Weeks and Weeks of Exams...

We have been inundated with exams the past 4 to 5 weeks having 2 to 3 per week. The last exam was finished today in microbiology of which I surprised myself with. I committed the material to memory without going to one single lecture!

Granted it took some effort but not as much effort as it takes to drag myself into school at the crack of dawn. I think approaching school this way will be beneficial for my psyche and based off my attitude when being diligent in planting my butt in a lecture hall, I think I prefer the former idea.

The exams are done which matters most. A sigh of relief can be had until the 14th which is when finals are, until then I intend on getting ahead this weekend and next week, reviewing early rather than the night before the final.

There isn't much more to share right now being I am so exhausted. After finals I will update with a nice synopsis of the quarter and venture forward into the next phase, the start of our clinical education.

All for now

Meeting with the President

I wrapped up the week with a 40 minute meeting with Dr. Brimhall, the president of WSCC. The meeting was concise but covered a lot of ground. My intention was to talk to him about the perception of chiropractic in the public's eye. Why does the public not understand what it is we are about? Beyond back pain, most do not understand chiropractic at all. They don't realize we are trained to diagnose ALL health problems and legally responsible to do so. Most don't understand the academic degree is at the doctorate level. And a high percentage clearly don't know we can order an onslaught of blood tests to track metabolism and nutritional insufficiencies.

We can defend ourselves by saying our education mimics that of an MD's. But this comes across as a ploy to keep up with them. There is no reason to defend ourselves. The fact is, we are going to be given a scope of practice when we graduate and for the most part, adjusting people is a minor element. I get excited when I think about this. When I was working as a personal trainer/coach in Flagstaff I always felt blood tests were needed to get clearer understanding of each particular client. If I knew the persons nutritional makeup, I could give supplemental/dietary advice customized to their needs. As a personal trainer, I couldn't do this due to my lack of skills as well as licensure.

As a chiropractor, I am legally authorized and professionally trained to order blood tests and evaluate them. My scope will allow me to advise nutritional supplements as well as counseling for dietary/lifestyle modification. It's a win, win for me and a benefit to those who I intend on helping at that level. This takes me back to the meeting today with Dr. Brimhall.

I asked him if it matters whether or not the public knows we are trained at this level. He said no, it doesn't matter. He told me I should only be worried about educating my patients as they roll through my door. My expertise and ethical approach to health will allow me to work with my patients at this level. Being that most people don't know chiropractors can perform most of what they are trained to do, each time a person questions our work we must approach it as an opportunity to show them what we're about. For the most part, he's pretty positive about chiropractic and where it stands in the health care market.

I know by writing about these things many people will learn more about chiropractic and might give it a shot. Or at least realize that most of the chatter on the street is questionable and diluted. Those who know me and trust me will realize what I write in this blog is real and true. I convey the information I receive at school to hopefully portray chiropractic as a medically-based/safe approach to health - a way to achieve wellness. In my mind, chiropractic is a way for some people to find wellness. For others, it is a non-surgical approach to reducing musculoskeletal pain. I intend to practice both approaches in 2011 and beyond.

Next quarter I am roughly half way through the program. In the summer, I will be starting as a junior intern in the clinic. The stories will be pouring in on my end and I hope they are taken objectively without bias obtained through street chatter. As an outsider looking in, I was once a HUGE skeptic of chiropractic but as I have ventured through the curriculum, my outlook has changed and I trust my new skills and intelligence with human health. Modern chiropractic is evidence-based (scientifically approached) which should be trusted. I never thought I would say these things but my impression is that I can trust the education I have been given. Being a person who initially wanted to go into medicine, putting these words down is a big deal in my world.

Think about dentistry. These doctors spend a ton of time learning how to work in a person's mouth without hurting them. They drill into teeth, cut out lesions, remove diseased teeth all without doing harm. Their training prepares them to avoid harm and to improve health. It is no different with chiropractic. We practically live on campus learning how to manipulate every single joint of the human body, safely. And we learn how to interpret lab results which define the internal chemistry of our patients. We spend the time practicing at school so that we are competent and safe at administering our treatments in the real world. Just like dentists or medical doctors, we are professionals and masters of health.

