So You Think You Can Diagnose?

By: Molly Kelly, OMS-IV

Case 1

A 56 year old woman is rushed to the Emergency Room experiencing chest pains radiating to left arm with shortness of breath.  She states the symptoms started suddenly correlating the onset with being scared out of her wits after crossing paths with Dr. Evil while walking home. An EKG shows mild ST elevations and the first set of cardiac enzymes are elevated. The patient is admitted to the ICU where an x-ray study of the coronary arteries and left ventricle with dye is completed demonstrating the absence of severe plaque buildup in a coronary artery as well as an unusual shape of the left ventricle.  This distinctive shape is characterized by a narrow upper portion with the lower portion enlarged like a balloon.Stress myocardiopathy

What reversible cardiac condition does this patient have?

A.) Myocardial infarction

B.) Takotsubo Cardiomyopathy

C.) Prinzmetal’s Angina

D.) Eccentric Left Ventricular Hypertrophy

 

Case 2

A 26 year old woman comes to your office at the behest of her friends as they are concerned with her recent inability to do well at her job as a librarian. They note that their normally shy and reserved friend has been reprimanded for talking too much and too loudly as well as dressing provocatively and giving out her phone number to boys simply checking out books from the library. They note this behavior began after her recent hospitalization for encephalitis.  She still does her job well with library operations and easily follows directions but her boss is threatening to fire her if the problems continue.

What medical condition does this patient have validating her friends concern?

A.) Bipolar Disorder

B.) Folie à deux

C.) Histrionic Personality Disorder

D.) Klüver-Bucy Syndrome

 

ANSWERS:

Case 1- Takotsubo, or Stress, Cardiomyopathy, also commonly known as “broken heart syndrome,” starts abruptly and unpredictably, with symptoms of chest pain and shortness of breath, usually triggered by an emotionally or physically stressful event, and with a predilection for women older than 50 years of age.  Although the basic cause of this condition is unresolved, the frequent association with stress has focused attention on the autonomic nervous system. It has been suggested that when powerful hormones such as adrenaline are released in excess, the heart muscle can be damaged in patients with takotsubo.  The shape of the heart, particularly the left ventricle, closely resembles the ceramic Japanese takotsubo pot used to collect an octopus. Because a large proportion of the heart muscle is injured, heart failure can occur.  Fortunately, with timely recognition and supportive therapy, takotsubo events are reversible, and recovery is usually rapid and complete. Heart function improves over several days and is usually normal within 7 days.

 

Case 2- Klüver-Bucy syndrome is a syndrome resulting from bilateral lesions of the amygdala most commonly from herpes simplex encephalitis. It may present with hyperphagia, hypersexuality, hyperorality, and docility. There is no cure for Klüver-Bucy syndrome. The disorder is not life-threatening, but the patient can be difficult to manage. With treatment, symptoms may slowly decline. This may be a difficult diagnosis especially in comparison to answer C with histrionic personality disorder, however, histrionic patients tend to base their symptoms on the need for intimate relationships and there is typically no correlation with illness or injury.

Life Needs Muscle Energy Technique (MET)

By: Syed Gillani, OMS-III

Living in New York is a unique experience. I have to admit that I did not anticipate the challenges it would bring to live here. For example, one of my challenges is that I need more time to drive from point A to point B. Currently; I am doing my regional clerkship at St. Barnabas Hospital, Bronx. I live 4.2 miles from the hospital. However, it takes me at least 20 minutes to get to the hospital at 5’o clock in the morning. I don’t want to even talk about rush hour commute and the time I spend to find the parking.

I have been thinking about why I take so much time from to get to any place. I thought about so many factors like, so many vehicles, narrow roads etc.  My thoughts started focusing on traffic lights.  I started counting how many red lights I had to stop before I get to the hospital. These red lights are the major part of my journey whenever I drive in New York.  However, I realized that I never consider them while I plan my commute. As I was thinking deeper, these lights started flashing in my mind. The chain of thoughts leads me to my own life’s journey.  In my life, I wonder how many times I have to cross so many red lights to get somewhere. All my life I plan how to face and cross these red lights. I grew up in a town of half a million people. Any place, which has people more than that, makes my life a bit more challenging. Growing up, my town did not even have any traffic lights. In my opinion, people were careful drivers and courteous to each other. Probably, because they already had enough red lights in their everyday lives. So, they wanted to keep it to a minimum when it comes to dealing with red lights on the street. Not many people like them because we need a lot of patience, vigilance and focus in order to deal with them. We have to be in the constant state of relaxation and don’t let them  get on our nerves.

