My first official clinic observation

Tuesday night I had my first clinic encounter observation, as part of my Intro to Clinic class. Exciting! I've observed dozens, if not hundreds, of clinical encounters, through shadowing my chiropractor, and other mentors since. Also, I've observed plenty with my wife and kids. But there was something different about this one. I think being in a clinic jacket, in a professional role, changes the perspective immensely. With observations, you are a silent party, but you are definitely taking notes as questions are being asked, findings delivered, treatment administered, and so on. This is an excellent opportunity to quitely assess what you would do with that same encounter, and to learn from the intern and staff doctor.

I can't discuss the particulars of the encounter, as that would breach HIPPA rights. While I could discuss details without divulging identifying information, I'm not even going to do that, as the details could identify the patient. I wouldn't dream of breaching that trust. It really is a profound privledge to be trusted with sensitive personal and health information, when you think about it. There are things discussed in a doctor's office that that person might not be willing to share with anyone else, including loved ones. This is just another aspect of how much responsibility is placed on a doctor.

In a few more months it will be me that is making those calls, and being observed by a fellow student. Time flies here.

Lots of tests and practicals this week!

I just finished two back to back. Had a mideterm test in visceral disorders. It was mainly on CBC (complete blood count blood indices test) with all the anemias and leukemias. But there was urine on the test too. Well, not literally... The first test was over UA (urinalysis) and everything it can uncover, and there were several review questions of that material on this test, especially because several diseases can cause abnormal findins on a CBC and a UA, so cross-correalation is important. Radiographic findings also relate to alot of things we look for when we order lab work too, so that is on the visceral disorders tests too. I'm definitely at a point in the curriculum where it's critical to put together all the seemingly disjointed material covered in dozens of other classes. DOn't think for a second that once you get through an anatomy or physiology course, and pass the class, that you're done with that material. Besides having to know it for Boards, you really need to know it to be a competent doctor!

After that test I had to take a Pelvic class practical. This one focused on being presented with a mock patient, with films and physical findings. and then having to determine listings, best adjustment, pre and post checks, care plan, and patient instructions. I missed one silly point because I accidnetally said ASIS when I meant to say PSIS. (These are bony landmarks of the pelvis, one is on the front of your body and the other on your low back. Obviously I didn't have them confused, just my Dislexia kicking in at a very inoportune time!Oh well just one point.

I've got an exam in Intro to Clinic wednesday, and a clinical psychology test thursday. Friday I'm delivering a 20 minute presentation on the social implications of Hepatitis B in my Social Aspects of Epidemics undergrad class. I also have a group investing project that I'm involved with in my Economics undergrad class.

Like I said, busy week!

Not to mention I'm putting up 200 feet of privacy fence, stick-built (not pre-fab panels, but piece by piece), scraping, priming and painting the garage, tilling and reseeding the yard, while I have several indoors renovation projects going on too, like hardwood flooring and tile throughout the entire house, etc...

Life is never dull!

Well, gotta go to extremities class to play with stinky feet.

Palmer Package Club

This morning I went to Palmer Package Club. Clubs meet once or twice a week on campus, and there are plenty to choose from. Every specific technique has its own club, then there are clubs that revolve around other interests, like sports, pediatrics, etc. Palmer Package Club focuses on Palmer Package, which is the group of techniques that are part of the standard curriculum here at Palmer. The main components are based on Toggle, Gonstead, Diversified, and Thompson. They are tweaked here and there to reflect current research, best practices, etc. Palmer has done an excellent job at integrating several techniques into an extremely cohesive "toolbox" of adjusting protocols and techniques. We get tons of hands on with all of these techniques within the specific courses, of coarse. THe club is an extra opportunity to go through the entire history taking, exam, findings, and actual adjustment, with another student, and a doctor observing. It's the real deal, not a mock experience. This to me really is the best tool in learning to put it all together, and practice a real chiropractic adjustment, rather than just setting up, then practicing the thrust into the air, which is of course all we can do without having a real patient with a real need for an adjustment, something that can't be controlled or guaranteed in a classroom setting.

