Saturday, September 22, 2012

Heart of Ghent 10k

This was a great little race and win this morning. The weather is perfect and sunny (though as normal a bit humid for my taste! :) And I was up at 5:30 eating my oatmeal and studying.

I jogged over to register, only 1/4 mile from my house and then watched pathology lectures while rolling out my legs until ~20 minutes before the race, when I jogged over and met up with Aric Martinez, a new running buddy for ~10min warm-up.

The gun went off and I started out fast, but I was so nervous. I think I went to the bathroom about 20 times before the race because it has been so long since I raced and I just didn't know how it would go. This is my home turf and I wanted to do my best... could I? Despite having gained my medical school 10 pounds? Oh, the nerves!

I dropped back from the first group of fast guys to a second group of two somewhat older fast guys and let them get ahead of me. I passed them baack at ~ mile 1.5 and~mile2, pulling of a 5:27 second mile.

Then right before mile 3 I got off course when a police officer was talking to a homeless man instead of giving the runners directions. Fortunately the man that I had passed yelled me back and I only added on ~.17 miles. I also got called back at ~mile 4.5, meaning I had to stop twice :( so I don't know how fast I could have gone if I had kept my stride!

The best moment of the race was the first time I passed the guy that called me back when he said "oh crap, I'm going to get beat by a girl aren't I?" And I replied "yep" and thought of my good friend Renee High, who just demolishes men with egos all over the place.

I came in having first with 6.48 miles in 38:09. A solid first race back on my feet around my flat and diverse neighborhood. I won with the hometown advantage :) Now I'm off to do a cool down jog with my new friends from Hampton Road Runners! Yay!

***As an aside when waiting for the medal I heard "Courtney Chapman will you please come up here." I ran up there and said I'm Courtney Chapman. And they said Oh, just making sure you are a girl. You finished so fast we thought you were probably a guy. I was #5 of 632 finishers, #1 for women. Kind of neat! Now if I can only pass my pathology exam on Monday, my life will be complete!

Friday, September 21, 2012

Getting owned by a surgeon: adductor myotomy,

I got owned. I was headed to a surgeon's office because I want to continue my research from the summer as to whether a questionnaire filled out be parents can adequately reflect a child with cerebral palsy's treatment needs and whether they will benefit from surgery.

 I should make the disclaimer that Monday, the day before, I was owned by a final exam on immunology, on a textbook of over 800 pages that was 90 questions in 105 minutes. And the questions were hard. I believed a failed it due to a classmates joke that other people didn't take seriously (found out Friday that I actually passed by a good margin). I have not reviewed anatomy and was studying for a pathophysiology quiz (Wednesday) pharmacology quiz(thursday) and pathology exam (next monday) so anatomy was not on my mind.

I was meeting the surgeon I would work with at EVMS for the first time. I was late. I showed up at 7:07 and should have been there at 7:00. I couldn't find my ID badge, I couldn't find the office, etc, etc, etc.

Then (surgeon): what muscles lift the thigh? The iliac, the psoas (iliopsoas)... this is as much as I remembered.
Surgeon: "What else?"
 Me:Blank. Blank. Random guess#1...#2....#3...

We go in to see a little boy who has broken his arm above the elbow and will need pins and should be operated upon asap in order to correct location. He also has a bronchitis for which be was put on antibiotics a week earlier, but his parents only gave him one antibiotic pill because they don't like medications, so we can't operate until the internal medicine doctor comes and sees the boy to give him IV antibiotics and ensure that he can be operated upon hopefully later that day without dying. Call the internist and pneumonologist.

Back to the elevator, where a fourth year med student is standing... great, now I get even more of an audience for my wrong answers...

 Surgeon: What else lifts the leg?
Random guess #4: Rectus Femoris
Surgeon: "Where does it insert"
Me: (thinking facial sheath, but now completely discombobulated) the femur?

 This continues...
Surgeon: And what else lifts the leg?
Me:......... (correct answer, the tensor fascia lata)
 Where does the iliopsoas insert?
Me: The femur below the acetabulum (this is the head of the femur)
Surgeon: There is a specific place
Me:......... (right answer is lesser trochanter)
Surgeon: Time to put on your scrubs

In the operating room. Three year old boy who is under anesthesia. Surgeon shows me the limited range of motion at three joints despite no possible residual tone: ankle (foot permanently pointed, can't go to 90degrees), knee, (can't extend knee past 90degrees, not even close to straight), and hip.

