I Miss Chompy

Chompy on the Rock

I caught him basking on his favorite rock. Unfortunately he is getting too big to fit below it.

I went home last weekend and visited my family as well as my baby Chompy. He’s gotten so much bigger, probably two or three inches in diameter! The tank looks a lot smaller now, and I want to upgrade him into a more spacious living quarter, but my dad says there’s no place to put a tank like that in the house, even though we have plenty of bigger sized tanks. My dad wants me to let him go and be free, which of course is where turtles should be…but he’s so young! Winter will come soon (this morning was seriously forty degrees) and he’d be defenseless. Perhaps next summer I will, but not now. =(

This week has been fair. I had my cell biology exam and it was easier than I thought it would be, but not that easy that I could do it in my sleep. It just required insanely careful reading of each question, and I mean insanely. I’ll probably get a B or barely an A. Now, all I have to worry and study my butt off for is organic chemistry! The exam is only a few days away and it won’t be an easy one at all.

There’s nothing too much going on besides the SFP Induction ceremony on Tuesday, which I have to talk near the end! I’m not too good with public speaking. I recently got paired with a mentee from the WISE Mentoring Program, so that was awesome. She e-mailed me and right now we are figuring out a time to see each other. Luckily, she lives on campus and we are in walking distance so making time should be easy.

Hmm, nothing else besides that. I took a picture of my USB that I use when I go to the machine for qPCR when I do research.

qPCR machine from research

I got the Hello Kitty charm for my USB from my friend that I met in the Taiwan volunteer trip.

Man, that machine has made me angry lately. Sometimes it doesn’t work, or sometimes someone comes late and takes up your some of your time slot so you end up waiting longer than you thought you would. It costs $20 each time I go, and an hour and a half of waiting time. Research can be tedious.

TaqMan

Research is crazy expensive too. I use this when I do qPCR and one of these 5mL bottles cost over $300!

I’m almost done watching “Hi, My Sweetheart.” It’s so good I just keep crying in every episode near the end! Ahh I will need to get a tissue box for the last two episodes left, I’m sure. Oh, and is anyone bothered by the sudden change in weather? I am indifferent for some reason. I like the cold because I like wearing more clothing to cover my skin, but at the same time it’s not very pleasant when you walk out and immediately start shivering! Brrrrrr.

No Kidding… A Week on the Pediatric Ward

This week I began foray into the land of runny noses, worried parents, and whaling children, otherwise known as the pediatric ward.  Above all else, I’d like to take this opportunity to express my new found admiration and respect to every single person who at one point or another was, has been, or currently is, the parent of a small child.  Seriously, one week down on the general pediatrics service and I am exhausted to the point of delirium.

I guess it had never quite occurred to me that pediatrics encompasses everything from newborns to adolescents – a full 17 and some years and countless developmental stages therein. With this wide spectrum of ages comes a whole spectrum of physical exam maneuvers and differential diagnoses, because children of different ages get sick with different diseases, and may even present differently even when they do have the same ailment.  For example, say in a given day, you see a 10 month-old, a 2 year-old and a 17 year-old, all in the hospital for a cough that sounds productive (i.e. they’re coughing up mucus).  Although, taken at surface value, the chief complaint is the same, there is very little chance that they are all suffering from the same disease process.

All this makes the field incredibly challenging.  The vast breadth of information that a pediatrician has to master is impressive to say the least.  And what is more, they have to do it all, often being unable to ask the patient questions – after all, a child younger than 5 probably isn’t completely aware of what’s going on with their body when they’re sick, and most of the time won’t know how to answer questions about their illness.

A pediatrician acts as a detective, a cryptologist, and an interpreter, all in one.  They have a variety of physical exam tricks in their arsenal, specific for age and ability level, using the results as clues as to what is going on with the child, deciphering body language and other non-verbal cues at the same time.  Most importantly, they have the keen ability to relate to parents, and ease their fears and concerns, such that they’re able to provide a thorough history and strengthen the other findings as to the etiology of the disease.  All in all, it’s a monumental task, which demands remarkable skill and the patience of a saint, what with screaming, flailing, and projectile body fluids thrown into the mix.