So this morning I went through the whole process of finding two subluxations, reviewing films, history, everything, then pick what I thought would be the best adjustment technique for those subluxations, and correct them. It went great! I had to switch techniques on one of them because it didn't respond to the manuever I had first chosen, but then I was able to pick a different procedure that would work better, and it did! It's a great experience to be able to be put into that clinical mindset, where I have to think on my feet, reassess, and move forward. Next tri I'm in the clinic, so I've got to start thinking this way!

This tri is awesome! As I've said before, I'm halfway between 6th and 7th tris due to my individualized schedule. I'm taking two technique courses, Pelvic Adjusting and Extremities Adjusting. It took me about a week to get used to Dr. Petterssen's demeanor; he has a very dry sense of humor, which I greatly appreciate. He's a great instructor. He wrote the book on Pelvic adjusting. Really. Dr. Sorgenfry teaches my Extremities class. This doc reminds me of my doc back home. Country at heart, he runs the family farm as well as teaches here. I can really relate to him, being raised in the country myself. Yesterday he gave away free eggs from his chickens to whoever students wanted them. Dr. Sorgenfry is very approachable, warm, and obviously caring. A great example of his dedication to teach is that he is starting up a student/doctor mentoring program with Palmer alumni out in the field, where we can get paired up with doctors practicing in the area in which we want to practice. We will get to go and shadow them in there practice a few times a year. I'm especially looking forward to this as I plan on practicing on the west coast of Florida! Great to have yet another excuse to get down to Florida a few times a year! Since we are planning to locate the practice somewhere on the west coast between Tampa and Naples, but are unsure of which town exactly, it would be very helpful to travel to that area and get a good feel for the different communities, while also getting priceless input from a Chiropractor working in the same area. I truly appreciate Dr. Sorgenfry putting this together. The idea to do this evidently came from an offer from a doctor that was here for the last homecoming, wanting to mentor a student in his practice. It's exciting to see that doctors busy with their own practice and life would want to take time to give counsel and advice to emerging doctors. Its exactly this type of gesture that will help to grow this profession to still higher levels of service and dedication. I'm in the Intro to Clinic class this tri. Name says it all. There's a lot to cover in preparation to start treating patients. Lately we've been discussing issues like Code of Conduct, Ethics, HIPAA, professionalism, Report of Findings, and so on. We had an assignment to actually deliver a report of findings on video recording, so that we can see ways to improve this critical visit. This was an excellent lesson in the power of how we interact with our patients. Subtleties like body language, rate of speach, filler words, eye contact, confidence, and so on, all add up in a huge way. Later this tri as part of this class we actually get into the clinic and do silent observations of doctor patient encounters. I'm really excited about this. First step into the clinic!! In visceral disorders calss with Dr. Tatum, we're learning how to know what appropriate labs need to be ordered in helping to diagnose all the various visceral disorders, and how to interpret these labs. For example, based on information in a patient history you suspect that the patient could be diabetic. We need to know that the proper course of action is to order the appropriate labwork to find out if your suspitions are correct. You need to interpret those labs, and follow up with the appropriate course of action. As Chiropractors we are often a patient's only regular healthcare vsit, and we are on the front line with the patients, and need to be able to recognize any helath problem they could present with, and offer the correct advice. This is huge. It's taking classes like this one that really shout to me "You're going to be a Doctor!!" It's a profound feeling, knowing the responsibility I will soon have to people's health. Scary too, but in a good way. Scaring me into doing everything I can to be the best Doctor I can be, deserving the trust that will be placed in me. Well time to go to Vis Dis. (Visceral Disorders) Talk to you soon.

Just talked to my brother. He's a Palmer grad, class of October, 2009. It was Josh that talked me into coming to Palmer, over the course of two years. When he started I was still living in Florida. I was so proud to see him get through Palmer in 10 tri's, while having two kids. OK it was his wife that had the two kids, but I think he's changed a few diapers. She made it through in the same 10 tri's. They're super-human. Meanwhile, I started in July 0f '07 and won't finish until October of '12. Took two tri's off to make some money after my daughter was born. Lucky if I broke even; honestly, I'm sure I lost money. The bigger part of it was probably that I couldn't wrap my head around becoming a dad for the first time and still focus on school. The tri that she was born I failed almost all my classes. We're all wired differently I guess, and Josh, I would venture to say, is wired better than I am. I'm better looking, though. Well, not really, but I like to say it. Mom loves me more though, she told me herself. She made me promise not to tell Josh or my sister Jani.



