Vaccines and Blood Drawing

The last couple weeks have been very busy for me.  I spent them studying for exams, preparing a bioethics presentation on prenatal genetic testing, and reviewing for my finals in genetics and physiology.    A couple weeks ago I contacted the person who had access to soon to be expiring vaccines, but unfortunately it looks like I will not be able to accept the generous donation.  Without a nonprofit tax ID code or a serious method of transporting the vaccines, I was not eligible to except them.  I was also worried that even if they did make it out to Ukraine, I would not know who would be receiving them nor would I be certain there was an adequate refrigerator to keep them viable - what with the frequent blackouts, I suppose we would even need a generator.  After I get this project off the ground I will definitely reach out to her again though!  

Since finals, I have made my way to California and have been spending time with my family and working in my parent's clinic.  I basically started drawing blood within ten minutes of walking into the clinic after coming straight from the airport!  Although I once thought of myself as a blood drawing prodigy, my delusions of grandeur were quickly shattered along with my perfect patient drawing track record.  Drawing on schizophrenics might seem challenging, but wait until you have to draw primary care patients - old, young, overweight, dehydrated...  You basically have to go in blind and start fishing - two techniques that I am not comfortable doing!  The medical assistants have been teaching me how to find difficult veins when you just can't see or feel them.  

My parents run a high volume clinic with a wide variety of patients for me to gain experience working with - that is why I am here!  I am proud to say that I have already drawn more patients in just two days than I have in my short career as a phlebotomist in Texas.   I am excited to continue to be challenged this week at the clinic.  I will continue to update y'all on my progress.    

Foreign Transaction Fees

Those fees will really get you.  Usually credit cards charge 3% per charge when traveling internationally.  I remember when I was gearing up for my trip along the Trans-Siberian Railway 2 years ago, I really wanted a credit card that did not have foreign transaction fees.  I have always prided myself for having excellent credit, so I figured I would be instantly approved for this Capital One Venture card I had been eyeing for months.  As soon as I applied for the credit card, I sat back and thought to myself how sweet it will be to not have to worry about those pesky fees while I spend 3 months traveling.  I was picturing myself potentially being robbed somewhere in Siberia, and imagining my future self simply smiling and saying to my future bandit, "Jokes on you! I only carry credit!  That card will be inactivated before you even have a chance to swipe it!"  Who carries cash these days anyways.  I was suddenly snapped out of my dream world when I noticed the website had finished loading - Credit card denied.  What happened?  Oh, right, LASIK doesn't come cheap and I had taken out a line of no interest credit to pay it off incrementally... Needless to say, I did not have a fancy no foreign transaction fee credit card for that trip.

Well, 2012 is a new year!  My LASIK is long since paid off, so I figured I would once again attempt to obtain the elusive Capital One Venture credit card.  I am proud to say that I was approved and am ready to start traveling, fee free!  Now, I just need to contact my old travel buddy and find out how to go about getting a checking account for his bank that did not charge ATM fees.     

Smoking Ban - finally!

While perusing the WHO website today, I found these awesome articles.

Ukrainian Health Legislation:
I just found out that in June 2012, Ukraine passed a smoking ban that made it illegal to smoke in restaurants, bars, clubs, cafes, etc.  There has also been a ban on smoking advertisements!  Let's hope this is one step closer to a smoke free world.   

Interesting facts:

• 163,000 Americans die each year from lung cancer.  
• In the US, the tobacco epidemic is responsible for 30% of all cancer deaths, meaning that lung cancer accounts for more deaths than the next four (!) leading cancers combined.
• California has been able to decrease the prevalence of smoking from 24% to 12% via aggressive anti-smoking campaigns. 

Not only will these new legislations make education about about dangers of smoking somewhat easier in a country where smoking is as common as drinking coffee, but now I no longer have to worry about getting burnt by flailing cigarettes while dancing at night clubs!  Win-win.


*Interesting facts courtesy of http://www.insidecancer.org/

Donations and Good News!

