Month: April 2014

The Seedfolk Store | An Urban Agriculture Project

Post author By Sanah Ali
Post date April 22, 2014
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I recently had the privilege of visiting The Seedfolk Store in Rochester, New York. The store is run by the non-profit ProperRochester, Inc. which focuses on community engagement through urban agriculture with a focus on healthy food availability, youth empowerment, and entrepreneurship. The shop takes some inspiration from the book “Seedfolks”, a children’s novel by Paul Fleishman, in which an ethnically diverse community in Ohio works together to transform a vacant lot into a garden. I visited the shop as part of an activity for a medical humanities course I am currently taking, entitled “Death by Zip Code”, taught by Katrina Korfmacher, Ph. D. This course explores the importance of the environment on population health, focusing on epidemiology. The Seedfolk Store provides some vegetation in an area that is otherwise a “food desert”. These areas usually have fast food restaurants and convenience stores/corner shops. The Seedfolk Store has a refrigerator full of vegetables that are often requested in the area by neighbors. As a new organization, they are working on spreading the word about their efforts and services. While a full-fledged vegetable market would be unsustainable and unprofitable, this hybrid-shop is a great compromise and is catered to current demand. The shop gains some profits by selling granola from Small World Bakery, selling coffee for Coffee Connection, and selling potted plants and green tea bags that they make.

The staff’s experiences with ProsperRochester, Inc. is inspiring−it is clear to me that this team is daring and ambitious. They are dedicated to teaching youth about the specifics of food planning, processing, and distribution (selling and educating). These youth are employees and volunteers who work at the Seedfolk Store, green house, and in community gardens. They are actively involved with cooking education, small-scale food production, urban farming and learning about the local food system. The Seedfolk Store provides nutrition workshops, cooking classes, soup for the general public on Tuesdays, potted plant sales at the Rochester Public Market, and a rentable kitchen space for cooks. On April 12^th, the team began planting at the M.K. Gandhi Institute for Nonviolence, a community partner which provides ProsperRochester, Inc. with space to widen in-ground gardening. In many locations, ProsperRochester, Inc.’s concerns about lead in soil has led to their use of raised bed gardening. ProsperRochester, Inc. also works closely with In the City Off the Grid, with which they are creating an aquaponics agriculture system at the Gandhi Institute and expanding a hydroponic greenhouse on Rochester’s East Main Street.

Most inspiring is that The SeedFolk Store’s team truly lives the message of health that they promote. Three members lost large amounts of weight and they told us their secret−namely they changed their diet, eliminating refined grains and processed sugars while increasing their intake of fruits and vegetables. One of the cooks renting the kitchen is a cheerful immigrant from Africa who wrote a children’s book about nutrition. She brought her own cooking supplies to The Seedfolk Store’s kitchen and waited in the rain for her ride home. This determination to further the health of one’s community through nutrition, no matter the obstacles, is very much necessary in all urban areas in the United States. I hope to help spread the word about this initiative and soon see similar projects pop up across the country to empower youth with the ability to make healthy life choices.

To visit The Seedfolk Store online or in person:
The Seedfolk Store
540 West Main Street, Rochester, NY, 14611
(585) 279-9943

General

5 things you learn as an MS1

Post author By Ankur Narain
Post date April 16, 2014
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Entering the first year of medical school, MS1’s believe that they have some idea of what they are beginning. We are inundated with information about medical school starting in our pre-med or post-baccalaureate years, and the application process heaps even more onto our plates. Along with this, we have stories passed down by older friends and relatives who have already started or gone through the medical school experience. When we finally get to school, we think nothing will surprise us.

Needless to say, this naiveté is quickly shed after the first week of classes. We soon realize that we have much to learn, and very little time to learn it in. Some of these lessons occur in the classroom, while others remain more personal. After having gone through most of my first year, I have some surprising lessons.

Here’s my Top 5:

1. The amount of material you learn in a short period of time is amazing.

I was an immunology major in college. I took two semesters of lecture and one semester of lab to qualify for this major, on top of all of the other pre-med requirements. My immunology course in medical school was three weeks long. The medical school course covered more material than my core undergraduate major classes in 27 fewer weeks.

