and attack the toxins or infection causing the inflammation. However, when these immune cells enter the brain constantly they may may instead wreak havoc on the myelin of the nerves (the current supported pathogenetic mechanism of MS is that the immune cells attack the myelin of the nerves). This theory, which is also mentioned in the article (so it really doesn't make sense that the article claims the findings oppose the belief that MS is an autoimmune disease), allows both the current understanding of MS and Dr. Zamboni's findings to co-exist peacefully.
An interesting subplot in this story is that Dr. Zamboni was motivated to perform this research because his wife was suffering from MS. He studied the current research on MS thoroughly and realized that patients consistently had increased iron deposits around the veins that drain blood from the brain. Most physicians and researchers attributed this to the constant autoimmune reactions associated with MS, but Dr. Zamboni thought that it might be more significant. After measuring the blood flow of the venous drainage of MS patients and realizing that they were significantly lower than healthy people...he developed his new therapy...
I bet that he won't be yelled at if he forgets to put his clothes in the hamper, at least not for a couple of months...
Monday, May 31, 2010
Work Life balance in med school
Work life balance is an important issue for anyone and everyone (with the obvious exception of those who don't have to work to afford a living...or conversely, those who are dead). However, the general impression that most of society has about med students is that the balance is tipped heavily towards the "work" side.
Before I share my thoughts on work life balance as a med student, I want to make a disclaimer: this is my perspective only...an obvious disclaimer maybe, but a very important one. I say this because for most of my post high-school life I have been warned about the horrible work life disbalance associated with the decisions that I was making. In high school, my teachers warned me that university, particularly engineering, involves consistent all nighters and long days hunched over books in the library. These teachers were clearly unaware of the digital revolution that would allow me to be hunched over a monitor in my home instead. Regardless, they were very wrong as I had an amazing time at university. The balance was tipped far to the life side, I did not study that much and I only ever pulled one all nighter (building a robot that would seek magnetic sources) while still being very successful. This was similar for most of the people I met in university. Sure, there were different periods where we didn't go out as much, particularly during exam season, but for the most part, most of us had a great time through university. I say most because there were certainly some individuals who had to work harder to understand the material taught in lecture, which resulted in them spending more time studying. I certainly respect these people for their dedication and perseverance, but they were definitely in the minority.
Next, when I finished my undergraduate training and I was offered a job at Microsoft, people were quick to tell me stories they heard about their friend's uncle's dog-walker's brother who was worked hard at Microsoft and never saw natural sunlight, much less his family. This was a particularly terrifying prospect for me because I am fairly opposed to developing osteomalacia. However, during my time at Microsoft, I had an amazing work life balance. I worked hard for 8-10 hours a day, but I had my weekends and evenings free and I was well compensated. I was able to manage this balance while still being successful at work and even being promoted at the end of my year there. Of course, in this situation again, there were individuals who were working much harder that I was...hacking away in front of their monitor all day, but they were the minority from what I saw. Keep in mind that I was only really exposed to one team at Microsoft, other divisions may have been run differently. Also, I was a junior employee and only there for a year. If I wanted to work my way up the ranks, I may have later had to work longer hours, I have no idea.
If you got anything from the above stories, I hope it was that you shouldn't whole heartedly take anyone's opinion about the work life balance of anything. My experience through med school thus far is my experience and every other med student has a slightly or very different set of experiences.
I have been able to strike an excellent balance between school and life throughout the first two years of med school. I go out at least twice a week with friends/family; I play soccer competitively and I can make it to two practices and two game per week; and I'm interested in research so I do that on the side, in moderation, throughout the year. I also have an awesome girlfriend, which I normally wouldn't mention, but I think it is relevant here because relationships do require a reasonable time commitment. I'm able to do this and still stay on top of the material being taught. However, in order to maintain this balance, I have to be more disciplined than I ever have been before. I barely ever procrastinate and I have made some sacrifices. I didn't think I could manage playing both soccer and hockey competitively, so I gave up hockey. I also don't program at all during the school year, which is a skill that I want to maintain, but I realize that it isn't necessary for my immediate needs so it has been put on hold. Again, my experience is not unique, I have many classmates that would say the same about their work life balance. However, with regards to life in med school, I'm not sure if I would say that the outright majority of students share this kind of balance. There are a fair number of my classmates that spend a significant amount of time at the library throughout the year and they are constantly studying. I personally believe that for the most part, they do not have to study that hard, but exam anxiety is driving them to study hard from the very beginning.
However, during the month before exams, work life balance is out the window. A month before the exams begin, I'm either in classes or studying. I'll go out once a week and go to 2 soccer practices and 1 game a week, but that is it. I'm basically working 14 hours, 7 days a week. There are times when I really do feel like a prisoner in my room. Unfortunately, we have so much material to learn that we have no other choice. Despite what I said earlier, I feel comfortable saying that all med students will agree about this kind of work life imbalance during exams.
