Author: Marc N. Katz

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Hope For Huntington’s Disease

After decades-long research that began with neural plasticity in Songbirds, scientists at the University of Rochester Medical Center have demonstrated a breakthrough method of treating Huntington’s disease that gives hope for future generations. Huntington’s disease affects a specific section of the forebrain- the basal ganglia. The basal ganglia is a collection of nuclei that control numerous functions including voluntary motor movements. In Huntington’s disease, the medium spiny neurons in the striatum of the basal ganglia degenerate resulting in involuntary writhing movements.1,2

After treating endogenous neural stem cells with BDNF and noggin proteins, scientists were able to demonstrate neural regeneration of the medium spiny neurons that are affected in Huntington’s disease in both mice and squirrel monkeys. Although they are likely years from clinical trials and even farther from having a ‘cure’, their breakthrough certainly gives hope for future generations affected by Huntington’s disease as well as for the future of regenerative medicine.1

Check out the original article here.

1-“Scientists Coax Brain to Regenerate Cells Lost in Huntington’s Disease.” – News Room. University of Rochester Medical Center, 6 June 2013. Web. 17 June 2013.

2–Romanian Journal of Psychopharmacology 9.2 (2008): n. pag. Web. 17 June 2013.

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See One, Do One, Teach One

I have completed countless dissections in the anatomy lab and have observed even more through videos provided by Ross University. Like any diligent student I have studied anatomy by creating my own drawings, mnemonics, notecards, and through the ever popular rote memorization. This semester as an anatomy TA I have been given the opportunity to teach first semester students the anatomy of the human body from head to toe. As the phrase ‘see one, do one, teach one’ suggests, my medical learning experience will finally come full circle. I’ve made it this far- how hard can teaching really be?

An experience I had with three first semester students in the gross anatomy lab in the beginning of my second semester made me realize how rewarding teaching is. In no time, I ran through the anatomy of the upper limbs and superficial back with them and quickly quizzed them on the brachial plexus. Not only was I amazed at how much material I had retained but I recognized that I was still learning, compounding new and old information, and making even stronger connections this time around. I loved being able to integrate the 2nd semester anatomy of the pelvis with the 1st semester anatomy of the lower limb. Being able to take the material I memorize and integrate it with the material I actually understand.

My favorite part, however, was how innate my understanding of the arteries of the body felt. It was like driving through a familiar town I hadn’t visited in a while. For instance, last weekend I visited Binghamton. When I drove through the city I lived in during my undergrad years it felt as if I had never left. The map of the city is engrained in my head. Even after major road construction, I could still contemplate the deviations and possible detours I could take to shorten my journey. Likewise, the twisting and often times confusing pathways of arteries of the human body is now engrained in my head. My understanding has become second nature as to how the arteries of the head and upper limbs branch from the arch of the aorta before it becomes the abdominal aorta and continues down to give rise to major branches like the celiac trunk, superior mesenteric and inferior mesenteric arteries. How the splitting of the abdominal aorta gives rise to all the major arteries of the lower limb. These arteries are a roadmap to the human body and I don’t have to stop for directions.

Besides improving my own understanding of the body, it was rewarding to help others improve theirs. It always amazes me when I see the material a student in the semester above me is studying. The work always seems infinitely harder, more complex, and something that I’ll surely never be able to understand…at least until I start chipping away at it. I’ve come to find that the most challenging part of studying is similar to the most challenging part of running- the first step. It’s easy to become overwhelmed with the vast quantity of material I need to cover or how far I plan to run. It’s what makes studying for a final exam that much more daunting. But by simply taking that first step, studying becomes a smoother and less stressful experience. And that’s what the best TAs did for me. They gave me a gentle push in the right direction. A spark to ignite my engines. Momentum to overcome inertia.

However, the best TAs weren’t always the smartest ones. Well, maybe they were. I never really stopped to survey them about their grades. The best TAs would always exhibit the same qualities that my favorite middle and high school teachers and undergraduate and medical school professors have exhibited over the years. They were able to take an innate understanding of a complex concept and simplify it so that someone with a rudimentary understanding could grasp the material at hand. Furthermore, they did so in an entertaining and engaging way utilizing clear and concise language that made the material relevant to me. Don’t just tell me that melanocytes are found in the stratum basale of the dermis. Tell me how the melanin of fair-skinned gingers like myself is both produced in smaller quantities and is also degraded more quickly than dark-skinned individuals.