Well, so far things are coming along much better than I had anticipated.  I have a few contacts lined up that I need to call this week.  Some have experience with medical nonprofits, clinical outreach, grant writing, and one even worked at the Ukrainian consulate.  A relative of my finance also put me in touch with another contact who may have some flu vaccines that she would like to donate.  It is a good thing I have an International Air Transportation Association (IATA) certification to handle, process and ship bio-hazardous materials!  Shipping vaccines to Ukraine definitely require more research...  maybe this friend from the Ukrainian consulate will have insight into the legality of the task at hand.  When I have some spare time, I intend to read the WHO online booklet on shipping vaccines found here.

Speaking of vaccines, I should reacquaint myself with all the different vaccines offered through Vaccines for Children (VFC).  I bet the VFC regional representative that works with my dad's clinic may be able to help me figure out how to safely ship them so they stay within their temperature range.  I can't believe it has been 5 years since I worked for VFC and the Public Health Department in Richmond, CA!  Oh, how time flies.

First monetary donation:
I am excited to say that my parents are generously donating some money to my cause!  I plan to start fundraising after I get back this summer and/or have nonprofit status, but having some funds to start with is definitely helpful.  My dad is considering flying to Ukraine to spend a week with me too!  I am looking forward to having a doctor present, especially since that MD will be my dad.  We are going to figure it all out when I fly to California in a couple weeks.  My parents always have been my heroes and faithful supporters - big shout out to Mama and Papa for their generosity!

Recent thoughts:
I should read as much about the health situation in Ukraine as possible - new legislations, recent outbreaks, statistics, etc.  More research on the WHO website is in order.

Well, maybe after my Physiology and Genetics finals... one step at a time.
   

Suturing and Infectious Diseases

Last night I played softball with the rest of my team, the Endorphinatics.  I was talking to the Physician Assistant in between innings about his time volunteering in Costa Rica.  His advice was to learn to suture, and know my infectious diseases and the antibiotics that treat them.  

Great advice.  My dad is going to teach me how to suture in a couple weeks when I am back in California working at his clinic.  After working at a psychiatric research clinic, I realize things can get ugly if you live in a group home or partially on the streets.  On occasion, we have patients who need stitches removed or who have cuts that need attention.  Might as well knock one skill that I will be learning in PA school down!

The second piece of advice will be a little more difficult to follow through with.  First of all, even if I knew exactly which infection or disease merited which antibiotic, who's to say that drug will even be available?  Thinking about how I would bring extensive amounts of medications into Ukraine reminded me of this smuggling story from My Trans-Siberian Journey - As I was going to St. Ives.  Something tells me that flashing a big American smile and being waved right past customs won't work this time.

My arsenal of medical skills:

• Vital signs (blood pressure, heart rate, temperature) 
• Ear examination using an otoscope (compliments of my dad)
• Blood glucose test 
• Blood test (if a suitable lab is found)
• General health education

      
Does anyone else have any advice on medical skills I should start working on?  I am excited to get to work!

Я еду домой! : I am going home!

Well, not quite.  Actually I am home...right now.  Over the years I have come to call many places my home - Los Angeles, Berkeley, San Francisco, Austin, etc.  One of those many places is Odessa, Ukraine.

I am excited to announce that this summer I am returning home to Odessa to volunteer at the wonderful Ukrainian nonprofit known as The Way Home.  For those of you who read My Trans-Siberian Journey, I appreciate your loyalty in continuing to follow me, regardless of where I go and what I am doing!  You might remember stories about my time in Odessa in 2010.  Volunteering at The Way Home helped me realize how rewarding international volunteer work is.  I admit that I am no Mother Teresa, but I have always known I want to help people in some way, shape or form.  Yesterday, I took one step closer to making my dream of being a professional international volunteer a reality.

The Plan:
This summer, I am going back to The Way Home in Odessa, Ukraine to volunteer.  This time, when I show up and they ask me, "What do you want to do?" I won't stare back at them dumbfounded by the question.  I know what I want to do - I want to start a medical outreach program that serves the vulnerable populations found in Odessa.  I will be in Odessa for 4 weeks volunteering at a clinic that currently works with The Way Home.  While I am there, I will get a better idea how I can organize a volunteer based program that helps The Way Home treat the street kids, drug users and homeless who reside in Odessa.  

