Always wear sunscreen

Those of you who know me know that I am a HUGE advocate of sunscreen.  I wear spf 75 on a daily basis on my face and neck.  I do sometimes neglect other exposed skin on a daily basis unfortunately.  (Let's face it, sunscreen isn't so great smelling and weather lotion or spray leaves an unwanted coating on your skin)  However every run, bikeride, swim, long walk, extended period of time outside I always make an effort to cover my epidermis.  I check for moles regularly and freak out about the smallest change.  I had a mole removed at one point leaving me with an attractive keloid scar secondary to an allergy to cat gut stitches.  Its improved since the lesion was excised but still... unsightly.  What's sad is I still get the occasional stranger to believe I was shot and many foreigners are convinced I was born somewhere where the polio vaccine is still used.  My old derm and I were tight.  I'm still working on a new one I like.  I miss Dr. Wise despite him potentially thinking I was neurotic.  

I thought I'd abided to my normal sunscreen application protocols this past Sunday when I chose to spend some time at the beach instead of the Pride Parade.  While I was successful in finding pleasantly empty near north side beaches my sunscreen application was not up to par.  I am still burnt; my booty is bright red, no joke.  My long ride yesterday could have been a good bit more comfortable.   Padded shorts only do so much.  I'd post pics but I'm not entirely certain they are appropriate.

To sum up, and oldie but goody.  Some good advice starts this song off, I couldn't agree more

Philippians 4:19

Today while more stressed than I've been yet throughout this whole board review process I decided I needed a break and some time for myself simply relax.  I had no idea what this should entail.  I thought through the vast list of things most people do to relax (television, movies, happy hour, massages, manicures/pedicures, shopping) and then to my usuals (a workout, grocery shopping, going to bed a little early, looking up airfare, reading a magazine, cooking something nice.)  Yes, I actually had to think about how to go about relaxing.  Well my usuals have all be used up the past numerous weeks and while I'm up for a run I'd already put in an early spin session.  As far as most others that came to mind, they were negated as either I don't have to money for them, I didn't think I'd be able to find anyone else to take a break with me, I didn't have various resources, or they simply aren't things I like to do... drinking to a stupor, no thanks

So what did I do, of course I called my mother with a mini-melt down.  She confirmed my thoughts that I needed a break and said informed me that another 8 mile run would not qualify as taking time for myself.  So she suggested a yoga class or something.  This is something that had come to my mind earlier but the average going rates of  $14 - 20 a class just wasn't going to cut it. 

I ended up trying to settle with some fresh watermelon from the farmers market and an iced (decaf) coffee.  Wasn't so effective.  Tried convincing one friend into making plans for gelato later and another into going to the puppy store with me.  No go.  So I again contemplate the yoga idea and I go to my handy Corepower yoga app on my phone to see if they even have a class I'm interested in at a nearby studio.  Lo and behold a FREE!!!!! 75 minute hot flow class in honor of the Oak Park studio reaching its one year birthday.  Step 2:  recruit a friend and a sister!   Step 3: a triple surprise!  Following class fresh fruit, sangria, and free massages :)  The Lord does provide.  

I'm now home studying away yet another Saturday night (6 in a row, but who's counting) I'm not particularly pleased about it but I have come to accept it knowing that in 3 days I'll be done with this phase.  And next Saturday night I will not be sprawled on my couch reviewing practice questions or browsing powerpoints

Fare Forward

“Not farewell, but fare forward, travelers”

 –T.S. Eliot The Dry Salvages

Farewell USMLE step1.  It will be 8 weeks before I know your outcome but ‘til then, out of sight, out of mind. 

Pre exam... what to expect?  Do I know enough? EEEEK!  A bit nervous.  Here goes nothing!
2 years of work for an 8 hour exam to evaluate it.  So it goes.
Yeah, I'm that lame girl who messed with her macbook camera to pass time in the morning before exam start

