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Monday, March 24, 2014

Selected Works II: Psychiatry-- because psychologists are dumb

Class: Eng 101
Assignment: What I want to be 
Grade: 92/100

Neuropsychiatry: Because Psychologists are losers
In May 2009, I was hired into the management training program at a local grocery store. I felt on top of the world. No longer would I be without a job, and the job I had was full of promise; however, in July 2011 my personal “cloud nine” fell to earth. I lost my job at the store, which was on its way to closing. I had no Idea what I would do, and my mind was too clouded for me to think of any viable options. I quickly took a job at Chick-Fil-A, hoping to work my way up to manager; meanwhile, my mind continued to wander, searching for something that felt correct, which I knew wouldn’t be Chick-Fil-A. As my mind continued to wander, I kept coming back to something I had only considered in passing beforehand: Neuropsychiatry.
                I have always had somewhat of a passive interest in Neuropsychiatry: from the time I was undergoing treatments as a child for learning disabilities, to my treatment for MDD and anxiety as a teenager, I always felt drawn to the field. The psychiatrists I’ve dealt with had left huge impressions on me about how wonderful psychiatrists truly are.  All three of my psychiatrists were been wonderful, caring, and intelligent people-- exactly how I had always envisioned myself as an adult.  Dr. Otto, the
first psychiatrist who treated me, was much kinder than I had expected. He took the time to explain everything about the neurology of ADD, and we was intuitive enough to know that I was smart enough to understand it. Dr. Pam, who was completing her fellowship under Dr. Otto, immediately came across as a sweet and gentile person. She would ask so many questions, wanting to know more about me than just my learning disabilities; she even gave my mom and me advice on how to get rid of some pests that had found their way into our house. Dr. Oh was the first doctor who was able to find the right treatment for my MDD and social anxiety. Instead of just drugging me up like most psychiatrist would do, he took almost an hour talking with me, getting to know all of me, and was smart enough to know what drugs to use when and when to use alternative means, such as psychotherapy. As I came to know my doctors, and began reflecting on the qualities that they put out, I began to feel like I should be just like them; I felt that I should use my natural intuition and caring nature to help others like they do. I began more and more to want to be a psychotherapist.
                As I began to think about what exactly I wanted to do, I thought of several ideas, including child/adolescent psychotherapy and addiction therapy. For a long time, I felt that I should pursue an undergraduate, graduate and Ph.D. in phycology; it gave me a clear road, and It was easy to accomplish. All I would need to do was get started by going to school. Graduate programs were aplenty enough, and I didn’t really need a Ph.D. to practice addiction medicine. I began researching different psychology programs across the country, and I began to educate myself on the different types of psychologists that existed.  But as I continued my learning and thought about exactly what it was I wanted to accomplish, I realized I was looking in the right direction, but I was a bit off; I am better suited for psychiatry. I wanted to treat people medically, and have means available to me that psychologists don’t, such as pharmaceuticals. While often confused, I learned that psychology and psychiatry differ in two fundamental ways: psychology is the general study of behavior, and can include things such as family counseling; inversely, psychiatry is strictly the study of abnormal behavior, and doesn’t include general counseling. Also, a psychologist is someone with a degree in psychology; a psychiatrist is, as mentioned earlier, a physician. A psychiatrist is either an MD or DO, meaning he has completed four years of medical school, and then completed a residency in psychiatry, possibly followed by a fellowship in some sub-specialty like forensics or addiction medicine. The main advantage of being an MD is I would get to use medications in my treatments. Medications were a vital part of my own treatments, and as such, I am a big believer is the use of medications is the treatment of psychiatric and neurological disorders. When I had my first appointment with Dr. Oh, he put me on a regiment of Prozac and Welbutrin.  The effect took some time, but as they slowly built up in my system, I began to notice changes in the way things affected me. I slept better; I felt happier; I enjoyed being around my friends again. Because of my experience with the positive effects on these medications, I’ve become a big believer in the place pharmaceuticals have in healing of both mind and body, for conditions such as MDD are both a psychological and neurological.
