Wow, it’s over.  I’m sitting at home and it’s over.  I’ve had some of the best and most rewarding experiences this summer.  Some people would call this internship a shadowing experience because I was “shadowing Dr. Nero and Dr. W,”  but to me it was more than that.  I learned what I wanted to be in a decade and a half and I learned SO many things, both medical and non-medical. 

I cannot express how much I thoroughly enjoyed this internship.  From the daily patient office visits, to going to the cath lab, to working on training 5,141 people in CPR (WOOT WOOT), to seeing PAMI patients in the hospital.  EVERY single moment of this internship from June 4th to August 25th, 2012 was absolutely unbelievable.  Despite wanting to be in NY this summer, I can now say that I wouldn’t have found anything this rewarding anywhere else.  

Did I work a lot? Of course.  Did I dislike the commute? You can sure bet I did.  But from the moment, I started my day at work was another happy day - sometimes, I would have to (persistently) tell myself that my day was over.  This internship was different from other internships with doctors and physicians because the people I worked with cared about their interns and worked *that* much harder to make their interns’ experiences more satisfactory.

It was accomplished.

Being a doctor requires more than just being knowledgeable.  It also means being a PERSON.  You’re not just the person with the MD degree, you’re a friend - someone to talk to, you’re the sympathetic one when you need to deliver the bad news.

Today, a patient learned that open heart surgery was was in the immediate future.  That’s like hearing you have cancer - NOT GOOD (obviously).  A good doctor does more than just deliver the news.  He/She discusses possible alternatives, if there are any, as well as next possible steps.

Having open heart surgery = bypass surgery.  That means having your chest cracked open.  Major surgery? Yeah.  But with a good team of medical professionals, a patient can have all the emotional support to make it through a harrowing, daunting, and oftentimes overwhelming future experience.

Medicine is not a path for the lazy.  Nor is it for undecided.  Nor is it for the queasy.   Nor is it for the weak-minded.  Nor is it for….I think you get the point I’m getting at.  Being a doctor requires a lot of hard work, intelligence, ambition, and desire.  Being a successful doctor requires a LOT of all three of these qualities.  As much as these qualities are important to be a successful doctor, it’s just as important to be happy and satisfied with your job, career, and life choices.  You can be the next TV doctor and be completely unhappy.  And happiness has different definitions for different people - happiness could simply consist of working (I sincerely hope not), being married with kids, being a stay-at home parent, juggling a successful career with a family…you get my point.

During one of the (few) quiet moments of my internship, Dr. Nero and I briefly discussed the intricacies of being a female doctor.  Obviously, I can’t say from personal experience, but it seems to me that every female wants a family at some point in their life.  The success of it all: the career, husband, kids, EVERYTHING.  J. Howard Miller’s “We Can Do It!” poster immediately comes to mind.  Here’s the thing with that poster and medicine:  How in the world does a female manage and balance a stressful career and a family?  It’s not like business or banking or finance where the bare minimum academic requirements are simply a BA/BS degree from an accredited 4 year institution.  Having a medical career is MUCH more complex: a BA/BS degree WITH the required pre-medical courses and a MD degree from 4 years in medical school is only the foundation for your career.  Getting that “white coat” and successfully completing medical school is fantastic - but the hard work is ONLY just begun.  Now it’s the time to really put in the work and (hopefully) it’s your time to start shining.

Example: I’m going to use Dr. Nero as my example of the extensive training.  As mentioned earlier, Dr. Nero is an interventional cardiologist (IC), meaning that he not only has his own patients, but he also does procedures in the “cath lab” (short for catherization lab).  Procedures like: “caths,” stents, angioplasties, pericardiocentesis/pericardial taps, etc.   Now, that kind of specialty requires the basic college and medical degrees…and then what?  3 years of internal medicine residency  followed by a cardiology fellowship.  For an IC, after those initial three years, next comes a 3 year cardiology fellowship, AND then followed by an additional 2 year IC fellowship.

