#or capture how certain muscle details amount to little more than a trick of the light & contrast with more sharpy articulated features!!

[contrappostoes]

gary the pictures I take will never be able to adequately reflect the things I saw with my eyes in the moment

[withgoodintcntions]

Moving on up.

It’s been over a year since I last wrote a post for this blog, and a lot has happened in the interim. Where to begin? In reading over the posts of M1-past, I am struck by how vivid a picture I painted of my first month of medical school--and how much has changed between that point and now. 

For starters, I’ve now seen so many SPs that touching a stranger or asking them questions otherwise unsuitable for civilized conversation is no longer a foreign feeling. Once I made the (what should have been obvious) connection that white coat equals a certain set of privileges and responsibilities with respect to personal space, I fairly quickly adjusted. I still remember the first time I did an exam other than HEENT. At that point, looking in people’s ears, eyes, and noses was now normal. Having them undress so I could take a look at their abdomen was certainly not. Again, with time, shock and uncertainty was replaced with confidence and self-assurance. Since then, I’ve learned a full lymph node exam, abdominal exam, chest exam, vision testing, cognition, neurological function and muscle strength/range of motion exams. I survived the dreaded evolution of taking a full patient history. I’ve now done it in the context of not only the well-looking patient, but one clutching their head in agony. I’ve counseled patients on diseases like diabetes, high blood pressure, weight loss methods, and how to properly use an inhaler. I’ve learned basic suture techniques, IV placement, injections, and intubation. 

In short: I look back at who I was then, and only through reading my reflections can I remember what it was like before I had the mantra of ‘CC, HPI, PMSHx, FHx, social, ROS’. The entirety of M1 year, we had checklists to help guide our histories of various present illnesses and to make sure we hit all of the most important physical exam techniques. Now, we’re tossed in the deep end and asked to swim--and it’s not that difficult to stay afloat. 

Classwork is still the same as it ever was, but I’ve streamlined my entire approach. I am very selective about which lectures I attend. I spend the majority of my time using outside resources to make sure I’m learning the material for each block in the order I need and with the right amount of emphasis on every component. I have tricks for learning pharmacology and microbiology. I’ve cultivated a small but effective library of textbooks that now live on a bookshelf by my (recently acquired) desk. I’ve got a comfortable work space set up with candles, task lighting, and a view to keep me from never seeing the sun, because I’m always here, working on something. 

My insights on life beyond studies still hold true. As predicted, times did get tough periodically. Running, volleyball, studying at a local Starbucks, and finding good groups of friends to study with really helped. Self care really can’t be emphasized enough in medical school. I’ve seen first-hand over the last year or so the toll it can take when you don’t take care of yourself. It’s a struggle to find a balance that keeps things tolerable, and at times you hate everyone and everything. To be frank, it sucks, but the good part is that if you take the time to look around and open up to your colleagues, you’ll find you’re not alone. Sometimes, that’s all you need to tip things back in your favor. 

I wish I’d taken the time to write about my first experience with our cadaver. I couldn’t even try to re-capture that moment. However, when we returned from our summer break, we found we had fresh cadavers to continue our dissections with. I couldn’t have been more awestruck by the delicate beauty of the fine nerve fibers piercing through muscle tissue as they coursed to their destinations. As I examined the tiny blood vessel running alongside each white strand, I realized how much my eye had developed for those sorts of details. Over the course of the last year, we examined the musculoskeletal system, sliced brains into cross-sections to study the structures therein, and removed hearts and lungs to study their lobes and valves. Now, we’ve come to the GI tract. Even though our cadaver honestly reeks to high heaven due to an inadvertent gallbladder decompression maneuver and an unusual amount of standing fluid, I have enjoyed every moment of lab. Searching through mesentery for vasculature and separating layers of muscles brings peace to an otherwise chaotic block--a feeling that has slowly developed since the very first time I laid scalpel to skin to expose what was underneath.

Other things have changed in my life. As I’d hoped, I found a better living situation with a roommate who is largely a joy to be around. We spend what little free time we have playing volleyball, cooking, and getting (very sporadic) pedicures. Though I enjoyed the change of pace that came with living alone, I have equally enjoyed having her here to distract and commiserate with. Though it seems like just yesterday I was assigned a ‘big sibling’ in the M2 class, I now have a ‘little sibling’ of my own to keep an eye on. It has been nothing short of extraordinary getting to know the new M1 class, and truly eye-opening. I recall looking at the M2 class above me with awe as they confidently strutted onto campus for their OSCE days. They seemed so calm and collected, like they had their lives together. Now, a year later, I find I am that M2, and it’s my job to assure the M1s below me that this time next year, they will be just as confident to don the white coat and enter an exam room. 

