MMC Mobile

Apparently, my podcasting days aren’t over… Who would have guessed a bioweapon would bring us back together? You could have guessed. If you understand the Medical Mastermind Community has always been about authentic leadership. From our research on disadvantaged students, to mentorship development programs culminating in the Bronze Outreach Award from my medical school. Thank you. Thank you for your support, and if you’re new to MMC – you owe a tremendous debt to the members that came before and built it up. Sadly, the membership software I’ve used for 14 years is no longer supported and it’s causing errors I can’t fix on the site. My project site is officially broken, after being available for free – with regular new sign-ups – for the past several years. Are you ready for something new? No matter your specialty, your patients are no doubt fearful and anxious. Their hypertension and fatigue are off the charts and not responding to non-adrenergic mechanisms. It’s not about burnout anymore Folks, it’s time for our young leaders in medicine to rise to the challenges our world is facing during these trying times. That is why I’m announcing the PTSD Academy Podcast on this channel – and some you have already answered. I’ve got at least one person from the good ‘ole days of the MMC to come back on for another interview, but on my new channel. At least, that’s all I can commit to right now. I am a little busy, as you know. Ever wonder what happened to the people we interviewed years ago? I’m extending invitations again for follow up, only this time it’s different. Join the cause and prevent physician and student job dissatisfaction, burnout, depression and PTSD. Tell your patients that can’t sleep to try out my free PTSD music therapy page. This is where I play live, improvisational guitar to help you fall asleep. Yes, I’m so sleepy on the guitar I’ll have you and your patients snoring. So, shall we bring back the MMC? Let me know your thoughts.

Episode 104: Dr. Dan answers a listener question about how to scramble up an effective study approach during the first semester of medical school. Getting Board Certified Hi, this is Dr. Dan here with both the Medical School Podcast. I am sorry, it has been awhile since I have issued a podcast. I finished residency and am now board certified in Psychiatry by the American Board of Psychiatry and Neurology. It’s a bit of an interesting podcast in that we’ve had over a million downloads total. I started off in Emergency Medicine and video and audio log an entire transition of burnout in that field. Having a bad malignant residency experience, transitioning over to Psychiatry and doing a lot of self searching, and did that somewhat publicly for at least a private audience of the medical school podcasts. MMC Mobile Listener Question Today I’m going to cover a listener question. I’m going to read his question and reply to it. Here we go. This was written to me by a student several months ago so he was in his first semester of medical school. He says that he’s listened to many of my podcasts in the past but doesn’t recall if or when this particular question has ever been covered. In fact, it hasn’t. Question He says, “When we had our first block of exams finished a few weeks ago, I scored in the 50s range for anatomy, physiology, and biochemistry. Histology was the only exam that I passed. As time progresses more closely to exams, I grow more and more anxious which becomes extremely distracting. I limit all other distractions such as phone, computer, and noises but I’m still left with my worst distraction, my mind. I begin to think about irrelevant things in my life and get too anxious as I try harder to concentrate on material.” This leads to depression, even trying medication to help him regain focus and care for things again to try to get motivated. However, he feels that his issues lie in his inability to keep pace with the curriculum because for him to learn something he has to really go slow to digest it. Which of course is not something that the standard curriculum permits. His father is a physician and suggests that he speak with Student Affairs to see if he can go into the five year program offered by his medical school, though he’s reluctant to spend any more time than necessary in medical school. He’s having a second biochemistry exam tomorrow which he doesn’t feel any more prepared for than the first one, but he will meet with Student Affairs afterwards. As far as his study techniques, he says, I use a timer and try to push myself to go faster. But I always slow down and never get everything done on my schedule. I’ve reviewed study habits exhaustively and attempt to be an active learner, but those habits take me too long and I fall behind. I suppose I am not all too sure what to ask you but I guess I could ask if there’s any active study method that doesn’t take a long time to do.” Answer That is the question, I’ll keep it anonymous, of course. I keep questions anonymous. I don’t say who is emailing me but this one sort of hit me between the eyes because, the truth is, that I taught a lot on study techniques. I have nine videos in the Medical Mastermind Community about study techniques. Even a speed reading course is in there. I even break down all the different classes you take in medical school and which study techniques for each one of those is the most likely to be beneficial. I have to admit, I’ve been doing the Mastermind Community and these podcasts for eight years now. I’ve always said that, based on my own experience, that it takes so long to learn different kinds of study techniques, that you don’t want that kind of distraction while you’re in medical school.