You learn so much in medical school so quickly that it is at times mind-boggling. While you do adjust somewhat to the coursework, you will still be amazed at how much you are expected to know from every day of class. Some people deal with this by studying all day, while others procrastinate and spend the days leading up to the exam stress eating pounds of chocolate. Either way, you get through it and come out more knowledgeable (and slightly heavier) than before.

2. Medicine has its own language, and it makes no sense at all.

Nothing, absolutely nothing, is put into layman’s terms. You can’t say “elevated heart rate”, you must say “tachycardia.” You can’t say “shortness of breath”, you must say “dyspnea.” You can’t say “low platelets,” you must say “thrombocytopenia.” That last one is my personal favorite. The ridiculous nature of this system is apparent to everyone, but since it’s been entrenched in the medical community for so long, it continues onwards. Have fun, future medical students.

3. You become desensitized to gross masses/fluids/images.

Menstrual fluid? No big deal. Oozing pus from a skin lesion? Not interesting. Penile sischarge? Just another Tuesday in the infectious disease/STD clinic. Teratoma? Well, that one is still rough. If you haven’t seen a teratoma, I’d suggest you google it (not at work, definitely NSFW).

4. Everyone is smarter than you.

I’m amazed every day by all of my classmates. They are all so accomplished and humble. One of my classmates is a published author (of a real book, not a research publication). One is a pilot. Another, an investment banker before beginning medical school. My college days of playing too much Xbox Live, while impressive for sheer immaturity, pale in comparison.

What I’ve really come to realize, however, is that you can learn a lot from viewing how others reach success. I’ve picked up many good habits and behaviors by just observing how my accomplished classmates go about their lives. As they say, imitation is the sincerest form of flattery.

5. Medical school is truly life changing.

For how much everyone complains about medical school, no one can deny that it is life changing. You learn so many interesting things, and all of them are relevant in positively affecting the lives of others. You meet so many interesting classmates and mentors, forming a motivating and comforting community. Most importantly, medical school teaches you about yourself. You learn that you are capable of so much more than you previously thought, and that you can deal with any challenge. All of these lessons and experiences are, quite literally, worth the price of admission.

Clinical General Opinion Public Health

Parents fight Croatian law enforcing mandatory child vaccinations | We don’t need no vaccinations, we don’t need no thought control

Photo courtesy of https://www.flickr.com/photos/zsoolt/

The Croatian constitutional court has made the vaccination of children a legal obligation. Their reasoning behind this law is that “a child’s right to health is more important than a parent’s right to choose (wrongly)”. Their words, not mine, although I do agree.

Vaccination has been a part of paediatric care in Croatia for years, and children have regularly been vaccinated throughout their education, although it has never before been officially mandatory. Now, parents have the potential of being prosecuted if they do not to vaccinate their children. In Croatia, children are vaccinated against the following: tuberculosis, diphtheria, tetanus, pertussis (DTaP), polio, measles, mumps, rubella (MMR), and hepatitis B. It was always said that vaccination was mandatory, but whenever I asked what to do with unvaccinated children, I was given vague answers. Nevertheless, the law now states that a parent’s failure to ensure the vaccination of their child will result in a fine and a visit from social services. A large group of parents, accompanied with some medical professionals, disagree with this and have called for a public discussion.

Photo courtesy of https://www.flickr.com/photos/jaccodeboer/

“Nobody wants to take the responsibility.”

This is an argument many parents have repeated when asked why they don’t want their children vaccinated. The majority of “modern” parents are best pals with Doctor Google, who has told them stories about apparently unnerving side effects of certain vaccinations. Furthermore, media dramatization and sensationalism add another factor in the vaccine debate. Although the Internet and media in general can provide strong patient education, it can also provide highly biased information thereby providing harmfully improper patient education. Even though they are dramatic and stand out, articles reporting on a child developing a long term and/or life changing disorder or condition are quite rare. Reading such an article invokes fear in readers. Statistics are what matter in possible negative outcomes. How many stories about serious problems arising from a vaccinations exist? And how many children are vaccinated every day? And what are measles, mumps, rubella, polio, pertussis, and the other diseases like when they take hold of a child’s body?

