Monthly Archives: October 2011

The move and week one at the VA

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It’s been a couple of weeks since my first post and quite a bit has happened.  I successfully conquered my finals and clinic requirements and spent my last few days in Davenport with friends and loved ones.  Sunday, Kyle and I loaded my car with the 6 bags full of my belongings and I took off.

It took me about 14 hours to get to Jackson.  The drive was pleasant and uneventful.  The scenery was beautiful with TONS of trees and I arrived around 11 p.m.  I spent Monday unpacking and getting settled into my new room, as well as getting to know my new roommate, Crystal, and her cute little dog, Gizmo.  Crystal is very kind, accommodating, quite talkative, and so far has been the epitome of “southern hospitality.”

Tuesday was my big 1st day at the VA.  My first shift started at 8 am.  Even though the VA is only about 30 mins from where I am staying, I left an hour early to account for traffic and to make sure I had time to recover from getting lost, as my Garmin tends to take me on some wild adventures.  Just as I suspected, the Garmin took me for a ride and I ended up having to call Dr. Pavalock to figure out how to get back.  Apparently, the Garmin took me to the “bad” part of town but I was able to find my way back and was about 10 minutes late to my first shift.  At least I had called Dr. Pavalock, so he knew I’d be late.  Great first impression.

So now on to the meat and potatoes…my first day.  We saw 6 patients the first day, three of which were new patients.  It was very interesting to watch how Dr. Pavalock interacted with and assessed all of the patients.  I was comforted by the fact that his new patient assessment and chiropractic assessment were very similar to what I have been doing with Dr. Crisp for the last 8 months of my clinical experience.  Although Dr. P is a Palmer graduate, it is cool to see that even after being out for 15 years (I think that is how long it’s been since he’s graduated) his assessment has not diverged much from the core of what he’s been taught.  It is reassuring to me that what I am learning will serve me well for years to come.  Dr. P has a great sense of humor.  I told him that I am from Montana and grew up on a farm/ranch so now I am branded (no pun intended) as a “cowgirl.” Although, Dr. P and has been teasing me about not being a “real” cowgirl because I’ve never used a bull whip and don’t know how to rope animals, lol.

Another interesting note about Dr. P is that he wears nitrile gloves while assessing his patients.  I asked him why and he said he wears them for multiple reasons.  He first wore them because he had burned his hand on his oven one day and didn’t want to rub his open sore all over his patients while working with them.  Pretty gracious of him, don’t ya think?  Hee, hee . Then he decided that the gloves were a good idea not only to protect his patients but also to protect himself, so the gloves have stayed.  When I get to start working with patients, I will have to wear gloves as well because the patients are used to it and expect it.  I am a little nervous about wearing gloves because I’m worried it will make my ability to palpate more difficult but then again when I transitioned from the student clinic to the public clinic I had the same fears about assessing patients without gowning them and its only a matter getting used to what you have to feel through.  By the time I’m done I will be able to feel a penny through a phone book, lol.

So onto some interesting cases….day 1 we saw a patient with neck pain and numbness in the fingers of his left hand.  The strange thing was that even though he stated his fingers felt numb, while assessing his sensation in that arm he had increased sensitivity to light touch and decreased sensitivity to sharp touch in the C7 dermatome.  For those not familiar, light touch usually is the first thing to go when someone has numbness.  His right side was normal and his x-rays showed some degeneration at C5/C6.  Because the neuro tests came up as so strange, Dr. P did not adjust him and sent the patient for an MRI.  The next day the radiologist called and reported that the patient had an infection in the disc between C5 and C6 that was eating the vertebrae above and below it….MAJOR contra-indication to adjusting!  Dr. P consulted with the patient’s primary care provider and he is now being managed appropriately.

Another patient presented with low back pain and his x-ray showed the biggest osteophyte (bone spur) off of the front of the sacrum I have ever seen!  It even took on the shape of the anterior of the disc and looked like a big claw off the front of the sacrum, almost connecting to the bottom of the L5 vertebral body.