Farewell to the past two years.  It has been whirlwind, crazy how much life has changed, how much I’ve changed (just compare the prices at j. crew now and two yeara go… I don’t want to talk about it), and yet how much I’ve grown, especially in knowledge.  I have no disappointment saying farewell to this stack of books.  Two  year worth of classes, three trimesters each year, and each trimester with more credit hours than even my overload semesters throughout college.  I remember hating finals week at Rhodes and thinking I always had so much work.  Well, I created most of that work for myself, but I now know I had no idea the amount of time one can spend studying and still have all sorts of other things they need to do.  On the other hand, while I was recently home I looked at my father’s bookshelf and noticed many books he has solely on the kidney.  That which that stuck out most was a two volume compilation from about 12 years ago on this essential organ.  Each of these books in and of itself was probably twice as thick as any textbook I’ve purchased for medical school.  It’s humbling to realize how much I still have to learn and how much I know I’ll never actually know.  (as an aside, I would not be surprised if my father has actually read those books cover to cover and actually knows everything in them, he could probably have written.  It’s disgusting how smart he is.  For that matters, he’s probably read similar books on just about every organ)

Farwell to second year breakfast!  (and more importantly, Happy Birthday Kate!)  The past two years would have been empty without all you lovely ladies.  I can’t believe how far we’ve all come together.  When I look back I think you all will be the ones who really define this short time period; not the exams, or lectures, or the labs, or the stress

I'd say we all look pretty good for a week and a day of final,
and just finishing a cumulative pharm exams :)

Fairly representative of how we actually felt

 Farewell to a faithful friend.  As I was taking Step 1 to move on to the next chapter in my life he was on a plane heading to Poland to start the next phase of his.  A two year master program overseas.   I know your love for Poland and while it’s never been on my must visit places, it recently moved up the list.  From meeting you at the age of what., 16? 17?  Blowing whistles in jumping into a cold pool followed by “Hi, I’m a lifeguard, I’m here to help? To various shenanigans I don’t want to include here.  Let’s just say I don’t think I’ll visit Ichuro for two years (good thing Ponzu is across the street from my new abode).  However, I can’t guarantee I won’t be climbing fences.  I also know you wouldn’t want your absence to keep me from trespassing at any decent and semi-reasonable opportunity.  Best wishes to you.  When you’re back in the States for brief visits, you know my number.  In the meantime, I’ll work on remember my Skype password.

Para siempre una favorita :)

Goodbye to one of my favorite doctors.  Two nights ago I learned that Dr. Wise, a family friend and my dermatologist and a teacher passed away a couple months ago.   I knew he’d been sick and actually took leave from his practice but I guess my dad forget to mention his passing earlier.  Dr. Wise was brilliant, he knew EVERYTHING about dermatology and something about just about everything else from silk worms to water quality in random countries.  It was always fun to see his name pop up in various women’s health magazines regarding skin conditions and preventative measures.  I was fortunate to have him as my Dermatologist.  He hated expensive soaps, all makeup, and scoffed at sunscreen over spf 45.  To this day I use generic baby shampoo to wash my face, wear natural makeup, and use sunscreen… spf 75… His prescription of Acutane saved my life (slight exaggeration) even if it does turn out to fry ovaries.  Note: this has not been proven.  Even so, I don’t want children so really no loss to me.  Perhaps a benefit of the drug?   I was also fortunate enough to have some clinical experience with him.  He was one of the physicians on a service trip to Blackfeet country in Montana two years ago.  The relief he was able to provide to these people with all sorts of rashes, skin disorders, and autoimmune manifestations in just one week was inspiring.  These people had gone to derms elsewhere with no success.  I really understood at this point there is a huge difference in the skill levels of physicians.  He also taught me two general practices to keep in mind while on any service.  1.  NEVER keep your hands in the pockets of your white coat.  2.  NEVER lean on anything in a patients room, hallway, or otherwise public place.  He also recommended to look up origins of words as a means of learning because it will both help you remember what that term means and you will learn a myriad of other information (ie silk worms).  I know he was planning to write a book when he “recovered”.  That would have been quite the book I imagine. 

Blackfeet child at the Pow Wow we were specially invited to on the service trip
Coco took this pic, and I love it!

Farewell Lombard and DG!  It’s been fun, really, but I was never meant to live here.  Onto a neighborhood with a 99 walk score, bike lanes, a short jaunt from the beach / zoo, lakefront path, favorite restaurants, shopping, museums, theater, indie coffee shops, the second largest Whole Foods Market in the country, and a 24-hr fro yo stand.  I can’t ask for much for (except lower rent).  Adventures ahead!

2233 S Highland (and Ikea), you've served me well.
I'll not miss you
Though never say never

"'Fare forward, you who think that you are voyaging;

You are not those who saw the harbour

Receding, or those who will disembark.

Here between the hither and the farther shore

While time is withdrawn, consider the future

And the past with an equal mind."