Using relevant examples and clear language in teaching is a simple enough concept but I recall as an undergraduate physics lab TA when it was far from second nature. I remember how unprepared I was. How I fumbled over my words. How difficult it became to describe velocity and sound equations to my peers who didn’t have the same understanding of the material as I did. I wasn’t the best physics TA to say the least but I learned a lot from that experience like the importance of communication in teaching. This brief but captivating 5 minute TED talk illustrates three key points to good communication between scientists and the public. Whether you are a TA or a tutor or just helping a friend with a concept they have trouble with, these three quick and easy communication tips can help anyone improve his or her teaching skills:

First, as Melissa Marshall from the Department of Communication Arts & Sciences at Penn State explains, “When you’re describing your science, beware of jargon. Jargon is a barrier to our understanding of your ideas. Sure, you can say “spatial and temporal”, but why not just say “space and time,” which is so much more accessible to us?” Likewise, the Latin or Greek name for structures often confuse students. Sure, you can use the term ‘profunda brachii’, but you could rather explain how it translates to ‘deep artery of the arm’, thereby making it more relatable [1].

Second, “tell us why your science is relevant to us. Don’t jus tell me that you study trabeculae, but tell me that you study trabeculae, which is the mesh-like structure of our bones because it’s important to understanding and treating osteoporosis. [1]”

Lastly, “a slide like this, shown below on the left, is not only boring, but it relies too much on the language area of our brain, and causes us to become overwhelmed. Instead, the slide on the right, an example by Genevieve Brown is much more effective. It’s showing that the special structure of trabeculae are so strong that they actually inspired the unique design of the Eiffel Tower. And the trick here is to use a single, readable sentence that…students…can key into if they get a bit lost, and then provide visuals which appeal to our other senses and create a deeper sense of understanding of what’s being described.[1]”

Trabeculae

Ultimately, communication skills are one of the many talents that an individual must master to become an effective teacher. Teaching is an art and quite possibly one of the most difficult arts to master because, as John Steinbeck wrote, “the medium is the human mind and spirit’.

Teaching is similar to other forms of the arts like painting, writing, or playing a musical instrument in that it can be learned. We rely too heavily on ‘the naturals’- people who have innate abilities to teach. Part of the problem is that we rarely teach individuals how to teach. For instance, I have a friend who understands our lecture material far better than anyone I know. He has stellar grades and can easily provide me an answer to almost all the questions I ask him, except he can’t convey his thought process to me. He might understand the material but I can’t understand him. In the end, teachers, tutors, and TAs must work to improve their own teaching skills with assistance from their universities to communicate material more clearly and improve their students’ understanding of lecture material.

1- Melissa Marshall: Talk Nerdy to Me. By Melissa Marshall. Perf. Melissa Marshal. TED: Ideas worth Spreading. N.p., Oct. 2012. Web. 05 May 2013.

 

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My Work Ethic

“There may be people that have more talent than you, but there’s no excuse for anyone to work harder than you do” –Derek Jeter

I needed a break after taking my gastrointestinal & renal block exam. A weekend to relax would be amazing. An opportunity to let the thoughts that normally race through my head dissipate. A chance to take a breath after I almost drowned in my studies that left me physically and mentally exhausted. Heck, an afternoon to go grocery shopping, play some soccer, and read a chapter from my Kindle that’s been lying dormant on my desk would be nice. Except for the fact that we start the reproductive block tomorrow. Sucks to suck right? It would if I didn’t enjoy it so much.

Don’t get me wrong, I wish I had more time to just hang out and do nothing, play some Call of Duty, and stay in to watch a movie. But I recognize that I’m putting in my time now so that I can enjoy what I do for a living tomorrow. I didn’t realize how important it was when I was training to play soccer in high school. I thought I just had to show up to practice and play hard during games. I was a talented but lazy soccer player and it eventually caught up to me. I didn’t realize that running sprints today conditions me into a better athlete tomorrow.

It was one of the most important realizations I’ve had during my second semester of medical school. My classmates and I often joke about how hard we work. Compared to undergrads we study every single day as if we have a final exam tomorrow. You can imagine how insane we get when we actually study for our finals. If only I had this same work ethic four years ago I could have gone to ‘one of the Hopkins or Harvards’…or maybe just a stateside medical school. Except that I’m happy here at Ross University.