Another reason most of us don’t like these red lights and try to run them because they are one of the barriers in our lives. As student of Osteopathic medicine, we are very familiar with this word. We also use terms like physiological and anatomical barrier etc. I think running a red light is just like passing the anatomical barrier. By doing so, we may end up having tissue disruption. These barriers cause dysfunctions in our lives. We should stay in physiological barrier by not being aggressive rather stay calm.

So how can we treat all the dysfunctions while staying within physiological barriers? First of all, we need to be optimistic and have a strong belief that these barriers can be treated. First of all, we need to be thoroughly examined and review our lives by putting everything into perspective. We need to Look, Feel, and Move, every aspect of it to find out the dysfunctions. Then we should proceed to treating it appropriately. In my opinion, life’s dysfunctions need muscle energy technique. We, as human, always wanted to be in freedom and everyday challenges put us into barriers.  However, if we treat it right, all dysfunctions will be gone. It will allow us not only to move on but also give us enough time to be productive until next challenge will create another dysfunction.

Rotations 101: “Push!”

By: Punita Shroff, OMS-III

In life we come across our many firsts. In medical school it is no different. My first article for the pulse this past year discussed  death, something as students we all will eventually have to deal with. But with life ending, there is also a joy with life being born.

In obgyn, most of you will have or already had the privilege of seeing babies be delivered or helping in their delivery. A few days ago while on call, I saw my first delivery. I speak of this moment because I don’t think words can describe what it felt like being in that room (but I’ll try). We tried to fully prep the room as the patient was fully dilated and ready to push. But before anything could happen, the baby had other plans and it was ready for its debut. The mother pushed with the encouragement of all the doctors and nurses in the room but midway, she stopped. The room went from mildly noisy to heavily chaotic. Everyone was screaming repeatedly push! But she sat tired. The intern tried but the baby wasn’t coming out. Then I watched in awe as the attending stepped in moments later and finally delivered the baby.

I stood, like a confused but happily observant medical student, as he took the baby out and quickly gave it to the mother. It was done. And then I stared at the baby for what seems like a really long time because it felt surreal. I worried for a second that the baby wasn’t okay but then I heard a cry. I remember smiling uncontrollably – it is an amazing thing to see a baby being born and to watch life in a way come full circle. It’s one of those firsts you’ll never forget.

Feed Your body, Fuel Your Brain

By: Lauren Iacono, OMS-II

As we are all amidst our books, noses buried deep, and legs tucked under our seat… it’s easy to forget that powerhouse nestled within our cranium needs some energy to power us through our “workout.” Proper nutrition is essential for the medical students brain – both physically and mentally – to prevent brain drain and that hypoglycemic spike, which can leaves us feeling anxious and drained! Now you all may be thinking – she is crazy – when do I have time to eat healthy? Well – it’s actually quite easy…

Eating healthy doesn’t have to take hours to prepare or our entire refund checks – but with these few tips you can have a healthy day from sunrise to sunset (and to sunset again for those of us who are night owls).

Step 1:Breakfast – Doesn’t have to be the hardy man’s (or woman’s) breakfast – but as you may have heard it’s the most important meal to power your day!

After a long night fast, our cortisol levels are high (hmm… our favorite stress hormone), and a balanced breakfast will help you get through those study filled mornings, as well as keep your blood sugar and stress levels in check! Choose something to your liking that combines protein, whole grains and healthy fats.

Step 2: Eat frequently – small meals! Who doesn’t love to snack? Again, those in between “fasts” should be no longer than 4 hours to prevent hypoglycemic shakes and cortisol spikes. This can also leave us ravenous and eating more than we had intended for that meal. Be conscious of the choices you make (5 bags of chips and pizza bites don’t technically count here). Remember to always choose a protein, whole grain and healthy fat!

