clearlydistinguishedllama

[clearlydistinguishedllama]

HOLY SHIT!!! I'M A DOCTOR NOW??

WOAH! so, I just graduated from med school and it's wild. the whole experience has been so surreal and unbelievable but here we are.

also, I turned 24 today?? how is the time going so fast??

I remember the first day of med-school as if it was yesterday and now suddenly it's all over and i'm an actual responsible adult human being who is responsible for people's lives...

I just re-read that all over again because i still can't believe it.

I hope I can power through all the challenges that I'll face in the near future and am able to get a decent score so that I can specialize further in an inspiring field.

Med-school has been a bittersweet journey, full of ups and downs, but that's how life's supposed to be, otherwise it's no fun

just wanted to give a life update (after being missing from here for like 2 years lol)

CheersX

[clearlydistinguishedllama]

CAN I JUST SAY THANK YOU?

ECG: quick and dirty

I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career. 

WHEN LOOKING AT ECGs FOR THE FIRST TIME:

1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough. 

2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number. 

3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.

4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II. 

up in lead I, up in lead II: normal axis

up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)

down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)

5. did someone say HYPERTROPHY?

look at V1

is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.

is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.

  6. P-waves

look at lead II

is it wide? left atrial enlargement.

is it tall? right atrial enlargement.

7. PR interval

should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].

long PR interval means there’s some sort of block at the AV node. 

1st deg block. PR interval is long. everything else is normal. cool. 

2nd deg block

type I: PR interval progressively gets long. eventually a dropped QRS.

type II: PR interval is constant, but randomly dropped QRS. 

3rd deg block “complete block”

there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg. 

8. QRS complex

narrow or wide? 

narrow: good. signal coming from somewhere above ventricles. 

wide: think BBB (bundle branch block)

LOOK AT V1 ONLY.

if the last deflection of QRS is DOWN, then it’s a left BBB

if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap. 

9. ST segment

always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval). 

elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes. 

look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:

posterior up, anterior down

anterior up, inferior down

inferior up, lateral down

lateral up, septal down.  

LBBB can look like STEMI. How to tell?

disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)

concordant changes is abnormal. 

massive discordance is abnormal. (STEMI is greater than 5mm)

this isn’t that important. Moving on. 

Inferior STEMI. Could right ventricle be involved? 

DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.

order a 15 lead

is STE in lead III > lead II? likely RV involvement

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

10. T waves

is it inverted? indicates recent ischemic changes. 

11. Q waves

is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs). 

I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart. 

  Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.

[clearlydistinguishedllama]

how to deal with mental fatigue

Hi, it’s werelivingarts! Exam season is coming so soon, and some of us might deal with a lot of stress and mental fatigue while preparing for the exams. 

Here are some tips on how to prevent and deal with mental fatigue (before it becomes too serious and leads to burnout). Exams are just ways to test your knowledge and understanding, so please do not expect too high and take care of your health! 🌿

Hope that we would all do well! 😊

[clearlydistinguishedllama]

[clearlydistinguishedllama]

[clearlydistinguishedllama]

Good morning, good lighting

[clearlydistinguishedllama]

Douglas Island News, Alaska, November 15, 1918

[clearlydistinguishedllama]

The aesthetic I need this year

this week’s moody study scenes. winter truly has arrived.

my current uni has a different exam system than my previous one, meaning december exams. got my second exam tomorrow! really looking forward to an actual christmas break and not one where i have to study for january exams🎄

🎶 ariel pink / another weekend

[clearlydistinguishedllama]

man i just want exams to be over and they havent even started yet

[clearlydistinguishedllama]

Studying with Anemia

Anemia is a condition caused by low numbers of healthy blood cells in one’s body. It is more prevalent in females than males and since the studyblr community’s demographics is predominantly females, I wrote this post in hopes that this will help some of you. Keep in mind that even if you weren’t officially diagnosed with anemia, if the following discussion applies to you, you should definitely see a doctor. 

These are some of the common symptoms of anemia: 

Fatigue

Weakness

Pale or yellowish skin

Irregular heartbeats

Shortness of breath

Dizziness or lightheadedness

Chest pain

Cold hands and feet

Headaches

These symptoms can lead to many complications in your academic life. Speaking from personal experience, one of the main problems is falling asleep/getting dizzy in class, while studying, during exams etc. Headaches and cold hands and feet are also among the problems. I’ve had anemia for eight years now, so I’ve tried many things and figured out what works for me. I’ll share with you some things that helped me but you’re welcome to suggest your ideas and experiences:

Taking short naps throughout the day: Can’t stress this enough. Even if you got a good night’s sleep, make sure to take at least one short nap during the day. Especially if your hemoglobin level is lower than 8, it’s hard to trust your body so don’t risk it. If you’re studying or taking an exam later in the day, make sure to take a 20 min nap beforehand so your body is fully energized for the task. 