Anyway, I'm immensely proud of my little brother. He's a great dad, great husband, great doctor, and he was even the drummer for a metal band for a while. Cool.



So anyway just talked to him. He wanted my advice on a couple of different used cars he's considering buying. I used to sell cars, and lots of them. Yeah, I'm the used car guy everybody dreads. "Come over this way, I just got in a real peach, and I'm sure it won't last a day at the price I've got on it. Got it for a steal and I'll pass the savings on to you. How's your credit?" Ah, the memories. Advice from a reformed car salesman. Never trust a car salesman.



It was nice to catch up with Josh. We don't talk enough. Asked him about how things were going in practice. They're going. He's working, along with his wife, in her dad's practice. They're self-employed, renting space from him. Business is growing, slow but sure. He's busy working on a diplomate in whiplash care, and also working on a certification in accident reconstruction. He's going the route that I'm interested in going, which is PI (personal injury) It's a lucrative and rewarding aspect of practice, if you can stomach working with attorneys all the time. His father-in-law does quite a bit of PI business, and is an expert witness in demand in the Peoria area. I would love to one day focus on helping people recover from an accident, having been in a couple myself. To not only help them on their road to physical recovery, but also help to make sure they are fairly treated by the insurance companies, now that's what I'm talking about. I used to work in the insurance business too. Worse than used cars.



I told him I'd like to shadow him in practice some day coming up. He politely told me I'd be better off with Doc (dad) as he's not seeing anywhere near as many patients as Doc is. I shadowed Doc for a while before deciding to come to Palmer. I was considering Physical Therapy as well. Doc said "Now why would you go to school all those years to not be a doctor?" Made sense to me. Shadowed some PT's for a while too, though, just to be sure. I learned that pretty much all PT's either work for a hospital or a large PT center; hardly any strike it out on their own. I asked them why and they said that the equipment costs a fortune, so it was only cost effective to be in large groups. Also, they're not portal of entry for patients, meaning pretty much all their patients are referred from other docs, who write a presciption for therapy. Since most hospitals have their own PT department, and most doctors are associated with a hospital, it would be difficult to make it if you started your own company. Well, I have no interest in working for a hospital, or for anyone for that matter. Also, I knew I wanted to be a primary care doctor. I want to diagnose. I want to be a doctor, not a technician. Now don't get me wrong, I have huge respect for PT's. They helped me immensely in recovering from my car accident, literally re-teaching me how to walk. Awesome work, what they do. It's just not the route I want to go. I'd rather be the guy writing the presciption for PT, determing the need for PT, than be the guy performing it. That's just me.



I'm really looking forward to being done with school. I love Palmer, love the classes, love the teachers. I feel it's the best school in the world to learn Chiropractic. But I can't wait to get out into the "real world" again. Josh tells me to enjoy Palmer, that he misses it. He says the stress of passing classes and board exams has nothing on the stress of going into business. I believe him, but I still can't wait. 5 more tri's including this one. I start seeing patients next tri. That's exciting! I've watched the class I started with graduate, last October, and the one I spent the most time with just a few weeks ago. And I'll watch four more tri's of students I've shared classes with along the way graduate too. Lot's of friends come through and pass me by, on my "slow track". I don't feel bad about it; I know it's what's best for my family. But sometimes it's hard to feel left behind. Oh well. I re-study all the classes I've taken. This tri I plan on sitting in on a few classes I've been through, just to get a firmer grasp of the material. I'm not taking a light load just to have a light load, I'm doing it to be a better dad, better husband, and someday, better doctor. My brother could do it in 10, and do it all well. But he's super-man. Funny, when we were little, he thought I was superman, being 5 years older than him. Lately, I have to remind myself that he's the younger one...Because I look younger...well, not really...

So last time I posted I talked about my back injury. I have to say that the more I learn about the body, the more empowered I feel regarding my own health. I have always been the typical guy in the regard that I figure if I ignore health problems, they'll go away. I was always mystified by the complexity of health, and figured that it was really out of my hands. While it is true that there are aspects of our health I feel are out of our control, there is a surprising amount we do have influence over. Let's take my back problem, as an example. I could simply mourn over my ailment, and hope for as little pain as possible, and avoid all the activities I love that I fear would make it worse. Or I could research ways to minimize the pain and damage that occur. There are a ton of things that I can do to have a healthier back. A lot of them are conventiona wisdom, but not things you would necessarilly relate to back pain.