Another patient with low back pain had some modic type 1 changes on his MRI in the L2/L3 area, meaning that he has some bone marrow edema going on due to degeneration.  Dr. P was curious about the findings on the MRI and so we went to chit-chat with the radiologist about it as well as to discuss the case of the patient with the disc infection.  The radiologist explained the modic types to us and then brought up a very interesting point.  The radiologist said that while the modic changes are something to be monitored, it is not terribly concerning and usually resolves itself but there is the potential that the edema/inflammation seen there could develop into an infection and become an osteomyelitis/discitis situation as we saw in the other patient.  This was interesting to me because as we learn it in school, the two seem very separated.  When you see modic changes, you think of it as simply evidence of degeneration happening in the spine which happens due to normal wear and tear of life BUT what if an organism does get into that inflamed site?  So my self-inflicted homework this weekend has been to find out if this has happened and been documented in literature.  If it has, how likely is it to happen, what could cause it to happen, and what is the appropriate management?

So far,  I have spent at least an hour or two every night looking up various things related to my day and I find it funny that I am doing more homework now than I did at school.  As Dr. Crisp would say “Welcome to Practice!”  It is awesome though and reassuring that the learning curve is going to be tremendous while I am here.

Well, this has been a LONG blog post so I am going to cut it off now.  Thanks again for reading and I’ll update you all again soon.  Until then, have a good one!

Alicia Ruiz, 10th Trimester Student
Davenport Campus

6th trimester observations

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Now that I am a 6th trimester student, I have my first opportunity to enter the clinic and see how things are going to run when I start seeing patients next trimester.  My first observations took place last month and I don’t think I’ll ever forget them.  It started with me knocking on the door and asking if I could observe the appointment. Then I made my way to the corner of the room so I would be out of the way.

The patient and the intern carried on with the examination while they proceeded to talk about everything from dogs to babies to marriage, and places they liked to eat in town.  It must have been 15 minutes before they looked over at me and said, “Hey Josh, why aren’t you saying anything?”  (I had previously thought I was just supposed to sit quietly in the corner and make notes about what I was observing.)  I joined in to the conversation and the intern proceeded to go over everything she was writing down on paper and the exams she was performing on the patient.

Not only was it a good review of the things I had learned up to this point, it was helpful to see how the paperwork and patient exams come together in a typical office visit.  It also showed me that students here at Palmer are willing to go out of their way to help the younger trimester students get the hang of how things run here on campus.  I think it is students like that, ones who go above and beyond to help others, who create the kind of atmosphere patients are looking for out in the real world.

Joshua Pattengale, 6th Trimester Student
Davenport Campus

Cadaver lab

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On my very first tour of campus, we had the opportunity to enter an anatomy lab where we had a hands-on experience with brain and spinal cord specimens. I had never been in an anatomy lab before that day, and I was a little nervous about what I was about to see. (My mom waited outside of the lab!) It was the time spent in that lab that really confirmed my decision to come to Palmer. I held in my hands the very highway of the nervous system; the foundation of the chiropractic practice.

In your first year of your Palmer education, you spend 6 credit hours in anatomy labs. What I have learned in that time is absolutely incredible!! Every week I am amazed by what I see, and it is so incredible to think that everything I see on the cadavers is living and functioning inside of me at that very moment! Chiropractic students take more anatomy credit hours than medical students, and it is this solid foundation that the rest of the program builds upon.

So, if you are nervous about your time in the anatomy labs, take a deep breath, rub some essential oils under your nose, and get ready to learn A TON!

Leah Hetebrueg, 2nd Trimester Student
Davenport Campus

Part 1 boards are behind me!

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Well, I just finished part one of National Boards last month and let me tell you, it is nice to have that behind me.  We all spent long days and late nights trying to cover everything possible that we thought may appear on the board exams.  I started to become anxious a couple of days before and couldn’t tell if I wanted them over with or thought I needed more time.  Friday morning on the way to the exams I put in my Bob Marley CD and, as my four year old would say, “jammed out” on the way to school realizing I was excited to see what this was all about.

As it is with a lot of things the anticipation leading up to a big event is usually more nerve racking than the event itself.  The same held true for boards.  I expected to receive several pages of paper just filled with questions and was prepared to be completely overwhelmed.  That wasn’t the case.  We received plenty of time to finish the exams and it turned out not to be so intimidating after all.

Of course everyone stands around after each exam discussing questions they thought were difficult, hoping that someone else will have answered the same giving you a little piece of mind.  But, when all was said and done, it wasn’t that bad!  The instructors had done a great job at preparing us for these exams!  I was particularly thankful for Mr. Morter, the Spinal Anatomy II teacher, and hope that we make Dr. Weinert proud with our Biochem scores. 🙂

Saturday night, my husband and I had a get together and campfire at our home where we were able to unwind and enjoy time with family and friends.  It is really hard to believe how fast the time has gone by since I started and here we are, planning our half-way party.  I look forward to all that is ahead and can’t wait to share my experiences with more prospective students in the upcoming trimesters!