As I continued researching psychiatry, I began making a mental checklist of the things I needed to accomplish before, and during, my undergraduate years. Because of the difficulties involved in Medical school, physical, emotional and mental, the admissions committees for most med schools want to make sure the people they select are genuinely interested in medicine as well as genuinely capable of handling medical school. There are almost three applicants per one medical school opening every year, so the admissions committees don’t want someone who couldn’t make it taking the place of someone who could. One of the things medical schools look at is clinical exposure: how much time has an applicant actually spent around people in a medical setting? Another aspect they look at is research. Almost all medical schools are large parts of the medical research community, and it’s vital that the students conducting the research have experience with how those kinds of things are done. Another
aspect of the application is community involvement. Long gone are the days of physicians who are simply physicians; todays doctors must be active, vitals pieces to the community as a whole. When admissions look at med school applications, they want the applicants to show that they genuinely want to be a part of a community and not simply to be the doctors of a by-gone era when doctors were above, and better than those they treated; likewise, they want applicants to be capable of being modern doctors. They want people who have real experience with the things doctors do.
In order to be a competitive applicant, I immediately began looking for ways to gain clinical exposure. One of the most common methods is shadowing. I had a friend who worked the E.R. at the local hospital, so I took an opportunity to shadow him during one of his shifts. While most of the patients we saw were, one could say boring cases, I did some first-hand experience with a patient showing the signs of psychosis. He had attempted suicide, and eventually had to be tied to his bed. During my time, I also saw the ugly side of medicine in regards to mental health. While my friend is a more than competent physician, he, and the nursing staff, treated the psychosis patient with complete apathy.  I later learned this is usually the case, and even some psychiatrists can behave similarly. While this startled me, I came away knowing even more that I needed to be different. While I certainly don’t have delusions of grandeur, I feel like the man in the starfish analogy-- I can’t help them all, but to the ones I do help, it makes a difference. As I reflect on the little experience I gained from that, I know that it will be useful to me as I pursue my dream of making the difference in people’s lives.
Aside Shadowing, I have the opportunity to fulfil other med school requirements here at BYU-I. BYU-I offers me the availability of all my non-academic prerequisites nearby. One of the classes I am required to take for my Neurobiology degree is a research course, which will also give me research hours I can put on my application. Likewise, there is a lot tons of opportunity on campus for me to shadow            
physicians at the Student Health Center, and various physicians around the Rexburg area. On top of that, the school offers many groups, clubs, and service opportunities that I can use to put on my application to medical school. These opportunities, as I use them, add experience that will help me prove to admissions committees that I am able to meet and exceed the demands of medical school, and a career as any time of physician.
The most important aspect of a med school application is academics. More than anything, admissions committees want to know that those whom they accept can handle the rigors of med school. Once a person fails out of Med School, they don’t get another chance; likewise, they took the spot of someone who may have made it all the way through. In order to have a good shot at being accepted, I would need to maintain a minimum GPA around 3.8 or so, and an MCAT of around 35. The average GPA for my first choice med school, the Florida State University College of Medicine, is a 3.6 and an MCAT of 29; however, that includes minority students who get in with less-competitive applications, but have affirmative action to back them up. My intentions are to graduate with a 4.0, making myself even more distinguished from the competition. While that seems far-fetched, I know it’s possible. My acquaintance  Kate recently graduated from BYU-I with a 4.0, and know of others that have as well. I’ve also chosen to take tougher classes to fulfil the academic prerequisites. Instead of taking application of physics to fulfil my physics requirement, I am taking a calculus-based physics. Admissions weigh the difficulty of courses when considering applications, and a calculus-based physics class will certainly be worth more in that light than a 101 physics course. Irrespective of exactly which courses I take, I still have to maintain a high GPA. While I intend to graduate with a 4.0 GPA, I cannot be so fixated on that goal that I lose hope simply with one grade that what could have been a 3.9 instead becomes a 2.9.

