USMLE Step 1

With my new 'lifestyle changes', I think my mind has become a bit more clear this week.

I've been studying for step 1 of the national medical boards exam, which I'll be taking in June, and I've been starting to panic a bit about the avalanche of material that I need to learn and memorize by then. Yesterday I decided to scrap my original plan (shoving my head full of facts and hoping it all sticks) and try something new. I've always been more interested in how things work than in the overall function of the machine. Like let's take a toaster; it burns bread... big deal. But if we start talking about the heating elements and the timer and the gears and belts and hamsters and elves that make the toaster work, then I'm intrigued. So my new plan is to view the human body as an appliance, and me as the repairman.

For instance, instead of just memorizing that exophthalmos (bulging eyes) is one of the symptoms of Graves' diseases, I try to think through the causes of bulging eyes. I'm a repairman that walks into a room in the emergency department and there's a person with bilateral exophthalmos staring back at me. Now I work backwards. What causes eyes to bulge out? Well, something must be back there pushing them forward, right? Right, so what could it be? Let's run down the short list of categories of disease; mnemonic "I VINDICATE Me":

Iatrogenic (caused by a healthcare worker)
Vascular
Infectious
Neoplastic (cancer)
Degenerative/Drugs (drugs can cause all kinds of adverse reactions)
Inflammatory/Idiopathic (idiopathic means 'of unknown origin')
Congenital
Allergic/Autoimmune
Trauma/Toxins
Endocrinal
Metabolic

When I get to inflammation and autoimmune, I'll think of the causes for inflammation of the orbital fat, muscles, or connective tissue... basically the only things behind the eye that could swell up and push the eyes out. So is there a disease where these things become inflamed? Yes! There's this crazy thing where the immune system accidentally attacks a hormone receptor (TSHr) that exists in the thyroid gland and in the muscles that control the eye. In the thyroid gland it causes wild over-production of the thyroid hormones (T3 & T4), which in turn causes enlargement of the gland itself (a goiter). The extraocular muscles don't produce any hormones, but they do become irritated and enlarged (i.e. inflammation) which is what causes the eyeballs to bulge out so creepily. What's that disease called again? Oh yeah, Graves' disease!

What makes this method better than the other? It relieves me from having to memorize a trillion little facts. Of course I still need to know about the diseases and their pathophysiology, but instead of trying to remember 2 seemingly unrelated things (bug eyes = Graves's ophthalmopathy), I can rely on logic (bug eyes = something pushing the eye out = a tumor, or inflammation).

Another advantage is that I can use the related symptoms to check my diagnosis. So for example if a patient only has one bulging eye, no elevated thyroid hormones, no goiter, and no serum antibodies, I'm going to start thinking of other causes for the exophthalmos. Maybe there's a tumor growing behind the eye etc...

So I'll try out this new method of studying and report back here on how it's working for me.

~Myles

So Far So Good

OK, it's been 6 days now and it's going just fine! On Monday and Tuesday I had a lot of motivation, so I made it through the day with no problems. On Wednesday I started having this throbbing headache, which I initially attributed to just the drastic change in diet. But when I told my friend about it, she said it was most likely due to the caffeine withdrawal so I decided to just take a couple of aspirin and plow through the day. Thursday I had no headache and I was feeling light and breezy, and it's been the same ever since.

I think my motivation technique has been working really well. I think about junk food every now and then, but I haven't had a desire strong enough to make me drive to the store yet. Maybe it's coming soon =)

Here's a picture of the stuff I don't want burned:

• On the left there are four US $2 bills from 1953-1976 and a $5 bill from 1950.
• In the middle there are bills from Spain, Cuba, Amsterdam, and Austria, from 1896 to 1903.
• On the right there's a US $1 bill from 1923, a pretty torn up $1 from 1891, and a Confederate $10 from 1863.

How cool is that?

A New Experiment

Hi,
I've been gone for a long time, and I may leave you again in the future. But for now I've decided to pick up the blogging again because I'm planning on performing an experiment on myself. I'm hoping it'll take about 2 months. See, sometimes I have trouble doing the things that I really want to do. Then I get all frustrated with myself and I start to feel down. I've been working on that last part recently (feeling down for stupid reasons), and I hope to write about it in the near future. But for now, here's my idea...

There are things that I want to do on an every day basis such as meditate, work out, eat healthy food etc. The problem is that sometimes I have excellent will power and sometimes I do not. Often I do not. One idea I had for overcoming this is to tell a friend that if I break my vows to do these things I'd give them a certain amount of cash. Maybe it sounds like a good idea to you, but here's the problem for me: as weird as it may sound, cash isn't very valuable to me. I don't mean that in some kind of new-age, Indian mystic kind of way. I mean that giving up a few bucks to a friend isn't sufficiently painful to make me to stick to my guns about my vows. So if I decide to eat only meats, fruits, and vegetables, and 12 days from now I feel like I'll die if I don't eat a Marshmallow Pinwheel, I'll probably eat one (or the whole carton) and just pay my friend the $20 or $30 or whatever it is. Then I'll feel shitty for having eaten the Pinwheels and then I'll pile on some more shitty feelings for having lost the $30 for such a dumb reason.

So, my latest idea is to find something that DOES have some value to me. What I came up with is any object with historical importance. I have always felt like it's a huge tragedy for anything old and rare to be destroyed. Things from a previous era are a direct physical link to that time, and they always seem to boggle my mind. I'm intrigued by them and I treat them like a valuable treasure. So in thinking through the idea for this experiment I remembered that I used to keep a coin collection when I was a kid. I'm sure the actual value of the whole thing put together isn't more than a couple hundred bucks. Most of it consists of American coins from the 20th century, and a few older pieces, and some pieces from other countries. But I also have some paper money, and it's amazing! I have a dollar bill from 1891 and one from 1920. I have a Confederate $10 bill from 1863. I have a $5 and several $2 bills from the 1950s, and I have bills from Spain, Cuba, Amsterdam, and Germany from the 1960s. Like I said before, the actual street value of these bills doesn't add up to much, but if someone were to light them on fire as I watched I would probably feel sick. As though someone were destroying an important, one-of-a-kind piece of art. Something that could never be replaced.

This is my idea... to put these items up for sacrifice if I fail to comply with my vows. Tomorrow I will ask my friend to agree to throw these beautiful old bills into a trash can and light them on fire the minute I break a vow.

Here is a quick and dirty list of the things I vow to do for the next 2 months (approximately):

1. Stop eating shitty food (follow the Paleo Diet)
2. Stick to my study schedule
3. Stick to my exercise/work out schedule
4. Meditate every day, if only for 5 minutes

These are the main points. There are some more subtle rules too, but I'll write about those in the days to come. I'll also be talking about why I want to follow these rules for the next 2 months. But this is enough for now.

Wish me luck. DO IT NOW.