Erica Boland, 4th Trimester Student
Davenport Campus

Ready. Set. Go!!!

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My blog will chronicle my adventures in Mississippi as I intern with a Doctor of Chiropractic in a Veteran’s Affairs Hospital.  I do this so that friends and family may keep a pulse on what I am up to in the south and also so that future recipients of this internship can have an idea of what to expect and become aware of special issues that may present themselves.  I plan to post once a week, most likely each Sunday.  So hold on….here we go!

I applied for the VA/DOD internship program in 7th trimester for many reasons:

  1. I felt the experience would be invaluable for my growth as a healthcare provider by allowing me to see a broader spectrum of issues that patients may present with and giving me a taste of what real life practice could be.
  2. I have worked in the hospital setting before and am familiar/comfortable with that type of setting.
  3. I feel that providing chiropractic care in a hospital setting is an amazing service to patients and hope to see this trend spread throughout the nation.
  4. I have a pipe dream of practicing chiropractic on the military base in Seoul Korea so that my boyfriend Kyle and I can broaden our knowledge of Tae Kwon Do.

The application process involves an initial interview with the program director at Palmer, Dr. Schrad, and then you wait until a spot opens up at one of the various sites around the country.  If a spot opens, you then interview with the DC at that site and are possibly chosen after that.  I passed the initial screening interview and my name was put in the applicant pool for all of the DCs to choose from when a spot opens.  After that, I didn’t hear from any of the DCs for 9 months!  Just as I was accepting the fact that I probably was not chosen to go to any of the sites, I was notified that I had two interviews (one for Texas and one for Mississippi) during the week of homecoming at Palmer.  So amidst the whirlwind of homecoming, I met with Dr. Pavalock of the Mississippi site for an interview and a day or two later was officially notified of my acceptance!

Since finding out that I was accepted, I have been on a mad scramble to get ready to leave.  The first obstacle was finding a place to live in the area, as housing is not provided through the program but helpful suggestions are provided by Dr. Schrad.  After a solid week of leaving countless messages and receiving many calls reporting lack of vacancies, I hit the jack pot and was able to find a lady renting a room and attached bathroom in her condo near the VA.  The place is fully furnished so I only have to pack clothes, school stuff, and toiletries…thank goodness.

The next obstacle was making sure I had all of my clinic requirements finished up to pass this trimester as well as finish up any pending paperwork I may have had.  This trimester is scheduled to end October 20th with finals scheduled for the 14th -20th BUT I was scheduled to start in Mississippi on October 12th…so I scrambled to finish up all of my assignments for each class and I re-arranged my finals so that I took them all the 1st week of October.  I also had to track down my vaccination records and have a tuberculosis PPD test performed and read to take with me to the VA for their records.

As if all of that was not enough, a year ago in November I started a Tae Kwon Do club at Palmer which has grown rapidly and turned into more than I ever envisioned it being.  Since finding out in August that I was leaving for my 10th trimester I have been preparing the club to be passed to the next leaders.  This process has included writing a constitution; electing an executive committee; organizing all of the club documents; outlining procedures for intake of new members, testing, and ordering supplies; making sure the next head instructor knows the material members need to learn to be able to test; and sharing my vision of the club with the new executive committee and the club advisor.

Whew!  I think that pretty much sums up my journey towards this amazing experience so far.  Thank you for reading.  My next post will likely be towards the end of October after I have made it to Mississippi and gotten a few days under my belt in the VA.

Alicia Ruiz, 9th Trimester Student
Davenport Campus

The craziest month of my life…

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WOW!! September was one crazy month!! When you come to Palmer you hear the upper trimester students talking about boards and you think no big deal I took the SAT’s, how bad could another standardized test really be? Well I found out just how crazy it can get! Not only do you have to study for boards but life goes on in class as well. So while studying for the five tests I had the week and a half prior to boards I was also refreshing my memory on all the information I have learned during my first year here at Palmer. As bad as this sounds we all made it through, some of us with very little sleep and A LOT of coffee. When you are this tired and trying to remember names of muscles, organs, and diseases every word starts to look like it should be pronounced in Latin. My friends will never let me live down the fact that I did not pronounce the word urgency correctly. I don’t remember how I pronounced it while we were studying but it sounded like it could have been a legitimate Latin word. And that is where sleep would have been really beneficial. LOL

I have to say the hardest thing about boards was not re-learning all the material (because you realize how much you appreciate your professors for making you learn it the first time, thanks Mr. Morter!!) but the hardest thing was only knowing, with absolute certainty, about 30 or 40 answers out of 110 questions. Many of you may be doing the math in your head and yes that would be failing in any other situation except on the NBCE boards! So when you walk out of school at the end of a the day feeling like you were just hit by a truck you have to pick your head up because everyone else is feeling the same way.