Thanks for reading

First Neck Adjustment

This week was challenging with the pathology exam on Wednesday and our principles of chiropractic exam Thursday. It is amazing the amount of work it takes to get ready for big exams. You don't realize it while you're in it but once it is over the body gives out and seeks a pillow. Today, there was a nice surprise waiting for me in adjustive skills that made it seem all worth it.

Our instructor announced that we'd be doing cervical palpating at the beginning of the class to learn more on how to set up a neck adjustment and if we found a restriction they would allow us to give it a little bump to free it up. It is a little nerve racking being the recipient of someone's first neck adjustment and it is even more nerve racking being the person giving your first neck adjustment.

I was the patient first. My partner palpated my neck to see how it felt and checked my motion in lateral flexion and rotation as well as extension. He found a right rotation restriction and a left rotation restriction lower down. The instructor checked to see if he was right and told him he could adjust it if he wanted to and if I was okay with it. I okayed it, he set it up at end range and gave it a little bump. It popped and I had an instant increase in range of motion. He didn't do the left rotation, only the right. So, my next partner addressed this one and it felt great. Both were confident and light-handed which means they had finesse versus being aggressive.

They told us to switch doctors and patients. Now it was my turn. I instantly got a little bit nervous being this was going to be my first neck adjustment. We've palpated each other's necks before but we haven't been allowed to find restrictions and release them. I found one on my partner and had the teacher come over to make sure I was right, she okayed it and I set it back up into end-range. I gave it a bump and nothing happened. I tried again, nothing. I set his head back down and talked with the teacher and the student, set it up again with a little help from both and tried it again. This time was successful! A little audible pop sprang loose and the student said it was good.

He said I slowly increased my force until it was high enough and seemed pleased. I moved onto my next patient who was the guy who adjusted my neck first and found a few restrictions in his neck too. I had a teacher double check and I set it up but this time I went to tension a few times too many because I wasn't confident with it. This caused some tension in his anterior neck muscles to develop because he felt he needed to help me (this happens when you don't trust the person who's behind the wheel, so to speak). I rested his head a minute, picked it up, took him back to tension and gave a bump and an audible pop happened. Two neck adjustments in one day! Pretty cool stuff.

The coolest part was that I could see an immediate increase in range of motion in both patients. It is pretty crazy how social adjusting people actually is. You have to gain their trust or it doesn't work. Fear is a big part of why people stay far away from chiropractic. They fear getting hurt which is completely valid. It looks like you can get hurt during an adjustment and you can if it isn't done right. So far, I have been getting adjusted almost every week by students and no injuries have occurred. This to me speaks pretty loudly because if there is any risk of injury it is way higher in a student adjusting lab. That being said, having been worked on continuously each week for the past year, there has been no problems whatsoever with any part of my back. If anything, this is the best my back has felt in years!

I realize there are quite a few people who read this blog that don't go to WSCC and will never go to chiropractic school. But they have an interest in what it is like to be a DC student. I want people to know that the chiropractic adjustment is safe and the validation for this should be what I have written above. In the real world the DC must rule out serious disease processes that can mimic mechanically oriented back pain or musculoskeletal pain. This is the reason for such depth in the sciences. Too often I get asked why we chiropractors have to study such complex science and my answer is this - the human element is complex beyond what we can ever imagine. There is a "typical" model of what a normal human consists of but when you add genetic variability and environmental influences into the mix, it gets complicated. If we didn't study basic science we couldn't really operate in the real world.

We hear the stories of people wandering in off the street with back pain and after taking a history and performing a physical exam the back pain is really some kind of visceral issue. It takes a trained eye to catch the bad stuff. Many people think we could become chiropractors in about a year. Graduate and just be on our way to crack backs. It is so much more complicated then that and I hope what I have written today will begin to shed some light onto why it is we go through such a vigorous amount of training.