Episode 103: Brain trauma, intracranial tumors, birth defects and infections – all in the head.

Episode 102: This is a sample of the Master the USMLE audio program online at MMC.works NUTRITION I. Eating disorders – includes obesity, anorexia, bulimia Difference between anorexia and bulimia? A. Anorexia Distorted body image; women with anorexia can have distorted image; control issue; they have lost control of everything in their life, and the only thing that they can control over is what they put in their mouth. With a decrease of body fat and wt, GnRH decreases, therefore FSH and LH also decrease, leading to low estrogen; as a result, amenorrhea occurs, AND predisposes to osteoporosis, as if pt is postmenopausal.  Anorexic people will eventually develop osteoporosis. Rx – convince person to gain enough wt to bring period back; not birth control. (ie first step in management of HP/diabetes = wt loss; as you lose adipose,  you upregulate insulin resistance). In anorexia, usually die to cardiac dz (heart failure: heart just stops). B. Bulimia Nervosa 1. Metabolic Alkalosis: It’s not a body image problem – they can be obese, normal or thin (no weight issue); however, they binge (eat a lot), then force themselves to vomit. Pic on boards: from vomiting, wear down enamel on teeth; so, brownish stuff seen on teeth is just dentine (erosions seen on teeth). Metabolic alkalosis from forced vomiting will be seen. Metabolic alkalois is bad b.c there is a left shift curve, and the compensation is resp acidosis, which drops pO2, therefore will get hypoxia with metabolic alkalosis, and the heart do not like that. The heart already with low O2 will get PVC’s (pre-mature ventricular  contractions), R-on-T phenomenon, then V-fib, then death. Therefore, met alkalosis is very dangerous in inducing cardiac arrythmias, and this commonly occurs in bulimics due to forced vomiting. Pt can also vomit out blood – Mallory Weiss Syndrome – tear in distal esophagus or proximal stomach. 2. Borhave syndrome, which is worse. In the syndrome, there is a rupture and air and secretions from the esophagus get into the pleural cavity; the air will dissect through subcutaneous tissue, come around the anterior mediastinum, which leads to Hemimans crunch – observed when dr looks at pt’s chest, puts a stethoscope down, and you hear a ‘crunch’. The “crunch” is air that has dissected through interstial tissue up into the mediastinum, indicating that a rupture occurred in the esophagus; this is another common thing in bulimics. So, there are 2 things imp in bulimics: 1) Metabolic alkalosis from vomiting (which can induce arrthymias 2) Borhave’s syndrome C. Obesity With obesity, using a diff method: BMI: kg’s in body wt/meters in body ht’2. If your BMI is 30 or greater, you are obese; if your bmi is 40 or greater, you are morbidly obese. Main complication of obesity = HTN; with HTN, leads to LVH, and potentially heart failure. MCC death in HTN = cardiac dz. Other complications of obesity include: gallbladder dz, cancers with a lot of adipose, you aromatize many  17-ketosteroids like androstenedione into estrogens. Therefore, will hyperestrinism (all obese women have hyperestrinism), you are at risk for estrogen related cancers – ie breast cancer, endometrial carcinoma, colon cancer. II. Malnutrition Protein-calorie malnutrition: 1. Marasmus – total calorie deposition, and wasting away of muscle; however, high chance of survival if they get food 2. Kwashiorkor – prob gonna die; have carbs, but no protein; also have anemias, cellular immunity probs (ie no rxn to ags), low albumin levels, ascites, fatty livers. These kids are apathetic and need to be  force-fed; therefore, kid with kwashiorkor is more likely to die than child with Marasmus. Example: kid with edema, flaky dermatitis, reddish hair (Cu def) – kwashiorkor III. Vitamins A. Difference between fat and water soluble vitamins: 1. Fat soluble vitamins dissolve in fats,

