Closed Case Friday: Intestinal Issues

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Diverticulitis

In our hypothetical situation, the physician would have seen evidence of an uncomplicated form of diverticulitis on the CT scan that she ordered, which led her to create the treatment plan described above. Diverticulitis is caused by the inflammation of diverticula, which are small, bulging pouches that can form in the lining of the intestines. These often form in the lower parts of the intestines (such as the colon). Diverticula are common in patients over the age of 40 and don't cause problems unless they become inflamed. If they do become inflamed, patients experience severe abdominal pain, typically on the lower left side of the abdomen (though it is more commonly felt on the lower right side in Asian patients), along with fever, nausea, constipation, and sometimes vomiting.

Mild cases of diverticulitis are typically treated with rest, temporary movement to a liquid diet to allow the intestines to heal before gradually increasing solid food intake, and changes in regular diet and exercise habits. These cases can be accompanied by infection, which may additionally require antibiotic treatment.

In complicated cases of diverticulitis, infections can progress to abscesses or peritonitis, scarring can lead to intestinal blockage, or fistulas can form between sections of bowel. The severity of those kinds of complications can require intravenous antibiotics, draining of abscesses, or surgical interventions, which involve either primary bowel resection or a resection with colostomy.

This condition can be prevented by managing diet and exercise to lower the risk of developing diverticula. Regular exercise, eating enough fiber, refraining from smoking, and drinking enough water can all help to lower your risk of developing diverticulitis.

Thanks for joining us for this week's Mystery Case and we hope to see you next semester!

2018 Fall Semester WALC Winner!

The moment that we have all been waiting for....

The Fall 2018 WALC Champion is:
Danielle Theis!

Danielle's cumulative score for the semester was an impressive 82.5 after collecting 28.5 points over the course of the semester and then picking up a solid 54 points during redemption week. Her feat has earned her a free t-shirt and a place on the Pre-Health Pathways Office's WALC of Fame.

Congratulations on winning this semester's WALC!

Thanks to all of the students who participated in WALC this semester! You can check out the semester rankings on our WALC Leaderboard page. Join us again next fall to compete for fame and glory (as well as for free candy and t-shirts).

See you again next fall!

FHSP Fundraiser TONIGHT!

Mystery Case Monday: Intestinal Issues

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Thought Questions:

What is the most likely diagnosis for this patient?

What causes this condition? How is it prevented?

What are the anatomical structures involved in this clinical issue?

What kind of surgical intervention would be needed if this condition progressed?

Leave your comments below and check back on Friday to see how our hypothetical patient was diagnosed!

U.S. Army Suture Lab & HPSP Information Session

Students show their sutured pigs' feet.
From left to right: Gabrielle Smith, Kaitlyn Dickinson, Alexia Hodgson, Kaelyn Kaul, Jordan Fostvedt, Kathryn Weyeneth, & Colin Jones.

Last night, seven of our SD Mines students gathered in the Chemical & Biological Engineering and Chemistry building to learn basic suturing from U.S. Army Health Care Recruiter, Sgt. Christopher L. Sturdevant.

Sergeant Sturdevant demonstrated the most fundamental technique for suturing as the students gathered around. Next, the students were given pieces of pigs' feet that had been cut to simulate a wound. They were then given sutures and allowed to practice suturing the "wound" using what they had just learned from the demonstration. Because of the small group size, students were able to ask questions and interact with Sgt. Sturdevant throughout the suture lab. A few of the students even got to experiment with using sutures with needles of different sizes and strings of different widths and made of different materials.

After the suture lab, students cleaned up before walking upstairs to enjoy free pizza and learn a little more about the Health Professions Scholarship Program (HPSP) that is offered by the U.S. Army for those interested in health professions. The HPSP offers many benefits for students, the most attractive of which is a full-ride scholarship through medical school. Medical schools cost students an average of $200,000 in tuition over four years. Students who earn the HPSP have their tuition and books covered by the U.S. Army (along with a generous living stipend of $2,000+/month) in exchange for a 4+ year commitment to practice in an Army facility after completing your training. There is also a $20,000 sign-on bonus for the program that is paid out over three years while you are in a medical program. While in residency and during the "payback" period, HPSP scholars do not have to purchase their own malpractice insurance as they are covered by the U.S. Army.

To learn more about the HPSP, you can go to https://www.goarmy.com/amedd.html.

RCRH Pre-Shadowing Tour

SDSM&T students who took a pre-shadowing tour at RCRH.
Left to Right: Kaelyn Kaul, Danielle Theis, Alexia Hodgson, Kaylee Wilson, & Kelcy Bentley.