Step 3: Hydrate! Now we all know the studying med students beverage of choice = coffee (or any caffeinated drink), but it is more than important to drink plenty of water to also beat fatigue, keep our lymphatics flowing and remove any waste from our body (which also gives us the perfect reason to get up more often in order to get to the bathroom – and just MOVE).

Step 4: Chocolate! A powerful antioxidant and endorphin – need I say more, chocolate never needs any justification.

Step 5: Late night munchies! If many of you are like myself, late night snacking has become one of my all time favorite past times while studying! But again, as medical students it’s important that we make the right choices to get us through our late night study sessions. Protein is key, healthy carbs will help you relax, and healthy fats give you that energy boost! A proper late night snack can also help you sleep better and prevent those late night hunger growls.

I have included some easy “healthy” food options that each of us can pair together or simply eat alone to create optimal study fuel and well as to satisfy our tummies!

Healthy Food!

Almonds

These healthy nuts are packed with protein to help keep your hunger pangs at bay! They are also filled with Vitamin  E – an antioxidant and aids in opening our blood vessels for optimal blood flow! And the mono unsaturated fatty acids help you feel satisfied longer and prevent you from over eating and a growling tummy.

Tips: about 23 almonds is a serving. Add to salads, top yogurt parfaits, make your own trail mix or just eat them on their own! Also try almond butter as an alternative to peanut butter and make some great almond butter and jelly sammies!

Blueberries

This fruit is a great snack to reach for when you are feeling stressed. Not only are they good for you, they are fun to eat and give you the perfect amount of sweet! They are full of vitamin C which helps to calm a racing heart. They are also filled with antioxidants which provide a dose of protection to your cells from stress and free radicals.

Tip: You can buy these frozen or fresh! Add to smoothies, top cereal or yogurt, (I love to also put them on frozen yogurt treats!). You can also add these tiny gems to salads, pair with any nuts you may enjoy (or chocolate), or again just pop’em a you study and enjoy them on their own.

Spinach

A green leafy power vegetable! Spinach provides both magnesium, which aids in lower stress, as well as B vitamins and antioxidants that have also been linked to preventing depression and reducing fatigue. Spinach is also packed with iron, which helps to transport our oxygen preventing that fatigue.

Tip: Enjoy spinach frozen or fresh. Make as a side dish for your lean protein, add to omelets and salads, throw them into your morning smoothies or bake into a healthy quiche!

Yogurt

Yogurt is a great in between meal or light night snack. It provides you with the protein to keep you satisfied, as well as calcium which is shown to reduce anxiety, and a dose of vitamin B2 to ease restlessness. Choose yogurts that are low in sugar, low in fat and have a good serving of protein

Tip: Yogurt can be prepared in so many different ways so have fun with it! Make your own parfaits, add to smoothies and soups for a creamy texture without the added fat, and freeze to make your own “fro yo”!

Avocado

Avocado truly is a super fruit and extremely versatile! Although it has received a bad name for it’s high fat content – the fat in this fruit is mono and poly unsaturated fatty acids that won’t leaving you feeling sick and your arteries clogged! The fat also helps you absorb vital nutrients from your diet, and feeds the brain to fight against fatigue, anxiety and depression! They also contain potassium and vitamin E which help with nerve function and stress reduction.

Tips: Avocados can be prepared in so many ways! You can add them to salads or sandwiches, to pastas and tacos; it can be eaten as guacamole, as well as combined with coco and some sugar to make a pudding type treat!

Lauren’s last foodisms:

We are all entitled to indulgences – so enjoy in moderation!

Eat slowly and savor each bite.

Have fun and think outside of the box.

Peace. Love. Food.

Lauren Iacono

OMS II

peace tomato                

Resources:

Feel Good Foods

http://health.slides.kaboose.com/113-feel-good-foods-10-stress-soothers/10

Stress less with marvelous foods

http://www.lifestylekick.com/body/freeingfood/stress-less-with-marvelous-mood-foods/