Episode 101: Note packets and syllabi usually have scribble notes all over them, but how can you judge, in a moment, whether you have high yield USMLE Step 1 notes in your hand? Listen to the podcast and find out how. USMLE Step 1 Lecture Notes (click) While most are electronic now, beware. There is evidence from law schools that electronic curriculum is associated with poorer test scores. Remember, there are different types of learners. Kinesthetic learners can’t simply learn on an iPad and take it all in, one-way. Calling all Scribes These notes are iconic and help students that sleep in (or in class) to recall the human emphasis. I recommend watching all video lectures for this important facet. There are a number of things to look for when choosing the USMLE Step 1 lecture notes to review: * A recent publication date * Trustworthy author * Scribe notes or faculty note packets? * Recommended from upper levels? * Purpose of the notes – strategically select resources depending on the phase of the exam cycle * Content review * Practice questions * Practice tests    

Episode 100: This special edition podcast highlights the conversion of MMC Mobile, with on-demand medical mentorship from any mobile device. www.MMC.works MMC Mobile – mentorship in High Definition Welcome to the Medical Mastermind Community, episode 100. This special edition is all about the mobile version and how you can go to the new mmc.works. That’s w-o-r-k-s. That’s right, not a dot com but mmc.works, so that you can type that URL straight into your phone, any mobile device, or tablet and access all the podcasts and all the online video training. www.MMC.works Plus, that domain, mmc.works, is a lot shorter and easier to type onto your phone and using your phone rather than medicalmastermindcommunity.com. That was way too long. I even hated typing that on my phone when I would do it. Mmc.works, and by the way, it does work. You can go to the about us page and read the peer-reviewed scientific literature that supports the conclusions that we make about increasing matriculation into medical school, as well as the good stuff on depression and burnout for medical students and residents. Mentorship for Medical Students, Resident and even Pre-Meds There are brand new content areas that were never released before until we had this mmc.works website. That is that we have an entire burnout and mental health prevention section for medical students and residents. You can go through that section and hear the latest peer-reviewed science, systematic reviews, and training on which burnout interventions actually work for students and which ones don’t. There’s plenty more to be desired there. I’d really love to hear your feedback on how much of the burnout and fatigue training you get at your school or residency is actually evidence-based, because I just published a paper in the summer of 2014 in Academic Psychiatry on all of the interventions that actually do work. Simple Mobile Navigation There are other areas in the website too that are neatly organized under one simple little pull-down menu. No longer is the medicalmastermindcommunity.com website so big and cumbersome with three columns of content. It’s really simple now. It’s basically a one-column page with a single menu at the top so you can listen now to all the audio podcasts streaming if you want. You can take the tour and watch a sample video of exactly what’s on the pages if you decide to sign up for Mastermind membership, and a simple buy button there. There’s a little login thing if you already have a password. Short URL We’re trying to keep the URL abbreviated and have all of the videos now converted over into vimeo.com. That’s one of these website video hosting services, kind of like YouTube, but it’s for professional grade. All the videos are high definition, because you deserve mentorship in HD. Right? That’s exactly right. The website name is mmc.works. Type that into your phone right now: mmc.works, because it does.  