 He cuts open the hip right under the boy's scrotal sac on the right side. Grabs a muscle with a hook-type tool...
 Surgeon: What muscle is this?
Me: An adductor (it is an adductor myotomy, the point is to cut the adductors so that the kids spastic adductors stop pulling the hip joint out of socket).
Surgeon: Which adductor? Me: ........RG (Random Guess)....#1Gracilis....#2adductor longus#3...adductor magnus....
Surgeon: adductor brevis
 Surgeon repeats this process with all other adductor muscles.
Surgeon shows random white stringy thing. "What is this?"
Me: Obturator nerve. (Ding I got one right!)
Surgeon: Which branch?
 Me: ........fml.....mental cursewords

Surgeon: what important structures are here?
Me: Everything in the femoral triangle.
Surgeon: What is the medial boundary of the femoral triangle?
Surgeon: It starts with a P
Me:.... Pectineus? I can only think of muscles in the knee like popliteus....
Surgeon: It's the pectineus. ***I got one kind of right***

 This continues as he performs the hamstring myotomy and opens up the side of the back of the knee, visualizing it. He showed me the muscles, and I correctly guessed the biceps femoris long headand the short head.
Surgeon: So why do we open up this area?
Me: Because there is an important structure you want to save?
Surgeon: And what structure
Finally an audience member intervenes! Note that  this is all infront of the entire OR team of 6 people + Me + The Surgeon
Nurse: It's a nerve
After many more hints...
Surgeon: it's the peroneal nerve. (this means he gave up on me. darn.)

 He opens up the medial rear of the knee. I am watching this and not paying attention. He continues to ask me questions, me not realizing it. Then I zone back in to him talking to me.

 Surgeon: Too nervous? Me: No, I was just interested in what you were doing, what did you ask?
Surgeon: What muscles are here?
Me (not thinking, not nervous, distrcacted by watching him): Semitendinosus
Surgeon: And what's underneath there?
Me: Semimembranosus.
Surgeon: and what important structures are there?
Me: I don't know any.
Surgeon, that's right, there aren't any, that's why we aren't invasively opening it up.

This process continued through the other leg as well.

So I got owned by a surgeon and left knowing how utterly inadequate I am. He reminded me that he took anatomy in 1985, not last year. Why did I choose to do this for fun? And why have I arranged to go back asap? That will be discussed in Part 2: How I have no ego and it has made me able to achieve a lot AKA what it means to be a little sister.

Sunday, September 16, 2012

High Cholesterol in a Runner

So whenever I eat and worry about fat content, I am told that people are just sure that I don't need to worry about cholesterol. Well let me tell you how WRONG you are! At 11 I had a total cholesterol level of 250. This would be of concern in a middle aged person. My mom was a health nut and I played sports. I still had a level of 250. My doctor put me on a diet where I could eat nothing with over 25% fat including cheese, egg yolks, ice cream, etc. and my cholesterol dropped down to a level of 180. Turns out cardiovascular disease runs in both my mom's and dad's family. Seems to have skipped both my mom and dad, but hit me somehow; my grandfather died at 45 while taking a dump.

I have tried to adhere to a low-cholesterol diet and I haven't gotten my cholesterol checked in over 10 years because I didn't want to go on medications and I didn't want to change my diet.

I finally got my cholesterol checked this past week and the verdict is: 205! I am so relieved, this means with making my diet just a bit more rigid, I can go back to the optimal range. I have a VERY VERY high LDL and an okay (not great) HDL level. LDL is what tends to deposit oxidized cholesterol into one's vasculature and HDL can have the capability to remove oxidized cholesterol from the vasculature.

Apparently what happens with me according to this test is I have a very high absorption of fat. This means that what I eat, I absorb. There are many people with low fat absorption. So the amount of nutrition someone else gets from 1 egg yolk, I can get from 1/8 of an egg yolk.