In Honor of National Running Day

New kicks!!!!
After a handful of almonds to a trail I went

I can still hardly believe the running store talked me into Nikes.  My whole running life I've worn Asics (with the exception of one mistake of a pair from Saucony), and now Nikes, a shoe company I've been against ever since they put out their "shocks".   :)  But they are pretty and work with my Nike+!


Get out and move!!!!!!  Today and everyday!

The Art of the Written Word

I'm currently home at my parents house in the souther suburbs of Chicago.  At times when I'm here I look through some of my belongings / collections that have been left here, or perhaps stored indefinitely (until they move).  One of my desk drawers is full of letters, cards, pictures, sketches, poems, etc. all sent to me from various individuals over many years.  Chances are, if you have ever sent me or hand delivered to me or my mailbox something in envelope it is either in this drawer, in a box in the basement, or a drawer in my current apartment.  Yes I've kept them all.  From birthday cards that say "Happy Birthday to a special 7 year old" to a post card from NYC with a bum on the front holding a sign saying "Money for weed (at least I'm being honest)."  On occasion when I'm here I browse through my collection and always tend to return to about 9 or 10 "Letters of Note."  Sometimes these letters make me cry a little, usually they make me smile, but mostly they allow me to remember just how lucky I am to have had some of these individuals in my life.

The first, and perhaps most prized letter I tend to go back to is one from Gampi.  It was written from Long Boat Key, Fl on March 26th, 1992.  The letter talks about the beach and a pelican and how he when he gets home I'll teach him to do cartwheels and handstands.  He was the only grandfather I've had and a wonderful man.  I only with I could have known him longer.  He passed away in peace at home, though in a hospital bed with a morphine drip supplied by my mother.  He'd contracted Hepatitis C due to a blood transfusion that he didn't need after a cardiac surgery years before.  None of this really contributes the quality of his character though.  He was a man that if someone needed something done would be there, even if just to screw in a knob for a drawer.   A favorite story of my mother's regarding him was when he drove out onto LSD to pick her up in the middle of the past most famous Chicago Blizzard when she was about 20.  Cars were stuck then just as they were this year, except that year there were more fatalities.

My favorite memory was when he came to pick my sister and myself up from school in his big old conversion van one afternoon.  Now he often did just this but this day was different, and we weren't expecting him.  My sister, Courtney, and I always fought over who got the front.  Usually he would intervene but this day he didn't and Courtney won out. Chances are it was a race to the van when we saw him pull into the parking lot, I think that's how it usually went.  So I begrudgingly got into the back seat while Gampi chuckled at my disappointment.  However, in the back seat I saw a large cardboard box and inside that box a Sheltie puppy.  I was elated, on cloud nine, couldn't have asked for a better afternoon.  This pup was soon dubbed Duke and if you thought a child loved going to their grandparents house before, well after this that was the only place I ever wanted to go.  I adored dog for quite some time.  

Gampi was self made man, hard working, successful, and artist, a photographer, and animal lover, a dreamer, a prankster, a ketchup lover, a migrator (yes Florida in the winter) a friend and neighbor, an honest businessman, a father, a grandfather, an explorer, a reader, just someone who lived every day God gave him to the fullest even up until his last.  Him and my grandmother were always quite the pair.  They were two people who knew how to live life right.  I hope have half the joy and zest for life he had, liver failure and all.

The second letter I came across that really struck me this evening is one from sister, sent with a birthday gift my freshman year of college.  Of course everyone is a little homesick their freshman year and birthdays are a little lonely when you've only been at school 500 miles from home for two weeks and your day happens to come.  So this letter was very welcome, though perhaps worsened some of the homesickness.  For the life of me I can't remember what all came with it, but I suppose that indicates where value in life lies, not necessarily with "things".  This was a remember when note.  A few bullets from it.  Dear S'more, Remember when... "We went and played under the bridge by the creek"  "We used to try to hide from Kelly Flanigan... always to no avail in the end"  "We made a fashion show in the basement"  "We played dream phone until we had to photocopy the sheets because we used them all up"  "Everyone used to argue because no one wanted to put the lane lines in"  "we used to play ninento over and over and over"  "We made a lemonade stand on the golf course"  "Caroline and Katy wanted s'mores and Amy and Courtney wanted oreos, so we split into 2 camp and were forever more s'mores and oreos"    She ends her letter with encouraging me to think of more and send them her way.  I regret to say I don't think I ever did this but better late than never.  

