Mnemonics!

Everybody loves mnemonics! Why work harder when you can work smarter? Got pain? LINDOCARRF! Differential diagnosis? VINDICATE! Less than a week left before the big exam. Here are ten more that I've got locked away in hopes that they will come in handy on the exam. Some of them are pretty stupid and don't really make any sense but they help me remember!

Mechanisms of BP regulation:
"Bold Clinicians Can Voluntarily Read Simple Charts Really Rapidly Everyday!"

Bold Baroreceptors
Clinicians Chemoreceptors (peripheral)
Can CNS (central chemoreceptors)
Voluntarily Volume reflex
Read Right A reflex
Simple Stress relaxation
Charts Capillary fluid shift
Really RAAS
Rapidly Renal pressure diuresis
Everyday Erythropoietin (EPO)

Bilirubin metabolism:
"Help Him Vividly Remember Understanding Complete Bile Secretion Solidly Until Urine"

Help Hemoglobin
Him Heme
Vividly Biliverdin
Remember Bilirubin
Understanding Unconjugated bilirubin
Complete Conjugated (bilirubin-glucoronide)
Bile Bile
Secretion Stercobilinogen
Solidly Stercobilin (oxidized form) à feces
Until Urobilinogen à kidneys
Urine Urobilin (oxidized form) à kidneys

Effects of Angiotensin II: VASARICT

Vasoconstriction
ADH
SNS
Aldosterone
Renin
Inotropic
Cardiohypertrophy
Thirst

Central and Peripheral Cyanosis: SHOPA CROC

Shunting (R à L) PaO2 low (from ↓FIO2 à ↓PaO2)
Hemoglobin abnormal
O2 saturation low (from ↓FIO2 à ↓PaO2)
Pulmonary function impaired
Atmospheric pressure ↓
Cardiac output ↓
Redistribution of blood flow from extremities
Obstruction (arterial or venous)
Cold

Anorexigenic hormones/neurotransmitters: GP NαILS CCC

Glucagon-like peptide (GLP)
Peptide YY (PYY)
Norepinephrine
α-Melanocortin-stimulating hormone (α-MSH)
Insulin
Leptin
Serotonin
Corticotropin-releasing hormone (CRH)
Cholecystokinin (CCK)
Cocaine- and amphetamine-regulated transcript (CART)

Orexigenic hormones/neurotransmitters: CAGE GAMON

Cortisol
Agouti-related protein (AgRP)
Galanin (GAL)
Endorphins
Ghrelin
Amino acids
Melanocortin-concentrating hormone (MCH)
Orexins A and B
Neuropeptide Y (NPY)

Duty of Care: "Don't Forget A Duty To Care!"

Don’t Diagnosis
Forget Follow-up
A Attendance
Duty Disclosure
To Treatment
Care! Confidentiality

Layers of Skin: "CLG Sucks Balls"

C Stratum corneum
L Stratum lucidem
G Stratum granulosum
Sucks Stratum spinosum
Balls Stratum basale (germinativum)

Functions of Skin: "The Sexy Skin Protects Me"

The Temp regulation
Sexy Sexual
Skin Sensory
Protects Protection
Me Metabolic function

TCA Cycle: "Can I Keep Selling Sex For Money, Officer?"

Can Citrate
I Isocitrate
Keep α-Ketoglutarate
Selling Succinyl-CoA
Sex Succinate
For Fumarate
Money Malate
Officer? Oxaloacetate

Lecture notes are such a waste of paper...

Four Months Away from Home

So I've passed the four month mark since I left my home in Calgary. I guess it seems like a big step to go from living at home in the same town I grew up in to living on my own on the other side of the world. I keep telling people that the adjustment living on my own and being in a different country hasn't been that bad - Brisbane/Australia and Calgary/Canada have a lot of similarities and there wasn't much of a culture shock.

Maybe it's from the fact that I don't have a car down here and haven't been traveling by car much, but I haven't seen any car accidents. Pretty surprising since Brisbane is so spread out that you basically have to have a car if you want to get around efficiently. My dad e-mailed me a few weeks ago telling me that mom got into a car accident. I received the e-mail on my phone and had a mini-panic attack. I found out later that some guy in an SUV backed up into the front of my mom's TSX. Probably a few thousand dollars damage just because some young guy didn't look behind him before backing up.


I do miss snow. It's interesting meeting people here who have never been up close and personal with snow. My parents just sent me a photo of our neighbourhood after some light snowfall in May. Personally, I think snow is beautiful. I couldn't imagine celebrating Christmas without snow.