The way this test shows this is with sterols, which are plant-based cholesterols. Mine are through the roof!!! There is a condition called sitosterolemia that I probably have. It is genetic, autosomal recessive meaning my parents were heterozygotes (each containing one normal and one mutant gene). This also explains why my parents and sister all have normal cholesterol, but I have high cholesterol. The genes responsible are the cholesterol transporters that absorb cholesterol from the gut and also pump bile into the gut to assist with fat absorption.

In summary, mutation of these receptors means "defective secretion into the bile of dietary sterols, increased intestinal absorption of plant and dietary sterols, hypercholesterolemia, and early-onset atherosclerosis". The best drug for this specific (uncommon) reason for high cholesterol is one that decreases absorption of cholesterol, ezetimibe.

The alternative is that I can just not eat cholesterol and be extremely conscious that I need to eat about 1/8 the total fat of that others need. I am willing to do this and stay of medications for a bit longer :) But PLEASE don't tell me not to worry about eating a burger with full fat. I need to worry about that. It means the difference between life and death for me.

            The problems that cause more people hypercholesterolemia are quite diverse and they include non-responsiveness to a high fat diet. So one's body continues to synthesize cholesterol despite eating too much fat already. This is not MY problem, as the markers of cholesterol synthesis are on the low end of the optimal range. For this group of people, statins would be more appropriate.

I will also begin taking Niacin (Vitamin B3) and omega-3 fatty acids, but I will discuss why after my next exam :)

Monday, September 3, 2012

A Medical Student/Runner/Psychologist's Take on Paul Ryan's Memory

So earlier this week Paul Ryan mis-remembered his marathon time as sub-3 when it was actually a little over 4 hours. There are very many ways to intepret this information.

First, it makes complete sense why he would mis-remember the time. In 1990 a 4 hour marathon time was a lot more impressive than a 4 hour marathon time today. Relative to his peers 21 years ago, he had a really high performance. Twenty years ago was the era of Richard Simmons and Jane Fonda. The first ladies were talking about not taking drugs (Nancy Reagan) and reading (Barbara Bush), not exercise and diet (Michelle Obama). We didn't have elliptical machines for cross training. And we didn't have the training groups we have today. Many marathons had just recently been started. In fact, it seems as though a conversion table could be called for so that we can compare racing times from years past the ways we do for monetary inflation. Then we could see how impressive a 4hr-1min marathon really was.

Second, as he did finish with an impressive time for twenty years ago, it is understandable that he would remember himself as being a relatively high achiever. According to my internal medicine mentor, who is a big Paul Ryan fan, Paul Ryan came from the working class to go to Harvard and was elected senate at a young age and is now a Vice Presidential candidate, along with several other very impressive achievements. This is not personally fact-checked (**Upon fact checking this information I received, it turns out that he went to Miami University of Ohio. This is the importance of Source Memory, another major source of Memory errors), but this story shows how in accomplishments that can be compared, Paul Ryan has outperformed probably 99% of the populace at what he has accomplished. Hence, when asked for a specific time, he knew that he had accomplished a lot relative to his peers in running, and substituted in a solid marathon time by today's standards, not by the standards in 1990. This is actually an understandable and normal memory mistake, the exact reason why eye-witness testimony is no longer taken for granted. Further, if he trained for a marathon with proper support, a personal trainer, he could probably at some point reach a sub-3 hour. He seems like a pretty fit guy and a lot of making a sub-3 marathon time as a man is just consistent training.

So what makes people uncomfortable about the memory mistake? Well it shows that he is not aware of how memories work and the common memory fallacies that everyone encounters. Memory is a reconstructive process. Every time we retrieve a memory it is altered by the context in which we retrieve it. Further, memory uses the same processes as imagination (which, by the way is one possible reason behind the strong correlation between reading fiction novels and improved memory at later ages). So Paul Ryan accurately remembered that 21 years ago he ran a time that was impressive relative to his peers and then spliced in a number that would be impressive for 21 years later.

This could be the Sin of Bias where we "often edit or entirely rewrite our previous experiences--unknowingly and unconsciously--in light of what we now know or believe. The result can be a skewed rendering of a specific incident." It could also be the Sin of Suggestibility which is when a memory is "implanted as a result of leading questions, comments, or suggestions when a person is trying to call up a past experience."  These are two of the "Seven Deadly Sins of Memory" that have wrought havoc on courtrooms throughout eternity (not to mention personal lives).