The Preparations:
In preparation for this trip, I am brushing up on my Russian language skills.  I have also picked up a Pocket Medical Russian book to help me learn vital phrases.  
I am looking into potential medical distributers that will donate supplies that I can take with me or have shipped.  I am learning more medical skills from my role model, my MD dad.  I will also be seeking help from people who have set up similar aid programs or have volunteered for an international medical program.  I need to look into the rules and regulations regarding shipping medical supplies, and regarding practicing medicine without a Ukrainian license in the event that my dad wants to come help me get this project started.

The Future:
If this summer goes the way I hope it will, I will start the paperwork to make this program a 501c3 nonprofit organization.  I will start writing grant proposals and look for a team that is passionate about my vision.  I will fundraise and start planning for the following summer - look for more suplies, volunteers and funding.  Hopefully I can use my future Physician Assistant (PA)  program to help me recruit enthusiastic PA students to go abroad and deliver medical care.  Lastly, I will come up with a good name for this organization!  

Links to previous blog - My Trans-Siberian Journey:
My Kids
Through your Eyes
Social Patrol

"It's just a flesh wound"

There are some perks to hanging around people who aren't studying exactly what you are studying.  In my case, whenever something goes medically wrong, or whenever something is bleeding, I get a call.  In my friend's case, when he split his finger open, he didn't have to go to the emergency room.

Last semester, I got a call at about 1PM on a Friday.  It went something like this:

Friend: "Hey, Erika... um... I cut my finger with a kitchen knife and I don't know if I should go to the ER."

Erika: "Oh no, how long has it been bleeding?"

Friend: "About half an hour..."

Erika: "I'll be right over."

I grabbed what was left of my EMT supplies and rushed over.  When I arrive, he explained that his room mate, also a law student, was too disturbed with the sight of blood to help him.  

Minor Finger Laceration

Upon examination, I realize that it was "just a flesh wound" and stitches would not be warranted.  I had learned at an early age when a cut or scrap was serious from my MD father.  I would often run to him crying when I had cut my toe running on asphalt.  He would look at it, give me a hug, and tell me it's just a flesh wound.  "Band-aids won't help," he'd explain, "We will just put some hydrogen peroxide and alcohol on it and it will heal up just fine."  I could see that the superficial skin layer, the epidermis, had been damaged, but the deeper layer of the dermis was not.  So, I told my friend it was just a flesh wound and gave him roughly the same treatment my dad would have given me.  I cleaned his injury with alcohol, hydrogen peroxide and some Neosporin.  Although, unlike my dad, I believe in the powers of band-aids, especially when flaps of skin are involved.  So, I tightly wrapped a band-aid around his finger to make sure the skin flap healed properly.  

This was early in my career as a personal on-call EMT, so unfortunately I didn't have the proper personal protective equipment (PPE) at the time.  I washed my hands thoroughly with soap and water both before and after treating the site.  Since then, I have increased my stock of medical supplies and am proud to say I now stash a box of gloves in my apartment.  Just in case my medical services are ever unexpectedly needed again!

Healed Finger

This is a picture taken months after the incident.  Glad to know he didn't have to waste his time at the emergency department over such a minor laceration. 

Osteogenesis Imperfecta

After an incredibly memorable summer in Dallas, TX and Newport Beach, CA, I am proud to say that I will inevitably be returning back to my roots and settling down in California.  Now that I know I will be exclusively applying to PA programs in Southern California, I will not have to take the much dreaded course, Organic Chemistry!  Hooray!  This semester I am taking Physiology (for science majors!) and Genetics.  My class load seems sparse, so I plan on filling the gaps by working at the psychiatric research clinic and volunteering.  

Let's start with some physiology.  On the first day of class, my teacher wrote, "Osteogenesis Imperfecta" on the board and asked us to tell her what we thought it meant.  I rose my hand and answered, "Imperfect creation of bone."  Translated literally, I was correct but I didn't really have any idea what causes the disorder or its specific symptoms.  My teacher went on to explain that Osteogenesis Imperfecta is also known as Brittle Bones Disease and that she, in fact, has this condition.  She shared this personal medical history with us because she stated it will at times affect her teaching.  I feel like I owe it to her to spend a few minutes researching this disorder and sharing it here. 