Last week, several SD Mines students gathered near the coffee shop in Rapid City Regional Hospital in anticipation of beginning a pre-shadowing tour of the facility. Preliminary paperwork in hand, they chatted about the kinds of shadowing that they hope to do over the next few months. They were greeted by Holly Perli at 3:30pm and shortly thereafter began their tour.

The group walked through the many hallways asking questions about protocols, equipment, and patient care practices. Health care professionals bustled around in scrubs and lab coats carrying medical supplies and charts between rooms as we continued the tour.

The students were impressed with the quality of the facilities on the various floors and one could feel their excitement about future shadowing grow with each step. Holly enthusiastically answered students' questions as we continued along our journey making stops here and there to look intently at all of the interesting the things around us.

After the tour, our group stood near the entrance for a few minutes discussing what we had seen and what students hoped to do in terms of shadowing at RCRH in the future. It was an exciting introduction to what will be fantastic experiences for each of these students in the coming months!

Obligatory pre-shadowing tour selfie!

If you are interested in shadowing at RCRH or other health care institutions in town, be sure to contact Dr. J and set up an appointment!

Closed Case Friday: Problems in the Pond

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical patient has an itchy rash on her ankles and the lower parts of  both of her legs. Last night, she has been swimming in a pond on her family's property. On the way back home after swimming, she first felt the itch and noticed the rash, but it went away after an hour or so. This morning, both the itch and the rash had returned and the rash looked (and felt) much worse than it had last night. After speaking with her physician, she went home with a corticosteroid cream and planned to avoid swimming in the pond again.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Cercarial Dermatitis ("Swimmer's Itch")

Cercarial dermatitis, a.k.a. "swimmer's itch", is caused by the cercarial stages of parasitic worms burrowing into accidental human hosts and dying within the skin rather than being able to effectively infect human hosts. As these little worms die, they cause the characteristic itchy rash that we saw in our hypothetical patient. This rash can last up to several days, so it is important to help patients avoid scratching to prevent secondary skin infections. The worms that cause cercarial dermatitis are searching for water fowl or other aquatic vertebrate hosts when they accidentally infect humans. The typical life cycle for these parasites begins with eggs being deposited into the water along with feces of a definitive host, such as a duck. The eggs hatch into miracidia and swim through the water until they can infect a suitable intermediate host, such as a snail. After growing and changing inside of the snail, the worms exit their snail host as cercariae, which then seek out definitive hosts, like our duck, to complete the life cycle. It is in this last stage that the cercariae might accidentally make their way into a human host swimming or wading in contaminated water.

While there is no specific diagnostic test for cercarial dermatitis, knowing a little about a patient's history can help distinguish this from other rashes. For example, knowing that our patient's rash began shortly after swimming in a pond, disappeared, and reappeared later, put our patient's actions and symptoms into context that would allow for a reasonable diagnosis of cercarial dermatitis. This condition typically clears itself over time, but again it is important to help a patient avoid scratching to prevent secondary skin infections. Anti-itch lotions, topical corticosteroid creams, and baths with colloidal oatmeal, baking soda, or Epsom salts can be helpful to that end.

Patients can avoid swimmer's itch by swimming in well-maintained, chlorinated pools. Patients who have had swimmer's itch before may experience worse reactions if they get it a second time. A 2015 review article of cercarial dermatitis calls it an emerging disease and asserts that it is responsible for the majority of dermatitis outbreaks worldwide (you can read the article here). While it is possible to treat waterfowl with medication to reduce parasite populations, this requires capturing, treating, and releasing birds individually, which isn't always practical. Control efforts have also targeted killing the snail intermediate hosts, but those efforts often have detrimental effects on other animals. The best way to prevent swimmer's itch is for people to know where cases of swimmer's itch have been reported to originate and to avoid those areas for the season.

Thanks for joining us for this week's Mystery Case and we hope to see you in two weeks!

Student Spotlight: Katherine Giorgio

Here at SDSM&T we have a growing and thriving community of pre-health students. Today, we are shining a spotlight on Katherine Giorgio. Katherine is an applied biological science major. She is interested in epidemiology and plans to pursue a graduate degree in that field following completion of her B.S. We caught up with Katherine to ask her about her pre-health journey and how she is preparing for a career in health care.

As a student preparing for a career as an epidemiologist, have you done any research? 

Almost all of my career preparation has come from research experiences. I did research in Dr. Wang's lab at USD the summer before starting college, then I did research in Dr. Sinden's lab during my freshman year. These labs were both in basic biomedical sciences. Since the summer after my Sophomore year, I have worked for the Avera Center for Pediatric and Community Research. The main research project I have been involved in is part of a national NIH study investigating environmental factors that affect child health and development. Our work is primarily focused on data collection from our cohort of 2000+ mothers and children.