Drink more water.

Sure, we all know to get at least 8 glasses of water a day, but do we really know why? Doctor's orders, right? Well, besides being the vehicle for which all nutrients get to all cells in your body, and being an integral aspect of waste management, getting toxins out of the body, it's also a shock absorber. It plays a crucial role in cushioning in our spine. Our intervertebral discs have a substance in them that makes them highly attractive to water, kind of like those dessicant pouches that come in new clothing to keep them dry, you know the ones that say DO NOT EAT all over them. This substance in the discs attract the water into them and hold it there, making the discs thicker and better shock absorbers. throughout the day the pressure on our discs squeezes the water out, and we actually get shorter due to this throughout the day. when we lay down and take the load off our discs, they imbibe the water back in, so we start each day with refreshed discs. Well if we're not getting enough water in our diet, this water that gets squeezed out might not be available to get attracted back into the discs. This could set us up for injury. Just another reason to get plenty of water.

Making sure your body's core muscles are strong is also vitally important. these muscles support the back, and safely move the spine through it's normal ranges of motion in all of our activities. But we have to careful what exercises we do. Before going to Palmer, I did all kinds of exercises that are horrible for the back, while thinking I was helping it. Sit-ups, for example.When we do a sit-up, we are putting tons of stress into our spine, and our discs, that our bodies were never designed to handle. It's one of the worst exercises you could ever do! Another I always did was the roman chair, while holding a 45 pound plate to my chest, throwing rotation at the lumbar spine in for good messure. I was asking for a blown disc! There's plenty of exercises that are safe for your back that are just as good at strengthening your core, but for some reason they're not the ones taught in health clubs...

Proper posture is paramount as well. You're Mom always said not to slouch. You always figured it was because it looked bad. Well it's also bad for your back. It forces the normal curve out of your low back, putting a lot more stress on the discs to carry the load. It accentuates the mid back curve, which subsequently makes it harder to breath deeply. Less oxygen for your tissues... It also causes your head to shift forward,placing tons of strain on your delicate neck spine and muscles. You can end up with headaches from this as well. This posture also tightens some muscles while weakening others. You end up with weak abdominal, low back, and butt muscles, and tight psoas muscles, which further comprimises your posture. Your chest muscles and neck muscles get tight, while your important upper back muscles get weak. You'll end up hunchbacked and shuffling by age 60!

I could go on and on and on...

The point I guess is...

We can empower ourselves to be healthier people. We can learn ways to make the most of the bodies we've been given. choosing a career in healthcare is an awesome decision. We are learning how to take care of ourselves, and our patients. We will be advocates for the health of the people we care for. this is profoundly important.

And back to my health problem, low back pain.

If, as a doctor, through my treatments, therapies, and advice, I accomplish nothing more than to relieve my patients' pain, I will consider myself a great success. Having lived with pain, and understanding how deeply it impacts a person's well-being and view of life, I would never dream of discounting the importance of this. I once heard a chiropractor, whom I greatly admire and respect, defensively proclaim "We're not pain doctors!" feeling, no doubt, that the larger impact that what we do has on the nervous system and subsequently general health, is much more important. It might be more important, but try telling that to someone dealing with pain. All they care about is the pain, and every thought revolves around finding a way out of it. If it's bad enough people will commit suicide over it. It may even persuade a man to go to the doctor! Pain is a serious thing, and a patient's pain should never be dismissed. I would gladly be a "pain doctor". Pain is what led me to Palmer, because chiropractic is the only treatment that addressed the cause of my pain, and resolved it. One chiropractic adjustment effectively ended pain that several days popping countless Vicadin , Ibuprofen, aspirin, (and a bottle of wine) didn't even put a dent in. If medicinal marijuana were available I would have tried that too! Acupuncture, hypnosis, sensory deprivation tank, sign me up! I would have tried anything to get out of that pain. But it was a Chiropractor who confidently delivered a precise and coordinated manual thrust into my low back and Voila! Eureka! effective? Heck yeah. Life-changing, in fact. Now, as an added benefit, chiropractic may also be keeping my blood pressure in check, and preventing some cancer from taking hold in my body, thanks to an efficiently functioning nervous system, but if it does I'll never know, right? What I do know is that with a good chiropactic adjustment, the horrible pain I was in goes away, and I'm able to enjoy my life rather than avoid my life. Isn't this noble enough? If, as a chiropractor, I could be known for anything in the community, it would be that I can help you get out of pain. In helping people with their pain, I'll be helping them with their health. I might prevent cancer, lower blood pressure, or restore vision to a blind man. Or I might not. In most cases, I feel there's no way of really knowing all the positive effects I might have on someone's health, and I don't feel the need to take credit for it, and I certainly won't advertise that I can perform these miracles. But if that person say's to me "I feel better doc, thanks!" I will consider that the greatest success, and worth all the time and effort I'm putting into this education. I can't wait to hear those words. My brother, on a Palmer mission trip to Vietnam, had an elderly lady, whom he just treated, say to him "You have God in your hands." He'll never forget that awesome compliment. I pray I hear similar praise someday from my patients!