I am enjoying this education more and more these days and I am very glad I didn't quit. I can't wait to get into the clinic with everyone and earn that doctorate!

All for now

Decompress and Refocus

The dreaded pathology exam is over. One A was earned out of 80 students, a handful of B's, a big handful of C's and quite a few D's. Sadly, I don't think the exam shows the student's true qualities. The professor has not offered any guidance to the class as to how to prepare or really what is expected from us. I think there is a lack of communication and leadership. And unfortunately, pathology is the bridge between the basic sciences and clinical sciences. The concepts are arduous to learn and the diseases are weirdly named and at times, only slightly different from one another.

I guess you just pick up and move on, take your lesson and hopefully not repeat. Dr. Shull, our physical diagnosis professor, made a comment today. He said that those who do not show up to class or lab that don't pass clinical competency exams are omitted from remedial review. In a nut shell he was speaking to me because I have been dogging classes every chance I get to get some needed rest. It struck a cord with me because I do take this stuff serious. It is a balance between the desire to learn and the need for a break from the constant influx of information. My grades are not slipping though, they are holding steady. I retain the information pretty well too. So, I don't know if the "rules" apply to me. If I weren't studying when I skip classes I think the rules apply, but the fact is I seem to do better if I am humming at my own pace.

Regardless, the biggest hurdle is over and now it's time to refocus and change gears to the next exams; principles of chiropractic, genetics and dermatology.

All for now

Mental Endurance

We are in our second week of exams this week and one still remains. After this week, we have an additional 3 exams next week totally 9 or 10 in 3 weeks. We get a break for Thanksgiving and then it's back at it in preparation for finals.

Today was a difficult day for me. Exhaustion had kicked in finally after a blink of a weekend and challenging exams during the first part of the week. I sort of caved today and lost focus earning a "less than adequate" grade in comparison to my last 5 exams. If you don't earn a bad grade once and a while the good grades mean nothing. Right? Thinking back to the material for today's exam, I couldn't get into it, at all. It was full of nasty infections associated with parasites (i.e., worms etc.). My motivation was lacking for this exam and I am lucky to have passed with this attitude. It is a crazy life in graduate school. One day you're on top of your game and the next you're down in the dumps. You learn to pick yourself up and keep on going no matter what!

As the quarter wears on the challenges are going to increase. Each day is one we can grasp ahold of and make it our own for our own benefit. What we are doing is not easy nor is it immediately satisfying. Sitting for hours on end looking at dry science-based literature sort of bites. Yes it is interesting but sometimes it is nice to not have to think! I wonder how next quarter will pan out with boards. They are scheduled the weekend prior to finals which will be a little more refreshing than taking them after finals like most other students have done previously. The total amount of testing will be enormous and quite taxing mentally. There is no way around it though. We'll just have to adapt to the stress and hopefully shine bright enough to pass them all. It is crazy to have dreams and ambitions with so many obstacles looming out there.

We can talk all day about what we are "going" to do but we can't do anything unless we meet certain standards set forth by our school and it's accrediting agency. For instance, we are taking a genetics course right now which is quite difficult. It is getting more and more complex each day we log a class. If we aren't able to meet the demands of this course we can't obtain our future licenses. Another course is pathology. Many of these disease we'll never see or touch in real life but we have to know them well enough (which is done by pure memorization) to pass exams and our boards in April 2010. Stress is what this all amounts to and sometimes I just want to hitch a ride to Hawaii and sip an intoxicating blue drink!

The funny thing is, during every single quarter thus far I always crack midway through and lose all focus. I have to rekindle the "love" in the next day to get going on the nutrition exam on Friday. In a way, it comes down to wanting to be smarter versus studying for exams. When you have the drive to learn no matter what the material is, motivation skyrockets out of control. Before you know it, you've finished the notes and retained all the information. But, if you freak (like I did for today's exam) and rush through the notes with the intention of "passing" the test, you don't learn crap and you get a crappy grade.