One of Ross’ principal explicit goals isn’t to push my peers and me into developing a superhuman work ethic per se, but I am yet to meet a peer of mine who has ever worked harder in their life. And I am thankful for it. Ross is the soccer trainer I never listened to.

Studying here is like going to the gym- I don’t personally enjoy working out, but I like how I feel the next day. Likewise, I don’t always love sitting down and studying for hours on end but I love being able to apply medical science after I understand it. And as much as I would like to think I work hard now, I know that the fourth semester students have it twice as bad. They took an exam the same day that I took my GI & renal exam but they have to get right back to the grind to study for their final being held in one week. And then they have to study for their comprehensive exam being held in a month. And then they have to study for their Step exam. It never ends.

It’s not like when I graduate from medical school I’ll just stop studying or working as hard as I do now. If anything, that’s when the hard work that goes into the core sciences at Ross will finally pay off. It will be that much more gratifying when I get to actually treat patients and will motivate me to push myself even harder. That’s why the relaxing afternoons after my exams are one of the most important days of the semester.

I got to see a glimpse into my life as a fourth semester. I’ll have to study just as hard as I did for my last exam but will have to continue studying just as hard the following day for a final. And keep on going until I graduate. And then keep on going until I finish my residency. And then keep on going until I finish my fellowship. As I continue to progress through my medical education, I will rarely be able to mentally checkout for a weekend while I recuperate from the caffeine and cortisol driven weeks of study and work. My daily grind involved in sustaining my life as a med student will eventually evolve into a nonstop grind involved in being a practicing physician. This is why Ross has not only improved my work ethic, but has even forced me to consolidate how long it takes me to relax and then get back into the swing of things. I simply can’t afford anything less than being maximally efficient with my time. My mental health and academic performance depend upon it.

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Turn Down The Music! It’s For Your Health.

       Your grandparents are probably hard of hearing- and they grew up in an era without iPods or expensive over-the-ear headphones. Today, a seemingly exponential number of adolescents and young-adults subject their ears to daily ototoxic levels of noise, or noise that is loud enough to cause irreversible hearing loss. As the graph below illustrates, ‘noise-inducing hearing damage is related to the duration and volume of exposure’.

Decibel Damage

It’s simple- the longer you are subject to noise and the louder the noise is, the worse the damage will be. But how does hearing loss actually happen physiologically? And moreover, why should you be concerned? In order to answer these two simple questions we must first understand how hearing works.

Hearing expert Billy Martin from the Oregon Health & Science University said it best in an article from June of 2011 when he stated, “1our ears are extremely sensitive devices- they’re designed for when you’re walking in the woods and you hear a twig break, signaling that the bear that ate your friend last week is close”. Our ears weren’t made for the constant barrage of noise that my generation has grown-up with.

The process of hearing begins with the transmission of sound waves through the canal that carries sound waves from your visible external ear to the structures of the middle and inner ear that function to transmit mechanical vibrations into sensorineural input that is sent to the brain. First, sound waves hit the tympanic membrane and cause it to vibrate. The tympanic membrane is what you would contact if you shoved a Q-tip as far into your ear as you can (please do not attempt this). It is also what physicians examine when they peer into your ear to assess the general health of your ear. The tympanic membrane causes the subsequent stepwise vibration of three bony ossicles found in the middle ear. These three small bones are the malleolus, incus, and stapes. (Fun fact: the stapes is the smallest bone in the human body at roughly the size of a grain of rice).

As the video below beautifully illustrates, the mechanical vibrations of the stapes cause vibrations to occur within the cochlea that subsequently stimulates sensory inner ear hair cells.

These sensory hair cells release neurotransmitters completing the transformation of mechanical vibrations into sensorineural input that can be interpreted by our brain as sound.  These sensory hair cells are of critical importance! For whatever reason, we are only born with 3,500 sensory hair cells- and they do not regenerate. Thus, the root of hearing loss due to old age is via damage to and eventual loss of these sensory hair cells. This is why you should turn down your music- ototoxic levels of noise accelerates the aging process of your ear by damaging the irreplaceable sensory hair cells which induce hearing loss.