Well its been a while I know. This tri has been a stressful one for me lately. I think it has more to do with everything I'm juggling in my life than the actual classes. Late last year I had a series of MRI's performed on my low back, as I have had recurring episodes of severe, disabling pain. They've been happening since 2003, but lately it's gotten a lot worse, well, a lot more frequent, and with less obvious causes. So I had my younger brother, who is a Palmer grad practicing in my home town of Peoria, IL, do a physical exam on me and he agreed that I needed special imaging. I learned in my NMS class that the symptoms I had suggested a space occuping lesion, or SOL, aggravating and sometimes compressing one or more nerve roots affecting my left leg. What especially concerned me was that I have a positive Valsalva, where if you cough, sneeZe, or bear down, it causes an increase in the symptoms. Well I sneezed one day while pumping gas, and my legs literally gave out from under me. This is a "red flag" deserving of MRI, because it suggests compression of the cord itself, when the symptoms are bilateral, as they were. Cord compression in the lumbar region is known as Cauda Equina Syndrome. This is a serious neurological condition that can result in loss of bowel and bladder function, which can be life threatening. Another possible result is loss of motor function to the legs, obviously something that I don't want to happen! Well the MRI confirmed our fears. I actually have four herniated discs, at L1, L2, L3, and L4. The first three are posterolateral protrusions that are encroaching into the intervertebral foramen, or IVF, lateral to the nerve root. This is actually the type of herniated disc that responds best to Chiropractic care, sometimes even immediately. This corresponds to my previous chiropractic care results, where sometimes I would come in to the Doctor in a wheelchair, and able to walk out after the appointment. I love it when that happens, but it doesn't always, unfortunately. Well the L4 disc has herniated straight posterior, meaning it is actually hitting the spinal cord. In that region the cord has already broken up into individual nerve roots, and is no longer a single cord. In dissection it looks alot like a horse's tail, hence Cauda Equina, latin for "horse's tail". With posterior protrusions care is a lot less successful, and in my case this seems to hold true. At this point, it seems that when these discs are fired up, all of my back muscles in that region, called paraspinal muscles in general, are spasming. It takes a lot of therapy to relieve the spasming, like triggerpoint therapy or an aspect of Sacral Occipital Technique, or S.O.T., called blocking, where you're placed laying with your pelvis on wedges, placed depending on the symptoms, to release the spasms. Supposedly it also restores Cerebrospinal fluid flow from the Occiput down to the Sacrum, but this is a little understood theory with far-reaching claims but little scientific data to support it. Not saying it's not true, more that science hasn't caught up with the claim. We're really just scratching the surface of our understanding of this amazing structure, the human body. I love it! Anyway back to my disc problem. Nothing can be done to reverse the damage to these discs, especially L4. So my care at this point is therapeutic at best. We've determined that a surgery, called a discectomy, will be at some point necessary. I'm debating when would be best to do this. Do I elect to do it, before absolutely needed? Or do I wait to see how long I can go before that's the case? At this point I'm leaning towards the latter, as I hate the idea of going into surgery right now in my life. But if the episodes, which render me pretty much paralyzed for up to two weeks, continue to be more and more frequent, it will really strain my ability to get through the program here at Palmer. So I guess I'm playing it by ear at this point. Well gotta go for now, time for P.T. class!