Toilet Training, Beta Blockers, and Butterscotch

Well, folks, another few weeks have flown by and I’m still fighting the good fight and all that. We finished up our first module, Foundations in Medicine, and moved on to the second, Genetics & Neoplasia. The final exam (part two) is tomorrow morning and of course, that’s in just about five hours from now and I have studying/caffeine induced insomnia–oh joy! So I figured I’d use these wee hours of the morning to update my HUGE fanbase on my WILDLY EXCITING life.

The highlight of my intellectual week: targeted therapies in cancers part 3. Yeah, it’s a 3 part series; I can’t write small enough to get it all up at once! Aren’t you mad jealous of my day?

First let me explain a little about how our curriculum works here. Instead of taking several different courses concurrently throughout the semester culminating in a week of final exams before winter break (like, say, in college…or like anywhere….ever), we take one course at a time, cramming all the material into a few weeks before taking the final. Afterward we move on to the next course. These 4 to 8 week blocks of time are called “modules.” Foundations of Medicine, the first module, was 8 weeks long and included a lot of seemingly random bits of information (Biochemistry being the focus, but also clinical introduction, professionalism, patient encounters, problem based learning sessions, metabolism, basic genetics concepts, and disparities in health care) that was intended to form the “foundation” of the “art and science” of medicine upon which all of our subsequent modules would build. In retrospect, it probably has done just that, although it seemed disjointed at times when I talked to med student friends at other schools who were taking Biochem, Histology, Genetics, Clinical Medicine, and Whatever else. I actually like the module format despite the fact that I basically have an anxiety induced final exam every four weeks or so and it really limits my ability to plan anything! Essentially the only free weekends are the ones immediately following an exam and they get progressively less available as the next one rolls around. I feel pretty guilty telling people ‘no, I totally can’t hang out this weekend…I have to study.” But I’m getting used to it…because it’s very nearly literally ALL THE TIME.

This module (the one I should be preparing for the final exam for by SLEEPING right now) is Genetics & Neoplasia (or Gen-Neo) has been not as biochemically strenuous as the last one and I’m actually a little frustrated. It’s a short module, just 4 weeks, but I feel like we could have really been made to sweat with many cancer pathways and hundreds of drug names and pharmacological mechanisms…but maybe memorizing 50 drugs and only half a million details of neoplasms is effective, especially when the knowledge that the next module is REALLY HARD is creeping up on me. Inflammation and Immunity (or “I2” as it’s creatively known), is supposedly a tricky one with lots of pathway memorization; at least it’s also 4 weeks. After that, we are officially going to be moving onto systems based lectures, starting with Cardiopulmonary which will carry us through past the couple weeks of winter break. I’m actually looking forward to I2; I like a challenge and getting excited by immunology is genetic (Hi, Dad!).

Well, here’s a little nerd alert from FOM: One of the coolest things we focused a lot on during FOM (and obviously, in Gen-Neo, too) is various signal transduction pathways. Basically, guys, signal transduction is why biology happens, and it’s way fun to know exactly what a Ras protein is and how it can induce the constitutive signaling of a growth factor pathway by a mutation inhibiting its GTP-hydrolyzing activity (the most common defect in oncogenes in human cancers! Who can tell me the most common defect in tumor suppressor genes in human cancers? Ooh, a nerd challenge!). Anyway, the process of a signal leading to a functional action by a cell through various pathways is central to everything. In FOM we learned that the Beta Adrenergic Receptor (a G-protein Coupled Receptor-GPCR) is activated by the neurotransmitters norepinephrine and epinephrine. These guys act as “ligands,” or “binding proteins” for the receptor. When they bind, it causes a conformational change in the receptor that activates the intracellular attached protein, the G-protein. This G-protein is made up of several different subunits; one of them is the alpha protein and it is functionally equivalent to Ras protein mentioned above. It is activated by a GDP to GTP transfer from a GEF (sorry, I know this is already way too much information for anyone who actually cares but at this point I’m on a roll and it’s actually mildly relevant to my test tomorrow…mildly). The activated G-alpha activates an effector protein called adenylate cyclase which helps transform ATP to cAMP and cAMP (a so called “second messager”) activates Protein Kinase A (PKA) which leads to an increase in calcium levels in the cell (by doing several things that I’m not going to elaborate right now). Increased Ca++ levels are directly linked to increased cardiac output, heart rate, breathing rate and other feelings associated with the fight or flight systemic response. Which makes sense because the ligands are essentially ADRENALINE. This racing heart stuff is normal most of the time, but sometimes pathological (severe stage fright, immediately following a myocardial infarction-heart attack), so sometimes it needs to be shut down. BETA BLOCKERS (Beta-Adrenergic Antagonists like atenolol) compete against the catacholamines and “block” the beta receptor. This leads to a decrease in cAMP upregulation of calcium and a lowering of heart rate and cardiac output. Whew, I feel like I could use a beta blocker right now…as it’s 4am and my TEST IS IN FOUR HOURS AND IT’S NOT EVEN OVER ANYTHING RELATED TO BETA BLOCKERS OMG.

Ok, well, that was just way too much information. I think I’m going to keep the next two parts of this post short and sweet (respectively).

SHORT:

CALLIE IS POTTY TRAINING. Yes, we’re using the Citti Kitty and she will be a toilet trained cat if it’s the last thing I do. We are officially on Day 13, and it’s been 5 days since our last accident. This process is actually pretty hilarious, so hopefully I’ll be able to get on here and give you some updates.

She definitely uses it now, but she could revert at any moment to floor pooping. Note the red duct taped lid…so no one closes her litter box…which would result in the inevitable return to said floor pooping.

Pic showing the different rings as Cal sniffs around, suspicious. We’ve removed the first ring (which was way too big for Callie, so we put the plastic insert underneath-see next pic). Today I cut away a bit more of the second ring, tomorrow I’m planning on taking it half out. The litter is flushable, which is good because she scratches pounds of that stuff down the hole.

This is the extra insert that has 1/2 sized rings for slow learning kittehs or ones that need to go back a step. When I realized I could just put it down beneath the main seat I probably saved myself hundreds of dollars of kitty litter that would have been scratched down the drain. Now I can just dump the clean litter that falls back into the main dish on top. In this pic I’ve taken out the tiniest ring just to reintroduce her to the idea that there is water under there. I’ll take out the next ring when I remove the full second ring from the top tray (set for Monday-1 week accident free!)

As far as SWEET goes:

I had a brief and glorious time a couple weeks ago where I remembered how much I loved to bake and actually ended up making a pumpkin tiramisu pie (some of which went to a pediatrics group bake sale) and pumpkin-butterscotch cupcakes (most of which ended up staying with me…haha). I also made some homemade butterscotch sauce which Colt and I then ate on top of everything from waffles (pumpkin-cinnamon flavored naturally) to icecream. I’m pretty sure I had some on ramen. I’m kidding (or am I?). Enjoy the random photos; I am so totally going to bed now…hopefully three hours will be sufficient!

~E ❤

PUMPKIN-TIRAMISU-DELICIOUS PIE

Kitchen Aid handmixer mixing up some pie stuff…yummy

making butterscotch is a delicate process that involves lots of brown sugar and little taste tests

not your average cupcake (have you ever heard of Biscoff?!)

pumpkin waffles with butterscotch sauce and pecans with some hazelnut coffee…made in my birthday present Keurig coffee maker whatup

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