Understandably, parents want to protect their children and don’t want their little ones to suffer any life changing side effects, short or long term. Before allowing for any vaccination, they want doctors to tell them with absolute certainty that no harm will come to their children from a vaccine. Surely parents would also like completely safe transport, but they are willing to put their children in a car, train, or plane because of the benefits of fast travel outweigh the small chance of an accident happening. It is impossible to expect doctors to claim that anything is completely safe, and “take responsibility“ if anything at all goes wrong. This is why there are patient consent forms and small directions in all medication boxes explaining possible side effects. If a parent asked me whether I would take responsibility for any possible side effects of vaccination, I would reply with another question: Would you, as a parent, take the responsibility of your child getting an infectious disease that could leave them with life changing consequences, or even possibly be a cause of death?

Although I would try and talk to people who refuse vaccination, if they continued to refuse I would respect their decision. In the end, I appreciate it is your right to decide what you want to do with your body. A friend of mine has pointed out to me that this law might limit the right of choice; therefore not allowing parents to make a choice about their children. I can see his point, and as I said, everyone should have the right to decide what to do with their body. However, this is a choice parents aren’t making about themselves, but about their children, who are too young to make an informed choice. Are their parents making an informed choice though? Do they have enough information to go against medical advice? Many countries don’t have a law about mandatory vaccination, and maybe those fighting against this law will manage to win, but I hope this whole debate will at least raise awareness and make people think about the importance of vaccination.

Featured photo courtesy of zsoolt

General

A Review of “Informed Consent” | A Play Regarding the DNA Tests and Lawsuits of the Havasupai Indians

Post author By Leah Dauphin
Post date April 11, 2014
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Photo courtesy of Moyan Brenn https://www.flickr.com/photos/aigle_dore/

Informed Consent, written by Deborah Zoe Laufer and directed by Sean Daniels, aims to show the emotional, psychological, and physical dangers that can occur when researchers fail to communicate adequately with their subjects. The play focuses on the tale of the Havasupai tribe and their battle against the improper use of their blood in genetics research. Laufer has stated she was inspired to chronicle their story after reading a New York Times article from 2010 entitled, “Where’d You Go with My DNA?”¹ The article summarizes the plight of the Havasupai, a Native American tribe plagued with type II diabetes mellitus. The tribe looked to researchers at Arizona State University to study blood samples of tribal members in an attempt to find a genetic link for the disease. Of note, is that blood is sacred to the Havasupai and they will not proceed to their desired after life without their blood. Though they believed to only consenting to diabetes research, the informed consent document was “intentionally vague” and researchers decided to use the blood sample for more studies than diabetes, without re-informing the Havasupai. It is this story that lead Laufer to her play, Informed Consent. Though inspired by true events, Laufer chose to fictionalize many aspects, while maintaining the central issue: What constitutes informed consent? On March 18^th, the play made its world premiere at the Geva Theatre in Rochester, New York and will be playing through to April 13^th. It will be then featured in the Cleveland Playhouse in Cleveland, Ohio from April 23^rd until May 18^th.

This character driven play features five actors, each jumping into different roles throughout the show. Their impeccable performance is matched by a beautifully rendered set design. Created primarily of cardboard, the set aims to depict the base of the Grand Canyon−the home of the Havasupai. In contrast to the sand colored canyon, there are white rectangles scattered throughout the set, juxtaposing nature with the sterility of the science research lab. While the actors’ performances are strong in conveying the strife endured by the Havasupai, there are occasional parts that take away from the brevity of the content. This is seen with random background interjections from actors not involved in certain scenes. It seems as though Laufer attempts to add comic relief to the script; however, it is misplaced and hardly receives any laughs from the audience. Lightheartedness is out of place when addressing such a sensitive topic based on true events.

Of note is the lead female protagonist, Gillian, who conducts the research with the Havasupai. It is because of her ill-guided decision to use the blood obtained from the Havasupai for more than diabetes research, which is all that the tribe agreed to, that she inflicts pain on a tradition-dependent group. She is painted as self-centered and career driven, allowing nothing to stand in her way to get publications in lofty journals such as Nature and Cell. She goes so far as to publicly deny the creation story of the Havasupai, which the tribe has passed down for hundreds of year.