According to PubMed Health, Osteogenesis Imperfecta (OI) is a congenital disorder (present when you are born) that affects the gene that produces collagen, one of the fundamental tissues found in the body.  OI is Autosomal Dominant so if you managed to obtain the OI gene from a parent who is affected by the disorder, you will also inherit the condition.  There are a number of symptoms associated with OI, but all those affected by the disorder have brittle bones and are susceptible to fractures.  People with OI are often below average height, have early hearing loss, bowed legs and arms and scoliosis or an s-curvatures found in the spine.  One trait I found especially interesting is that the sclera, white of the eye, has a blueish tint.  

The prognosis depends on the type or severity of one's OI case.  Those with a mild case such as my teacher, will likely experience fragile bones, blue scleras, early hearing loss, and height impairment, but will ultimately live a normal lifespan.  Good news for my Physiology teacher!      

Cause of Death: Boyle's Law

My quest to apply to Physician  Assistant school this year was thwarted recently when I found out that my summer Physiology was not for science majors, thus rendering it entirely useless.  Unfortunately this means that I will no longer be eligible to apply to school this year.  Every cloud has a silver lining, however!  I have an entire year to put together the most outstanding Physician Assistant application known to those admissions committees!  What better way to prove my understanding of science than by getting certified as a SCUBA diver.  Let me explain why - SCUBA stands for Self Contained Underwater Breathing Apparatus and is an underwater diving sport that involves knowledge of Chemistry, Physics and even Physiology.  I believe that my knowledge of SCUBA along with my EMT training in underwater emergencies will enable me to be a better mid-level provider in the future. 

The number 1 Rule in SCUBA is "never hold your breath." 

I know the relationship between holding your breath and being submerged in water seem quite natural, but while SCUBA diving holding your breath might actually kill you.  You might remember a rule from Chemistry called Boyle's Law - The absolute pressure and volume of a given gas are inversely proportional.  Simply put, as pressure increases, volume decreases; as pressure decreases, volume increases.  

One of the organs most affected by Boyle's law is the lung.  The lungs are the sac-like respiratory organs found in your chest cavity that are made out of thin elastic tissue.  This elastic tissue is perfectly suited to withstand the expansion and deflation that takes place during inhalation and exhalation.  This concept is complicated by pressure, however.  

So, imagine you take a deep breath and begin your descent into the ocean depths - pressure increases, causing the air in your lungs to decrease.  No problem, right?  Well, yes.  The problem lies in the ascent.  Take that same deep breath underwater, but this time start your ascent to sea level.  As you start swimming to the surface, the pressure of the water around you will decrease, thus the volume of the air in your lungs will increase.  When the volume of your lungs increases past its normal capacity, one may suffer from pulmonary pressure damage.   This damage may result in an over expansion injury, but in the worst case scenarios, your lungs might even pop like a balloon!

So, if you ever find yourself SCUBA diving, be sure to remember Boyle's Law.  I bet you never thought that those Chemistry skills might just save your life someday!

Let Bygones be Bygones

Bygone - a thing dating from an earlier time

I bet you didn't know that phrase had a real meaning!  Well, now you know.  Today I took the GRE, and although I still can't get a grip on if I should be ecstatic about my score, I find that it really does not matter.  I am extremely proud of myself, and how well I did compared to what I was prepared to get, given my dismal history with standardized tests.  I guess the hiatus I took from life to study everyday for 8-10 hours a day paid off! 

Now, back to the good stuff - graphic picture I have accumulated during my path to PA school!

A few weeks back, after fulfilling my duties as DD and driving everyone back to my friend's house, we decided to hang out into the wee hours of the night.  It seems that after 4AM, all filters fly out the window and candidness takes its place.  Somehow, everyone's sordid medical history became the center of conversation.  Even though we had just been introduced less than an hour ago, one guy started telling us all about his cerecum impaction.  Of course, he had a picture of this excised ball of ear wax on his phone.  I insisted that he show me the picture, but at first he didn't take me seriously.  After a bit of coaxing, he relented and gave me permission to post it here on my blog.