Admittedly, sometimes on the floor it feels like a zoo.  But at the same time, it’s refreshing to see the resilience of children when faced with adversity, something I think we can all learn a lesson from.  For instance, a young child who felt crummy on Thursday, by Friday, will have forgotten the trial of the day before, and will play as if nothing had ever happened.  That innocence that allows them to truly live in the moment is beautiful, especially in a field like medicine, where often those moments are limited.  So far it has been inspiring to walk in the shoes of a pediatrician, and get a glimpse of the long-forgotten joy for life that we all had as young children.

A whole new 3D world

I created, or modeled, my first 3D living thing this week! It is a mouse embryo. No, I did not choose to create a 3D model of a mouse embryo. It is not a beautiful thing, and it is in fact a little bit gross. But it was an assignment in my 3D space modeling class in which we’re learning the program called “Maya.”

Maya is used by Pixar to create a lot of their animated movies. The finished products certainly have a certain feel and look to them, despite the vast amount of controls Maya gives you in terms of shading, coloring, texturing, lighting, etc.

Here are a few screen shots of the process, and my current end product. I hope to mess around with it a little bit more and sculpt it more to refine it. Then I’ll set up some lights… and camera, action! No, the mouse embryo will not move. It will just sit there, perpetually in 3D space.

the mouse embryo at its beginning stages, having started with a cube and built from there.

wire mesh of the mouse embryo

You can see in the background of the above picture that I imported an image of the embryo to use as a reference for size and shape. The blue shape is the model that I’m building. To create it, you start with a basic polygon shape, and “extrude” the edges and faces of the shape to build more and more of the mouse. You can manipulate every single edge, vertex and face of the surface, which should ideally be made of four-sided polygons.

It’s all still pretty overwhelming to me, and there is a TON to learn! Maya has like 50 bajillion buttons and tools. Hopefully I’ll model an organ or biochemical process for my main project in the class, or perhaps even a big toe!

current mouse model- it looks a little sad? Don't cry, little mouse embryo!

Can’t We All Just Get Along?

A relationship without communication ends in expletives, tears, and likely a breakup.  A hospital stay without communication ends in close calls, medical errors, and in the worst of cases, death.

The patient had a complicated history, with a recent kidney transplant managed with immunosuppressants, a subsequent ear infection, and complications which led to him to get parts of his facial bones resected in order to avoid any further spread of the infection. Nevertheless, by the end of that hospitalization in July, he was doing fine and was on the road to recovery.  With some help, he was walking short distances and overall was showing signs of improvement.

That being the case, it was quite a surprise when he came back just a month later, with leg weakness so severe that he could barely lift a foot, let alone take a step.

So he was admitted to the hospital once again and was placed under the primary care of the transplant service, despite the fact that his current symptoms were likely neurological in origin.  Now, it’s important to understand the logic here, which in itself isn’t wrong:  given his complicated medical history and kidney transplant — the complexities of which are likely to complicate any course of medical treatment — it was absolutely appropriate to have the transplant team see him.  However, the unfortunate design of the medical system (records, billing and all) meant that this initial determination of primary service precluded any other specialty (for example neurology) brought in to care for him from making medical decisions; anyone other than the transplant team were consultants, and would ultimately have limited control over his clinical course.

For the neuro team, this meant that we could only make recommendations for tests and procedures to be done, all of which would have to go through the middle-man approval of the patient’s primary team before being executed, slowing diagnostics and impeding treatments that would prove to be time sensitive.  In the case of our patient in particular, the decline was quick and severe.

Though he had come into the hospital with generalized muscle weakness, he was still able to move all of his extremities, even if that meant only a little lateral movement of his legs and wiggle of his toes (remember, his legs were the worst off).  He was also able to speak, only requiring occasional help from his daughter when communicating with us, and overall, seemed to be in no acute distress.  Over the next few days, though, he began a steep decline, as his speech rapidly worsened along with his motor capabilities.

On the second day I saw him, he was barely understandable, with marked facial weakness and the beginning signs of labored breathing.  The neurology attending I was working under realized the gravity of what she was seeing and told us to make sure we put in an order for a blood analysis known as an arterial blood gas, a test of oxygen absorption which would help us determine how well the patient was breathing.

