The Final Countdown: Approaching the Days Leading Up to the APMLE Part 1

The Final Countdown: Approaching the Days Leading Up to the APMLE Part 1

The important thing to know is that you have prepared your best for this exam. You have what it takes to succeed. You should be proud of the effort you have put into studying and preparing for this exam. You’re now one step closer to becoming a great future podiatric physician.

The best advice I can give for a student in their last few days of exam preparation is to stick with what works for you. This applies to not only your trusted study materials, but also to your diet, sleep, exercise, and relationships. Be confident that the last two years of strenuous studying will be more beneficial than whatever you learn in the last week, and be reminded that it is statistically more likely for you to pass than to not. That said, whether you pass or you do not pass on your first attempt, becoming an excellent podiatrist is a goal you can still achieve.

Extinguishing Burnout in Medical and Graduate Schools

Extinguishing Burnout in Medical and Graduate Schools

Mental exhaustion, loss of motivation, and self-doubt are no strangers to medical or graduate school students. Many individuals come into higher education already expecting to endure the struggles necessary to graduate and attain their lofty career goals. While trading relaxation for academic success can be a noble undertaking, being in this high-stress environment without the proper work-life balance and mindset can have dire consequences. These settings often facilitate a culture that links productivity and academic achievement to self-worth, making it easy for students to internalize these beliefs and cause them to overwork themselves. This is a slippery slope that can lead to symptoms of burnout and chronic stress which continue to be increasing concerns among students of higher learning education.

Mindset is everything

Mindset is everything

Within a few months the medication had started to fail me, but I pushed forward, ignoring the signals my body sent me. This was a mistake, there’s no shame in reaching out for help, there’s no shame in your illness and that’s something it would take me a year at WesternU to realize.

Podiatry versus Orthopedic Surgery By Alex Dang

Patients are often stuck between deciding to see a podiatrist versus an orthopedic surgeon for their foot and ankle care. Not many are familiar with podiatry since it is still a new field of medicine, so why choose podiatry over orthopedics or vice versa? What are the differences in skills and education between the two specialties? What are some everyday things that a podiatrist versus an orthopedist treats? Are outcomes generally better between one profession over the other? Are risks higher when treated by a podiatrist versus an orthopedist? This article hopes to serve the purpose of answering these questions and to compare and contrast the two specialties to help assist patients in their decision making.  

An orthopod or an orthopedic surgeon who specializes in foot and ankle goes to a U.S. M.D. or D.O. school for four years, matches into a residency in orthopedic surgery for five years, then a two years fellowship in foot and ankle surgery. Even with a specialty in foot and ankle, they could still treat the whole body without any licensing restrictions. Orthopedic surgeons work in hospitals, clinics in the same specialty practice, or a multispecialty group. They often treat conditions related to bone injuries and malformation, muscle and joint pain, or musculoskeletal conditions. Some common procedures orthopedic surgeons perform include Achilles’ tendon repair, ankle replacement, and ankle arthroscopy. Due to the nature of their unrestricted license, they can also do knee replacement, carpal tunnel release, and hip replacement. 

On the other hand, a podiatrist or a podiatric surgeon goes to a U.S. Podiatric medical school for four years, then an additional three years of podiatric residency. There are an additional 1-2 years of fellowships for those who wish to further their education. Radiology, dermatology, wound care, sports medicine, and orthopedic care through footwear, orthotics or prosthetic devices are some of the subspecialties for podiatry. Podiatrists are specialized since day 1 of school and are restricted to treat only the foot and ankle. However, license restrictions are varied between states. Similar to orthopedic surgeons, podiatrists can work in hospitals, multispecialty groups, or open their own practice. Podiatrists do a plethora of procedures: ranging from lower extremity reconstructive surgery, various lower extremity wound care, diabetic foot care to ingrown toenail avulsion and callus debridement. 