Now that I'm done 2nd year, I'm hearing horror stories about how busy I'll be in 3rd year. Should I believe them?
Before I share my thoughts on work life balance as a med student, I want to make a disclaimer: this is my perspective only...an obvious disclaimer maybe, but a very important one. I say this because for most of my post high-school life I have been warned about the horrible work life disbalance associated with the decisions that I was making. In high school, my teachers warned me that university, particularly engineering, involves consistent all nighters and long days hunched over books in the library. These teachers were clearly unaware of the digital revolution that would allow me to be hunched over a monitor in my home instead. Regardless, they were very wrong as I had an amazing time at university. The balance was tipped far to the life side, I did not study that much and I only ever pulled one all nighter (building a robot that would seek magnetic sources) while still being very successful. This was similar for most of the people I met in university. Sure, there were different periods where we didn't go out as much, particularly during exam season, but for the most part, most of us had a great time through university. I say most because there were certainly some individuals who had to work harder to understand the material taught in lecture, which resulted in them spending more time studying. I certainly respect these people for their dedication and perseverance, but they were definitely in the minority.
Next, when I finished my undergraduate training and I was offered a job at Microsoft, people were quick to tell me stories they heard about their friend's uncle's dog-walker's brother who was worked hard at Microsoft and never saw natural sunlight, much less his family. This was a particularly terrifying prospect for me because I am fairly opposed to developing osteomalacia. However, during my time at Microsoft, I had an amazing work life balance. I worked hard for 8-10 hours a day, but I had my weekends and evenings free and I was well compensated. I was able to manage this balance while still being successful at work and even being promoted at the end of my year there. Of course, in this situation again, there were individuals who were working much harder that I was...hacking away in front of their monitor all day, but they were the minority from what I saw. Keep in mind that I was only really exposed to one team at Microsoft, other divisions may have been run differently. Also, I was a junior employee and only there for a year. If I wanted to work my way up the ranks, I may have later had to work longer hours, I have no idea.
If you got anything from the above stories, I hope it was that you shouldn't whole heartedly take anyone's opinion about the work life balance of anything. My experience through med school thus far is my experience and every other med student has a slightly or very different set of experiences.
I have been able to strike an excellent balance between school and life throughout the first two years of med school. I go out at least twice a week with friends/family; I play soccer competitively and I can make it to two practices and two game per week; and I'm interested in research so I do that on the side, in moderation, throughout the year. I also have an awesome girlfriend, which I normally wouldn't mention, but I think it is relevant here because relationships do require a reasonable time commitment. I'm able to do this and still stay on top of the material being taught. However, in order to maintain this balance, I have to be more disciplined than I ever have been before. I barely ever procrastinate and I have made some sacrifices. I didn't think I could manage playing both soccer and hockey competitively, so I gave up hockey. I also don't program at all during the school year, which is a skill that I want to maintain, but I realize that it isn't necessary for my immediate needs so it has been put on hold. Again, my experience is not unique, I have many classmates that would say the same about their work life balance. However, with regards to life in med school, I'm not sure if I would say that the outright majority of students share this kind of balance. There are a fair number of my classmates that spend a significant amount of time at the library throughout the year and they are constantly studying. I personally believe that for the most part, they do not have to study that hard, but exam anxiety is driving them to study hard from the very beginning.
However, during the month before exams, work life balance is out the window. A month before the exams begin, I'm either in classes or studying. I'll go out once a week and go to 2 soccer practices and 1 game a week, but that is it. I'm basically working 14 hours, 7 days a week. There are times when I really do feel like a prisoner in my room. Unfortunately, we have so much material to learn that we have no other choice. Despite what I said earlier, I feel comfortable saying that all med students will agree about this kind of work life imbalance during exams.
Now that I'm done 2nd year, I'm hearing horror stories about how busy I'll be in 3rd year. Should I believe them?
Sunday, May 30, 2010
New Respiratory Illness
I'm a little late on this one because I was busy with exams, but here is an article talking about a possibly new respiratory illness that seems to be contagious.
So be careful if you live near Glengarry hospital and you are thinking about going in!
So be careful if you live near Glengarry hospital and you are thinking about going in!
Saturday, May 29, 2010
Pre-Clinical Years....Done
Most medical schools in North America are 4 year programs. The first two years focus on pre-clinical, lecture based theory. The final two years are practical, hospital based training where we actually learn how to practice medicine.
Being lecture based, the first two years are very similar to undergraduate years...just a lot more work, a LOT. As an undergrad, I usually had 6 or 7 final exams per term, which is more than most undergrads because I was in engineering. In medicine, I had 10 or 11 final exams per term. On top of that, each exam had considerably more material than I ever dealt with in undergrad. So, like I said, med school is a LOT of work.