At the top of out differential diagnosis was something called Guillain Barre Syndrome, an autoimmune disease where the body produces antibodies directed against a certain type of myelin (the fatty material that insulates nerves) found particularly in the peripheral nerves of the body.  Over a variable period of time (the process can be slow or fast, as was the case of this patient) these antibodies destroy the nerves, leading to both loss of reflexes, sensation, and ultimately paralysis of pretty much any part of the body.  In its classic presentation, the paralysis ”ascends” or goes from the periphery inward, starting in the feet and legs, (sometimes the arms) and heading towards the trunk, where it ultimately paralyses the most important muscle of all: the diaphragm.  This is the main muscle reponsible for breathing, and its paralysis basically means death.

This was our main concern, and more than anything else, we wanted to make sure that our patient didn’t progress that far.  But alas, per the system, he was not actually our patient.  And so we had to go through convoluted means of communication to get anything done, with every suggestion we made seemingly under-appreciated with regards to the urgency at hand.  So our attending, fearing that the patient could (and would) go into respiratory failure any minute, offered to take responsibility for the patient and have him transferred to the neurology service and moved floor where we’d be able to expedite the treatment plan which we thought, from a neurological standpoint, would serve him best.  Unfortunately, likely due to some inane hospital politics that never fail to surprise me with their absurdity, the primary team refused the transfer, and our poor patient stayed in the same room, on the same floor, and under the same primary service, when hour by hour he needed more and more monitoring and urgent care.

And so, with a growing sense of frustration matched only by our resolve to do right by the patient, we set out to make sure that our treatment plan would be carried out as quickly and efficiently as possible, despite the communicative obstacles. We had to breathe down the necks of the primary service to get the arterial blood gas we’d requested the day before drawn, and had to jump through hoops in order to ensure that he was getting the proper work-up for his condition.

This included an invasive procedure known as a lumbar puncture, in which a sample of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is drawn up through a needle inserted between the patient’s 4th and 5th lumbar vertebrae while lying on their side.  So we went about preparing to do the procedure, and positioned the patient accordingly.  My job was to hold him in place from the front while the residents did the procedure on his back.  While holding the patient in this position, alternating words of encouragement and comfort, I noticed something odd about the movement of his abdominal muscles that coincided with his now erratic breathing pattern.  It looked like something I vaguely remembered from my pulmonology lectures years before called paradoxical abdominal breathing, a unique phenomenon which signified exceptional impairment of the respiratory muscles, top among them, the diaphragm.  In other words, if this were the sign I thought it was, our patient was in trouble.

But never having actually seen it outside of an illustrated textbook diagram, I was less than positive that I was actually seeing one of the harbingers of respiratory failure, and not wanting to bother the residents during the stressful procedure, waited until I saw the attending shortly thereafter back on the neurology floor to report what I had seen.  By that time, she was already on the phone getting word that the patient’s respiratory rate had doubled with decreased oxygen saturation levels (the ultimate sign of respiratory failure) and that he was about to be intubated and placed on a ventilator to make sure that he would continue to breathe while we worked on getting his muscle function back.

Fortunately, he was successfully intubated minutes later, for which the primary team deserves the credit; indeed he received the care he needed when he needed it most.  Since then he has been receiving various treatments for his condition with some improvement of motor and respiratory function (although he’s still on the ventilator). All that aside, the question remains as to whether or not we could have prevented the close call and stopped him from progressing to that stage of severity had we been able to act more preemptively and aggressively. It’s debatable, but certainly not outside the realm of possibility.

Whether it was the lack of cooperation/understanding between the teams, delayed diagnostic testing, or my own personal failure to convey a significant physical exam finding in a timely manner, better communication probably could have made a real difference in the case of this patient.  And while disaster was averted this time, it warrants thought for the future.

It seems, as in the case of a relationship, a little communication early on can go a long way in preventing less-than-ideal outcomes down the road.

Postponing Article

UIC!

Unfortunately, I am unable to provide this week’s article as I am at a hospital helping my dad recover from an illness.

In addition, a tribute to 9/11 this weekend I wish to pay respects to those who have passed and to salute those serving our nation in a time of need.