A picture of my cul-de-sac in Calgary

Failure to Thrive

In a couple of our PBL cases this year, we have looked at the failure to thrive. It is marked by a weight consistently below the 3rd to the 5th percentile according to age, a progressive decrease in weight to below the 3rd to the 5th percentile, or a decrease in the percentile rank of 2 major growth parameters in a short period. Basically it is caused by inadequate nutrition that can result from decreased nutrient intake (eg. pyloric stenosis), malabsorption (eg. Celiac disease), impaired metabolism (eg. galactosemia), increased excretion (eg. diabetes mellitus), or increased energy requirements (eg. cystic fibrosis).

For Christians, spiritual growth is of paramount importance. Without proper care, it's easy for us to fail to thrive and mature. I don't think there's a definitive scale for us to compare ourselves to in order to determine what percentile we fall under. But there are definitely several activities that we should become routine in our lives to prevent a failure to thrive. Spiritually we need to eat (eg. read the bible), breathe (eg. pray), maintain good hygiene (eg. confess our sins), have a caring family (eg. fellowship with others in Christ), regular exercise (eg. serve the body of Christ), protection (eg. against temptation), and to give generously (eg. be good stewards of the all God has entrusted to us). Staying healthy spiritually is really no different than keeping physically healthy.

I think one area that is rarely shared about in Christian circles is the area of confession. It's no surprise. Any normal person would not jump at the opportunity to confess his shortcomings - to tell the world that their marriage is falling apart or that they are suffering from depression. It has the potential to tarnish our image and hurt our reputation. I don't know about others but sometimes there's this pressure to put up a front that gives everyone the impression that things are all fine and dandy in life.

When the people saw Jesus hanging out with a tax collector, they lost respect for Him - not understanding why He would associate with sinners. But Jesus made it very clear while staying at Zacchaeus' house that He came to seek and save the lost. Healthy people don't need to see a doctor. In the same way, Jesus came not so much for the righteous but for those who were spiritually weak and sick. Similarly, when Jesus told his parable of the lost sheep, he was gathered around by tax collectors and "sinners." The church isn't meant to be a place where perfect people gather. It's a place for sinners to come, to confess their sins before God almighty, repent, and be saved by grace. We've all sinned and people need to understand that church is filled with people who have messed up but have found hope in the Lord. The apostle Paul himself confessed that, "Christ Jesus came into the world to save sinners - of whom I am the worst."

When things aren't going so well between God and myself, and I need to reconnect with Him, I like to read Psalm 51. Well, I guess I shouldn't say I like to read it...I don't enjoy reading it because of the guilt it makes me feel but I know that I need to fix things with God and the psalm really helps me to wrap my head around that. It's a psalm that David wrote after he had committed adultery with Bathsheba. David, a man after God's own heart, said this humble prayer for forgiveness and cleansing because he screwed up. It's really hard to confess my sins - especially if it involves someone else on top of God. Pastor John Underhill outlines 7 A's for confession: Address all involved, avoid ifs/buts/maybes (real confessions don't have excuses!), admit specifically what you did wrong, acknowledge the hurt you caused, accept the consequences, alter your behaviour, accept God's forgiveness. For my oral hygiene, I brush my teeth twice a day. I don't even come close to that frequency when it comes to my spiritual hygiene. Something that perhaps could use some work.

"Have mercy on me, O God,
according to your unfailing love;
according to your great compassion
blot out my transgressions.
Wash away all my iniquity and cleanse me from my sin...

Create in me a pure heart, O God,
and renew a steadfast spirit within me.
Do not cast me from your presence
or take your Holy Spirit from me.
Restore to me the joy of your salvation
and grant me a willing spirit, to sustain me...

You do not delight in sacrifice, or I would bring it;
you do not take pleasure in burnt offerings.
The sacrifices of God are a broken spirit;
a broken and contrite heart,
O God, you will not despise."
- parts from Psalm 51 (NIV)

Jesus Lead On

I was just thinking about the whole idea of allowing God to guide our lives and it reminded me of a song by Brent Helming, a worship leader with Vineyard Music. I don't have an mp3 of it (otherwise I'd load it on the sidebar for you to listen) and I can barely remember how the melody goes. I think the last time I sang this song was during a chapel back in junior high school. Right now, it's my "song of the moment."