But now that boards have come and gone, class goes on and then came three more exams! But thankfully I made it through those relatively unscathed. Next, I was looking forward to the multiple seminars that ended that crazy month. First, a trip to Cleveland Chiropractic in Kansas City for a Motion Palpation Full Spine seminar! This was my first MoPal seminar so I was excited to put my skills to the test! Seven people in a hotel room for the weekend made for an interesting time, but here at Palmer we are such a tight knit group that it was a blast!

Finally to round out the month, I went to a small animal chiropractic seminar here in Iowa, and took more exams, of course. Animal chiropractic is my passion and what got me interested in this profession. I love these seminars because my dog gets to come to class with me! For those of you who have never seen an animal get adjusted, it is not as difficult as you may think. You just have to be quick, precise, patient, and a little creative especially with the horses. I was very excited because the animal seminars are hands on, and Juan Diez Rancheros a horse therapy center for children, allows us to use their horses for these seminars so there are animals of every size. It was definitely a great end to such an insane month! September showed me that I can survive anything, which is good because I hear part two and three board exams are just as hectic!! However, that is a year away so I am going to get to catch up on sleep before then. As crazy as this sounds if they told me I had to do it all over again I probably would because I love chiropractic and cannot wait to start sharing it with others.

Kaitlin Bowen,  4th Trimester Student
Davenport Campus

My Homecoming

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Homecoming was such a blast! I went to my first Palmer homecoming last August as a prospective student and it was tons of fun getting to attend this year as an actual Palmer student. Even more so because I was able to interact with the new prospective students – to hang out and share my experience with them, answer their questions, and pass on my enthusiasm as campus guides did for me last summer.

Homecoming festivities started for me on Wednesday with the opportunity to have lunch at Front Street Brewery with a Palmer alumnus from my home state, Washington! Sometimes I feel far from home out here in Iowa so it was exciting and refreshing to be able to spend that time with Dr. Houk, hear about his time as a student in Davenport and the great success he has had since graduating. Something so great about Palmer is the opportunities you have to meet with alumni and learn from their experience and there is no greater place than homecoming to take advantage of that!

I left from lunch at Front Street (which I totally recommend if you are looking for a great place to go out to eat!) to meet up with some friends from my class at the barbeque and talent show in the campus courtyard put on by student council. That was one of mine and my family’s favorite memories from last summer and again, it was fun to be there as a current student, recognize people participating in the talent show, and be able to hang out with all my friends. There was food and snow cones and cotton candy and tons and tons of fun!

The eventful weekend continued into the next morning for the official opening ceremonies of Homecoming 2011. I feel like opening ceremonies are a wonderful time for prospective, current and past students to come together, hear about what is going on in the world of chiropractic and to get re-fired or fired up about our incredible profession. I don’t feel like my excitement for chiropractic fades much, especially getting to be around it every day here at school, but I just LOVE hearing about the research being done to support my passion and the way that chiropractic is reaching the world today.

There is no place I would rather be than a student here at Palmer! I worked for years to get here and homecoming this year was just an affirmation of what I am doing here as a student and hope to be as a future doctor of chiropractic.

Also, if you don’t want to wait to visit Palmer until next Homecoming in August 2012, come to one of our prospective student events. We’re having a big Saturday Campus Visit on November 5. Hope to see you soon!

Devanni Partridge, 3rd Trimester
Davenport Campus

“You’re Moving to Iowa?”

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I have a confession. Before moving to the Quad Cities, my perception of Iowa was limited to corn and farm fields. (I don’t say that to offend anyone who is from Iowa. I recognize that my view was obviously very limited.) I struggled with the idea of leaving a progressive, cultural college-town in Wisconsin to move to Davenport. I was confident that I wanted to attend Palmer, but I was still hesitant that I’d enjoy the community I was moving to.

If you have had any of these same thoughts, then let me put your mind at ease. The Quad Cities is a metropolitan area that has a lot to offer students. There are a number of museums in town that offer discounted rates to students. We have a year-round farmer’s market (and Palmer even hosts its own farmers market on Thursdays during the summer months!). There is a minor league baseball team that plays in Davenport. One can also find a plethora of shopping and restaurant options in the area.