What kinds of volunteering do you do?

 I am highly involved in the Newman center on campus. This isn't exactly volunteering, but it is all about community! In the past I have led music sessions at a nursing home here in town.

How did you prepare for taking the GRE?

I plan to take the GRE this spring. So far I have participated in a GRE prep course that was offered through my research internship program. I have a prep book that I will use when I begin studying on my own.

How did you prepare for your interviews?

I have not done any interviews for post-graduate education yet. For other types of interviews that I've had, I find that writing down the main ideas I want to get across helps me to not stumble over my words.

What do you do when you aren’t studying?

I like to study alone, so I like to free time with my friends whenever I can. We like to go hiking, cook dinner, play music, and watch movies. I also enjoy chatting with friends at coffee shops.

How do you manage stress?

This has been an important learning curve for me throughout college :) One thing that helps me is giving my attention to my internal to-do list that wants to run through my mind only when I need to. Then once things are written down and organized on paper, I forget about it in my mind and make sure it gets a chance to relax and enjoy whatever I'm doing that day.

What advice do you have for our freshman pre-health students?

My advice is to take time to reflect on what you're passionate about and why, and then go do more of that! I have found a lot of motivation and inspiration through getting invested in the community, specifically because I see how it can improve peoples' lives through public health. Now looking at graduate schools, I feel like I have something unique I could contribute to an Epidemiology program because of my experiences here in Rapid City.

WALC Week 10 Winner: Danielle Theis!

Every Wednesday, the Student Success Center holds a
Weekly Anatomical Language Challenge (WALC).

This week's winner is: 

Danielle Theis!

Congratulations on winning WALC for the sixth week in a row!

This challenge series was held weekly throughout the semester to give students a chance to showcase their anatomical knowledge for chances to win prizes! This was our last regular week for the WALC, but in the week before finals, we will have a special bonus round of WALC. On November 28th, students can re-take all of the previous WALCs from this semester for a chance to collect redemption points in a final push to climb the leaderboard!

See Dr. J for details!

Mystery Case Monday: Problems from the Pond

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week's hypothetical patient has an itchy rash on her ankles and the lower parts of  both of her legs. Last night, she has been swimming in a pond on her family's property. On the way back home after swimming, she first felt the itch and noticed the rash, but it went away after an hour or so. This morning, both the itch and the rash had returned and the rash looked (and felt) much worse than it had last night. After speaking with her physician, she went home with a corticosteroid cream and planned to avoid swimming in the pond again.

Thought Questions:

What is the most likely diagnosis for this patient?

What causes this condition? How is it prevented?

What are the anatomical structures involved in this clinical issue?

How is this condition typically treated?

Leave your comments below and check back on Friday to see how our hypothetical patient was diagnosed!

WALC Week 9 Winner: Danielle Theis!

Every Wednesday, the Student Success Center holds a
Weekly Anatomical Language Challenge (WALC).

This week's winner is: 

Danielle Theis!

Congratulations on winning WALC for the fifth week in a row!

This challenge series will be held weekly throughout the semester to give students a chance to showcase their anatomical knowledge for a chance to win prizes!

SD Mines Students Attend Research & Compliance Conference Hosted by Regional Health

Students arrived at the Rushmore Plaza Civic Center bright and early last Tuesday morning for the 2018 Research and Compliance Conference hosted by Regional Health. These students were there to learn about the policies and procedures involved in working with human subjects while conducting medical research. Each of the students in attendance was either actively involved in research efforts or had plans to be involved in research projects in the coming semesters.

Information tables and posters were set up for attendees to learn about clinical research in South Dakota.

Dr. Pritchard speaks at the conference.

Coffee and/or breakfast treats in hand, our SD Mines group chose a table in front of the podium that was situated between two projector screens prominently displaying the name of the sponsoring organization. We discussed our backgrounds and research interests for a few minutes before the conference was called to order. The guest speakers for the conference had traveled from Washington D.C. to represent the Office for Human Research Protections (OHRP), which is within the U.S. Department of Health and Human Services.

Dr. Lau speaks at the conference.

The first speaker, Dr. Ivor Pritchard, spoke about ethics and how ethics inform regulation policies for conducting scientific research. The second speaker, Dr. Yvonne Lau, discussed the requirements, flexibilities, and challenges of informed consent in research involving human subjects. After a short break, the third speaker, Julia Gorey, talked about how vulnerable populations of human subjects are defined, identified, and protected through regulations and special considerations through institutional review boards. Afterward, Dr. Pritchard returned to the podium to discuss the risks, objections, and special considerations involved in social, behavioral, and educational research projects.