Episode 99: Learn the 5 pathways possible for osteopathic physicians and their chances of matching into a residency. Osteopathic Residency Match and Scramble: * Residency options: 5 pathways * Board certification * Malignant residency programs * D.O. match and scramble rates * NRMP Match and Scramble Course * Further reading D.O’s or the Doctor of Osteopathic is a fully licensed physician who specializes in all of the areas of medicine. D.Os differs from M.Ds; not like M.Ds who deals with specific symptoms and illnesses, D.Os regard the body as a whole thing. For med students who are applying for the match this is the one to aim at. This will give you a lot of clinical and residency time to be able to gain the right experience you need. The Osteopathic Options: AOA: American Osteopathic Assn. The AOA serves as the primary certifying body for DOs, and is the accrediting agency for all osteopathic medical college and health care facilities. ACGME: Accreditation Council for GME ACGME is the agency that’s responsible for the accreditation of post-MD medical training programs. See this site to know what you need in order qualify for an application for ACGME. * AOA Residency (internship incl.) * AOA Prelim. (mostly at same institution) * AOA Traditional Internship (stand-alone) * ACGME (internship) * ACGME (residency) AOA Boarded? 1. D.O.’s want Osteopathic Board Cert. 2.  Some states require AOA internship for Osteopathic Licensure 3. Can get AOA approval for doing ACGME internship 4. In 2006, there were only 90 dual ABMS-AOA programs out of over 8,000 AOA-Approved ACGME * From July 2007 to December 2007 * 1,603 D.O. petitions * 1,217 (76%) approved * 369 (23%) pending completion ____________ * * 99% total <1% denied or withdrew app. * Assume that all of them applied to either an AOA or ACGME program, then use ACGME data to complete the picture. Want to know more? Consider joining MMC Mobile to take the Mastering Residency course.

Episode 98: Learn about the coming MOBILE version of the MMC, plus Dr. Dan outlines the 7 Stages of a Medical Career in Development. Seven Career Stages and MMC Mobile updates TRANSCRIPT This episode is about the Seven Career Stages being in the palm of your hand. That’s right whether you’re listening to this on your phone, a tablet or a computer, more and more technology in web traffic is going mobile. It is expected that mobile devices will overtake desktop and laptop computers in the next year in terms of traffic and usage. The Medical Mastermind Community has been putting at this podcast for over five years and has always positioned itself as a podcast. I’m not trying to ever replace USMLE or MCAT type of audio materials or full courses that would compete with your own medical school, that’s ridiculous. There are big courses out there that you can take such as Kaplan or Princeton Review to help supplement your material if you want a sit down course to review stuff. Most people don’t have time with that. We’ve been focusing on podcast that can help you squeeze in some extra study time while you’re washing the dishes, or jogging, or taking a dog for a walk, et cetera. I particularly listen to podcast when I’m traveling. We are going mobile folks. Right now, I’m in the process of converting everything mobile. When the website first launched five years ago, believe it or not it was state-of-the-art at that time, but the state-of-the-art changes so fast. We got lucky that all of the MP3 audio podcast were already using a tool that happens to still be valid as a mobile, playable device, so from Android, Apple, iPhones, tablets, PCs and Mac, et cetera, you can click on the audio podcast play button and it will work on all those devices. We’re expecting this year 2014, to reach a total of one million podcast downloads. We’ve had about 30 or 40,000 people listened to the podcast which is about 20% of the market by my math out there in at least premedical realm and in the medical school. We’ve had about five or 10% of those joined the Medical Mastermind Community at one point or another. The majority of those memberships had been free memberships that we’ve donated in the exchange for people filling out surveys over the years that have been used to conduct pure review research and are in the process of being submitted and edited for journals. These research projects have to do with getting accepted in a medical school and residency, the percentages, MCAT scores and et cetera. Today’s podcast ties right in with the way this new mobile friendly Medical Mastermind Community website is being reorganized. I like to study everything. My research experience has changed the way I think in a lot of ways, changed who I am as a person when the scientific method really overtake you and changes who you are and how you think. That’s happened to me. We have surveyed people on what they wanted on the website, how they want the podcast; if it was mobile friendly, would they use it more often, et cetera, et cetera. What you may not know is that there are over 100 videos on the Medical Mastermind Community website that train you about every aspect of the medical education process, 12-year journey, on one website. Those are all inside the paid community, so you have to have pay … a membership to access those, but unfortunately, those videos that I was uploading using state-of-the-art best practices in the last three to five years are no longer mobile friendly. I’ve got them hosted on Amazon web server which is state-of-the-art and playability in the speed at which it plays when you click on the play button. That’s what you care about, the loading time and the buffering time. Amazon website was supposedly the best. The problem is they did not support mobile friendly versions and there are s...

Episode 97: This concludes the discussion of the core research that went into the MMC anxiety intervention.  Get anxious before tests? Good. A certain amount is what motivates you and is healthy. But what about when it becomes counterproductive? Listen to this podcast to hear how to tell the difference between normal anxiety in USMLE test preparation, from the alphabet soup of ADHD (attention-deficit hyperactivity disorder) and OCD (obsessive-compulsive disorder).  