Several studies were done to assess surgical outcomes when performed by an orthopedic surgeon versus a podiatrist. One study on 11,115 patients performed by an orthopedic surgeon and 630 patients performed by a podiatrist showed no significant difference (p<.05) for the rate of post-op complication following an ankle fracture fixation (Chen et al.). Another study on 3674 patients for total ankle arthroplasty and 4980 patients for ankle arthrodesis showed no significant difference in the outcome, post-op complication, infection, or duration of hospital stay when performed by a podiatrist versus an orthopedic surgeon (Chan et al.). It is down to the patient’s preference to decide whether or not they want to see an orthopedic surgeon or a podiatrist for their foot and ankle care.

Sources: 

  1. Chan JY, Truntzer JN, Gardner MJ, Bishop JA. Lower complication rate following ankle fracture fixation by orthopaedic surgeons versus podiatrists. Journal of American Academy of Orthopedic Surgery. 2019; 27(16): 607-612. 

  2. Chan JJ, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E. Surgeon type and outcomes after inpatient ankle arthrodesis and total ankle arthrosplasty: a retrospective cohort study using the nationwide premier healthcare claims database. The Journal of Bone and Joint Surgery. 2019; 101(2): 127-135

  3. Foot problems and the podiatrist. National Health Service. 2018. 

  4. Levrio J. Podiatric medicine: a current assessment. Journal of American Podiatric Medical Association. 2009; 99(1): 65-72.

  5. What is an orthopedic doctor? University of Utah. 2020.

Barefoot in Hawaii By Alyssa Miyasato and Jonathan Ibanez

The island paradise of Hawaii is known for many things; its beautiful beaches, the local food, the adventurous hikes are just a few. One thing however that Hawaii is lesser known for is its’ fashion, specifically, the local population’s love of slippers (flip-flops) and their love of walking around barefoot. The most popular brand of slippers in Hawaii is a brand called “Locals”. These are made of a flat rubber material with a translucent plastic band to hold your foot in place. With the majority of the population wearing “locals” or walking barefoot for most of their lives, the likelihood of acquiring foot problems is extremely high.

Pyramid Rock, Kaneohe Hawaii

Pyramid Rock, Kaneohe Hawaii

The population of the Hawaiian Islands is estimated at 1,415,872 people (1) with 15 practicing podiatrists currently in Hawaii (2). Hawaii is one of the states with the lowest number of podiatric professionals but has one of the highest demands due to the walking lifestyle of the local population. This lifestyle has become common from the time of immigrants working on the Hawaiian sugar cane plantations (3).

Sugar cane cutting, Kauai, Hawaii, 1932 (4)

Sugar cane cutting, Kauai, Hawaii, 1932 (4)

The prevalence of foot problems in Hawaii can be seen by looking at a local podiatrist owned company. The Ultimate Foot Store is a locally owned company that specializes in selling arch supports, supportive sandals and shoes, and other foot specialty items. The company is owned by a local podiatrist, Dr. Gregory Morris, who works out of Queen Liliʻuokalani Medical Center’s physician offices (5). The company started off in 2010 with one location, however, the popularity of supportive footwear among the locals has spread to the point where the company now has 6 locations throughout the island. With each location carrying everything from foot rollers to Hoka One One running shoes and Birkenstocks, it’s clear that the population of Hawaii had taken an interest in supportive footwear.

The Ultimate Foot Store at Ka Makana Alii in Kapolei (6)

The Ultimate Foot Store at Ka Makana Alii in Kapolei (6)

To get an idea of how the local population has been affected, one of the companies repeat customers, Terri Wong, was interviewed outside of the pearl-ridge mall uptown location. Terri is a 54-year-old mother of two and is a patient of Dr. Morris. She had stated. “I’ve had plantar fasciitis for years and didn’t know it, I just thought I had bad feet. You wear “Locals” your whole life and no one says nothing, but when you get to be my age you realize how important your feet are. I bought some of those slippers here and it wasn’t a miracle cure, but it’s making each day possible for me”. Her sentiment on the effect of supportive slippers seems to be shared as one of the store managers; John Gorman stated “Our job is to help the local community get supportive footwear to improve their lifestyle, we’re here to help and it’s clear that there’s a large demand. Nothing is a quick fix, but we’re educating the public that there are options.” In a place that’s 24 times smaller than California but with a population of over a million people (7), the amount of podiatric professionals we have is not enough to educate and treat a population whose culture is to walk around barefoot. So maybe one day, if you’re looking for somewhere with a beautiful view of the ocean to work, consider Hawaii “Makemake wau e ʻike koke iā ʻoe, ma nā kahakai o Hawaii” (Translation:I hope to see you soon, on the beaches of Hawaii)

Reference:

(1)Census. (2019, December 30). Retrieved from https://census.hawaii.gov/.