Being mindful of class locations and schedules: If you have classes in different locations and you have walk a lot or climb several flights of stairs to get there, make sure to replenish your energy before class starts. If this class is scheduled before your designated nap time, chances are you might fall asleep or fail to focus in class. In that case, drink coffee or chew gum to keep yourself focused. If those don’t work, tell a friend or your desk mate to check up on you if they notice you dozing off. If you can, don’t take classes too far apart because you’ll be tired before even getting to the class.

Paying attention to diet: For most common anemia, a simple diet change could work wonders. Make sure you’re consuming iron-rich food. If you have iron supplements and if it works for you, definitely take those, preferably in the morning so you feel good enough the rest of the day. Don’t eat junk food while studying or before studying. Food like banana, almonds, pumpkin seeds, sunflower seeds etc are ideal snacks that can give your nutrition and also help you stay awake. 

Keeping your body warm: Wear an extra layer or at least keep a scarf/sweater with you. Most definitely carry lotions. Sometimes feelings too cold can make you fall asleep so don’t underestimate this problem. Drink tea/coffee. Carry heat packs. 

Dealing with headaches: I don’t usually get extreme headaches but whenever I do get mild headaches, washing my hair and/or drinking green tea or eating something extremely sour helps. You should definitely explore and figure out what reduces your pain.

[clearlydistinguishedllama]

Impostor Syndrome: What it is and how to deal with it

There may be times when you feel like a fraud, like at any moment people will find out that you have no clue what you’re doing and you don’t deserve any of your achievements. You think that you’re unworthy of praise, that you only succeeded out of luck.

This is known as Impostor Syndrome, and around 70% of people have struggled with it in their lives. The problem arises when high achievers fail to internalize their success, i.e. when you attribute your success not to your own abilities but rather to external factors.

Some say that impostor syndrome could be linked to traits like anxiety or neuroticism. Impostor syndrome has also been commonly attributed to behavioral causes like childhood experiences, e.g. being labeled as “the smart one” or “the talented one”.

Another huge factor is how well you think you fit into a certain group, e.g. impostor syndrome is common among people of a racial/ethnic/cultural minority, women in STEM, and international students at US universities.

Dr. Pauline R. Clance was the first to design a scale to measure impostor syndrome based on six factors

The impostor cycle, where someone is given an achievement-related task and they either (a) overprepare or (b) procrastinate

The need to be special/the best

Superhuman characteristics

Fear of failure

Denial of ability and discounting praise

Feeling fear and guilt about success

There are different types of impostors, as categorized by Dr. Valerie Young, an expert on impostor syndrome (note that these categories aren’t mutually exclusive):

I’ve personally dealt with the first two types. I’m fairly certain I can attribute being ‘the genius’ to childhood/adolescent circumstance: I’ve been known as ‘the smart one’ throughout elementary school and high school - every time I made a mistake, it was met with a chorus of ‘wahh jo made a mistake…’ Even last month when I had a mini-reunion with some of my high school friends, one of them said something along the lines of “I like when Jo makes mistakes because it reminds me that she’s human, too.” I can definitely say I’ve overcome that now because, you know, college - everyone’s as smart or smarter than you and works pretty hard.

Being ‘the expert’ is still something I’m still trying to overcome. Last spring when I was applying to internships, I only dared to apply to those where I met 100% of the requirements. I’ve been coding for like 4 years but I constantly think I’m incompetent. It once got up to the point where I literally took 3 similar courses to assure myself that I actually do know how to do full-stack web programming. I still struggle to draw the line between relearning something because I don’t think I really know it, versus learning something for the expansion of knowledge.

How do I deal with it?

Firstly acknowledge that you have impostor-related thoughts Awareness is the first step to changing how you think and how you act.

How does impostor syndrome look like in a school/college setting? Examples include

You refrain from asking questions because you think other students/TAs/the professor will think you’re dumb;

You don’t respond to questions even though you kind of know the answer but you always think your answers aren’t right enough or that they’re simply wrong;

You don’t participate in discussions because you feel that you won’t add any value; or

You prevent yourself from having an opinion because you feel like you have no right to have one.

Reframe your thoughts

Think of their possible effects Do these thoughts help or hinder me? Will anything useful come out of thinking this? Acknowledge that not speaking up may mean slowing your team down or depriving your classmates of potentially valuable insights.

Separate fact from feeling Are they factual or simply a misinterpretation of my environment?

Differentiate feelings of fraudulence from feeling like an outsider Does my work show that I’m incompetent or is the fact that I’m the only female in a team of males/POC in a team of Caucasians make me think I’m inferior?

Stop comparing yourself to other people You might think something along the lines of “there are already so many people who can do what I do but so much better, so what’s the point in even trying?” However, remember that these people were once where you were, and taking even the smallest of actions could help you get to where they are.

Be more forgiving with yourself

Rethink perfection Not everything has to be perfect. Even if you have high standards, not achieving those standards doesn’t make you any less worthy.