Episode 96: Learn the facts about stress during USMLE Step 1 preparation. Download Slide Set: MS2 Lecture- Preventing Burnout While Preparing for USMLE Step 1 Burnout in Medical Students In this episode, you’ll learn the statistics behind the 5-30% prevalence of suicidal ideation among medical students. Depression is more common in residents than the general population. [ad#250×250] Fortunately, there is a growing number of academic centers incorporating some of this education into its curriculum. But is it too late? Medical students don’t have time to seek help There are many barriers to medical students seeking help for mental health issues, TIME being the biggest offender. Want to know more? You’ll have to listen in…

Episode 95: Learn what to look for in a mentor and how they can help you accomplish your goals. Download transcript: Choosing a Mentor  Melinials Want Mentorship in Medicine In today’s episode, I’m going to be talking about how Millenials want even more mentorship, at least supposedly, than their predecessors. Specifically, I’m looking at an article from the American Psychiatric Association. Their education director, Dr. Hales, put an article, and she was interviewed in a title called “Mentoring Residents: Often a Lesson in Chemistry.” [ad#300×250] What she’s talking about, primarily, is interpersonal chemistry between mentors. The article states that residency is often about evaluation. It doesn’t matter which activity you’re involved in with residency. It’s not so much about evaluating whether or not the resident is good or bad necessarily, but as a function of professional development, to mirror feedback to the resident to let them know what they’re doing effectively and what they need to work on. At least, that’s the most hopeful, positive spin you can put on it. As you may have heard in prior episodes, constructive criticism on clinical rotations isn’t necessarily painless. In fact, sometimes you have to look for the positive action items after someone reams you and maybe yells at you for a mistake. You have to put a positive spin on that intentionally. So she makes a statement here that I don’t think is based on fact, and I would like to bring under closer scrutiny, as I would encourage you to do any time you hear something that doesn’t jibe with your personal experience, or your knowledge, or just doesn’t seem to be quite right. Don’t necessarily dismiss it, but investigate it, and examine it, and become a little scientists related to things about your medical career, not just medicine itself. For example, she says, “The Millenials, these are individuals coming of age in the new century, want more structure and guidance than the earlier Baby Boomers did.” I would like to see a study that asked Baby Boomers in medical education how much mentorship they wanted. Hmmm. How can you make a statement like that? I don’t know. You don’t have evidence. So I kind of dismiss that. But I do generally enjoy and agree with the topics otherwise presented in this article. For example, this idea about needing interpersonal chemistry. Definition of Mentorship So let me back up a step and just kind of describe in my own words what a mentorship relationship is like when you’re a resident working with some faculty. In many programs that you would get into, there are faculty that are assigned to supervise you in different capacities. Often you can choose either a formal mentor, if they have a program like that, or maybe it’s called career supervision, or something. Hopefully, your program will cut out a little bit of time, as you progress through the program, to meet one on one with a faculty member for guiding you and answering your questions about career decisions, as you do figure out along the way what kind of things you’re interested in doing in your medical career. They can give you their tips and guidance. That’s a formal relationship. It’s not necessarily going to be someone you would go have a beer with, or whatever. Also, their advice can be tainted with recruitment. Sometimes it’s a criticism of career advice, if they’re really trying to keep you at the program, they might distract or change the subject to that often, and you might not feel comfortable. I would say that this is the time and place to be assertive. If you don’t want to go to that program, or stay there, you’re going to move away,