Jesus Lead On

This is my cry, this is my song
You are my guiding light, when the way is unknown
And when these sunny skies turn shades of grey
I'll stay close by your side as You lead the way

Jesus lead on, I will follow
Jesus lead on, let Your love light the way
Jesus lead on, I will follow
Jesus lead on

Hear now this cry, hear now this song
You are the guiding light, for this journey I'm on
And when my vision is clouded by the wind and the rain
I'll stay close by Your side as You lead the way

Dermatomes

Just under 3 weeks until my mid year exam. It's a little bit scary reviewing all this material and realizing just how much stuff I need to remember. The sheer volume of information is overwhelming and it seems that as I stuff more information into my head, I'm just pushing old information out. Back in undergrad, it was a constant cycle of cram and forget. Study like crazy for one exam, hit the memory erase button, and cram for the next. But I can't do that anymore. Everything from day 1 onward is cumulative and I need to know it unless I want to be responsible for killing people due to mental negligence.

Here's a song about dermatomes that I came across. No idea how the melody goes or who the authors are (Doris and Bek with the help of Mr. Smirnoff) but maybe I can stick my own tune to it and it will help me with all the referred pain...

Doris and Bek's Dermatome Song

"When you know the points to prick, you can diagnose anything."

"C2 – the back of your head to the bump

C3 – the supraclavicular fossa
C4 – the area crossing the AC joint
C5 – the lateral antecubital fossa
C6 – lateral arm going to the thumb
C7 – that rude middle finger
C8 – little finger to the medial hand
Which brings us to the T, T, T, T’s
T1 – the median antecubital fossa
T2 – the apex of the axilla
T4 – the strip covering those erect little nipples
T10 – the level of your belly button
L1 – upper anterior thigh
L2 – the mid region of your thigh
L3 – medial femoral condyle area
Which brings us to the knee, knee, knee
L4 - the leg to the medial malleolus
L5 – covering your first 3 toes
S1 – the lateral foot and your calf
S2 – the popliteal fossa
S2 – also does the hamstrings
S3 – the ischial tuberosities
S4-5 – that itchy perianal area
Which ends this little song song song song"

Find Us Faithful

It is a bittersweet feeling knowing that God has called the senior pastor from my church back in Calgary on to a new ministry. He has led our church for many years and will be greatly missed. I was just reminiscing back many years ago on one of the old songs we used to sing in church by Steve Green called Find Us Faithful. I think it's one of my pastor's favorite songs and it has a great message in it.


"We're pilgrims on the journey of the narrow road
And those who've gone before us line the way
Cheering on the faithful, encouraging the weary
Their lives a stirring testament to God's sustaining grace

Surrounded by so great a cloud of witnesses
Let us run the race not only for the prize
But as those who've gone before us
Let us leave to those behind us
The heritage of faithfulness passed on through godly lives

Chorus:
Oh may all who come behind us find us faithful
May the fire of our devotion light their way
May the footprints that we leave lead them to believe
And the lives we live inspire them to obey
Oh may all who come behind us find us faithful

After all our hopes and dreams have come and gone
And our children sift through all we've left behind
May the clues that they discover and the memories they uncover
Become the light that leads them to the road we each must find"


Pastor Moses, thanks for your faithful leadership and dedication in serving the Lord all these years. May the Lord continue to bless you and keep you wherever you go and give you peace!

NHL Conference Finals

The only surprise is that Detroit is still in the mix after Calgary and San Jose. Datsyuk is firing on all cylinders, Hasek is playing great, and all appears to be well. Giguere is playing even better than he did in his 2003 playoff MVP year (1.28 GAA, 0.952 SV%) and the Ducks have Niedermayer/Pronger to counter the Lidstrom/Schneider complement Detroit has to offer. The Ducks are a young, big, fast team that should overwhelm the Red Wings. Hasek should see a lot more rubber in this series and traffic through the crease. I predict that the Ducks wrap up a Western Conference win in 7 games.

Out East, it's a match-up of two biggest offensive guns in NHL. The Sabres and Sens scored 308 and 288 goals for during the regular season - putting them first and second in offensive production respectively. Ottawa has that monster line option of Spezza, Heatley and Alfredsson that's probably better than any of the Sabre lines. However, the Sabres can generate dangerous scoring opportunities from basically all four lines. The Sabres are faster but Ottawa is bigger. Goaltending may be a big factor. Miller was solid last round but so was Emery. I think the Sabres are just too good to not make the Cup finals and they will dispatch of the Senators in 6 games.

A random floor hockey action shot courtesy of Sheridan.