Cerumen Impaction

Ceruminous glands are found in the external auditory canal (ear canal).  Their main function is to produce the wax (cerecum) that waterproofs this sensitive area and simultaneously kills bacteria and traps particles.  

A cerecum impaction can occur after an individual uses Q-tips or bobby pins to clean his or her ear.  This is because doing so inadvertently pushes wax too far into the ear canal.  The external auditory canal is rather remarkable at cleaning itself.  So unless you want to fish one of these suckers out of your ear during your next visit to the doctor, you might want to think twice the next time you decide to "clean" your ears! 

"Abscond - to leave secretly"

I didn't really abscond from Austin, but I feel like I have.  For the past few days, I have been hiding out like a misanthrope at my aunt's home in Dallas.  It's not that I don't like people, its just that my boyfriend, Nat, has been driving my car to work everyday, and living in Dallas without a car is like social suicide!  So, while Nat goes to work everyday, I have been spending the days alone in my aunt's lavish home.  My aunt's place is like a 4 star resort - ornate, full of delicious food, and has an amazing pool.  

Although it might sound like I am in paradise, I am far from being on vacation, lounging by the pool margarita in hand.  On the contrary, I have actually been painstakingly studying for the Graduate Records Examination (GRE).  Standardized tests and I have a poor history - the SAT attenuated my confidence years ago, and left me dreading the thought of even considering graduate school lest I have to take another test that has been suggested to be biased against both women and minorities (of which I am both).  In high school, I was impetuous and audacious - and obviously overconfident in my intelligence because I purposely chose not to prepare or study for the SAT.  I thank fate, the stars, God and the admissions department at UC Berkeley for ignoring my SAT score and pitying this young aspiring actor with a love of stage theatre, Shakespeare, and the ridiculous.  

I will not be as inchoate and lazy in my approach to the GRE as I was in studying for the SAT.  My only hope is that I can shake off my diffident mentality and regain my confidence that was lost years ago.  If I study hard, I know I can make it through another soporific exam (I am pretty sure I almost fell asleep during the Reading and Comprehension section of the SAT).  You may have guessed that the bold-faced words scattered throughout this post are from my GRE work books.  I apologize if they make me seem like a pedant, but I find that using new words in sentences is the best way to study!  

My GRE is scheduled for May 24th - a day that will go down in infamy or great triumph! 

This blog post was brought to you by the following words:

Abscond - to leave secretly

Misanthrope - a person who dislikes others

Lavish - to give unsparingly; extremely generous or extravagant

Attenuate - to reduce in force or degree; weaken

Impetuous - quick to act without thinking

Audacious - fearless and daring

Diffident - lacking self-confidence

Soporific - causing sleep or lethargy

Inchoate - not fully formed; disorganized

Pedant - someone who shows off learning

O time, thou must untangle this, not I...

“O time, thou must untangle this, not I...It is too hard a knot for me t’untie" 

(II.ii.38–39) Twelfth Night by William Shakespeare

I learned this quote in high school when my love affair with Billie Shakespeare began.  Although this quote has more to do with forlorn cross-dressing lovers than with anything I am currently experiencing, I still find comfort in its call for fate's intervention.  There are just too many questions lingering to really determine what will be happening with my academic future: will I apply this year, will I return to California or stay in Texas, will I have to take Organic Chemistry, will I need to spend more time working to accumulate clinical experience?  It all got too stressful to think about, so for now I am going to kick back and just let fate do some of the work.


Over the weekend, I paid a visit to my home state of California.  My main motivator was an open house held at Western University of Health Sciences.  I had been in contact with the university for some time now, and we eager to see the program and learn about all the school had to offer.  Their motto, "The disciple of learning, the art of caring," really embodies what I hope to get out of my experience as a future Physician Assistant.  I left the open house excited to write my personal statement and turn in my application!  


I also had the pleasure of attending an event held by The University of Southern California, where my father went to medical school.  Hearing the dean talk about the future of the Keck School of Medicine was awe-inspiring to say the least.  I would be honored to continue the family tradition and attend the Keck School of Medicine as a Physician Assistant, although, as an alumni from the University of California, at Berkeley I would be a Bear in wolf's clothing! 