Episode 95: Whether it’s inadequate note taking, or if something is missing here or there or mistake, or some kind of habit, let’s face it. Not all doctors are very good, at coaching mentoring, or teaching some of them are very [abrought 00:01:07] in some cultures and specialties. They pride themselves in being mean to each other. You’re going to have criticism, the question is how do you handle it. What I like to think of is to make the criticism constructive. It may not come across to you, in a way that’s constructive. It’s your job to find out what can I do different, what can I learn from this, what process do I need to change in order to make this improvement in this area. You’re going to put a positive spin with the tangible handle, something physically different that you’re going to do. Make it action based, very much like the book Getting Things Done with David Allen. I highly recommend that audio book while you’re straightening at your office, and cleaning up your house. Especially if you’re going through a massive inbox, or making new files, anytime you’re organizing. The bottom line there is that instead of putting somebody on a to do list, that just says paint the house. Break it down to the next physical, tangible step in that big project and put something like, go to Lowe’s and look at different paint colors, or something like that. Something that you can break down, in the simple action task. You’re going to do the same thing whenever it comes to criticism you received on clinical rotations. Let say for example, and I bring this up now because I just got a criticism. I wasn’t putting enough information in my HPI, in my History of Present Illness section, okay. It happens sometimes I think it happens when you start getting a little [inaudible 00:03:12] that’s still a little bit early but regardless the straight forward, and wrote simple to me now and they want me to kind of write a little bit more. Most in this don’t. That’s a good side bar here is criticism you may get maybe just one person’s opinion and you might be getting prices in that same area from everybody else. It could be just that one person, that’s giving you the criticism. Take it with a green assault, it doesn’t mean you’re a bad person. Remember the difference between shame and guilt, it just doesn’t mean you’re a bad person, it means you could improve in this area, your job is to turn it into a tangible handle. Look at that thing and say okay what specific task could I do different to change the process here, so that I can improve based on this criticism. In other words how can I make this constructive. In this example, of not putting enough information in the history of present illness section. One thing that I could do different would be to before I’m done with my note, and complete my note. Go back and look and make sure that my note reflects all the substantiation and documentation require to make whatever diagnosis I’m suppose to make in the bottom, okay. I normally do that, I made a mistake today. That happens, I can make more thoughtful effort. Let say I catch myself next week, doing the same thing again. I can realize, “Hey, just to have that memory, of I’m suppose to do this or that.” That’s not working, I need to adjust. What I need to do, maybe put a three by five card on their monitor something. I need to change something about my system or practice, make tangible handle. Let me talk a minute about the dynamics with feedback, on the rotations. You get what they call the 360 degree feedback in a lot of places, some places have medical students billing out, reviews and performance evaluation on each other, and their attending, and their residence, and everyone else is doing it too.

Episode 94: Learn what programs are looking for in an ERAS application. What draws people to psychiatry? *   Interest in serving patients with chronic, severe mental illness. Enjoying psychotic patients can be a big determinant. *   Fascination with neuroscience. *   Strong interpersonal skills. Ability to engage and successfully navigate almost any typeof person. *   Introspective types; ability to look within and then MODEL appropriate, mature behaviorto your patients. *   Lifestyle. You can’t beat it. Possibility of a cash-only practice with relatively little start-up costs; anytime, anywhere. More people chose psychiatry in 2013.1 *   Longer appointment slots: 20-30 minutes vs. 10 minute follow-up visits. *   In psychiatry, priorities and staying centered in family is respected.  What types of programs exist in Psychiatry? (adapted from http://www.psychiatry.org/medical-students/subspecialties-in-psychiatry) * Child and Adolescent Psychiatry * Geriatric Psychiatry * Addiction Psychiatry * Forensic Psychiatry * Psychosomatic Medicine * Research – 2 years Combined Programs *   Triple Board Residency (Psychiatry/Pediatrics/Child & Adolescent Psychiatry) – A five-year combined residency which integrates psychiatry, pediatrics and child and adolescent psychiatry. *   Psychiatry/Family Practice – five-year combined residency. *   Psychiatry/Internal Medicine – five-year combined residency.   Psychiatry/Neurology – five-to-six year combined residency. What medical school grades do competitive applicants have for psychiatry residencies? A solid medical school performance is important. Therefore, passing all of your medical school classes the first time is huge, but I don’t have to tell you that. That said, it’s nice if you got a High Pass or Honors in your Psychiatry rotation but that’s not required. That grade isn’t often going to be a deciding factor by itself. So, my answer here is for the student to have an absence of failed classes rather than the presence of Honors grades. What are the Step scores of competitive applicants? Data adapted from http://www.nrmp.org/match-data/main-residency-match-data/. Unscientific research into this question puts the number needed for USMLE Step 1 historically around 208. Don’t let that number “psych” you out. Different programs emphasize different things and an application is viewed in its entirety. How important is research to remain competitive? This depends on where you’re applying. Personally, I interviewed at Duke and UT Southwestern where it is very important. I’m training at Scott & White where it’s not emphasized but I’ve done 20 scholarly activities; far more than I could have accomplished at the other, busier programs. If you have a publication, that stands out because of the amount of dedication required to follow through on it. Otherwise, a few volunteer assignments on someone else’s project isn’t that impressive. If you have no research experience at all, it may appear that you are unmotivated or cocky. How to research, grades and Step scores interplay? Again, the application will stand as a whole and should reflect who you are. If family is a priority and you haven’t done much “extra”, don’t worry about it. Find a way to mention them in your personal essay. In psychiatry, priorities and staying centered in family is respected. Other ways you can shine in your residency application are mission trips, volunteering with the underserved, recommendations for Psychiatry program directors and AWAY rotations. How important are away rotations? Away rotations are KEY if you really want to train at that residency. It’s a 1-month interview! Similarly,