Assuming, you don’t take ANY time off from school, that’s 16 years straight of training from college to your last fellowship.  Meaning you would be 34 years old when you finished all of the training.  16 LONG years of training.

34 years old is fine to really start a career…for a male.  By the time most females hit 34 years old, they’ve already established a successful career, got married and/or have at least 1 child.  A truly dedicated IC at 34 years old may be married, but are almost definitely no kids.

So back to my original question: “How in the world does a female manage and balance a stressful career and a family?”  I won’t know that answer to that question because I’m simply a college senior (go Lions!), but from this internship, I can certainly tell you this morning: it is NOT easy.  At All.  Being a successful female physician, internist, hospitalist, surgeon, etc. requires an intricate balance of time.  And that may very well mean putting off the family aspect for several years - other female friends may have surpassed you, but you know that this career that you’re striving towards makes you happy.

I’ve known for a very long time that I want to have that coveted “MD” after my name.  It’s happening - I know it in my bones (as cocky as that seems).  But with my decision to take time off and get my MPH, I am VERY well aware of the fact that I’ll be done with all my fellowships at 35/36 years old.  And let’s be real: society seriously condones young mothers.  And with science primarily supporting society (women who have children after 35 are more likely to have miscarriages, offspring with Down’s syndrome or other chromosomal abnormalities), the odds seem stacked against me.  But, let me be completely honest:  I’ve tried to imagine my life with a career other than medicine and the image is never..um…pleasant (and neither is my facial expression). 

Thanks to this internship, I am 99.9999% sure that I want to be an interventional cardiologist.  With every ounce of my being.  There wasn’t a SINGLE moment that I thought: “Eh, maybe this is not what I want to do.” Never.  This internship also made me realize that it is possible to be a female, have a successful career and have that white coat.  Remembering to keep my eyes on that prize is the key - and remembering why I wanted that prize in the first place - is crucial to that happy and successful career and family. 

I’ve worked for cardiologists Dr. Nero & Wagner for almost 2 months and I haven’t taken the time to define what a heart attack is.  Here goes:

A heart attack is medically called a myocardial infarction (MI).  An MI happens when there’s a lack of blood flow to a particular part of your heart because of a blockage - that lack of blood flow causes damage to that heart muscle or necrosis to that part of the heart muscle (myocardium).

What causes a heart attack?  ANSWER: plaque build up.  

Everyone has veins and arteries.  Duh.  Arteries take blood AWAY from the heart to the rest of the body and veins RETURN blood from the body back to the heart (remember A&A:  arteries away from the heart!).  Your arteries have three layers: the outermost tunica externa/tunica adventitia, the tunica media (or just media), and the innermost tunica intima (or just intima) as well as an internal hollow cavity called the lumen.  Blood flows from the heart throughout the rest of the body through the lumen.  The intima is directed related with blood flow: blood flow = happy heart = happy body!

Plaque will build up just outside the innermost layer of the arterial wall, i.e. the media.  When sufficient plaque builds up in this layer, it begins to put additional pressure on the intima and the lumen.  Hence, high blood pressure.  

Plaque can (and will) continue to build up and this is where a few things can happen:

1.  The innermost layer of the artery (the intima) will break because of the pressure, but fibrosis will quickly occur.  Fibrosis = formation of connective tissue as a repair process.  When the intima layer breaks, all that plaque that has been previously building up will start to fill that lumen space.  BUT, the body has an incredible reparative process, which is where fibrosis comes into play.  At this point, you MAY not have any symptoms and you have a 20-50% narrowing (or stenosis) in one of your coronary arteries (arteries that provide blood for the myocardium).

2.  The intima will break because of the pressure and fibrosis will take a while to occur.  Same as #1, but for some unknown physiological reason, your body may not recognize the torn intima as quickly as it should, so you may have a 50-95% stenosis.  Again, you MAY not have symptoms at all - terrifying, I know.

3.  The intima will break because of the pressure and fibrosis will not occur.  AS I’m sure you can deduce by this point, the intima will fill up with plaque. That area of the torn artery will not fibrosis  —> causing a blockage in blood flow to a section of heart muscle —> causing that heart attack —> potentially causing Sudden Cardiac Death (SCD).