Food For Thought

So this weekend I decided to try out something entirely new (for myself anyway). I had finished eating all of this 4kg salmon that I bought a couple months ago; all except the fish head. My roommate made a miso soup using a fish head and I decided to give it a shot since there was extra miso in our fridge and the Chinese inside of me didn't want to waste the precious meat that was on the fish head. It actually turned out okay. I need to find another place that sells cheap fish. The Chinese grocery store in Sunnybank that I really liked burned down a month or so ago.

The pan fried steaks are not going so well. It could be in the way I season the beef. I've tried using salt, pepper, other spices, barbeque sauce, soy sauce...the meat always tastes very "iron like." Back home I would bbq fresh steaks that weren't frozen and it was easy to get a nice medium rare steak with some Montreal steak seasoning. But with frozen meat, I don't want to leave it bloody and pink on the inside so the outside ends up being quite well done in order to make sure it's all cooked thoroughly. I miss Alberta beef and a good 'ole barbie.

In an attempt to save some coinage, I've been buying a lot of generic brand stuff and so far it's been pretty good. Coles brand ice cream, however, does not make the cut. It has this artificial sugar taste rather than a rich, creamy taste. Of course, I bought a 4L container of the stuff because it's cheaper to buy in large quantities. This time around, I went with Bulla ice cream. My roommate really likes it and it's not as expensive as getting Breyers.

I was reunited with my good friend the zucchini last week. Got an entire bag of eight for $1 at the farmers market in the West End. Stir-fried it with some chicken and it was fantastic - not bitter at all. I did overcook it a bit and some of the thinner pieces were a bit soft so I'll have to watch that for next time. This week I'm probably going to do a pasta rotation and I bought some more zucchini for the sauce. I'll see how that turns out.

The Power of Prayer

I was reading about King Hezekiah the other day in Isaiah and I was just blown away by the power of his prayers. His story is also found in 2 Kings 18-20. Hezekiah, King of Judah, was one of the few kings that did good in the eyes of God and because of his righteousness, Judah was delivered from the hands of the Assyrians. They had already captured most of the cities in Judah and all that was left was Jerusalem. Sennacherib, king of Assyria, tries to strike a deal with them but Hezekiah refused to listen. The Assyrians were very powerful and had laid waste to all of the nations around Judah (Gozan, Haran, Rezeph, Eden, Hamath, Arpad are some of the ones mentioned). Hezekiah isn't stupid and knows that Judah's army has no chance against them. But unlike those other nations, Hezekiah trusted in the Lord - the one true God. And he did what many of us would do when faced with a hopeless situation - he prayed and asked God for deliverance from the hands of the Assyrians.

"...Now, O LORD our God, deliver us from his hand, so that all kingdoms on earth may know that you alone, O LORD, are God." Isaiah 37:20 (NIV)

And how did God answer his prayer?

"Then the angel of the Lord went out and put to death a hundred and eighty-five thousand men in the Assyrian camp. When the people got up the next morning - there were all the dead bodies!" Isaiah 37:36 (NIV)

God answered his prayer and went in and killed 185,000 Assyrian soldiers! Just like that. God decides he's going to save a nation and what does he do? Kills off a couple hundred soldiers at the blink of an eye. Now I know God is a God of unconditional love but He's also a very powerful God that you don't want to mess with. The fear of the Lord is the beginning of wisdom and it's stories like these that make me glad I'm on His side.

Then in the next chapter, Hezekiah becomes very very sick and Isaiah tells him that it is time to get his house in order because he's going to die. What does he do? He prays and says, "Remember, O Lord, how I have walked before you faithfully and with wholehearted devotion and have done what is good in your eyes." And God answered his prayer and added 15 years to his life.

I am reminded of a passage in James that talks about the prayer of faith. It says:

"13Is any one of you in trouble? He should pray. Is anyone happy? Let him sing songs of praise. 14Is any one of you sick? He should call the elders of the church to pray over him and anoint him with oil in the name of the Lord. 15And the prayer offered in faith will make the sick person well; the Lord will raise him up. If he has sinned, he will be forgiven. 16Therefore confess your sins to each other and pray for each other so that you may be healed. The prayer of a righteous man is powerful and effective." James 5:13-16 (NIV)

Bill Hybels wrote a book called "Too Busy Not to Pray: Slowing Down to be with God" that I want to read. Yet another book added to my already long list of books I want to read. There's so much going on in my life that I can't afford to not take time to pray and seek God's guidance. Time to pray more like Hezekiah!