Thank you all and god bless,
-Darren Ujano

Already Anticipating the End

I know it seems a bit too early to be thinking about next semester and the summer following that since we just started school, but I think I have already gotten so routine with my schedule right now that the time will pass by even faster than I imagine. I mean, we get out in December and that’s only three months away!

Smiley Cut

One of my eczema patches on my hands looked like a smiley. It was both entertaining and itchy to me. It's healed now though...

I had my nutrition exam this past week, and it was pretty easy. I think she made it that way so we could get used to the questions, but regardless of her intentions I hope I do well in the future tests if they are like this.

My cell biology exam is Thursday, and I need to study insanely hard for it! We had a quiz this past Tuesday and it caught everyone completely off guard. You would expect the quiz to be a multiple choice or short answer type format about the material we covered, but it was not even close! We were given the abstract and first paragraph of a research article, and from that information we had to design an experiment and explain why it would work. Miraculously I got 5/6 on that quiz (more like free-response essay), but if I did not do research on campus and did not have journal club with my research lab, I would have probably gotten a 0/6. Application of the things we learn is so crucial, so I guess I was kind of excited she gave us such a quiz to keep me on my toes, but at the same time I was terrified I would not have answered the prompt correctly.

Eek. I don’t even want to think about organic chemistry! I get the majority of the iClicker questions correct on lecture, and it all makes sense during lecture, but when it comes time to be on my own and understand the material, I get a little lost. The organic chemistry exam is four days after my cell biology exam, which I pray is enough time for me to really nail the material, but whatever happens I’ll be sure to practice more problems in this subject! Oh chemistry you will be the death of me.

Anyway, to keep things a little more happier, I went downtown yesterday with a bunch of AAMP (Asian American Mentor Program) people. Of course, I’m not in the program, but it wasn’t an official outing so anyone was welcome to join. There were a lot of us though! Eventually the group just split up, and I went with some close friends to Chipotle, and then FreshBerry, and finally a quick stop to Jimmy Johns (I’m a hungry one). I was sad Jimmy Johns ran out of their 50-cent bread. That was really the only thing I wanted…ah oh well.

Jazz in the CTA

When you're waiting for the CTA, there's almost always someone performing music! I think I've seen this Jazz guy perform all over downtown.

FreshBerry Froyo

I got split a large Green Apple Frozen Yogurt with my friend. It looked a lot prettier before we indulged in it...but here's a glimpse! I put gummy bears, rainbow mochi, and kiwi for my toppings.

Surgical Stories

“Were there any good ones this morning?” asked my illustration professor as I passed him in the street.  I had told him that I just came from an early morning session of drawing in the Operating Room at UIC.  My response was at first cheerful and satisfied, “Yes, a mastectomy!”  But then I hesitated.  And my prof was having the same thought going through his head.

“Good for you, not for her,” he said.

I agreed.  I had had a frustrating morning of rising early to watch a surgery for 2 ½ hours that turned out to be a different surgery than I thought- the surgeons had switched rooms before I got there. I waited for that “key moment” that our surgical illustration professor tells us to watch for and illustrate… and it never came. I was looking for the wrong thing!  Strangely, both the surgery I intended to watch and the surgery I ended up watching had to do with an incision in the neck. So, innocent mistake. At least it was me mixing up the surgeries, and not them!

That’s why I was pretty delighted when I walked into the room where the mastectomy was to take place and the surgery was about to begin. It was taking place an hour later than scheduled, and I had gotten lucky. So I introduced myself to a nurse as a medical illustrator, and she said it’d be fine for me to stand in and illustrate, but that I shouldn’t touch anything blue.  All of the blue material in the room was sterile, and the clean instruments sat sparkling on the blue surfaces.

I stood next to a third year medical student who was also observing the surgery. He and his co-student were switching off between observing and partaking in surgeries that day. It was his turn to watch. His partner held the instruments and did some of the suturing at the end.