As we move toward the end of this block, I am cognizant of the fact that it has not been my favorite one. A chaotic final week of exam prep is about to commence, and with it comes responsibilities that seem to have tripled since my first days here. The biggest change I can cite in this moment is how relatively unperturbed I am. Eventually, you begin to roll with the punches; and not a moment too soon. That flexibility I spoke of when I was moving across the country is still invaluable. The week ahead brings thousands of flash cards, practice clinical vignettes, the weekly case assignment, and likely a few unforeseen obstacles. Thankfully, I’ve got friends, a free yoga class, and two pairs of sneakers ready for a jog to carry me through. This not-so-freshly-minted M2 is ready to say so long to GI, and hello to Renal!

[jimdroberts]

 “The hero and the coward both feel the same thing. But the hero uses his fear, projects it onto his opponent, while the coward runs. It’s the same thing, fear, but it’s what you do with it that matters.” 

Cus D’amato

We’ve been forced to wait a very long time. Not since the early 70s, with fights like The Rumble in the Jungle, and The Thrilla in Manila, has heavyweight boxing been this entertaining.

The last golden era in the division occurred during the career of one man, Muhammad Ali. An era which saw Ali take on fighters like Sonny Liston, Joe Frazier, George Foreman, Ken Norton, Floyd Paterson and Larry Holmes, each of whom would have been good enough to dominate in any other era.

On Saturday, December 7th, Andy Ruiz will defend the heavyweight boxing titles he took from Anthony Joshua 6 months ago, in a rematch. Ruiz’s win was one of world championship boxing’s biggest upsets. Not since, 1990 and that night in Tokyo, when James ‘Buster’ Douglas knocked out a then undefeated, and what looked like an unbeatable, Mike Tyson. Ruiz’s win was a shock, there can be no doubt about that. Before the fight bookmakers had him at 9-1 against, ridiculous odds in a sport with only two competitors, and where one punch can end a fight. But those odds reflected the chance public opinion gave Ruiz when he defeated Joshua, at the beginning of June, in Madison Square Garden. The, Ruiz – Joshua rematch will formally kick-start a golden era in the heavyweight division, some might argue started already when Deontay Wilder fought a dramatic draw against Tyson Fury. There are, at the moment, five legitimate contenders for the title meaning that all of them will be less likely to cherry pick easy fights and forego a big payday. It really is a case of make hay while the sun shines, except in this case substitute hay for money, and sunshine for punching your opponent in the face.

Boxing Abroad

Heavyweight title fights have historically been held in the United States and on occasions in Europe, fights outside of these two locations are very uncommon. But holding one of sports biggest prizes in an out of the way, exotic location from which neither boxer originates is not new. Such fights do, somehow, capture the imagination as well as huge piles of cash. These locations have been decided purely for the financial benefits to the boxers and the potential for generating positive publicity for the hosts. In some instances this has seen the blending of sport and morally bankrupt ideologies, which for a time are forgotten until several weeks after the fights conclusion.

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January 22, 1973, The Sunshine Showdown, Kingston, Jamaica. When Foreman annihilated Frazier, knocking him down six times before scoring a technical knock out with one minute and twenty-five seconds of the second round still to go. Foreman achieved this despite going into the fight a 4-1 underdog.

October 30, 1974, The Rumble in the Jungle, Kinshasa, Zaire. Both boxers were paid $5 million. To put this into context, Joe Louis, world heavyweight champion from, 1937 to, 1949. Who made a record twenty-five consecutive defenses of his title, never made $5 million throughout his entire career.

October 1, 1975, The Thrilla in Manilla, maybe the most iconic boxing match of all time. Staged by president Marcos to divert attention away from the civil war that was being fought in the Philipines at that time.  Ali walking away with $9 million and Frazier netting $5 million. To give these figures some perspective, both Wilder and Ortiz were paid $4.5 million in disclosed purses for their second fight a couple of weeks ago, this does not include their shares of pay per view television,

February 11, 1990, A fight that was expected to be so one sided that nobody bothered to give it a name. What was certain is that nobody in America was willing to pay for the right to host Mike Tyson to destroy James “Buster” Douglas inside of three minutes. With now mythical odds of 42-1 against, Douglas achieved the impossible inside the Tokyo Dome, Japan. 42-1 against. When Foreman beat Frazier twenty-seven years earlier it was considered a shock with Foreman overcoming odds of 4-1. Tyson was paid $6 million, Douglas walked away undisputed heavyweight champion and $1.6 million richer.

April 21, 2001, Lamely given the moniker Thunder in Africa. Obviously rumble in the jungle was the beginning and end of any catchy rhyme and wordplay when it came to fighting in this continent. With   Rahman a 20-1 underdog, this was thought to be such a one-sided affair that no Las Vegas casino was willing to pay the amount South Africa was, to stage the fight, Rahman being paid $1.5 million, while Lewis made $7 million. In similar fashion to Buster Douglas, Rahman shook the boxing world, knocking out Lewis with a straight right driven through the sloppy guard of the champion in the fifth. Compare this fight to the Ali fights, nearly thirty years earlier and you appreciate how Ali captured the world’s imagination and generated  the extreme revenue necessary to justify his purse.