I said earlier that there are several different combinations of the three options.  Once you have plaque build-up, you could go just to #1, OR you could go #1 and then #2, OR you could go straight to #2, OR you could go straight to #3, etc.  Going straight to #3 = silent MI, silent meaning that you had no symptoms prior to the heart attack.

What if you DO have symptoms?  The most important symptom you’ll have is:

1.  Chest pain/ discomfort/ tightness/ fullness/ “squeezing”: people will describe their pain/discomfort differently, but there are general “red flag” phrases, most commonly: “I feel like there’s an elephant/big track/ [insert heavy object here] sitting on my chest.”  This symptom will last at least 10 minutes and can either refuse to go away OR the symptom can go away and return back at the same or higher intensity.

2.  Jaw pain

3.  Back and/or neck pain

4.  Arm pain

5.  Fatigue

6.  Nausea and/or dizziness and/or lightheadedness and/or “indigestion”:  some heart attack victims will describe a feeling of “indigestion” in their chest.

7.  Shortness of breath

8.  Fainting

9.  Moderate to heavy perspiration/sweating

Oftentimes, women, diabetes, or elderly people will describe little to no chest pain - instead, it might just simply be a discomfort.  There are some people who won’t have any chest pain, but will have some of the other symptoms mentioned above (#2-9).  Or, some people will have the silent MI - no symptoms at all.

Heart attacks are treatable medical conditions.  You may have a stent put into one of your coronary arteries (a stent is a small, hollow, metallic tube that is placed in the blocked artery to reestablish blood flow) to get blood flow back to the affected part of the heart muscle.  And, you’ll have to be on certain medications either lifelong or for a certain length of time.

WHICH is why there are certain things you SHOULD do to prevent a heart attack: a good diet, regular exercise, and smoking cessation.  Things that can put you at higher risk for a heart attack are: age, genetics/family history, smoking, lack of exercise, overweight/obesity, poor diet, high cholesterol, diabetes, hypertension (high blood pressure).  Those risk factors were listed in no particular order, but it’s really important for you to be able to control the changeable factors - everything but age and genetics.  As you get older, your risk for a heart attack increases (if you’re over 65, your chances are about 5-10% ever year); having a family history of heart problems/attacks, hypertension, high cholesterol and/or diabetes is obviously something you can’t control, but you can decrease your chances of getting any of the above.

Here’s a simplified version of the ins and outs of a heart attack - hope it makes sense!

It’s been about a month and half since I started this internship (!) and I can really say that I’ve learned A TON.  I knew basics, but I have a much clearer idea about how important the heart is to the body and how our lifestyle can really affect our life span.

So, everyone tells you to exercise close to every day, right? But the question is why?  Exercise has a ton of benefits - you keep your metabolism up, it helps you lose weight, help you keep a toned body, boost your energy, etc.  From a heart stand point? - OH MY GOD, AMAZING.

Exercise is SO heart-healthy for you.  Exercise prevents high cholesterol, hypertension (high blood pressure), heart disease, the list goes on and on.  By exercising on a regular basis and for an extended amount of time, you increase your heart muscle and heart function.  Increasing heart muscle and heart function decreases or prevents the likelihood of getting the illnesses that I mentioned above.  

OK, but in simple terms this is what exercise means - exercising allows your heart to become a stronger organ and allows your heart to pump blood throughout your body more efficiently.  Your body contains about 5 liters of blood in your body that’s constantly pumping throughout your body - your heart needs to be as healthy as possible to consistently and effectively pump this much blood throughout your body.  Doing “cardio” workouts keep your arteries nice and clean - no (or less) inflammation in the arterial wall due to plaque or cholesterol, keep your body cardiovascularly healthy.