Lesson learned. Resting tonight will be blissful and a new focus tomorrow will bring great results for Friday.

All for now

Boards are Approaching

For those interested, we have about 6 months until our first round of boards. The basic sciences are emphasized during these exams, as you all know. Below I have posted a link to practice exams offered for free online which might come in handy. Study them at your leisure if you want to.

www.chiropracticnationalboards.com/part_one_questions.html (cut and paste)

I think if we share the depth of science we are exposed to and are expected to become masters of, we'll educate those who are skeptics of our training and quite possibly break down the barriers in public perception of modern chiropractic.

For those interested in the complexity of these exams who aren't attending school, check out the emphasis and specific competencies required below. Also, historically speaking, chiropractic has always been questioned as to how it educates it's doctorate holders. Many believe that our education doesn't prepare us to be competent portal of entry health care providers. Our basic science education and requirements mimic traditional medical school in the complexity and depth of scientific training. Take a look below to see what we'll be tested on next spring. Keep in mind we have 3 other board exams as well as clinical competency exams to progress within the clinic system at school

General Anatomy

I. Topographical Anatomy (7%)
A. Planes of the body and anatomical terminology
B. Head and neck
C. Backand thorax
D. Abdomen, pelvis and perineum
E. Upper and lower limbs F Integument (including histology)

II. Osteology of the Appendicular Skeleton (14%)
A. Upper limb and shoulder girdle
B. Lower limb and hip bone
C. Development
D. Histology

Ill. Arthrology and Syndesmology of the Appendicular Skeleton (12%)
A. Classification of joints
B. Articulations of the appendicular skeleton
C. Biomechanics

IV. Myology of the Appendicular Skeleton (17%)
A. Upper limb and shoulder (including innervation)
B. Lower limb and pelvic girdle (including innervation)
C. Development
D. Structure and histology

V. Cardiovascular and Lymphatic Systems (15%)
A. Heart
B. Arteries
C. Veins
D. Lymphatic vessels and lymphoid tissue (including spleen and thymus)
E. Development
F Histology

VI. Digestive System (11%)
A. Oral cavity and pharynx
B. Digestive viscera
C. Development
D. Histology

VII. Respiratory System (9%)
A. Nose and sinuses
B. Larynx, trachea and bronchi
C. Lungs, pleura and mediasti num
D. Development
E. Histology

VIII. Urogenital System (9%)
A. Urinary organs
B. Male reproductive organs
C. Female reproductive organs
D. Development
E. Histology

IX. Endocrine System (6%)
A. Endocrine glands and tissues
B. Development
C. Histology

Spinal Anatomy

I. Osteology of the Axial Skeleton (18%)
A. Skull
B. Vertebral column
C. Ribs and sternum
D. Development

II. Myology of the Axial Skeleton (15%)
A. Face and head
B. Back and neck
C. Thorax and abdomen
D. Pelvis and perineum
E. Development

III. Arthrology and Syndesmology of the Axial Skeleton (16%)
A. Classification of joints
B. Articulations of the axial skeleton
C. Biomechanics

IV. Anatomy of the Central Nervous System and Related Structures (22%)
A. Cerebrum
B. Brainstem and cerebellum
C. Spinal cord and meninges
D. Blood vascular relationships
E. Ventricles and cerebrospinal fluid
F Development
G. Histology

V. Anatomy of the Peripheral and Autonomic Nervous Systems (21%)
A. Spinal nerves and plexuses
B. Cranial nerves
C. Visceral innervation
D. Cutaneous innervation
E. Development
F. Histology

VI. Organs of Special Senses (8%)
A. Vision
B. Audition and equilibrium
C. Olfaction
D. Gustation
E. Development
F Histology

Physiology

I. Neurophysiology (23%)
A. Membrane potentials, action potentials, and synaptic transmission
B. Motor function
C. Sensory function
D. Autonomic function
E. Higher cortical function F Special senses