Although there are numerous hearing aids available on the market, there are currently no widely accessible regenerative therapies for hearing loss specifically aimed at the regeneration of sensory hair cells. However, a recent discovery by researchers from Massachusetts Eye and Ear and Harvard Medical School grant an optimistic outlook to hearing restoration through regenerative therapies. Researchers applied a drug to stem cells isolated from the ear and were able to restore hearing to deaf mice. 2For the first time ever, researchers demonstrated that “hair cells can be regenerated in an adult mammalian ear”.  Senior author Dr. Albert Edge of Harvard Medical School and Mass. Eye and Ear explains that, “With more research, we think that regeneration of hair cells opens the door to potential therapeutic applications in deafness.”

We are still years away from being able to supply commercially available and financially responsible stem cell-based therapies for sensorineural hearing loss to the public, but these findings fuel cautious optimism for the field of regenerative medicine and ultimately give our next generation of hearing impaired individuals a reason to be optimistic about long-term regenerative therapies. However, as with the rest of the human body, the promotion of health and wellness must be implemented as the primary defense against the advancement of the aging process with specific regards to hearing loss. A good rule of thumb for ear safety- if you have headphones on and you cannot hear the person next to you speak then your music is probably too loud (of course, assuming you aren’t wearing noise cancelling headphones).

In the end as much as it pains me to say it- my parents were right once again. Loud music can in fact cause hearing loss and also accelerates damage to irreplaceable sensory hair cells. So do yourself a favor and turn down your music- it’s for your health.

 

Works Cited

1- Newman, Jim. “How Much Noise…is Too Much Noise?” OHSU News. Oregon Health & Science University, 9 June 2011. Web. 02 Mar. 2013.

2- “Mass. Eye and Ear Researchers Regenerate Sensory Hair Cells, Restore Hearing to Noise-Damaged Ears.” Mass. Eye and Ear Researchers Regenerate Hair Cells, Restore Hearing. Ed. Mary Leach. Massachusetts Eye and Ear, 9 Jan. 2013. Web. 2 Mar. 2013.

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How To Study In Med School

One of the toughest parts of starting medical school for me was figuring out how to study. Here are some of the best pieces of advice that I have discovered along the way.

 

 

Find your own study method.

Everyone does something different. Some students love the library while others are more productive at home. I like loud music while others need absolute silence. Find a method and routine that works for you and stick to it. And let me save you the time and trouble and let you know that study groups only work if everyone has studied on their own individually already.

 

 

Study for long-term retention

There is no way around it. You have to work hard every single day. However, studying in medical school is different than studying in undergrad. There is no more study and purge. You need to learn for long-term retention. This material is going to come back on the final. And the USMLE Step 1. And then again on Step 2 CK. Oh and also Step 3. It might even be important during residency when you treat actual patients. Just remember that if you understand it now then you won’t have to study it again later.

 

 

Work smarter, not harder

Medical school is like trying to drink water from a fire-hose. There is always more material to study and never enough time to study it. So you have to be succinct when it comes to taking notes and making study products. I liked to combine the two. Fold a piece of paper in half and write a question or topic on one side and the answer or explanation on the other. This way you can take notes while creating a study product at the same time. Then later on you can use your notes to quiz yourself. Cover one side and try to regurgitate as much as you can. Lather, rinse, repeat.

 

 

Actively study

When you are studying your lecture material you must remember to actively study. By actively studying, you challenge yourself to summarize and regurgitate the material in your own words. Don’t just read the same sentences several times. Ask yourself questions about the topic at hand and different questions about the same subject. What artery supplies the muscle? What action does this muscle have? What nerve supplies this muscle? The nerve that supplies this muscle also supplies what other muscle? If you’re lucky, you might even accidentally guess an exam question.

 

 

Stay ahead of the game

Let’s compare your lectures to a pancake breakfast. Each day you have to eat ten pancakes. It’s manageable. However, if you slack off and don’t eat all of your pancakes, then the next day you will have to eat you ten from today and the remainder from the day before. That’s a lot of pancakes (and a lot of carbs…). This will continue until you’re looking at a mountain of flapjacks with no end in sight. Likewise, don’t fall behind in school- you can’t afford to. Stay ahead and always finish your day’s work. Find whatever works for you and stick to it.

 

 

See one, do one, teach one

The old phrase of ‘see one, do one, teach one’ carries weight in medical school and residency. After being taught something and studying it, test yourself by applying your knowledge. Practice questions are the simplest way to illuminate gaps in your knowledge and are an excellent way to apply what you’ve learned. This point is worth repeating- do practice questions! Eventually though, to test if you truly understand a topic try teaching it to a friend. You’d be surprised how much you think you know until you try to teach it to someone else.