While some may think Gillian is over caricaturized, it is easy to see parallels in the everyday medical world. It’s the doctor who asks for a urine sample without telling the patient what he is testing for. It’s oversimplifying or leaving out details because a doctor thinks it is “best for the patient.” I even saw this in myself on the night of the show. After the play, there was a “talk-back” session featuring the director, a clinical geneticist, and a Native American man, not from the Havasupai tribe. When asked about DNA, the Native American man stated that he was “skeptical” of DNA and that he did not place much trust in its usage. I nearly jumped out of my chair. How could one not “believe” in something with such tangible proof? In that instant, I was Gillian, the overzealous scientist with tunnel vision whose sole perspective is scientific. Though momentarily shocked, I was pleased with this experience for play aims to make individuals realize the importance of respecting differences in opinions and beliefs. It will be through the understanding of patients’ perspectives throughout our careers as physicians that we will gain insight into their lives and, hopefully, provide them with the best personalized care we can offer.

Featured photo courtesy of Moyan Brenn

Narrative Reflection

On Anatomy Lab

Photo courtesy of UC Davis School of Medicine

For a medical student, anatomy lab is a rite of passage.

Everything about it is a test: Can you withstand the sharp sting of formaldehyde at 8 AM? Can you differentiate between the vagus and the phrenic nerves? Can you delicately dissect the muscles of the forearm?

Can you make that first cut?

Human emotion fascinates me and my psyche just so happens to be a complex, peculiar, and interesting specimen to study. The psychological effects of working in the anatomy lab had a profound impact on me, even with scalpel in hand two months after my first day. Day one of lab went just as I had anticipated: I kept my cool until someone broke my composure by casually asking how I was doing. I fought back tears after the harmless inquiry until I could isolate myself and let it all out in a corner between a large window and a countertop covered in plastic model brains. I had been trying to make a positive first impression on my lab group by keeping a composed demeanor despite being in an environment worthy of vast displays of emotion. Clearly, this was no simple task. Although mixed with a bit of embarrassment, I immediately felt relief upon the crumbling of the emotional dam that I had worked so hard to build. I would have stayed in the corner longer to release all of the fear, sadness, and confusion had I not felt so guilty about leaving my group within the first five minutes of lab. I typically use distraction techniques to rid myself of negative thoughts but the impending return to the lab table invalidated those tricks. Instead, I accepted that I had nothing to be embarrassed about, that I could sort through my feelings on my bike ride home, and that it is okay to let my classmates see me cry. One deep, cleansing breath later, I rejoined my group and together we embarked on our seventeen-week journey.

After that episode, I dreaded returning to the chilled tank that housed the body of a woman who could have been my mother: same age, same surgical scars, same body type. In the seven-day interim, I pondered her life. I wondered about her family, where she had worked, what made her choose to donate her body. I wondered if she died in peace or in pain. I thought about the people in my life who had passed away. Each of their deaths was sudden, painful, unanticipated, and unjustified, and left me with an incredibly significant sadness. I wondered if my perspective on death was natural, if it was normal for me to feel such heartache in the presence of a deceased stranger. I eventually concluded that there is no perfect answer because there is no norm by which to judge my perspective. With that understanding, I made peace with my emotions.

My sadness subsided over the subsequent weeks as I found myself head-over-heels in amazement and respect for the human body. I felt like a pilgrim finally reaching a sought-after shrine, seeing for the first time with my own eyes the conglomerate of vessels, nerves, organs, and muscles that until then I had only ever read about. Despite the body’s collective complexity, the individual parts seemed unbelievably simple and incapable of carrying out the multitude of physiological functions required for life.

As we uncovered one pathologic finding after another in our hunt to determine our cadaver’s cause of death, I began to involuntarily formulate a mental scenario of this woman’s final years, months, and even the day she died. Soon enough, each physical finding that suggested a potential cause of her death was accompanied by an imagined reproduction of her life. One half of me was determined and anxious to uncover new pathology that might lead to a stronger differential and the other half wished it could painlessly declare natural causes. In the histology lab, I encountered yet another emotional challenge. One minute I was eagerly anticipating visible signs of liver metastasis and the next I was welling up behind the eyepiece of my microscope, imagining our young patient receiving the news that she had five months to live.