Perhaps keeping in mind my experiences as a youngling will be what it takes for me make it all the way through medical school and residency. It was my own treatments that encouraged me to pursue Neuropsychiatry after all. I know that I would be happy being the type of person my psychiatrists are. Pushing through my clinicals, putting in hours of community work, hours of research, and rigorous academics certainly are not appealing in and of themselves, but they are the means to an end: Dr. Joshua Aaron Pillow, MD

Friday, March 14, 2014

New Series: Selected works

So, since I never write anymore, I'm gonna do something that I think is awesome. It's called Selected Works. Basically, I'm gonna post my essays for school that I think are pretty awesome. Feel Free to critique.

Selected Works, Episode I
Angiogensis Inhibitors 
Class: Bio 199
Assignment: 700-900 word essay on the documentary "cancer warriors"
Grade Received: 99/100

The History and Development of Endostatin as an Angiogenesis Inhibitor
Joshua A Pillow
Brigham Young University- Idaho
                When the US military developed its first nuclear submarine, they were faced with the problem of how to store blood long-term. At the time, human blood could not be stored for more than three weeks, which was significantly shorter than the 6 months that nuclear submarines were to be deployed. The military recruited several physicians to research the viability of reconstituted RBCs. While the experiment with reconstituted RBCs was successful, one of the physicians working on the project, Dr. Judah Folkman, made an observation, and that observation has led to possible improvements in the treatment of cancer: Angiogenesis Inhibitors.
                While working on the RBC project with the US military, Dr. Folkman added tumor cells to the thyroid gland that was being experimented on. He observed that the cells did not grow any larger. Thinking that they might be dead, he extracted the cells and put them in a mouse, where they immediately began to grow again. Dr. Folkman was curious about what would cause this. As he continued through his career as a surgeon, he noticed that every time he would remove a tumor from a patient, the tumor would be unusually bloody and be surrounded by blood vessels. This lead Dr. Folkman to hypothesize that cancer cells produced a protein that causes blood vessels to form around the tumor, giving it enough blood to grow rapidly. This idea was almost universally rejected. In order to prove that angiogenesis (the process of growing new blood vessels) was real, he devised an experiment. He placed a small sample of a tumor in the cornea of a rat’s eye. Because the cornea contains no blood vessels, this would prove that the presence of blood vessels around tumors was not coincidence. Not long after planting the tumor into the rat’s cornea, blood vessels began growing into the cornea towards the tumor. Immediately, the doubters turned into colleagues.
                The next task then turned to identifying the individual protein complex that caused the angiogenesis. It took over ten years before the protein was identified. They proved that it was the correct protein by placing a packet of it in a rat’s cornea, simulating the effect of a tumor cell, causing angiogenesis. Now that the researchers knew what was causing the angiogenesis, they needed to identify a way of combating it. They thought about bone marrow: because bone marrow contains blood vessels early on, but quickly loses all of its blood vessels, they figured that the answer to angiogenesis inhibitors must be hidden in the proteins of bone marrow. Researchers spent countless hours scraping bone marrow from bovine bones, and searching for an angiogenesis inhibitor. Eventually, they found one. The then placed a packet of the protein that caused the angiogenesis inside a cornea along with a packet containing the inhibitor. Blood vessels began growing, but stopped once they reached the inhibitor packet.
                Next came the search for an angiogenesis inhibiter that worked more often. One researcher found one in a drug that was used a few decades earlier, Thalidomide. When Thalidomide was metabolized and then placed in a chicken embryo, the blood vessels in the chicken embryo bypassed the area when the Thalidomide was placed, proving that it is an angiogenesis inhibitor. Researchers then turned to developing new inhibitors, and eventually landed with Endostatin. Like other angiogenesis inhibitors, Endostatin differs from traditional chemotherapy in that it isn’t a poison- it simply stops the tumors from growing new blood vessels, limiting their ability to grow.            
                Endostatin when into stage I trials. There were thousands of people who signed up to receive the treatment. One of those picked was Duane Gray, who had advanced stage lung cancer. Duane, as well as 14 other participants in the stage I trial, were removed after their cancer grew beyond the guidelines set for trial. Sadly, he passed away from his cancer in 2009.

                Through all three phases of the trials, Endostatin proved to be only marginally effective as a monotherapeutic treatment for various cancers; however, it did prove extremely valuable in one criteria: unlike traditional chemotherapy, the cancer cells were unable to mutate a resistance to the Endostatin, which has always been a major cause of the overall ineffectiveness of traditional chemotherapy. Research on Endostatin still continues, and has expanded to include various other fields such as autoimmune diseases like arthritis and Crohn’s Disease. 

Next week: Selected Works, Episode II: Neuropsychiatry: Because Psychologists are Losers