By insisting upon of the veracity of a false memory, Paul Ryan shows he is unaware of how memory works and how it plays tricks on people. Further he shows that he can asserted as fact an false memory based on circumstantial evidence. Thus, the scary thing (in my opinion) is his ignorance of how healthy cognitive and memory processes lead to false memories. Or his refusal to admit that his memory is subject to the same fallacies as have been proven in the vast literature on memory and especially memory and courtroom testimony.

Is this enough to demonstrate that Paul Ryan is not adequately humble to be a good leader? Or that he will be a poor leader because he will not account for how the mind and memory works? I don't know. Are the other candidates more aware of memory fallacies and more willing to account for memory fallacies to prevent mis-information from being disseminated? Once again, I don't know.

I do know Paul Ryan's memory made understandable mistake and thus he created a memory of a time he never achieved. I also know that being adamant about the veracity of a false memory is a dangerous trait to have in someone close to you or with power over you (Oh, I would NEVER let a boy get away with something like this). So let us all hope that he uses this as an opportunity to learn about how memory works and in the future be more aware of how the present circumstances affect one's memory of the past.

** For more information on memory in the courtroom see anything written by Elizabeth Loftus. For a layperson's book see the "Seven Deadly Sins of Memory" by Daniel L. Schacter, Professor of Psychology at Harvard and was Chair of Harvard's Department of Psychology. For a great textbook see Memory by Alan Baddely

Sunday, September 2, 2012

Why I chose Not to race the Va Beach Rock and Roll Half

Hello everyone! So this weekend is the big half marathon in Va Beach. I ran it last year and got a PR for myself and I believe my first sub-1:30 with a 6:30 average. I believe I could do better this year, but we will never know because I chose not to race it. (Yes, there is a bit of agony in the tone of this statement).

There is a lot that went into this decision because I love racing and running. The first factor is my priority, which is medical school. Whenever I run and it is too humid, I get stomach cramps and diarrhea. This is proportional to how much I run. Last year after the race for the rest of the day I was in bed and running randomly to the bathroom. It was a bad experience. This year I am going into work at my mentorship for the day and don't have time to be running randomly to the bathroom or being unable to stand/walk around the office because I made myself sick from running in the humidity. Doing this would be irresponsible. And it is hotter and more humid than last year.

The next major factor is my physical condition. I have been getting slower at half marathons, not by much, but a little slower and more miserable each time. I need to focus right now on training and building myself up, not racing. After the last half my left knee was strained in the back so that it still hurts a little to squat, etc. And yesterday while doing a 5 mile tempo (6 min/mile for 5 miles) my right knee began to hurt, as I was diagnosed earlier this summer with tibio-femoral pain syndrome. Apparently my right quad and hip are slightly weaker than my left (hence why I strained the back of my left knee) and this is making my knee cap mis-track. While right now there is only a dull and achy pain and not too bad, I can't keep racing and expect it to get all better magically. I need to work for the healing!

All that said, I was going to use the Va Beach Half Marathon as a training run, jumping in with people doing 7:30/mile and park ~2miles from the course, so I would do a total of 17-18 miles today. Lol, and I was just intimidated by the crowds and the parking (the shuttle to the parking lot was actually ~12 miles!!!!! That means I would have spent at least half an hour commuting and would be late for my mentorship) or I totally would have done this. If anyone who has done this wants to share their opinion, please tell me how to do it legitimately in the future!!!! It is painful to miss out on such an exciting event! And I can't wait to hear about how it went for everyone else!

It was suggested that I put up this post because my friends and family will want to know why I didn't race. Really it is because my number one priority is medical school and this has made it so I have not done the training I need to be in top shape right now. I have to recover from my injuries and that means not just running, but also weight-lifting, stretching, icing... It means doing all the things I cut out of my schedule in order to study more hours. It also means that I will not run if it comes down between running and being sick/not being able to work in a day and being able to work for sure, but not racing.

If anyone has tips, feel free to give advice. I already feel quite guilty that I'm not studying more or volunteering more. But running is something I enjoy so much and it makes me healthy. I have hypertension and heart disease runs in my family (my grandfather died at 45 from a heart attack while taking a dump). Running means I will not only be happy, but will live longer, and be able to help more people over time. I do not want to give that up.