During the lunch break, students discussed their take-aways from the morning’s presentations and shared their experiences as pre-health students with one another. After lunch, a discussion panel composed of local individuals who have worked with research policies and regulations, including one person who had participated in a clinical trial himself. The panel discussed their experiences, shared their insights, and answered questions from the audience. After another break, Dr. Lau again took to the podium to involve the audience in a case study aimed at further discussing informed consent. This part of the conference prompted excellent group discussions regarding how to communicate effectively with patients to ensure informed consent during clinical research. The last few minutes of the day-long conference featured a question and answer session during which Dr. Lau and Dr. Pritchard answered questions submitted by attendees. Afterward, attendees were invited to a social event held in the Ice Arena Club overlooking the ice rink in the civic center.

Panel discussion about research involving human subjects. From left to right: Regional Health IRB Chair, Dr. Carman Timmerman; Regional Health Research Participant and member of Purdue University's IRB, Dr. Jeff Bailie; Director of Regional Health Research, Mr. Roger DeRaad; Regional Health IRB Member and panel moderator, Mr. Kevin Queen.

Our SD Mines students who attended were given lots of useful information and were able to learn more about the participant recruitment process of working with human subjects for scientific research. In some of our table discussions, students connected things they were hearing at the conference with things they were already learning in their courses at SDSM&T. They also expressed how interesting they found the details of regulatory processes and considerations that are involved in working with human subjects...especially with potentially vulnerable populations, such as prisoners or children.

"The most useful thing I learned...was the origins of the three main ethical “camps” and what they believe is ethically right. This will help me identify the ways I’m thinking about ethical dilemmas, and process the pros and cons of each." --Jacey Merkle, SD Mines Student

Overall, it was a wonderful conference that was a positive experience for our pre-health students and we hope to send more students to next year's Research and Compliance Conference!

"I would tell students that are planning on attending next year that is was a very educational experience and that I would strongly recommend that they go and get exposed to all of the information and discussions."--Hunter Roy, SD Mines Student

Excited SD Mines students learning about research and compliance.
From left to right: Hunter Roy, Liam Jensen, Samantha Johnson, & Jacey Merkle.

Health Professions Week at SDSM&T!

It is Health Professions Week and we have lots of
free information and events to help students explore careers in health care!

Here's additional information regarding this week's events:

On Monday, November 5^th, Live stream of a presentation and a lecture:

Beyond Classification will be presented by Mr. LeDerick Horne

This informative and entertaining presentation provides strategies for increasing the academic performance, self-determination, and self-advocacy skills of students with and without disabilities. As an entrepreneur and performance poet with a learning disability who has worked as an advocate on the national, state, and local level, LeDerick Horne provides a unique perspective on our school system and issues related to creating a more equitable society for people with disabilities.

Navigating Your Journey on the Academic Sea will be presented by Dr. Christine Grant

This lecture will empower current and aspiring Health Professionals with a hands-on set of tools to: identify a path that is consistent with their overarching personal career goals, create strategies to combat the waves crashing up against the academic boat in the form of critical career challenges and execute a plan to negotiate the potentially "rough seas" (e.g. difficult people and situations) while pursuing exciting career opportunities in the health professions.

On Tuesday, November 6^th: Live stream of a health advocacy panel discussion.

This panel includes professionals working to advocate for the health professions and their education programs. Panelists will discuss their own experiences in politics, the health professions, and advocating for health care. Learn more about advocacy and the intersection of politics and health care!

On Wednesday, November 7^th: Live chat event and an informational session:

Students will be able to live chat with students in professional programs and health care professionals via the Explore Health Careers website: https://explorehealthcareers.org/hpw/

We will have a representative from VCOM here to talk about their osteopathic medicine program.

On Thursday, November 8^th: Virtual career fair and a meet-&-greet with USD medical students.

The virtual career fair will be hosted by Sanford Health from 9:00AM-3:00PM. Students can sign up by going here: https://www.ecareerfairs.com/e/sanfordhealth/

Medical students from the University of South Dakota’s Sanford School of Medicine will be coming for a meet-and-greet with our Future Health Science Professionals club that evening. The event starts at 5:00PM and will be in the Bump Lounge. All students are welcome to attend!

On Friday, November 9^th: Grand Rounds and a MLS meet-&-greet.