Reframe mistakes and identify areas of improvement It’s okay to be wrong or not to know everything. Think of mistakes as learning opportunities and indicators of gaps in your knowledge/understanding of something, as opposed to a negative measure of your self-worth. Being wrong doesn’t mean you’re fake; it just means you have more to learn.

For example, previously I would only answer a question in class if I was at least 90% sure that was the correct answer. That’s a high threshold, and I don’t think it’s very useful for helping me learn and grow. Over the course of a year, I’ve managed to lower that down to I’d say around 60% (50% with coffee lmao).

Collect positive experience

Remember and reflect on praises Think about the efforts you exerted to help you achieve something and the positive responses you garnered when you finally achieved it. Remind yourself of the words of encouragement other people have told you, no matter how small. You could even keep a folder/document/journal to look back on when you feel like a fraud.

Heck, sometimes I feel like my posts aren’t useful or my designs are terrible, but then you guys tell me such kind things and I think, maybe I’m not as bad as I thought.

However, while it’s good to remember the good words people have said, don’t work just for the sake of praise. Focus on the value of the work itself and not the validation that comes from it.

Focus on providing value

Focus on what you can say Instead of thinking about what you don’t know, focus on what you do know and what you can say. Even if what you say isn’t entirely correct or relevant, it’ll get others around you thinking.

Remind yourself that holding back is like robbing the world of your ideas There’s always some value in your words, even if you don’t initially think so. How that value affects the world or other people may differ. For example, when you put forward an idea/thought in a discussion, it could be that

If there were parts that were incorrect, other people might have had the same misconception and are more than happy for the clarification;

Again, if there were parts that weren’t correct, they might not have had the same misconception but now realize that there is a way in which the subject can be misinterpreted, thus allowing them to have a more comprehensive understanding of the subject; and/or

It’ll stimulate further thinking and discussion and raise more questions, especially if other people wouldn’t normally think what you just thought. Then other people could bounce off your idea and form an equally great one.

Take action You won’t feel as much of a fraud if you’re doing something that brings you a little closer to achieving your goals or that adds value to your work.

However, be careful not to overwork yourself. Every time you start doing something, pause and think: is this really important to my progress or am I just trying to prove myself?

Instead of working on too many things, do something outside your comfort zone each day no matter how small. Once you do this, focus on quality (your growth) instead of quantity (the number of things you do).

Also, for those of you who fall into the ‘expert’ category, this also means practicing just-in-time learning, i.e. learning things when you need it, not just to comfort yourself.

I hope that was helpful, and please don’t hesitate to reach out if you have any questions/comments/suggestions :)

[clearlydistinguishedllama]

Hey guys! I know I've been away for quite a while but you can't really do much when your life turns upside down quite literally. In November 2019 I was diagnosed with a condition called "pseudotumor cerebri"/ IIH. It's a rare condition that causes my intracranial pressure to shoot which basically produces symptoms of a brain tumor when there isn't one, and me being a med student, I was quite sure I had cancer when I started going almost blind, but here I am a year later writing this life update while we face this horrible pandemic. I mean before this hit me, I thought I was an invincible 21 year old who's ready to take on the world but priorities change and now I feel just a bit scared of life and the world in general, and how all of this is just so fragile. I only hope this makes me a better doctor, cuz now I understand pain and patience so hopefully that helps me, other than that covid has pissed on this year enough. But on the brighter side, I'm in the best shape of my life so there's that and I think I've accepted all of this now finally but it still comes back in waves sometimes and tonight was no different but I only hope this makes me stronger than ever before and hopefully the world goes back to normal soon. Sending everyone lots of positive energy

X

[clearlydistinguishedllama]

The twenty something

I am a twenty something, according to "adult" adults this is the prime of my life, the make or break years of my life. But as a twenty something, I also feel lost sometimes. And I often question, Am I doing this life thing right? I mean how did I even reach here? It was just yesterday when I was out playing around in the park, when did we become adults? Am I missing out on my life by not going out enough? Will I ever find a person to love? Or I just need to focus on building up my career right now? Should I drink? But what if it fucks up my liver and I die? But aren't we all just gonna die one day? What is even the point of all this?

Is it just me?

[clearlydistinguishedllama]

Relatable af

[clearlydistinguishedllama]

remember to take care of yourself. eat, drink, rest, do what you need to do. you are worth it, you deserve acceptance, you deserve happiness, you deserve love. be kind to yourself. i love you always.

[clearlydistinguishedllama]

What is your absolute favourite thing to have for breakfast? Name three animals you really like and three you really dislike? Does getting your socks wet frustrate you or do you just shrug it off and ignore it? 🌻

My absolute favourite breakfast would be pancakes! The three animals I like are Puppies, Pandas and llamas Never really thought about the one's I hated, I don't think I hate any animals And lastly, getting my sock wet irritates the shit out of me

[clearlydistinguishedllama]

Anonymously message me (3) things you want to know about me.