Cold Sores = The Kiss of Death

In PBL last week we learned about the kiss of death. Apparently, if you have a cold sore, you are a very serious risk to newborns.

Cold sores are caused by the herpes virus. The herpes virus has the ability to travel through nerves and infect the brain, which is called herpes encephalitis. This normally doesn't happen because healthy people have an immune system that is strong enough to prevent the virus from entering the brain. However, a newborn's immune system is still developing, which means that babies are extremely vulnerable to herpes encephalitis (among other things).

We were told the story of a resident who had a cold sore and kissed his 2 week old son. Within the next two weeks the baby had herpes encephalitis and died.

Many people carry a herpes infection; however, they are normally do not spread the infection because the virus is not actively replicating in their bodies. Cold sores are indicative of active, replicating herpes virus. Moral of the story, don't kiss a baby (or anyone really) if you have a cold sore.

No You Can't Leave...I'm Not A Real Doctor

I'm writing this post to beg everyone to remember that a 1st year medical student is NOT a real doctor. Make no mistake about it, you are doing US a huge favour when you let us see you in the clinic. You are helping us learn how to interview, give shots, perform a head and neck exams, etc. The most we can do for you is give you pleasant conversation and maybe a laugh.

This week in the clinic, I saw a man who was diagnosed with bronchitis during his previous visit, he wanted to know if he was getting better. I took his history and listened to his lungs. I haven't been formally taught how to do a respiratory exam yet, but my preceptor told me to give it a shot. How hard can it be? I know both where the lungs are and how to use a stethoscope. Anyways, I took my best guess and his lungs sounded fine to me. Unfortunately, I have no idea what they would sound like if they weren't fine, so my opinion is relatively worthless at this point and I made sure to let the patient know as much. I would hate to make him think that he was getting better only to have the preceptor see him and tell him that he needs to go to the hospital immediately.

Anyhow, I left the patient in the exam room and waited outside for my preceptor, who was seeing another patient. Eventually, my patient got tired of waiting and tried to leave. He told me that I checked him out and that was good enough.

No, it really wasn't good enough. I had to twist the guy's arm to get him to stay. Maybe next time I should tell the patient I think they have SARS, that way they'll probably wait to hear an opinion from a real doctor.

Walk-In Clinics Need To Educate Their Patients

In the medical community, there seems to be a stigma that walk-in clinic physicians only care about money and not the well being of their patients. I have primarily heard this generalization from patients who have gone to a walk-in clinic and felt rushed through their examination. I believe that walk-in clinics serve a good purpose because they allow people to see a doctor for non emergent situations that occur when their family doctor's office is closed, like on a weekend.

Recently, a friend of mine went to a walk-in clinic because he was having groin pains. The doctor diagnosed him with an inguinal hernia, which occurs when your peritoneal sac obstructs your inguinal canal. However, my friend called me after the meeting with his doctor to ask "what is a hernia?" and "why do I need surgery for it?".

Sure, my friend should have asked the doctor these questions, but I would argue that the doctor should make sure his patient understands what kind of hernia he has, what a hernia is, and why he requires surgery to fix it. Answering these questions would only take 2 minutes of the doctor's time, so there really isn't any excuse to not explain the diagnosis.

Now maybe the doctor thought that inguinal hernias were common knowledge, but I really hope that isn't the case.

Corey Hill's Leg Break Hypothesis

Corey Hill is a giant in the UFC. He is 6'4" and fights at a mere 155 lbs according to Sherdog. Some may say that this is understandable because he is a professional athlete and probably has only 1% body fat. However, Barack Obama is 6'1" and weighs 180 lbs! Now, unless you think Obama is stacked like a body builder or you think he is obese (either conclusion would make me question your ideas about body image), you will agree that Corey Hill is REALLY light for his height.

Being so light probably suggests that his bone density is relatively low. I really have not learned anything about bone density, so I don't have any science to back this conclusion up...but it makes sense considering his BMI is 18.9 (probably not entirely true because I'm sure Corey Hill, like most UFC fighters cuts weight to fight in his weight division, however, I doubt that he cuts more than 10-15 lbs). Keep in mind, Hill IS an athlete, so he has a fair amount of lean muscle mass, which is relatively dense, i.e. heavy.

So, if his bone density IS relatively low, that would explain this:



I'm sure I'll eventually learn more about measuring bone density and in the future I'll be able to understand if my hypothesis about Corey Hill really explains his leg break. For now, I'm just going to drink a lot of milk.

HIIT: High Intensity Interval Training Myth

High intensity interval training (HIIT) is one of the new fad training techniques that promises quick strength gains and immediate weight loss. HIIT is a training technique that involves many strenuous, short intensity workouts, such as doing wind sprints and super sets. In this post, I'll explain the magic behind the weight loss involved in HIIT.

From my experience, most people who follow HIIT believe that HIIT is the best, most efficient workout when it comes to burning fat. This belief is supported by the fact that they end up losing 5-10 lbs in their first week of HIIT. This doesn't happen with most workout plans, so HIIT must be the real thing! Most horses can't answer math questions, but that doesn't mean Clever Hans could do arithmetic. The secret behind the quick weight loss resulting from HIIT can be found by looking at the fuel you burn when you are doing high intensity exercises.