December 7, 2019 In the crazy cash sports era of today Joshua will earn at least $40 million, Ruiz will take away $9 million, and both will have an agreed cut of the pay per view revenue, details of which I haven’t been able to find. Needless to say, they’re both walking away rich men.

The history of heavyweight boxing in obscure locations is colorful and littered with upsets. Ruiz, Joshua promises to be a far closer fight with no heavy underdog. In fact it’s much in debate as to who the underdog is.

    Why Ruiz Will Win

As in the first fight, I expect to see Joshua touching cloth on multiple occasions in the rematch.

Styles are said to make fights, it might equally as well be said that styles break fighters. Ruiz’s style couldn’t be any more awkward for Joshua. On paper, and to the eye, Joshua would win every time, but Ruiz has the box of tricks to beat Joshua. Ruiz’s main strength is his hand speed and accuracy. What this crudely translates into is, Ruiz’s fists spending more time connecting with Joshua’s head and face. Ruiz’s movement is also deceptively good, and he has proven that he has durability having been knocked down by Joshua, then coming back to destroy him. Joshua’s strength will always give him the ‘puncher’s chance’,  but Ruiz is likely to throw and land more punches. Meanwhile Joshua hasn’t convinced when under pressure of a high volume puncher. AJ was floored four times by Ruiz, ans was knocked down once when he fought Klitschko. Ruiz’s style of throwing quick combinations is AJ’s Achilles heel.

It’s ironic to remember that it was Eddie Hearn who cursed the career of Joshua when he selected him as the replacement for Jarrell Miller after the latter had failed multiple drug tests. Ruiz had only one month to prepare for the first fight, but had fought at the end of April, meaning he was already conditioned. But that should have counted for little when it came to fighting the multi titled world champion and former Olympic gold medalist. Few gave Ruiz any chance, including the bookmakers who were offering 25/1 against Ruiz winning by stoppage.To their credit, the Irish newspaper Independent.ie considered Ruiz to be more dangerous than the  originally intended opponent, Jarrell Miller. 

What AJ has in size and strength, he lacks in speed and skill. That’s not to say Joshua is slow and without talent, it’s just that up until now it’s been his size and strength that have been most telling in the fights he has won, Ruiz has the skill set to neutralize Joshua’s attributes.

One of the more amusing things about the fighters is that they have both been criticised for their physiques. In the past, Andy’s figure has been on the adipose, rotund end of the conditioning spectrum. Joshua meanwhile has been criticised for being over conditioned. AJ has some glaring similarities to Frank Bruno, he carries too much muscle bulk which ultimately makes him powerful, but slow. It’s been said that Joshua is looking to address this matter, but how quickly and how successfully he can reshape his physique is a question that remains to be answered.

While it looks impressive, too much muscle slows a boxer down

pkt5282-394323 FRANK BRUNO BOXER It was too much to expect the truth, the whole truth and nothing but the truth. This is heavyweight boxing for the big bucks after all. But when the manager of Lennox Lewis said there waws absolutely nothing bad aboiut Frank Bruno’s performance, at least he had the good grace to do so with a smile and ask: ‘Is my nose growing?’

It’s difficult not to support Ruiz, and I’m British. Ruiz is only getting 25% of the purse, and despite cutting weight  still bares a striking resemblance to British comic Johnny Vegas, a man whose act centres on him being drunk and unhealthy, but who doesn’t love Johnny Vegas?

They do actully look like each other.

It’s not just that they’re both fat.

In the future, out of Ruiz, Fury, Usyk and Wilder, I can only see Joshua beating Wilder. The other three have far higher boxing IQ’s, far better movement and hand speed. It’s the hand speed, combined with questionable durability that makes me believe that Joshua would succumb to any of , Fury, Ruiz or Uszyk.

Twenty-twenty, might be a format of cash fueled cricket, but it will also be remembered as the year of the mega fights in heavyweight boxing. The year that should see the Fury-Wilder rematch, Uszyk fighting one of these four, and Wilder fighting Joshua or Ruiz. Be cause the division has five huge talents it’s difficult to see how these fights can be avoided, and the huge pay per view revenue any combination of these fights would make should be too tempting to resist. Twenty twenty is the year that will stay long in the memory of boxing fans around the world. And my prediction as to who will be king of the hill,

Usyk

The talent of Oleksander Usyk will ensure that the heavyweight gold rush of twenty-twenty will sustain itself for a few more years, with any combination of huge fights. The countries that these fights end up being hosted in, and for what cause, remains the most difficult thing to predict.

Ruiz Vs. Joshua – A Gold Rush in a New A Golden Era of Heavyweight Boxing  “The hero and the coward both feel the same thing. But the hero uses his fear, projects it onto his opponent, while the coward runs.

[maplesugarshot-blog]

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