No two medical students have the same anatomy lab experience. For me, the past nine weeks have altered my view of death and further sensitized me to human suffering. Death no longer seems personal, but rather a fundamental biologic process. It is the suffering that often precedes death that has consumed me as an anatomy student. Death undoubtedly brings about a suffering all its own—which was my initial source of heartache at the beginning of lab season. Who did this woman leave behind? Are they still grieving over her passing? But as we uncovered her countless medical problems, I wondered what was harder for her family and friends: to live with her absence, or to live with her suffering?

When it comes to anatomy lab, many medical students would express that there is nothing to it — it is simply another requirement. For others, it is unashamedly so much more. It is said that the cadaver is the medical student’s first patient. I only wish I had the opportunity to thank mine.

Featured photo courtesy of UC Davis School of Medicine

Lifestyle Narrative Reflection

Time | The Balancing Act of Medical School

Post author By Stephanie Wang Zuo
Post date April 8, 2014
2 Comments on Time | The Balancing Act of Medical School

Not too long ago, I was rushing from one informational meeting to the next, trying to gather the scoop on medicine, medical school, and what exactly it meant to be a pre-med (I found it strange that these three rungs on the medical ladder were not necessarily complementary with each other… Did acing a nit-picky orgo exam really hold any bearing on my future abilities as a physician?). During my data-gathering in college, I soon saw a common theme emerging from all of the advice I accumulated.

Regarding the medical school experience: Medical school is tough.

Courtesy of Dalya Munves: http://thehealthscout.blogspot.com/

I was told that the material would be overwhelmingly vast, that I would spend most of my spare time with my nose in the books, memorizing, and that I should not even think about third year yet, because that was a whole ‘nother story. I was not deterred—I had found medicine (or rather, medicine had found me) and I could not imagine myself pursuing any other field. I was a little afraid because I knew I was not much of a memorizer. But, I would try my best. This all happened after my sophomore year of college, when I finally decided to “go pre-med.” (My path to choosing medicine will have to wait for a future blog post… stay tuned!).

I couldn’t imagine being busier than I already was. I was already heavily involved with three extracurricular activities, was starting to go into a lab to do research, and had a full course load. Yes, medical school was probably going to be busy—everyone said it would be—but somehow, I couldn’t wrap my mind around a life busier than what I was experiencing in undergrad. If I had been a more pro-active of a pre-med, I might have planned for the time-suck that I heard medical school was going to be. Maybe I would have started studying anatomy on my own, flipping through an atlas over the summer and starting to put down to memory muscles and nerves. Maybe I would have freshened up on my biochemistry or genetics.

Either way, I don’t think it would have prepared me at all for the balancing act that attending medical school has been. (In any case, I’m glad I didn’t fritter away my summer with a Grant’s Dissector.) It’s true that I’ve never been expected to memorize so much material in such a short period of time ever before. And that my attending lecture, small groups, and mandatory clinic sessions have resulted in much more class time (and hence, less free time) than in undergrad. Yet, these challenges are singular, and I have come to accept them as essential parts of the path I have chosen to take. The real challenge arches over other aspects of my life. It is the challenge of prioritization.

Most, if not all, doctors would agree that in order to keep sane, they’ve had to prioritize activities other than studying during their medical career. Often, it’s working out, cooking, sleeping, watching TV, or spending time with friends and family. It’s ultimately all about balance.

Being a medical student is like this: a teetering balancing act that may lean or sway more towards one activity or another on a day-to-day basis, but ultimately, in the big scope of things, stays firmly upright. This dynamic, rocking state of being is what balance truly is. I’m still awful at memorizing, and binder-loads of lecture material still catch me off guard. Yet, the biggest challenge of medical school has been learning how to best use the limited time I have in the most fulfilling way for me. It’s about learning to promote balance in my life.

In C. Dale Young’s poem, “Gross Anatomy: The First Day,” he begins the poem with an anatomy dissection instructor telling his students to:

“Begin with bone and muscle to discern exactly what you need to memorize. Each region has so many things to learn.”

He ends the poem with a snapshot of a sentiment too often felt by medical students:

“…You have many things to learn:
procedures, facts, new words at every turn.”
His introductory words elicit sighs.
Begin with bone and muscle to discern?
There is no time—too many things to learn.”