 

 

In the end, only you stand in the way of your success.

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How To Pass Your First Semester At Ross University

A fourth semester student made me realize that I will be giving the same advice to first semester students again next semester. And again after that. Instead of repeating myself, I’ll simply share how to pass your first semester of medical school at Ross University as well as study skill advice.

 

Beware of who you take advice from (except me of course)

I distinctively remember being told by an upper semester ‘not to bother focusing on lymphatic drainage’. Low and behold, at least three questions on lymphatic drainage popped up on my first exam. Similarly, last semester was the exordium of Ross teaching first semester students immunology. It just goes to show you that each semester is unique. Be aware that Ross is continually adapting to improve our educational experience and professors and material change- no two semesters are identical thus far. So, listen to your upper semester peers. They are smart and have gone through everything you are about to experience. Just take everything with a grain of salt.

 

Surround yourself with positivity.

You are going to have enough on your plate this semester without having negative-Nancy bothering you. It might seem discourteous, but avoid negative people who bring you down at all costs. Find a good group of friends who exude positivity and stick with them. I don’t know how I would have been able to make it through my first semester without the support of my friends down here in Dominica.

 

Work hard, play hard.

Find ways to reward yourself for all of the hard work you put in. It can be going for a swim in the Caribbean, playing basketball or soccer in the evening, or simply enjoying a good novel. Whatever it is that helps you unwind and relax- do it. You can’t study non-stop every single day or else you will simply burn out. Med school is a marathon, not a race (and no, you don’t sprint marathons).

 

Remind yourself why you are here.

Every once in a while I found myself down and out. It was a long and hectic week with not nearly enough sleep. I needed to find motivation to keep going. I went home, showered, relaxed, and reminded myself of all the years of hard work and dedication I invested in myself in order to simply gain acceptance into medical school. I thought about how proud both my parents and I will be when I graduate. I thought about how much I look forward to treating my first patient. Just like that, my smile returned to my face and motivation to my mind. Keep your long-term goals in the back of your mind and don’t forget why you are here.

 

Don’t compare yourself to the valedictorian.

There are going to be other students with master’s degrees in biochemistry and other students who have previously been anatomy TA’s. Don’t stress about what other people know. Focus on what is in your control instead of lamenting over the fact that someone else might know a certain subject in more detail that you do. There is a fine line between recognizing that you might want to look over the anatomy of the arm once more after your friend displayed such an amazing mastery of the limb and freaking out because you feel like you don’t know anything.

 

Although it should go without saying, don’t forget to study.

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Pre-meds: Do what it takes to get into medical school

I sit at my home in New Jersey as I anxiously await my 6am flight two days from now that will take me to the Caribbean island of Dominica where I will begin to take my first steps in the journey of becoming a doctor at Ross University School of Medicine.

 

Many people attempted to discourage me from continuing on the path I started on. Doctors I shadowed would warn me of the daunting hours, how much medicine has changed over the years, and how you can make more money in other fields for the amount of time you put in. Even my undergraduate pre-med guidance counselor at Binghamton University told me, on several separate occasions, that I simply did not have the grades to get into medical school. And these people were right…sort of.

 

It is true that medicine is changing. And you can more than likely make more money in business or in banking. And at the time, I did not in fact have the grades to be accepted into medical school. I am here to tell you that can get into medical school, even a stateside school, if you want it badly enough. This isn’t to say that your past mistakes will vanish into thin air- that ‘C’ in organic chemistry isn’t going anywhere. What you can do is affect your future. Show that you remember your mistakes and learn from them.

 

Likewise, I try to forget the people who attempted to dissuade me from medicine, but remember the people who accepted my decisions and encouraged me along my path. The one doctor I spoke with at a high school graduation party of a mutual family friend who highlighted that, “It doesn’t matter how many rejections you get, because in the end you only need one acceptance”. Or my parents who pushed me to apply to that reach school after explaining, “I’m not doing myself any favors by rejecting myself before even applying”.

 

I am here to give you a pat on the back and a kick in the ass. I had to take the MCAT twice and had to apply to twenty-eight medical schools, but all it took was one acceptance to make it all worthwhile. If you have explored medicine and have decided that it is the path for you, don’t let anyone discourage you from it. Own it and do whatever it takes to succeed. It is what I intend to do starting September 3rd on my first day of class down in Dominica.

As seen on @KevinMD