Okay, so you need to exercise regularly - but how much and what kind of exercise?  Most studies and doctors will recommend an hour a day for exercise for about 6-7 days/week.  What kind of exercise? Essentially anything - dancing, running, walking, cycling, Zumba, ellipticals, rowing, kayaking, swimming, or any other sport I didn’t mention.  Clearly the list is almost endless - as long as it’s getting your heart rate up for a prolonged period of time.  That “prolonged period of time” is 45 min- 1 hour/day minimum.  Anything less than that isn’t helping your heart.  

Studies have shown that too much exercise can be detrimental on your heart.  This most recent study, http://www.ama-assn.org/amednews/2012/06/18/hlsa0618.htm, looked at distance running and showed that running more than 20 miles/week may be detrimental to your general health.  This king of extended distance running (>20 miles/wk) can cause myocarditis (inflammation of the heart muscle) as well as abnormal heart rhythms.  

And weight lifting? Generally good for you.  BUT try to avoid lifting weights that cause you to really grunt and strain yourself.  Weight lifting causes a temporary increase in your blood pressure - and if you already have high blood pressure, that’s really increasing your chances of having a stroke or a heart attack.  

Exercise is extremely important in anyone’s lifestyle - whether it’s to keep a fit body or to have a fit body.  It helps your body both inside and out - just remember to not to overdo it.

Smoking is ABSOLUTELY HORRENDOUS for you.  Point blank.  There are absolutely NO benefits to smoking. At. All.  Find one and it can very easily be disproved. 

Smoking affects every single part of your body in a negative way.  Heart, lungs, brain, stomach, pancreas, larynx, mouth, bladder, kidneys, the list goes on. I’m not even going to being to discuss the various ailments/illnesses that can arise to one and/or multiple organs from smoking.

From a heart standpoint, smoking does several different things, but I’ll focus on a couple crucial ones. 

1.  Smoking and plaque.  Smoking increases the amount of plaque that builds up in your arteries.  Especially those crucial arteries - your coronaries.  Fat and plaque build up in your arteries —> narrowing in your arteries —> artery (or arteries) continue to narrow to as you continue to clog them with tobacco  —> artery (or arteries) become completely blocked —> HEART ATTACK.

2. Smoking and cholesterol.  Plaque is partly made up of cholesterol and guess what smoking does? Increase your bad cholesterol (LDL) and fats (triglycerides) AND decreases your good cholesterol (HDL); both of these consequences increase your chances of having a heart attack.

3. Smoking and blood pressure.  Smoking increases your blood pressure because of the nicotine.  Nicotine, as a powerful stimulant, causes your blood vessels to constrict.  That constriction causes your blood to work harder to pump the same amount of blood through that constricted artery.   Results: heart attack or stroke.  Neither of which are desirable.

This is just a few photos that show the negative effects of smoking:

-1? Healthy.  4?  You’re very, very, very, very, very close to a heart attack.

-How a clogged artery is fixed.  Don’t get here.

As the weekend comes to a close, I thought I’d give a quick educational post about something that everyone has tried to do at some point in their lives: diets.  Over the past three weeks working as an intern for Comprehensive Cardiology, one of the recurring phrases that I hear is “diet and exercise.”  Diet and exercise is a crucial lifestyle choice (or change) to keep your heart happy & healthy and one of those crucial diets is a Low-Sodium Diet.

A long-term diet that is high in sodium can cause several negative effects including high blood pressure and swelling (edema) in the legs and ankles.  Having an excess amount of sodium in your diet can cause your body to retain water (hence the swelling) and can also cause high blood pressure.  If not fixed, a high sodium diet can decrease your kidney function, cause chronic high blood pressure (hypertension) and cardiovascular disease.  By decreasing the amount of sodium in your diet, you can decrease your risk or even prevent these side effects.  It’s currently predicted that about 60% of Americans will have high blood pressure by 2025 (http://www.webmd.com/food-recipes/features/salt-sodium).  Make an effort not to become part of that statistic and keep your heart healthy by avoiding some of these foods:

a) Chips, Pretzels, Cheese Puffs (general junk food): these foods are generally high in calories, high in fat, high in cholesterol, high in sodium.  Generally avoid.