If I were to give advice to my naïve, pre-med self, I would sit her down and look her in the eye. I would tell her with confidence that she will be able to handle the course load of medical school just fine, that she will one day wield a stethoscope and call herself student-doctor without a second thought. But I would add, after motioning her to listen carefully, that she should make sure to pay particular attention to what is important to her. I would urge her to not let those things wither and to make finding balance a priority during medical school. Then I would share some sage advice I have gotten from fourth years past, “The extra hour you spend studying may not help you become that much of a better doctor in the long-run, but the extra hour you spend with your friends/your significant other/your family/your hobbies can make all the difference for your current and future happiness. Either way, you are going to get that MD. How you get there is yours to choose.”

General

Guinea’s Ebola Virus Outbreak | Connecting the Classroom to Current Events

Post author By Arvind Krishnan
Post date April 7, 2014
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Road in Kamsar, Guinea, Africa. Photo courtesy of Jeff Attaway.

Guinea, Africa. Photo courtesy of cjlvp user.

Ebola Virus Outbreak in Guinea

Medical students spend hours upon hours in the classroom learning about the transmission, diagnosis, treatment, and prevention of infectious diseases on a daily basis. While it is important to learn as much as possible from professors and textbooks in order to be successful doctors, it is equally imperative for medical students to stay informed about current events, especially those that are medically related. Of note, there is currently a dangerous outbreak of Ebola virus in the country of Guinea in West Africa that has led to over 100 infections and already 83 deaths in the past month alone. In fact, there have been multiple reports of the virus spreading to the densely populated capital city of Conakry, which is troubling due to the fact that it has historically only been seen in rural parts of the world. In light of this deadly disease, here are a few points of information about Ebola virus that are important to know:

What is Ebola?
Ebola is a virus that belongs to the Filoviridae family of enveloped and single-stranded, negative-sense RNA viruses. Since 1976 when Ebola was first reported in the country formerly known as Zaire, there have been 5 documented species of Ebola virus known to cause infection. Each one is classified by the country or region in which they were found to have caused an outbreak of disease, which include Sudan, Uganda, Cote d’Ivoire, and even Virginia, where lab primates imported from the Philippines were found to have been infected.

What are the signs and symptoms of Ebola Virus Disease?
Upon entry into a human host, the virus causes damage to the blood vessels of the body leading to an array of different symptoms. The incubation period usually lasts between 2-21 days. Initially, the clinical presentation involves intense weakness, fever, muscle pain, and other influenza-like symptoms. As the virus damages the circulatory system and elicits inflammatory responses by the human immune system, more severe issues such as hypovolemic shock and hemorrhagic fever develop. Of note, this viral disease has a 90% fatality rate.

Transmission electron micrograph causative RNA filovirus of Ebola. Photo courtesy of CDC:Cynthia Goldsmith.

How is it spread?

Although there is still controversy over the natural reservoir of Ebola virus, it has been well documented that fruit bats (Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata) are the most likely candidates. In many rural parts of Central and Western Africa, fruit bats are considered a delicacy leading to the initial infection in humans. In addition, the handling of other exotic animals such as non-human primates and rodents that have been infected, has been reported to further spread of the disease. Once a human is infected, the virus can be transmitted from person to person through direct contact of blood, mucous membranes, or bodily fluids.

How is it treated/prevented?
There is currently no vaccine or antiviral agent to prevent or treat Ebola virus disease. If an outbreak is suspected, quarantining is vital to limiting the spread of infection. In addition, raising awareness of the potential threat of infection to those who are risk is also an important task, which includes educating people in rural areas to avoid consumption and handling of exotic animal meat.

Is there ongoing research to come up with a vaccine?
Many pharmaceutical companies and academic laboratories are currently working on creating both effective vaccines and treatments against Ebola virus. In fact, an article recently published in the International Business Times reports that a Canadian pharmaceutical company called Tekmira Pharmaceuticals Corp³. has begun clinical trials for a drug called TKM-EBOLA to treat Ebola viral infections. According to the article, “in January the company dosed the first human subject in a clinical trial” and in March received a “fast-track designation” from the Food and Drug Administration to expedite the trial process.