Grand Rounds at Regional Health will be held at 7:30AM. Dr. Clyde Markowitz, M.D., is the director of the Multiple Sclerosis Center and an Associate Professor at the Hospital of the University of Pennsylvania. He will be giving a presentation titled: Evidence-based Diagnosis and Management of Multiple Sclerosis in the West Auditorium at RCRH. Breakfast will be provided.

Medical Laboratory Scientists from Regional Health will be in the Student Success Center from 10:00AM-12:00PM. Be sure to swing by, grab some coffee, hot chocolate, or caramel apple cider, and chat with these RCRH professionals!

Be sure to take advantage of all of this information
and these fun events to learn more about careers in health care!

For questions or additional information, contact Dr. J.

Closed Case Friday: Drive-thru Salads & Diarrhea

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical patient has been experiencing watery diarrhea with frequent (often explosive) bowel movements, bloating, fatigue, and nausea over the last week and a half. The patient's physician did a physical examination and order an analysis of our patient's stool. The physician informed the patient that there has been a local outbreak of people exhibiting similar symptoms and that they would be testing the patient's stool for a specific pathogen. Like many other patients with similar symptoms, this patient reported eating a salad from a local fast-food chain a few weeks ago. The lab found relatively large oocysts that demonstrated a blue autofluorescence under ultraviolet epifluorescence microscopy. These results confirmed the presence of the suspected pathogen. The physician prescribed trimethoprim-sulfamethoxazole and told the patient to rest and get plenty of fluids.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Cyclosporiasis

To be fair, this patient's symptoms could have indicated the presence of a wide range of pathogenic organisms. However, the indication of an outbreak from contaminated salad, the description of the laboratory results, and the prescribed drug point more specifically to the presence of a coccidian parasite known as Cyclospora cayetanensis. This parasite is often the center of outbreaks involving contaminated fruits and vegetables, including an actual outbreak among patients who had consumed salads from a fast-food chain in the Midwest during July of this year. (You can read about this and other 2018 outbreaks of C. cayetanensis here.)

Typical wet mount preparations of stool samples can reveal the presence of this parasite, but is more reliably diagnosed with the use of staining/fluorescence examinations. Depending upon resources and outbreak severity, other diagnostic tests, such as immunodiagnostics or PCR, can also be used to confirm cases of cyclosporiasis.

Symptoms of this disease typically present after about a week post-infection. Over this period of time, the parasites are developing into their infective forms and impacting the intestines and these organs' abilities to form and pass fecal material. There is little water reclamation occurring in the large intestines of infected individuals, leading to watery stools and frequent bowel movements. For this reason, patients need to increase their intake of fluids to prevent dehydration and rest to allow antibiotics and the immune system time to clear the body of infection.

You can read more about domestic cases of Cyclosporiasis that occurred in 2018 here.

Thanks for joining us for this week's Mystery Case and we hope to see you next week!

Students Attend Avera Open House

On Monday of this week, a few of our pre-health students attended an open house event for the Avera Research Institute's Center for Pediatric and Community Research here in Rapid City. Our students were excited to see the research facility and to learn more about the kinds of research that were being conducted by the institute.

Katherine Giorgio (far right) talks about the kinds of research
conducted at the center. An attentive Kate Dickinson (left) listens.
Note the adorable lab coats for children who participate in these studies!

Upon arrival, we were welcomed to the center and directed to a room featuring a delicious spread of hors d'oeuvres, including fruits, veggetables, seasoned grilled chicken skewers, cheeses, and strawberries filled with whipped cream or chocolate mousse. We made our plates and read the employee biosketches posted on one wall of the room.

As we read about people's educational backgrounds and areas of research focus, we were greeted by a familiar face! Current SDSM&T student, Katherine Giorgio, has been working for Avera while she wraps up her final semester at SD Mines. (Keep an eye out for Katherine’s Student Spotlight, which will be posted in the next few weeks!)

Katherine gave us a tour of the facility, showing us research posters, brightly-colored rooms where children participate in various studies, and interesting equipment for collecting and analyzing data. She also introduced us to her co-workers and we learned a lot about the kinds of research that are being conducted and the special considerations that are given when working with children, infants, and expectant mothers.

Avera collects data using EEGs. To help the children feel more comfortable, this room has an under sea theme and children
are asked to "put on their scuba hat" for the research. After collecting data, kids can get a prize from the treasure box!

For some students, this was an interesting and informational experience. For other students, it also provided an opportunity to consider getting involved with Avera in the future. We will be sharing information regarding opportunities for paid internships with Avera through the pre-health listserv in the coming months, so if you are an SDSM&T student, be sure you are signed up for the listserv and checking your e-mail!