(2)O'ahu Doctors: Foot Doctors in O'ahu, Hawaii. (2018). Retrieved from https://podiatristshawaii.com/oahu-doctors/.

(3)History of Labor in Hawai‘i. (n.d.). Retrieved from https://www.hawaii.edu/uhwo/clear/home/HawaiiLaborHistory.html.

(4)“The Hawaii Nisei Story Americans of Japanese Ancestry During WWII.” Sugar Cane Cutting, Kauai , Library of Congress., http://nisei.hawaii.edu/object/io_1168534833171.html.

(5)Morris, G. (n.d.). Honolulu Podiatrist - Dr Gregory Morris, DPM - Foot Doctor Honolulu and Aiea, HI. Retrieved from https://www.drgregmorris.com/

(6)Silva, Brian. “Do Your Feet A Favor...” Eleve8 Hawaii , Elev8 Hawaii , 29 May 2017, https://www.elev8hawaii.com/single-post/2017/05/24/Do-Your-Feet-A-Favor.

(7)“Size of Hawaii Compared to California.” MyLifeElsewhere , https://www.mylifeelsewhere.com/state-size-comparison/hawaii-usa/california-usa.

What's in a name? By Eduardo Glass

What's in a name?

I've gotten various pronunciations and spellings of my name over the years. Eventually, I just fell back to any nickname of Ed to not bother people over introductions, Eddie my most common pick.

Eddie G, the silly guy in high school.

If it was up to my dad, I would have just been named Nelson. But my mom had different plans than a George Foreman kinda deal.

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Eduardo Francisco Mendez Vargas, my grandfather, my namesake.

I never got a chance to meet you, cancer took you away before I was ever even in the picture.

You met my dad though. You were remembered as a very kind and compassionate man; almost everyone in San Pedro back then knew who you were even if it was a small town at the time.

You made 3 best friends for life who all stuck by each other, right until your death. They said you 4 were a force. You went out of your way to help people; you always wished you could have done better to put your 12 children through college. Never was enough I guess?

My mom was a silly little girl one day, and played hide and seek where she shouldn't have. She ended up majorly lacerating the medial side of her right foot, you were away getting things done for your little brush business.

It was pretty bad, right to bone, right across the whole foot.

Her grandmother saw to pack the wound with ground coffee to stop the bleeding, there wasn't much then. The closest hospital was in the capital, about 30 minutes by bus? San Pedro, your town, had no transportation back then. The closest bus stop was in Coronado.

You got back late that night from work, you weren't happy. That wasn't good enough, your daughter needed to go to the hospital. She could lose her leg. Your family was saying it was way too far of a walk to catch the bus in Coronado, let alone San Jose.

That didn't stop you. You took my mom and put her over your shoulders, and you walked to catch the earliest bus in Coronado and trekked to the capital. The docs took a look, it wasn't gonna be a simple sew job. Contaminated open wound, going for quite a few hours now.

They needed you to keep coming back for aggressive wound care.

So you made the same hike every other day to the capital to get your daughter her care, while balancing work. A perk of self-owned businesses.

Whatever they did in San Jose worked, my mom still has her foot. The scar is still there to this day. Quite a few stories defined who you were. Your children still think about you and miss you.

Mom remembers the most important thing you taught her:

"Be humble; don't pretend to be something you aren't, always carry what you feel in your heart and be honest with yourself."

Bernardo Mendez and Catalina Vargas passed this on to you, whom you passed on to my mother who passed it on to me.

At my lowest points, I always go back to what has been ingrained in me, in my name. I stumble here and there, but if I can live up to even a fraction of what went into my name, I will be content. It’s almost like a hand pushing me forward when I can’t budge anymore. 