It turned out to be a wonderful subject to draw, since the surgery was “open” (not through a scope and using a video camera), the surgeons weren’t standing in my view, and it incorporated figure drawing as well as the depiction of instruments.  It was not a full-blown mastectomy–it was “partial”–which means they opened up the breast and removed the cancerous material.  They called the blobs of fat “specimens,” and poked and prodded at them before sending them off in sterile bags.  I will not describe the surgery any further, but the key steps are illustrated below in some sketches, if you’d like to see.

incision and retraction- opening up the breast for removal of tissue

clean up, exploration, blunt dissection by surgeon

The extracted sample and suturing the incision

closure of the incision

From Leeches to Lidocaine

I’m taking a class called Surgical Illustration, where I get to go into the operating room with a sketch pad to observe and record various surgeries. As a fly on the wall, I’ve come to see how advanced surgery has become. Most surgeries are now “endoscopic,” which means the surgeons don’t even have to cut open the person to move things around, cut or suture.  They make a small incision to insert a video camera, or scope that has its own source of light, and another small incision to insert special tools that are easily manipulated from outside the patient.  Some surgeries are completely robotic.  For most modern day surgeries, the patient feels nothing, and has a quicker recovery than ever before. What’s next?

Ancient surgery consisted of treating wounds and a thing called trepanation- the act of boring holes into the patient’s head, a procedure believed to release pressure and “evils” of a sickness. (although some believe ancient physicians were more deliberate and knew the science behind the surgical act.)  Can you imagine if modern day lawyers had been around during that time?  There would probably be lawsuits up the wazooo.

The foundation of modern surgery was, in fact, the barber.  With manual dexterity from cutting and trimming and shaving heads, the barber had the skills and tools to conduct basic surgeries like teeth-pulling or bloodletting.

An ancient bloodletting chart

 

In fact, the red and white striped pole originates from the two roles of the barber- red for surgery and white for barbery.

A breakthrough in surgery came with the first human dissections, which took a while to be accepted because of beliefs and religion. It also was a difficult task back in the day due to lack of refrigeration or sterilizing techniques.  A guy named Galen was a chief physician in Roman history during the second century AD and was named the “father of anatomy.”

He actually only dissected monkeys and pigs, but discovered a lot about medicine from these dissections, and was one of the first supporters of the theory that the brain controls the muscles of the body.

Much much later, Da Vinci became the father of accurate human anatomy, because he actually dissected human cadavers.

He did this controversial work in his own home, creating magnificent illustrations of anatomy that he never published during his lifetime. Andreas Vesalius, a Flemish anatomist and physician living around the same time as Da Vinci, stole bodies from graves to study them, and produced a book called “De humani corporis fabrica,” which corrected a lot of the errors of Galen.

Further breakthroughs in surgical history include the invention of the clamp and ligamenture by Amboise Pare in the 1500′s, which replaced the age-old techniques of pouring boiling oil onto a wound to stop the bleeding. Another one was the practice of hypnotism and use of alcohol for pain relief, and use of ethers and chloroform as anesthetics, adopted in the early 1800′s. Before then there was no such thing as an anesthetic!

Handwashing has its own history.  Ignaz Semmelweis lived in the mid 1880′s and developed the theory that a doctor’s hands were the cause of the spread of disease during surgery. He was ridiculed, and died of septicemia. (bacterial infection.)

Louis Pasteur later on discovered that bacteria caused decay, and finally a guy named Joseph Lister, born in 1827 in England, started using carbolic acid to clean his instruments before surgery, thus greatly reducing the number of deaths after a surgery.

I’m happy to say that I don’t remember the pulling of my wisdom teeth when I was 16. I remember waking up, drowsy from the anesthetic, awaiting my pain medication. 100′s of years ago I could have easily died from this surgery.  Thank goodness for these breakthroughs!

Top 5: Tips to Get Higher Grades & UIC Spark in the Park

Hey Flames!

Just got back from UIC’s 2nd Annual Spark in the Park Music Fest!– featuring Lupe Fiasco with special guest The Cool Kids, Flosstradamus, and The Hood Internet.

The Chicago sunset with The Cool Kids performing before Lupe Fiasco

Lupe Fiasco entering the stage!!! Performed Superstar, Kick Push, Beautiful Lasers, The Show Goes On, and much more.

Other than that, an absolutely exciting week as I give you my,

Top 5: “Tips to Get Higher Grades”

5. Create a “Game Plan”
Get down and read the syllabus. Know how the points are divided, then create a studying plan on how to get an A. Throughout the semester, be sure to calculate your grade and know what you need to get to pull off a passing/high grade.