Episode 93: Doctor Dan reveals where the finances have gone and his best-kept secret all these years… I want to reveal my best kept secret. I say I want to. I’ve really hesitated, for the past 2 years, I’ve kept something from you. It’s been more than that, actually. Pretty much the whole time I’ve been a resident. That is, what happens to the money, that people spend to join the medical mastermind community? Half of it goes to operate the site. The other half has been going somewhere else. It just seems like it’s the right time, the right thing to do, to tell you, though I’ve hesitated for a long time. I’ve literally had this note set in front of my desk for a couple of months. Here we go. I support a few non-profit charities. My favorite and the largest one that we contribute to is Compassion International. It has a unique model of 1 to 1 sponsorship in empowering local churches. Has been helping children, put them on hopeful paths since 1952. I sponsor more than a dozen children, all over the world, in different places. If you ever watch the news and you see tsunamis here and there, earthquakes, usually the medical mastermind community is sponsoring a child  that’s in that area. I mean, I get these personal letters. Sometimes they have to drop out of the program. They don’t tell me exactly why. It certainly makes global issues come to life. It makes me a lot more connected to the world. I think that is a good thing. When budgets get tight, I really fight, trying to keep this mode of sponsorship going. Let me give you a few fun facts for Compassion International, understanding that if you help with the medical mastermind community costs, this is where your money is going. 4 to 8 hours is the average amount of time per week that a compassion assisted child spends at a child development center. Understand that the general picture of what they do, is provide clothes, food, and books, spiritual guidance. Really, a school environment for kids that are in third world countries, that don’t have anything. Some of them live in either shanty towns, or in some cases, they live in trash or whatever. I see pictures. They dress them up for the pictures, but I know a little bit about the third world. It was in the third world, that I got interested in medicine. I think that’s helped me connect back to my roots. As a pre-med, the very first pre-med thought I had was in Africa. Here we are, I’m helping folks in Africa, Haiti, all over. 44 weeks out of the year is the typical amount of weeks that a child participates in the program. The program is comprehensive. They do give them exams. In fact, that’s one of the biggest things that the children write letters to me and comment on, is their exams. They try hard. It’s so sweet. They really write these letters. I have a file, that is literally 2 inches thick, of letters that I’ve received from these children, over the years. Honestly, I  could help writing them back sometimes. That’s one of my motivations for unveiling what I’m doing, is I’m too busy to sponsor, or at least be a pen pal, with 13 plus children. Your first sign up for something like that, you think, oh, it’s a financial thing. It becomes quickly, a personal thing, when they’re writing you letters and notes and that sort of thing. If you are interested, you could sponsor them. In fact, now, the monthly membership for medical mastermind community is less than the cost of what it takes to sponsor one of these children monthly. If that’s something you’ve been interested in doing, and you’re into charity and helping folks in the third world, that are less well off than you, then you could look at it that way and join as a philanthropic type of motive. The number of hours invested weekly ranges from 5.6 million to 11.2 million.