With all that official business out of the way, I also got a chance to catch up with my best friends from high school, eat delicious Indian and Thai food that is just infinitely better than anything in Texas, and even go on hospital rounds with my dad!  Going into the family business is handy, especially when you want to gain real work experience.  Even though I felt like a little kid, stumbling in high heels, trying to keep up with my dad as he flew from room to room in the hospital and his clinic, I was able to get some great exposure to some interesting cases.


Our first visit was to a patient who had been suffering from pitting edema, a condition characterized by fluids exiting the capillaries and vessels which leads to swelling.  When we visited this patient, instead of seeing the swelling that persisted, the patient's legs were a dark purple/black color.  This was because the hematocrit in the blood had leaked out of the capillaries when the patient first started experiencing the edema.  When blood oxidizes, it turns a dark purple/black color.  My dad assured me that, although his patient's legs looked grave, he was in fact healing nicely.


While at the clinic, I got to palpate a rebounding and painful abdominal Right Upper Quadrant, indicative of an inflammation of the gallbladder; examine the smallest bone in the body, the stapes, while using an otoscope (instrument with a flashlight built into it that is used to look into ears, nose and throats); and even watch my dad remove a foreign body from an inverted eye lid!  All that in just one morning.  I can't wait until I can be at the clinic every day shadowing my dad and our PA.  For now, it's back to the books!  One more test in Anatomy and Biology.  Then, I get to take the dreaded standardized test for big kids, the GRE.

What's on your mind?

Since December 2011, I have been working at a psychiatric research clinic as a patient care technician.  It all started with a conversation I had last semester with my Biology lab partner.  His explanation of the facility and all characters he encounters got me thinking that maybe I could get some valuable experience by signing myself up.  My experiences at this clinic have really opened my eyes to the work of psychiatry!  

Today, I started my day by learning more about the Central Nervous System in Biology.  The brain is incredible and should be treated with the utmost deference.  It's ability to integrate sensory information in mili-seconds is just astonishing!  With a plethora of neurons and receptors, however, you better believe that something is bound to go wrong from time to time.  When this happens, cognitive dissonance often occurs and the doors of psychiatry are flung open.  After examining a sheep brain in lab, I made my way to the psych clinic.

This job has been great, not only because I am getting valuable work experience that will serve me well when it comes time to apply to graduate school, but also because I have been lucky enough to shadow the Physician Assistant (PA).  The last two days shadowing have corroborated my thoughts of possibly becoming a PA at a psychiatric facility someday.  I know it may be a depressing and often  hopeless field to work in, but the thought of helping someone fight the demons, angels, government spies or torpor that plague their mind fills me with zeal.  

The Blood Brain Barrier

For the purposes of this blog, my name is Erika Erikovna.  Two years ago, I documented my travels around the world via the The Trans-Siberian Railway.  I come to you now with a new, but definitely no less exciting, subject matter.  After spending time traveling and volunteering abroad I realized that I am destined for more in life - I want to help those stigmatized by our society, in every form they come.  My passion to help the world around me will be done by learning about a field that I have been immersed in my entire life - medicine.  


The title of this blog is inspired by a structure I learned about in Anatomy.  The blood brain barrier (BBB) is the vital gate keeper that protects the delicate neurons found in the Central Nervous System (CNS).  The tight junctions of the capillaries around the entire perimeter of the CNS make those capillaries the least permeable capillaries in the body.  All essential nutrients needed by the brain's neurons, including oxygen, simply flow in, while most toxins are prohibited entrance.  Although the BBB seems impregnable, it does allow some entrance of fat-soluble molecules, such as alcohol, nicotine, and anesthetic agents.  I feel like the BBB accurately represents how I feel about own current aspirations. 

My best friend recently told me, 

"You follow your dreams and it's intoxicating!"  

My dreams may seem impossible at times, but with enough hard work and dedication, I am convinced I can cross the blood brain barrier.  After all, my dreams are intoxicating, so I must have a pretty good shot, right?  

By reading this blog, you will learn the difference between "a flesh wound" and a serious gash, see graphic pictures of anatomical structures I dissect in class and track my pursuits in medicine.  I sincerely hope you enjoy my blog as much as you enjoyed the last!