As I look at the profession I have chosen, I look back to this story of my grandfather and my mother. This journey we students chose is long and unforgiving to our wellbeing and the chaos that life can bring. The delayed gratification, the pursuit of performance for the well-being of our patients. At times, even demanding that we put a mask over our struggles. To anyone outside this field, it could be easily interpreted as selfish or self-centered. The only ones who truly understand what we go through is our own classmates and mentors. This point, in my belief, makes it crucial that we all try our best to be supportive of each other. You never know what someone is going through outside of our medical bubble. Physicians have to wear masks for our patients after all. But that doesn’t mean we are barred from seeking help either.

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What’s in a name?

Sometimes a memory of which to follow. A wildcard that simply can't be taken from you, no matter how hard life tries.

I like my name, maybe I should go by it more often.

Mental Burnout in Medical School By Tracie Shaw

I’ve toiled with mental health problems most of my adolescent life. I sought professional help before and was able to keep the battle at bay. I thought I had control of my symptoms, but to my surprise, anxiety, and depression still debilitated my ability to focus during medical school. At the start of my medical journey, I was still unaware and unable to recognize, diagnose and treat my already established condition. I ignored what I was physically and mentally feeling and attempted to plow through, not dealing with the matter at hand but, instead, putting a bandage on the situation. My ignorance of my mental health impaired my ability to focus on my education.

I understood that part of medical school is learning how to juggle academics with your outside and social life. Everyone is exhausted, moody, unfocused and loses time and interest in some of their hobbies due to the stressors medical school is known for having. I figured this was part of what I was feeling. There is such a stigma of depression and mental health problems in our society. This culture has made me question my mental health diagnosis. Do I even have depression or just severe medical school exhaustion? Going into a career that encompasses taking care of the well-being of others shouldn’t come at the expense of our own mental health. I am not here to tell you the solution to this issue. However, I do have tips that worked for me. There are some things I learned along the way to help me cope with my mental illness: staying active, nutrition, sleep, and seeking help.

STAY ACTIVE. After a workout, I feel energetic, positive, like I have control over some aspect of my life. Academics should always be the priority, however, as long as you set a routine and stick to it, you can always find time to fit in a couple of workouts.

SLEEP. Inevitably, in medical school, there will be those days where you will be up late studying for a big exam or working on a project. I lose sleep over a poor test result or bad performance on my part. Despite all this, getting as much sleep as you can is extremely important. It makes all the difference the next day. Getting sufficient rest clears my mind. Like after a workout, a good night’s rest makes me feel more energetic and helps me perform better in class.

NUTRITION. Eating healthy is difficult, especially on a tight medical school budget. However, it’s important to make sure you’re eating and eating well. Diversify your palate, eat your fruits, veggies, protein; cover all the foods in the pyramid. Make sure to take care of yourself in order to perform the best you can.

SEEK HELP. As future practitioners, we should understand that we are not invincible, we need just as much medical attention as any other individual. Find help when you do need it. Going to therapy can help you learn to deal with your anxiety and depression. Most importantly, they are there to LISTEN to you. For me, most of the time I just need someone who is willing to sit there and let me rant about my situation and I feel liberated after doing so. Medical school should not be an extra challenge due to your anxiety and depression or any other mental illness you may have. Sometimes just seeking some professional help and making some lifestyle changes is your solution.

Humanity’s weakness is the inability to admit their weaknesses. We have to understand that we are all human. I admit to those weaknesses and I use it to my strength. My mental health will make me a better doctor. My anxiety allows me to understand what my patients are dealing with each time they come for a visit. I can empathize with the anxiety a patient must go through coming into the hospital, not knowing their results and unable to understand those results.

I hope this gets to everyone out there; every single student who feels they are alone in this journey. I hope my story can help those who have not been able to come forth with their situation. I hope sharing my story will help everyone else out there to face their own struggles, regardless of what it may be. My ignorance of my mental health briefly stumped my ability to focus on my academics and it took time and numerous pitfalls for me to readjust. I don’t have the answer to dealing with mental health issues while in medical school, but I am open about my struggles. Sharing it has brought me closer to some of my classmates. We all go through our own difficulties and we are all here to support one another. I accepted that I am not perfect, and I still work hard every day to deal with my mental health, but I won’t let it get in the way of my medical journey again.