Looking back, I have definitely learned a lot in the past two years. Not just about the science of medicine, but also interacting with patients. As physicians we have a limited amount of time (often only 10 minutes) to talk to patients when they are most vulnerable. Comforting and reassuring a patient with that kind of time restriction is definitely a skill that takes time to learn and experience to perfect.
I'm interested in seeing how things progress in the next two years, when we get to put theory into practice...
Being lecture based, the first two years are very similar to undergraduate years...just a lot more work, a LOT. As an undergrad, I usually had 6 or 7 final exams per term, which is more than most undergrads because I was in engineering. In medicine, I had 10 or 11 final exams per term. On top of that, each exam had considerably more material than I ever dealt with in undergrad. So, like I said, med school is a LOT of work.
Looking back, I have definitely learned a lot in the past two years. Not just about the science of medicine, but also interacting with patients. As physicians we have a limited amount of time (often only 10 minutes) to talk to patients when they are most vulnerable. Comforting and reassuring a patient with that kind of time restriction is definitely a skill that takes time to learn and experience to perfect.
I'm interested in seeing how things progress in the next two years, when we get to put theory into practice...
Wednesday, April 14, 2010
Why does massage or movement relieve pain?
Have you ever stubbed your toe and then grabbed or massaged your foot to relieve the pain? Or have you ever seen someone hit their own thumb while they were using a hammer and wondered why they would then shake their hand to make the pain go away?
If anything, these actions are counterintuitive methods of pain relief. If you just damaged a body part, wouldn't putting pressure on it or moving it around cause more damage?
Turns out that a lot our behaviour that appears counterintuitive at first glance makes sense once you finally understand the mechanics at work. In this case, when you hit your hand, foot, or any body part, your pain nerves from that body part send a signal through your spinal cord into your brain. This signal is what makes you think "ouch". There are other nerves that also originate in this same body part that send signals when the body part is being touched or moved. When these nerves are activated they temporarily attenuate or reduce the signal being sent from the pain nerves to the brain, giving you temporary pain relief.
Of course, this phenomenon doesn't work in every scenario... if you ever have your arm sawed off... it will hurt, a lot, no matter how hard you shake it...
If anything, these actions are counterintuitive methods of pain relief. If you just damaged a body part, wouldn't putting pressure on it or moving it around cause more damage?
Turns out that a lot our behaviour that appears counterintuitive at first glance makes sense once you finally understand the mechanics at work. In this case, when you hit your hand, foot, or any body part, your pain nerves from that body part send a signal through your spinal cord into your brain. This signal is what makes you think "ouch". There are other nerves that also originate in this same body part that send signals when the body part is being touched or moved. When these nerves are activated they temporarily attenuate or reduce the signal being sent from the pain nerves to the brain, giving you temporary pain relief.
Of course, this phenomenon doesn't work in every scenario... if you ever have your arm sawed off... it will hurt, a lot, no matter how hard you shake it...
Tuesday, April 6, 2010
Does Tiger Wood's platelet-rich plasma transfusion therapy work?
Tiger Woods, and apparently many other athletes, have tried platelet-rich plasma transfusion to accelerate their bodies' natural healing process to get themselves fit to play after injury sooner than normal. Platelet-rich plasma transfusion is used to heal tendon injuries, which are very common in both professional and amateur sports. The treatment involves collecting a patient's blood and removing his red and white blood cells so that only the plasma remains. This plasma, which is injected into the injury site, contains platelets, which release platelet derived growth factor (PDGF), which plays an important role in the natural healing process.
One of the reasons tendon injuries usually heal slowly is because they do not receive much blood; thus, very few platelets and PDGF ever reach the injured tendon. Injecting platelets into the injured tendon augments platelet delivery to the damaged tissue.
This article is a great introduction to platelet-rich plasma transfusion and also contains an interview with the physician who used it to treat Tiger Woods.
An important thing to note from the article is that we have not properly studied the effects of this therapy; thus, we cannot truly be sure that it actually works, nor can we be sure that it doesn't lead to some additional harm years after the injection is given. The article agrees that we need more research before we can state that platelet-rich plasma is a reasonable and effective treatment option for chronic tendon injuries.
One of the reasons tendon injuries usually heal slowly is because they do not receive much blood; thus, very few platelets and PDGF ever reach the injured tendon. Injecting platelets into the injured tendon augments platelet delivery to the damaged tissue.
This article is a great introduction to platelet-rich plasma transfusion and also contains an interview with the physician who used it to treat Tiger Woods.
An important thing to note from the article is that we have not properly studied the effects of this therapy; thus, we cannot truly be sure that it actually works, nor can we be sure that it doesn't lead to some additional harm years after the injection is given. The article agrees that we need more research before we can state that platelet-rich plasma is a reasonable and effective treatment option for chronic tendon injuries.
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