Oreo, Remember when we got welts on our legs from running through the golf course sprinklers?  Remember when we used to sled down our driveway and go airborne over the slow plow ice?  Remember when you used to paint our nails with tinker bell nail polish and days mom was going shopping so we'd be occupied picking it off the whole time she was trying on clothes?  Remember when we would ride out bikes to the Trolley barn for lunch and then the creamery for dessert?  Remember when it used to take me 30 minutes to eat a small vanilla ice cream cone?  Remember calling a special someone "Dudah" and then all of a sudden we started to get in big trouble it?"  Remember when we had two fish that always got ick?  Remember tweets...?  Remember having to wake up at sunrise to go out on the boat, and then eat lunch on the boat, and then stay on the boat all day because we had to get every minutes worth of time out of it?  Remember helmet girl (goodness what was here name, Tess? Tara?..?) in our Ski school class at Boyne every year?  Just a few things for memory's sake :)

Goodness I'm sappy this evening.  Not sure where that all came from

A third letter of note for the evening comes from one of my old roommates mothers of all people, Mrs. Leila Mischer.  Now most people here don't know Leila, if you did you'd understand the extra charm it adds to the letter.  Now my own mother also has a tendency of writing a monthly note her three children (though these have been lacking recently... hmmmm) that I value but this note came out of the blue.  Mrs. Mischer has by no means been a stranger to me since the summer before jr year of college.  I was moving into a house her daughter, Morgan Jane, and another friend of ours Maria Cowley.  So Leila came up to Memphis early to help buy some things for the house to check everything out.  While she was there I was about to take a final in 1 of 2 Physics courses I was taking over the summer as well in the middle of a lot of lab work and still volunteering.  Typical pre med student...   Thus my first encounter with Leila rushing through Target and Bed Bath and Beyond and Macy's and you name it.  Throughout the following two years i saw her on and off as she was traveling through Memphis, or at Rhodes to see a field hockey game, or graduation.  I also spent some time at the Mischer house in Houston for Morgan Jane's debutant ball.  Mrs. Mischer is without a doubt the most gracious hostess I have ever met.  This was again reinforced after a stay at their house in near Vail.  Well, this specific letter came after a dinner I'd shared with her, Morgan Jane, and another roommate (Katie) and her boyfriend at the time. This evening I was a little frustrated because I'd also been asked to invite a guest to dinner and he refused to come.  Nothing out of the ordinary, but as always disappointing.  This was Senior year and we were all talking plans for the next year.  I was at the time undecided about what institution and what type of medicine I'd be attending / learning the starting the coming August.  I don't remember all that much more about the dinner but it was lovely, good company, lots of laughs, and absolutely wonderful food.  For those of you in Memphis we were at BlueFin in Cooper Young.  I can't believe it was the first time, and only time, I was there.  In the mail a few weeks later I received a letter receiving encouraging advice from Leila.  The letter started out saying she hoped she wasn't presumptuous about writing.  No, I didn't think so at all.  Her advice was regarding means of navigating through life at times of change.  "If whatever you are reflecting on gives you a sense of life, fullness, positive anticipation, or excitement - or a sense of expansion- pay attention to it!  That could very well be an indication of a direction that would be good for you.  On the other hand if a decision, experience and person ect gives you a sense of constriction, of low energy, of deflation - pay attention to that too.  The world can be so complicated but if we can stay in touch with who we are - our truth - which we experience through our bodies then I think one has a great chance of living the life that is uniquely theirs to live.  The one only that only YOU can fill"  Now she closes the letter with my favorite part "You are pretty and you are very smart and you have a wonderful personality.  you have all you need"  ok j/k not my favorite but always nice to hear or, more specifically, read :)  Sometimes words like that from an unlikely source are more encouraging than those from someone close to you who you  might regularly hear similar things from.

I could go on and on with letters and with my feelings about the lack of letters that are now written but I realize 1. its getting late    2. This is long   and last and least significantly 3. chances are no one had read this far.  

But as a final note what I've learned from my years of collecting letters, and writing many is the written word is profound.  That sounds cliche but it's true.  Thought definitely goes into speech.  I've learned all the neuro pathways that prove that.  But I believe more thought goes into the deliberate writing of language and subsequent deliverance.  Whether it's pressing send on an email or sealing an envelope you can't take back what you've written.  Do I wish I could take back some things I've put in ink (or on a computer screen), well yes.  But at the same time I don't regret the unfortunate verbiage that's been used.  I've learned from it, and learning is one of the best things about actions / reactions and all experiences in life.   Besides, when it comes to letters, even without all the frills of calligraphy print and sealing wax and embossed cards; a simple letter or card is one of the most delightful things to find in your mailbox on any given afternoon.  