THUMBNAIL CREDIT: Ali Blackwood Illustration

Preparing for the APMLE Part I By: Tien Nguyen, Salem Lebada, and Daliya Heng

Preparing for the APMLE Part I By: Tien Nguyen, Salem Lebada, and Daliya Heng

The American Podiatric Medical Licensing Examination Part I is the most difficult exam podiatric medical students face in their academic careers. There is a multitude of different strategies and resources utilized by students across the nation in preparation for the exam — this article is geared to depict a detailed look into three different students’ approaches to the APMLE Part I, with the intention to help give first and second year podiatric medical students insight on how to cultivate their own plan of action for the exam.

How to Succeed in Externships by Alexis Conley and Janae Pinckney

How to Succeed in Externships by Alexis Conley and Janae Pinckney

In preparation for the APMLE I board exam, all attention during spring semester of second year is focused on studying and passing the test. Before students have time to catch their breath, they are required to send in an application detailing where they hope to extern the following year. This leaves little time to gather and process vital information on which programs they might want to attend. To help students get the most out of this process, we interviewed fourth year podiatric students who have recently gone through this very application process. These students are currently externing at residency programs all over the country and had the following advice to share.

The Pod Fathers by Kira Cramer

The Pod Fathers by Kira Cramer

In medical school, mental fortitude and perseverance are routinely tested. It is a period characterized by growth both personally and academically. The first two years of medical school are dedicated to academics in preparation for the first board exam at the end of the second year. Students take exams, work on research, hold leadership positions, and volunteer.

CASE REPORT: NON-HEALING ACUTE HALLUX PARONYCHIA IN A PATIENT WITH PERIPHERAL ARTERIAL DISEASE, DIABETES MELLITUS TYPE 2, AND DIABETIC PERIPHERAL NEUROPATHY  BY NICOLE LAGSTEIN, MS-1 

Paronychia is an inflammation usually involving the lateral and proximal nail folds.  It may be acute (lasting six weeks or less) or chronic (lasting longer than six weeks).  There are multiple predisposing factors such as trauma, ingrown nail, peripheral arterial disease (PAD), and diabetes mellitus (DM).  Acute paronychia is typically caused by bacteria such as Staphylococcus aureusStreptococcus pyogenes, and Pseudomonas aeruginosaas well as other serotypes of Gram-negative bacteria. 

Post-CASPR/CRIP Interview Reflections – by Brittany Mammano

Post-CASPR/CRIP Interview Reflections – by Brittany Mammano

I gazed from the plane window, watching the city of Dallas come into view. My stomach was a pit of anxiety, aware that the fate of my career hinged on my academic and social interview performance in the coming week. As the plane landed, and throughout the whole week of crip, I still couldn’t shake the fear. But now! The weight has been lifted. Interview week at CASPR/CRIP has officially ended, and I hope to share the good and the bad.

Medical School Journey, Despite Lupus by Sahar Gholam

Medical School Journey, Despite Lupus by Sahar Gholam

For the past few years, I’ve been approached by friends and strangers who merely look at me and say “aww I’m sorry that you have Lupus” or “poor you” or anything along the lines of feeling sorry for me and my diagnosis.  Many of these people know the facts, that lupus is a systemic auto-immune disease that can manifest in any shape or form, ranging from a small infection to heart and kidney failure.

Diabetes Mellitus Type 2 by Samy Tabari

Diabetes Mellitus Type 2 by Samy Tabari

Type 2 diabetes mellitus, often referred to as simply “diabetes type 2,” occurs when your body cannot use insulin properly in response to your blood glucose levels becoming higher than normal. This phenomenon is called insulin resistance to hyperglycemia. Your pancreas first tries to make extra insulin to compensate, but, over time, it cannot keep up and does not make enough insulin to bring your blood glucose levels down….