II. Muscle Physiology (14%)
A. Cardiac muscle
B. Skeletal muscle
C. Smooth muscle

III. Cardiovascular Physiology (17%)
A. Cardiac mechanisms
B. Electrophysiology of the heart
C. Hemodynamics
D. Regulation of circulation
E. Circulation in organs
F Lymphatics
G. Hematology and immunity

IV. Respiratory Physiology (10%)
A. Mechanics of breathing
B. Ventilation, lung volumes and capacities
C. Regulation of respiration
D. 02 and CO2 transportation
E. Gaseous exchange

V. Body Fluids and Renal Physiology (11%)
A. Regulation of body fluids
B. Glomerular filtration
C. Tubular exchange
D. Acid-base balance

VI. Gastrointestinal Physiology (10%)
A. Ingestion
B. Digestion
C. Absorption
D. Regulation of GI function

VII. Reproductive Physiology (4%)

VIII. Endocrine Physiology (8%)
A. Secretion of hormones
B. Action of hormones
C. Regulation

IX. Exercise and Stress Physiology (3%)

Chemistry

I. Carbohydrates (18%)
A. Metabolism
- catabolic pathways
- anabolic pathways
B. Chemistry
- structure
- properties
- function
C. Nutritional concepts
- food sources
- digestion

II. Lipids (18%)
A. Metabolism
- catabolic pathways
- anabolic pathways
B. Chemistry
- structure
- properties
- function
- transport
C. Nutritional Concepts
- food sources
- digestion

III. Proteins, Amino Acids & Peptides (16%)
A. Amino acid metabolism
- catabolic pathways
- anabolic pathways
B. Chemistry
- structure
- properties
- function
C. Nutritional concepts
- food sources
- digestion

IV. Enzymes (7%)
A. Classification and function
B. Kinetics and regulation

V. Hormones (7%)
A. Metabolic effects of specific hormones
- carbohydrate metabolism
- lipid metabolism
- protein metabolism
B. General properties
- chemistry
- mechanism of action

VI. Nucleotides and Nucleic Acids (9%)
A. Metabolism of purines and pyrimidines
B. Chemistry
- structure
- properties
- function
C. DNA, RNA and protein
synthesis

VII. Vitamins and Minerals (16%)
A. Chemistry
- structure
- properties
- function
- coenzyme precursors
B. Nutritional concepts
- food sources
- absorption
- storage

VIII. Biochemical Energetics (9%)
A. Basic concepts
- high-energy phosphate compounds
- oxidation-reduction reac tions B. Krebs cycle C. Oxidative phosphorylation
- electron transport system

Pathology

I. Fundamentals of Pathology (21%)
A. Disease at the cellular level
B. Inflammation and repair
C. Neoplasia
D. Hemodynamic disorders

II. Genetic and Congenital Disorders (5%)
A. Chromosomal disorders
B. Inborn errors of metabolism
C. Congenital disorders

III. Disorders of the Immune System (6%)
A. Hypersensitivity reactions
B. Autoimmune diseases
C. Immunologic deficiencies

IV. Environmental & Nutritional Diseases (5%)

V Disorders of the Musculoskeletal System (18%)
A. Bone
B. Joint
C. Muscle

VI. Disorders of the Nervous System (10%)
A. Central nervous system
B. Peripheral nervous system

VII. Diseases of the Organ Systems (35%)
A. Cardiovascular
B. Gastrointestinal
C. Respiratory
D. Genitourinary
E. Endocrine
F Hemopoietic

Microbiology and Public Health

I. Principles of Microbiology (14%)
A. History
B. Microbial structures and
functions
C. Systematic medical micro biology - morphology
- cultures
- biochemical character istics - resistance
- microbial genetics
- antigenicity
- pathogenicity

II. Communicable and Infectious Diseases (44%)
A. Bacteria, Chlamydia, Rickettsia and Mycoplasma
B. Viruses and prions
C. Fungi
D. Parasites

III. Epidemiology and Disease Management (14%)
A. Health agencies and parameters used by epidemiologists
B. Reservoirs of infection and modes of transmission
C. Prevention and control
D. Emerging diseases
E. Morbidity and mortality