Sources
1) http://www.nytimes.com/2014/04/02/world/africa/ebola-reaches-guinean-capital-stirring-fears.html?hpw&rref=health&_r=0
2) http://www.who.int/mediacentre/factsheets/fs103/en/
3) http://www.ibtimes.com/us-defense-department-spent-140m-ebola-treatment-research-theyre-getting-close-1566666

Clinical General Innovation Opinion Public Health

A Quick Guide to HPV Vaccination

Post author By Sami Saikaly
Post date April 4, 2014
No Comments on A Quick Guide to HPV Vaccination

Photo courtesy of Agência de Notícias do Acre (https://accounts-flickr.yahoo.com/photos/fotosdoacre/13065655185/?rb=1)

ThinPrep of CIN 1/HPV Photo from Ed Uthman — ThinPrep of CIN 1/HPV
Photo from Ed Uthman

Human papillomaviruses (HPV) are non-enveloped, double-stranded DNA viruses which infect human mucosal and epithelial tissues. They survive well in the environment and can be spread through direct contact with a wart, a fomite (ex. doorknob or toilet seat), or when an infant passes through the birth canal. HPV is now the most common sexually transmitted infection in the US¹. Even though most infections resolve spontaneously without further progression, it can lead to the formation of skin warts and has been associated with cervical cancer since the 1990s. HPV-6 and HPV-11, two types of HPV, are known to cause genital warts and low-grade cervical abnormalities, while HPV-16 and HPV-18 cause about 70% of cervical cancers. Despite the prevalence and potential severity of this viral infection, there is no specific treatment for HPV. Medical intervention involves treating clinical manifestations of the infection, including removal of warts or cervical neoplasias.

The spread of HPV can be reduced, but not prevented, through the use of condoms and other methods of physical barrier protection. In addition, two new inactivated subunit HPV vaccines, Gardasil and Cervarix, were recently approved by the FDA. The vaccines have no therapeutic effect on those who are already infected and the duration of vaccine protection is unknown, but studies are underway to determine if immunity wanes as time goes by. Both vaccines use the L1 capsid protein, which is produced through recombinant technology. This capsid protein then self-assembles into noninfectious virus-like particles (VLP), which function to elicit a memory immune response.

In 2006, Gardasil, a quadrivalent vaccine (HPV4), was approved by the FDA for both males and females of ages 9 to 26. Gardasil is composed of HPV6, HPV11, HPV 16, and HPV 18 and is administered in a 3 dose course. If a patient has not had all 3 vaccine doses by the age of 26, the remaining rounds can still be administered. HPV4 vaccination is also recommended for all immunocompromised males and men who have sex with men under the age of 26. In 2009, Cervarix, a bivalent vaccine (HPV2) containing HPV 16 and HPV 18, was approved by the FDA. HPV2 is approved for females ages 10 to 25, but is not approved for use in males. Neither HPV4 nor HPV2 contain any preservatives or antibiotics, and more than 99% of those who are vaccinated produce an antibody response to the viral types present in the vaccines. Prior infection with one of the virus types does not diminish the protection against the other types of HPV present in the vaccine.

The vaccines should not be administered to those who are allergic to any vaccine components, are acutely ill, or pregnant women. If a woman becomes pregnant prior to completing the 3-dose vaccination, the remaining doses should be postponed until the completion of the pregnancy. Side effects of HPV vaccination include pain or swelling at the site of vaccination and fever. Overall, no serious adverse reactions have been documented.

Dr. John Kreider's son and grandson with a historical marker recognizing Dr. Kreider and Dr. Mary K. Howett's work which lead to the development of the HPV vaccination. Photo courtesy of PennStateNews. — Dr. John Kreider’s son and grandson with a historical marker recognizing Dr. Kreider and Dr. Mary K. Howett’s work which lead to the development of the HPV vaccination. Photo courtesy of PennStateNews.