During high intensity exercises, your muscles' demand for oxygen exceeds your body's supply of oxygen. Thus, your body must create energy, ATP, anaerobically (without oxygen). This means your muscles burn glucose, which is stored in the body as glycogen, instead of fat (as mentioned in an earlier post, you need oxygen to get energy from fat). Glucose and glycogen are polar molecules, which means they attract and hold onto water molecules.

In HIIT, the high intensity exercises burn your glycogen stores. Without the glycogen holding onto the water molecules, your body excretes water that was held by the glycogen as urine, sweat, or moisture in your breath (yes, technically you lose weight whenever you breathe...or talk...explains why my girlfriend is so skinny). This loss of water is responsible for the immediate weight loss seen in HIIT. Ironically, for those people who think that HIIT burns fat, the high intensity exercises cause your muscles to stop burning fat and to start burning glucose.

I'm not saying that HIIT doesn't help you lose weight. Obviously, I just stated that it initially results in the loss of water weight; however, as far as I'm concerned, exercise is exercise and burning calories doing HIIT will result in weight loss, just like burning calories any other way will result in weight loss. People should just realize that there are no easy ways to make your body instantaneously lose 20 pounds of fat. The most effective way to lose weight is to find a workout routine that is both strenuous and fun, something maintainable that you can do for an extended period of time. Of course if that doesn't work, just try talking more.

House MD: Merry Little Christmas Error

I was doing what every med student does in place of studying, learning from House, when I noticed an error in the medicine on the show. I'm fairly certain the writers get their medical advice from real doctors, so this is actually quite surprising. However, there is also a good chance the writers get their information from wikipedia, so maybe the American healthcare system has nothing to worry about (on the flip side, that means us medical students DO have something to worry about because wikipedia is THE source for PBL info...haha, just kidding of course...).

In the episode, "Merry Little Christmas", the patient, Abigail, has both liver problems and lung problems. House advises Foreman to get ahead of the disease and look at the pancreas. I have no idea whether this is good advice or not...I'm a first year student, I can barely spell pancreas! However, Foreman follows this advice by testing for alpha-1 antitrypsin deficiency. When Cuddy and Wilson question him about the test, they ask why he suspects a problem with the pancreas.

The problem with this sequence of events is that the pancreas is not related to alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein that is created by the liver and its function is to protect the lungs. Genetic mutations that lead to alpha-1 antitrypsin deficiency result in defective alpha-1 antitrypsin being created in the liver. The liver is unable to secrete this protein into the blood stream and it ends up accumulating in the liver cells and damages them. The absence of alpha-1 antitrypsin also results in lung damage because the protein is not present to protect the lungs. Thus, alpha-1 antitrypsin deficiency is a good diagnosis for the liver and lung damage...but has absolutely nothing to do with the pancreas.

Seriously...if House can't get this right, where am I supposed to learn about medicine?

Exams: Med Exams + Bad Luck = Hilarious

Exams often induce a lot of stress in any university student. Sometimes students stress out and have an anxiety attack or an emotional breakdown. Sometimes, it seems, the universe conspires to ensure that you have a panic attack, aka, you have bad luck.

As I mentioned in my previous post, we recently had our first set of finals in med school. Most of us didn't really know what to expect from these exams, so that caused a couple people to pull all out study sessions the night before the exam (I don't know how people do this...personally, I need my sleep before an exam). However, an all-nighter was nothing compared to what happened to one of my friends.

Our final was at 9 a.m. on the day after a snowstorm, my friend, "John", calls me an hour before the exam freaking out because his car won't get out of his driveway. He was trying to pull out of his parking garage and while he was trying to go up the relatively steep driveway, his car lost traction due to the ice and he slid backwards into the garage's gate. Luckily, the resulting dent was on his already dented bumper, which he thankfully had not had time to replace yet.

Obviously, John was worried he was going to be late for the exam, but fortunately, he only missed the first 5 minutes. Unfortunately, we were given the exam's instructions during those first 5 minutes. Eventually John heard the "15 minutes left in the exam" warning and he noticed that he still had 70 questions left and started panicking. He began to fly through the questions as quickly as he could, but 10 minutes later he still had 40 questions left. At this point, he was in fight or flight mode, John was sweating, shaking, and could barely focus. He ended up asking a TA how much time he had left. Well, that was a bit of a lie, he TRIED to ask a TA how much time he had left, but he lost the odd syllable in his panic. Anyhow, the TA looked at his exam...and told him that HE had 1 hour and 5 minutes left, it was the DENTISTS that had 5 minutes left.

See, the part that John missed in the instructions was that the dentists, who are in most of our classes, had 2 hours to complete their exam. We had 3 hours to complete our exams because we had 60 extra questions for our Family Practice course, which the dentists did not take during the term. After John heard that he had over an hour left to finish the final, he was speechless from sheer joy. The TA felt so bad for John that he gave him a pat on the back and reached into his pocket and gave John a halls.