IV. Environmental Health (10%)
A. Community health (food, milk, and water quality)
B. Occupational health
C. Pollution (solid waste, water and air)

V. Immunology(18%)
A. Types of immunity
B. Cells of the immune system
C. Antigens, antibodies and complement
D. Immunization
E. Assessment of immune responses (serology)

Evidence Based Chiropractic

My last post was a bit dramatic. I know. Sorry. I get a little "in to it" when I think about this path leading to the inevitable DC degree in under 2 years. I see things I don't like in the profession and want it to change. Then I look up at the clock and it's like 2 in the fricken morning and I have wasted a good 4 hours pondering and writing about these concepts. What can I say, I guess I like our program after all and want the profession to head into a bright future. Most students seem to care less about this stuff which is bothersome. Some care a lot and the balance is found between the two. If you can call it that. It is like this in the "real world" where some DC's participate in political action and foster change and others sit around on their thumbs caring only about themselves.

I guess I could be convinced that my actions thus far have been merely rhetorical. I haven't joined SACA (Student American Chiropractic Association) or participated in any real effort to change the face of chiropractic. There are reasons for this. One biggy is I am big critic of chiropractic. Although, I am one. Weird, I know. I suppose I am not ready to "get on board" with things yet because I remain unconvinced that I can really change anything. I also view student organizations as social clubs where productivity is sacrificed. That is probably not cool to say but that's how I see it. We can sit around bickering about what we should do or what we are all about till the cats come home and until someone takes a giant leap forward away from the bullshit, nothing will change. At least from my current non-enrollment, I can have a say without getting swamped by the same ol' chatter. I would consider joining a student organization if it was some kind of think-tank that generates ideas for non-cheesy chiropractic marketing.

My hunch is things will slowly change for the better. We'll likely unify ourselves and march forward like other professions have done. By becoming fluent in evidence based chiropractic, we'll be able to get there quicker. As budding doctors of chiropractic, we'll likely put things on the back burner because of time constraints or lack of motivation and that is expected. EBC is not one of those things though. Knowing how to extract the latest and greatest research is so damn important as future doctors. This is what people expect in us. When they come knocking on our doors, they literally expect the best care and assume we are up on the literature. It is my opinion that we owe this to them as "professionals" no matter how big a pain it is to learn how to do. Sure, there will be some who simplify things and carry only a hammer to "every" patient problem. It is easier that way, right? I wonder why that might be? To have the world defined for you must feel nice and comfortable. Like a big blanket that mommy tucked you in with. Sleepy, so sleepy... Anyway, as you can see, I think there are some who fall into this category of "laziness" in our profession who migrate toward the big bright light with shining dollars signs. Buying into a technique system rather than using your skills in EBP is selfish, unethical and substandard to be qualified as a "doctor". Yep, I said it again. Ouch!

Out of any of the courses we are taking right now, EBP is ranked #1 or #2 on my list. Adjusting skills is a biggy and physical diagnosis is too. EBP is hard to learn with all the statistical rules and antics but it gives you logical solutions you can trust. Clinical judgement is not just formed out of the blue or by buying into some dude's technique. Learning ways to become fluent in finding answers is a skill we can't take for granted. Our future patients expect it and we really do owe it to them. With that, many of the technique systems offer a way to "find" the subluxation. Use my method and you'll find it every time and create referrals. Whatever! How about this, learn more hands-on skills so you can decipher between tissue variability. Or using range of motion, proprioceptive stretching or movement analysis.

If we jump into the world of kinesiology (not applied kinesiology) and exercise science, the answers are there. PT's have done this and use these science-based paradigms to help their patients. Why do you think mainstream medicine supports them?

WSCC recently added the Masters in Exercise and Sports Science and that was a VERY smart move on their part. Integrating such training into the DC program will help us be scientific practitioners and quite possibly push us away from the tempting technique systems being marketed to student doctors.

All for now