Despite the fact that HPV-16 and HPV-18 are highly associated with cervical cancer, controversy has surrounded the HPV vaccines. In general, parents are understandably reluctant to vaccinate their children against a sexually transmitted infection at such a young age, perhaps because the duration of the protection resulting from vaccination is still unknown. Dr. Diane Harper of the University of Missouri-Kansas City School of Medicine does not believe the vaccine should be mandated by law since only 5% of women infected with HPV develop cervical cancer². While that seems valid logically, the basic principle of vaccination is to prepare the body’s immune defenses for eliminating virulent agents before they can lead to harmful medical conditions. As an example, consider poliovirus. Poliovirus affects each individual differently, with up to 95% of the total cases being inapparent or asymptomatic³. Only a small percentage of those who are infected with poliovirus get paralytic polio, the condition which was seen in the public eye so often. Even though infection with poliovirus rarely leads to paralytic polio, parents do not usually hesitate to vaccinate their children in order to prevent this outcome. So, both vaccines prevent a serious outcome which rarely occurs as a byproduct of viral infection, yet polio vaccination has general support around the globe. Despite the fact that the HPV infection doesn’t always result in cervical cancer, parents should not overlook this vaccine, as it drastically reduces the risks of this serious complication even further.

Sources:
1) http://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html
2) http://www.npr.org/2011/09/19/140543977/hpv-vaccine-the-science-behind-the-controversy
3) http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html

General Lifestyle Narrative Reflection

Stop, Look, Go | An Approach to the Medical Student Lifestyle

Post author By Czestochowa Francois
Post date April 2, 2014
No Comments on Stop, Look, Go | An Approach to the Medical Student Lifestyle

From David Steindl-Rast’s TED talk, “Want to be happy? Be grateful”

Medical school is not what I expected. I’m neither saving lives day in and day out, nor am I the most knowledgeable person in my class. I’m not performing medical miracles and I’m not revolutionizing medicine as I envisioned I would be (yes, with just my twenty odd years of “life experience”). Instead, I feel as though I am trying to drink from a full powered water hose that won’t shut off. I am continuously faced with my own idiocy, ineptitude, and more importantly, fear. I see these super-human, overly capable figures who bear the name of doctor and wonder if I’ll ever be able to stand beside them. And then I stop, look and go.

“Stop, Look and Go” is a theory discussed by a monk who goes by the name of David Steindl Rast. He believes that the key to happiness is to be grateful for every moment that one has in life. However, he stipulates that this can only come about once one realizes that in every moment there lie an infinite number of opportunities at ones disposal. Now, keep in mind that this is, of course, easier said than done. I am far more comfortable wallowing in my self-loathing guilt-infested thoughts about all the opportunities I’ve missed, than focusing on the promise of the moment at hand. Rast’s ideas challenge human beings to do more−all by employing a simple rule we learned to follow as children before crossing roads.

So, what do I gain from the application of said rule? Here is an example of my utilization of this theory, albeit on a rather small scale:

When I Stop, I allow myself to be in the here and now. I am not thinking about the amount of material I have to learn over the next few days, or what I neglected to go over the night before. I am simply absorbing what is provided to me in this moment in time.

Then I Look. Of course, this requires so much more than simply looking. It requires the utilization of every sense to, as Rast puts it, take in the enormous amount of richness provided to us. Looking is the process of making associations and enjoying the present. It requires full awareness. For example, I happen to encounter a patient with inguinal hernias in a clinical setting, after just learning about the condition in the classroom setting. This is a highly enriching experience−an invaluable experience.

Finally, I Go. Now that I have grounded myself in the present and made associations about the overlap of opportunities of that present, I move to motivate myself to do something with this newfound peace and knowledge. This ranges from sharing my thoughts with a colleague who might appreciate them; to renewing my interest in a subject matter I am studying thereby incentivizing myself to continue studying when weary.

For some, all of the above may very well prove to be an exercise in futility and I certainly do not know if everyone will take from this theory what I have−wise monk or not. What I will say is that this has very much widened my perspective on the power of purposeful action and, in my opinion, enhanced my ability to learn and absorb the waterfall that is medical knowledge. To me, medical school is a lot of things. Some days it’s a nightmare, other day the bees knees. Some days it’s taking over my life, other days it is my life. It is difficult but awe-inspiring; fun but tiring. If it were a drug, I’d be an addict and if it were a person we’d be in a torrid love affair. Overall, medical school and being part of the medical profession is surely an invaluable opportunity and I strive to remind myself of my fortunate position as often as necessary, fueling my daily work and propelling me into the future. Thank you brother Rast.