The Concept of Synergy

Like beta-lactams and aminoglycosides (those bugs are done for)
or
Smoking and alcohol (esophageal cancer? sign me up!)

The boards and actual medicine are full of the concept of synergy

Well this concept shouldn't be so difficult (except when you're given some crazy graph and 5 answers that all seem to mean the same thing).  All the simple things in life are synergistic

Take for example:

coffee and chocolate

a fluff and some flirt

strawberries and champagne

Well here's one more for you:  a beach and a sunset

Separately, two things that bring me many happy thoughts.  Possibly two of my favorite things. But I'm telling you, put them together and something magical happens.

And it certainly doesn't hurt when you make a new friend on your third mile down the beach.  Especially when he keeps you company the entire run back home (even if he may have initially scared you as he bounded toward you with no one else in sight).  Meet Mr. Bo Jangles.  Fortunately, Bo had a tags on him to call his home.  Unfortunately, his owner didn't end up being quite as handsome as he was.  

Remember when "question master" was part of a drinking game?

Now my only goal for the next two weeks it master the questions of qbank.
Then maybe a reversion to college drinking games for a night or two with no discussion or even thought of alcohol metabolism, anecdotes for toxins, just what I'm doing to my liver, and why I feel not so good at all in the morning even after probably maxing out at 3 beers.

1.  What med should you give a little boy who seems to stare into space out all the time with a blank look on his face?  Several years later he on occasion has spastic uncontrolled movements.  What med should you now give him for both problems?

2.  Your boyfriend who knows he has a metabolic deficiency decides to play a joke on you  and pees in the toilet but does not flush it.  You use the washroom a little later are horrified to find the toilet filled with dark gray.  You freak out and he's laughing hysterically, why does he think this is funny?

3.  Your gymnast friend tells you she has ringing in her airs and is starting to lose her ability to hear.  She claims she never has loud volume in her headphone.  Actually she never even wears them because she thinks they harbor bacteria.  You go to her next gymnastic meet and she has terrible performances all around, she even fell off the balance beam 5 times during her routine.  She tells you this has been a problem the past few weeks and that a similar problem caused her sister to quit gymnastics.  What chromosomal mutation does she have?

4.  What extra supplement to african american babies often need that caucasian babies don't?

5.  Your roommate has been really stressed studying for her medical school board exams recently.  She's been eating not so well but exercising like crazy to beat the stress.  You (not a med student) notice she's turning yellow and mention it.  She smiles/chuckles and says a lot of people have this happen to them when they're stressed but that there is nothing wrong with her or them.  What disease does she have?

Look to the bottom for the (hopefully relatively correct) answers

If I'm stuck studying for quite some time I figure I might as well make the most of it.  Isolation, no cell phone, a stocked fridge / pantry, and the great outdoors

I think I have just about the best study buddy, even if he can't help me answer qbank questions

And we both have quite the view and running location to enjoy :)

Answers
1. Ethosuximide for absense seizures initially.  Valpoic acid for the later development of tonic clonic seizures.  You can stop the ethosuximide because Valproic acid covers both seizure types

2. Your man has alkaptonuria, nothing to worry about although he may experience some arthritis come middle age.  He is simply missing homogentisic acid oxidase.  His urine turns black when exposed to air because homogenisic acid in his urine is oxidized

3.  Chromosome 22 --> the NF2 gene.  She has autosomal dominant Neurofibromotosis type 2.  THis causes bilateral acoustic neuromas or  "schwannomas"ie a tumor affecting Cranial Nerve 8 (vestibulococholear) This nerve allows you to hear properly and helps you maintain your balance

4.  Vitamin D.  African American's require more sun exposure to effectively synthesize D.  This is not a problem in adults with sufficient diet but breast mild does not contain vit D so all babies must either have a different exogenous source or the ability to synthesize it themselves.

5.  Gilberts.  She has low UDP glucuronyl transferase.  This decreases her ability to uptake billirubin in the liver where it is normally conjugated to be excreted. 5% of Caucasians have this.  Labs would just show a temporarily elevated unconjugated billirubin when under stress.

Per typical, I didn't proofread.  and I wrote the questions myself.... I'm certain there are errors