b) Anything that is packaged or canned: the preservatives added to keep the foods lasting longer in the package or cans? Loaded with sodium — avoid them.  Alternatives would be making the packaged/canned item from scratch (i.e. soups) or finding a low-sodium kind (i.e. frozen dinners).

c) Fast Foods: see Point A.

d) Marinades, Flavorings, and Condiments: lathering your hot dog in ketchup? You just added at least 150 mg of sodium per tablespoon ON TOP of the 500-700 mg that’s in your hot dog.  Teriyaki sauce on your chicken = roughly 690 mg of sodium per tablespoon.  One of the biggest surprises is soy sauce can contain up to 1,024 mg of sodium per SINGLE tablespoon!  

e) Soups: this one I put as a separate category because it’s a common food item across many cultures and generations.  People have soup for a variety of reasons: it’s easy, it’s a remedy for when we feel sick, and it keeps us warm when it’s cold.  BUT, soups bought in the store are FULL of sodium.  As much as I love my Ramen Chicken Noodle Soup and its seasoning (it’s easy to make as a college student…), I was astounded to discover that it contains up to 1,660 mg of sodium! What can you (and I) do to reduce that whopping amount of sodium out of your diet? Don’t use the seasonings that is packaged with the soup - that’s the source of the high sodium. Alternatives - you can make your own chicken broth and you can add a mixture of spices and herbs and voila! You have your own homemade chicken noodle soup!

These are just a few of the foods that can be avoided to keep your heart healthy and happy.  After 3 weeks as an intern, I can tell you that I’ve made some significant dietary changes in terms of sodium and I’m a pretty health eater.  Once I began realizing that many of the negative dietary choices some patients make were very similar to mine,  I started changing my diet even though I don’t have any fluid retention or high blood pressure.  I want to keep my heart as healthy as possible so just maybe I’ll live to be 100 years old and preventative medicine is a crucial aspect of living a long and healthy life.

More posts to come in the future!

Hi Everyone!

As I near the 4th week mark of my internship, I wanted to write my first (albeit, delayed) reflection on my internship experience.  As stated in the description (and the title of the blog), I’m working at a cardiology practice this summer.  The office meets and surpasses anyone’s ideal office: comfortable, cozy, and welcoming.  Everyone knows everyone by name and genuinely care about you and your well-being.  The partner practice is effectively run by two extremely intelligent doctors who make sure not to treat the presenting condition, but rather every individual patient.  

Now what do I do as an intern? For one, there has been very little, if any, paperwork (so far, we’ll see).  Instead, I’m interacting with the patients that walk through the office and taking their EKGs, taking vital signs (breathing rate, pulse, blood pressure), and interviewing the patients.  By the time my portion is completed, I should be able to provide the cardiologist with a full report as to why the patient has an appointment (follow-up, 1st time patient), any symptoms the patient may have (shortness of breath, chest pain, angina, dizziness, hypertension), as well as any other relevant information that may and can pertain to any further tests.  I like to call it “playing doctor” for each patient.  The goal of this internship is to have a feel for what a medical intern (or resident) would do on a daily basis.  For a comparison, here’s a popular culture reference: it’s like playing Meredith Grey or Christina Yang during the first three seasons of Grey’s Anatomy.  When I’m not in the office interviewing patients, I’m at Stamford Hospital observing interventional cardiac procedures including stents, angioplasties, pericardiocenteses and cardiac catherizations.

Although I’ve had a couple of experiences in the medical field, this experience is very different from any other healthcare work or volunteer experience.  Although it’s only been 3 weeks, I can tell you that the theme of this internship is “hands-on.”  Yes, there’s a lot of observing, but this internship provides me the opportunity to really understand what a doctor does on a daily basis.  This internship also provides me with an opportunity to explore a different field of medicine.  Although I’ve switched my mind at least half a dozen times, this internship is one of the more hands-on experiences in a particular medical specialty.  Who knows — I may decide at the end of the summer to be a cardiologist.

More posts to come in the near future!