ME 250 class spring 2011. Creating a game plan will ease out the semester. It was simple to create this 10-week golf project.

4. Know thyself
Know your strengths and weaknesses; meaning, if math isn’t your thing, then plan on spending time on it. Know your best study conditions as well, like studying at the library and create a study group when it helps.

CME 205 Professor encouraging study groups to solve this quiz problem, realizing that there's an error in calculations

3. Ask Questions and Volunteer
Know the material– in some, but not all difficult classes, you are literally competing for your grade. For instance, my physics professor a year ago only awarded A’s to the top 10 students in the class. So ask questions, volunteer, and get extra credit whenever possible, because that 1% grade difference will be the game breaker.

2. Attention to Detail

CME 205 notes with colored pen

     I learned this in the military and the same goes in university life. Always make sure your well prepared for class, taking the most accurate notes, keeping well organized; because in the end, the student with the better game will come out on top.

1. “If you ain’t first, your last” -Ricky bobby, Talladega Nights

This applies to where you sit in class. Sitting in the front row saved my butt multiple times and gave me higher grades. Not only will the professor get to know you, but you can hear them better, see the board better, know whats happening in class, sit with the most active students, and most importantly not doze off.

Sitting in the back of class is very difficult to see or even hear the professor

Tuesday, I did a photo shoot with UIC photographers at Millennium Park. Random fact, that was the first time I had a make-up artist. As a thank you, they gave me a $25 gift card to the bookstore which leads me to the question of the week.

——————–
TOPIC NEXT WEEK:  “Top 3: Things Not to Do During Class”

 QUESTION OF THE WEEK: What’s the best way to spend $25 at the UIC Bookstore?

ANSWER FOR LAST WEEK: SCE’s previous name was CCC, Chicago Circle Center. 

Happy September

I still find it hard to believe that we’re on our ninth month of the year 2011, and that my beautiful roommate and friend Simona turned 19 today! Soon I will turn 19 (in October) and it just feels weird. I know it is probably nothing like turning 20, or even 21, but it’s almost like the last “teen” year I’ll have.

Ice Cream Cake

We went to Dairy Queen in downtown to get an awesome Blizzard Ice Cream Cake for my roommate's 19th birthday!

Starting next week, I will have my first nutrition exam; the week after, I will have my first cell biology exam; and finally, the week after that, I will have my first organic chemistry exam. I feel so fortunate to have taken 18 credit hours and coincidentally have almost every exam spaced out! It is a rare quality. Week two of my crazy schedule went well, but I still need to study a bit more in organic chemistry. We have a Russian TA, and he seems a bit impatient and intimidating to all of us.

Yesterday in Music Therapy, my class and I watched a video on an overview of the arts and medicine, and it was just so inspiring! It made me want to play my violin again, and the piano and erhu. I miss music so much but it really takes a lot of practice each day to be good and it is just very difficult to balance study time and class time, work and research, and of course all of those extra-curriculars. Fortunately, the extra-curricular clubs tend to be unorganized (sad, but it is true) so I do not have to worry a great deal. Every club that I joined last year started out great, but overtime people just got busy I guess and did not contribute or attend. I suppose it is because undergraduates just like party all the time, but I seriously don’t understand how people who do that can maintain good grades. It is quite boggling.

Anyway, Spark in the Park was AMAZING. Lupe Fiasco sounded just like he does on the CD when he performed live. The only annoying part was when people blew big puffs of cigarette smoke in front of my face. My eczema definitely does not react well with those free radicals…

Spark in the Park

Lupe Fiasco at Spark in the Park! I love UIC. :D

It’s labor day weekend! I am going home tomorrow…somehow. My brother has to meet with the restaurant owners of Bop n’ Grill because they want us to design their t-shirts! My brother’s designs are pretty cute, haha. Speaking of which, I need to switch hosts because my brother is complaining that it’s annoying to click “store” and not arrive to the store…and other things. Yeesh.

My cousin is having a baby shower this weekend! I’ve never been to one, so this will be a fun and new experience. =)