I’m a pretty outdoorsy person, and I have been able to find a few mountain biking and hiking trails. There are a number of state parks in close proximity to the Quad Cities. And, of course, the beautiful Mississippi is right in our backyard!

If you have the chance to visit the Davenport campus as a prospective student, spend some time exploring the Quad Cities area. It might feel a bit like home!

Leah Hetebrueg, 2nd Trimester
Davenport Campus

Balance

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I am now in 9th tri and just a few short months away from being unleashed upon the world as a doctor of chiropractic.  Amidst the seemingly endless lessons I have learned at Palmer, one unspoken principle has been demonstrated and reinforced over and over since the beginning of my journey in Davenport is this: Balance.

The first year of the PCC-Davenport curriculum is packed with the basic science classes.  Through classes such as cell physiology, biochemistry, gross and spinal anatomy, I learned the intricacies of balance within each living cell of our bodies.  I learned the balance of energy production and utilization, along with the balance between our neurological system and muscular system.  I learned how important balance is to everything we do in life from the most simple, such as breathing, to the most complex such as conscious thought.  Outside of class, I learned to balance 30+ credit hours, studying, open labs, sleeping, making new friends (part of which involved becoming a member of the world’s oldest chiropractic organization, the Sigma Phi Chi Sorority), and adapting to a new area of the country and a new city.  While I lived in the largest city in Montana during my undergraduate years (about 90,000 people), moving to the quad cities area of about 400,000 people was still an adjustment (pun not intended).  My first Midwest winter was nothing short of a system shock and I think I called home every week with a new eye witness description of weather accounts!  P.S. Freezing rain is something you would never believe until you see it, it is beautiful!

In my second year of Palmer, learning patient assessment became more of the focus with classes in physical diagnosis, radiology, orthopedic testing and chiropractic evaluation/techniques.  Through these, I learned the balance of using knowledge of anatomy and proper function to gain information from the body.  I learned the balance between doing a quick exam and still doing a thorough exam without cutting corners.  I learned how to balance x-ray spinographic analysis and instrumentation with what patients physically present with.  Outside of the classroom I had lessons in balancing relationships and school.  I learned that as rigorous as the curriculum was, I still needed to spend time with the people I love and care for and to make sure they knew they were still an important part of my life.  I learned to balance extra-curricular activities as well.  I joined the Campus Guides organization on campus through which my understanding of the history of chiropractic and the significance of our campus as the fountainhead of chiropractic was deepened and enriched.  Coming from a medical background previously before Palmer, I often had many internal struggles with how my new view on healthcare fit into my definition of healthcare and I had to learn how to let go of my qualms with some of the extreme viewpoints out there in chiropractic and accept that my model of chiropractic is just as valid as anyone else’s.  I learned that while I have been exposed to many different viewpoints on what chiropractic is, what it is not, and how it should be utilized, I do not have to take any of those viewpoints as dogma.  Chiropractic philosophy comes from within just as innate does.  You don’t have to build it, it is already there – you only have to find it within yourself.

The third year is the transition from classroom to clinic.  This portion of the curriculum has been the most eye-opening for me.  Now, I am learning to balance being a technician with being a doctor.  I am learning to connect the dots between my basic science classes (such as anatomy), patient presentation, and how I will treat that patient based upon those two factors.  I am learning when to talk to patients and when to shut my mouth, observe and listen.  I am learning to talk with patients and not at them.  I am learning to think on my feet about what the patient is presenting with as they describe it and how I will narrow down the growing list of differentials in my head while still paying attention to what the patient tells me verbally and physically.  The most impactful lesson I am learning now is to trust the knowledge and skills I have acquired the last two years and to be more confident in myself and my abilities.  Outside of class I am learning to reconnect with the world and get out of student mode.  I am learning to open doors and make opportunities for myself and my future.  And I am learning to balance my ultimate goals and ambitions with the process that is needed to achieve them.

So back to this concept of balance and what I have learned here at Palmer College of Chiropractic…Chiropractic seeks to restore balance within the body so that balance outside of the body may be achieved.  Don’t forget that as you plow through your years at Palmer.  Remember to play, laugh, love and relax; otherwise no matter how “well adjusted” you are, you are wasting the gift your innate is giving you.

Alicia Ruiz, 9th Trimester Student
Davenport Campus