Episode 92:  Learn the difference between carcinoma, sarcoma, mesenchymal tumors, oncogenesis, and the protooncogenes. NEOPLASIA I. Nomenclature: Benign vs. malignant A. Difference between benign and malignant cancer: Main difference – Benign usually does not metastasize, malignant has the capacity to metastasize. Exception: B9 tumor that metastasize: invasive mole (metastasize to lungs, but goes away). B. Overview of Neoplasia a) MC skin cancer INVADES but does not metastasize? basal cell carcinoma. b) MC B9 tumor in woman is MC located in which organ? Uterus – it’s a leiomyoma; tumor of smooth muscle! c) Fibroids – smooth muscle; become very hard d) MC B9 tumor in male (yellow) = lipoma e) B9 tumor of glands = adenomas (ie adrenal adenoma – thin adrenal cortex b/c it is functional; it could be making cortisol, therefore suppressing ACTH, and the zone fasiculata and reticularis would undergo ATROPHY…leads to Cushing’s. If tumor secreting mineralocorticoids – it is Conn’s syndrome, causing atrophy of the zone glomerulosa (GFR – salty sweet sex) f) Tubular adenoma = MC precursor lesion for colon cancer (looks like strawberry on a stick) C. Carcinoma vs. sarcoma 1. Carcinoma Malignancy of epithelial tissue (3 epithelial tissues – squamous, glandular, and transitional) a) Squamous carcinoma – how to recognize? Little swirls of increased redness (bright red) called squamous pearls; b) Glandular carcinoma – Round glands, with something in the middle = adenocarcinoma c) Transitional cell carcinoma – from bladder, ureter, renal pelvis (from genital urinary tract) – all with transitional epithelium. Therefore, 3 carcinomas = squamous, adenocarcinoma, and transitional cell carcinomas. d) Example: Malignant melanoma – first step in management? Excision (b9 version = nevus), both are derived from melanocytes. This is the most rapidly increasing cancer in the USA, not MC. They are S-100 Ag “+” tumors – aput tumors e) Aput Tumors: S-100 Ag “+” tumors – aput tumors; aput is precursor uptake decarboxylation, meaning that they are of neurosecretory or neural crest origin. Therefore, on EM, have neurosecretory granules. S-100 Ag is used to stain things of aput origin or neural crest origin (most, not all, will take up that Ag). Examples of aput tumors: melanoma; small cell carcinoma of the lung; bronchial carcinoid; carcinoid tumor at the tip of the appendix; neuroblastoma (secretory tumor), ie 2 y/o with tumors all over skin, and on biopsy, it is S-100 “+”, tumor was from adrenal medulla, metastasize to skin. 2. Sarcomas Sarcomas are malignancy of MESENCHYMAL tissue (not epithelial). * Sarcoma of smooth muscle = leioymyosarcoma; * Striated muscle = rhabdomyosarcoma; * Fat = liposarcoma; (these are malignancies of mesenchymal tissue, while carcinoma’s are of epithelial tissue). Examples: a) Bone, see metaphysis, see Codman’s triangle, and sunburst appearance on x-ray b/c this tumor actually makes bone. Dx = osteogenic sarcoma (bone making sarcoma). b) Biopsy from girl having necrotic mass coming out of her vagina, Vimentin and keratin “-“, and desmin “+”, dx? Embryonal rhabdomyosarcoma (see striation of muscle). This is the MC sarcoma of children (vagina in little girls and penis in little boys). c) Movable mass at angle of jaw = mixed tumor (in parotid); ‘mixed’ b/c two histologically have two different types of tissue but derived from SAME cell layer (not a teratoma, which is from three cell layers),. MC overall salivary gland tumor (usually b9) = mixed tumor. d) Teratoma = tooth, hair, derived from all three cell layers (ectoderm, mesoderm, and endoderm) Aka germ cell tumors – b/c they are totipotential, and stay midline. Ex. anterior mediastinum, or pineal gland; therefore, teratomas are germ cell, midline tumors.