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.

Still coffee-free and loving it!

I still haven't had any coffee since I quit about 10 days ago, and I'm still feeling good. Have I also mentioned that I've been alternating between running and lifting weights every day for the past 3 weeks too? Yeah, well that's also making me feel incredible. So I dunno if it's the coffee or the working out or just the holy spirit in my ass, but who cares? It's good stuff.

Yesterday I had planned to hang out with a friend and play some guitar, until he called me later on saying that he couldn't make it. Three of us fellow med students are sort of forming a band because the other 2 guys are damn good musicians. Anyway, he told me that he didn't want to come over unless the 3rd guy was gonna play too. I know that a month ago I would've taken it as an insult. Like why wouldn't he just want to come hang out even if the other dude isn't there? But he told me he had a lot of studying to do and didn't want to play unless it was a legitimate rehearsal. I didn't take it as an insult, it didn't depress me or "hurt my feelings" or anything (I'm a douche, I know). In fact, I took it as an opportunity to do some transcribing. Remember when I said I would put up a new transcription once a week? Fuck!

Well, I think this one might be a bit more popular than my last one. I transcribed (and somewhat altered) the "You Have AIDS" barbershop quartet song from Family Guy. The original is not actually a capella. There's a band behind the singers, and technically there are 5 voices (the quartet plus Peter). But I just altered it to sound decent as an a capella barbershop quartet. I'll put it up in a few days. Music never seems to get scanned well. It always looks like an Amsler grid does to a diabetic.

OK, I'm done rambling.

Feeling good without caffeine

After thousands of years of drinking coffee, I think it's finally starting to dawn on me that it has a horribly negative impact on my mood. I feel like a puppy that everyone's given up hope of him ever understanding not to shit on the carpet. He just doesn't understand why he's always getting yelled at, and as an unrelated wisp of a spark in his desperately feeble consciousness, he needs to drop a log. To him it's as if you're trying to say there's a correlation between doing high kicks (a la David Lee Roth) and the Great Crush Train Crash of 1896. Until one day, somehow, a single neuron with the willpower of Thor finally synapses with a hot looking neuron he's been eyeing from across the Corpus Callosum, and Winkie begins to understand what all the yelling has been about. Now when he shits on the carpet he's just fucking with you.

Well, it's the same with me and caffeine. I know everyone goes through ups and downs, just like I do. I just never put together the seemingly unrelated events of coffee drinking and shitty-feeling. The reason is because of the lag time, I think. At the moment of ingestion, I feel great and bubbly. But the downer doesn't come until many hours later, maybe even the next day or two. So it might also be the effects of withdrawal, as opposed to the caffeine itself. If that's the case, then the only solution other than cutting out caffeine is to never stop drinking it. But that's no good. You never know when you might find yourself in a coffeless hamlet. So I've decided to experiment for a bit and see if it really is responsible for some of the downiest of downs I've experienced in my life.

The last time I drank coffee was about 6 days ago. Then I was mildly depressed for about 2 days after that, which is when I finally thought of the possible connection. So I haven't had any since then and I feel great. I know it doesn't mean anything yet, but at least it's not a negative result. I'll go another week or 2 without coffee, then I'll try drinking a little decaf to see if anything happens.

I wonder where Winky would shit if he drank coffee?

Mini-piphany

So I was in Utah for the past 2 weeks, where the mountains and trees are just fucking spectacular. It's always a very easy place to 'wake up' and see yourself and your life from a different perspective.

I was thinking about what compassion means while speeding along a snowy trail through the barren aspen trees on a snowmobile. One simple meaning is the understanding that every person seeks happiness and seeks to avoid displeasure. Just picking specific people out and thinking to yourself "this person seeks happiness and seeks to avoid unhappiness" is enough to change your point of view about the world after a few hours. They don't have to be contiguous hours, mind you. Just keep a rubber band on your wrist to remind you to say it every 15 minutes or so. If you really say it mindfully (instead of just blurting it out quickly so you can get back to picking your nose), it might change the way you see someone. Try it with someone you like before you try it with someone you hate! That's a lot harder to do mindfully.

Anyway, after having thought about compassion like that for many years, I thought of an example that shows how we really are all the same. (I believe that everything's relative, so I know that we're the same in some ways and different in other ways, but that's a topic for another post). The night before the snowmobile adventure I was watching a documentary about WWII that showed some footage of a big US bomber (probably a B52) landing in an airfield, with a bunch of guys in the foreground ignoring it and just going about their business. I thought something like "that's so insane" when I saw that huge machine flying through the air. But to the people who were actually there, it must have seemed like the bazillionth bomber landing that morning. So I thought about how we all become accustomed to our surroundings and take it as "the norm", even though to a foreigner it might seem completely insane. And this I thought was the basis of all the strife and horror in the world!

If only we could see that we are the same as everyone else; that we're all just seeking happiness and avoiding pain... maybe less people would lose their lives at the hands of another person. OK, OK... I'm climbing down from my soapbox now.

Let It Slide

Well, after finally coming to the conclusion that I was going to tell my dad how it makes me feel when he jokes about gay people, I've gotten over it and decided not to tell him. I'm sure if it happens again I'll get angry again and I might tell him then. But for now my heart is filled with love for my dad once again. We had a long day of snowmobiling in the deep powder of the Uintas with no beginners and no amateurs with us. It was a blast! So all is right with the world once again.

If anyone is reading this I hope 2007 brings lots of good stuff and only a tiny bit of crappy stuff.

Filed in: Contented

Me Bashing

I really have a hard time figuring out what to do when I hear my dad laughing at a gay-denigrating comment. I mean, I know my dad loves me. He's generally not afraid to tell me so or to show me with a nice heartfelt hug. But he has this friend and when they get together it's like the "good ol' boys" hanging out, telling un-PC jokes and laughing about them for way too long.

I don't know why being gay is such a horribly negative thing in our culture. Why does anybody give a shit really? I mean, the whole fucking country is petrified of being called gay. Seems like a silly thing to waste your energy being afraid of. If someone called me a sheep fucker I think I'd probably laugh at them. But since I'm a gay person and not a "bestialist" I suppose it doesn't push my buttons in the same way.

Today my dad, his friend and I were having lunch together. We were getting along fine and laughing at stupid stuff until the conversation turned to this psychic woman that my dad's friend had gone to see. Apparently she told him lots of "impressive" things, including that he and my dad had been friends in a previous life. This of course led to a full 30 minutes about how they weren't "that kind of friends", and that "I hope that's not what she meant." And I was sitting right there thinking "ummm... my dad and his friend are now arguing about how horrible and repulsive it would be to be me."

Now I'm not stupid. I know that's not literally what they were thinking, and I know they were just joking around with each other. Still, I couldn't help feeling like the retarded kid they were telling retard jokes about.

So should I just let it slide and try to be secure enough in my dad's love for me to know that he didn't really mean it? Or should I tell him that I didn't like being in that situation? I'm afraid that'll just make my dad think I'm being a little pussy whose feelings are always in danger of being hurt.

The irony is that this friend of my dad's has a 28 year old son who was staring at me uncomfortably for several hours the other day. So somewhere in the back of my mind I'm wondering if they both try to mask their fear of the other one finding out about their shameful gay son by spouting their macho, gay-maligning humor and nervously laughing at each other?

Filed in: Angst • Homosexuality • Psychology