The Mixup With Tea

Tonight I made a blunder. I drank a caffeinated cup of tea. It would not be an issue, except that my mind pretends to turn old and weary as the days wrath beats down on me. My body wants warm milk and honey not agitation and aggravation.

I have two rules before bed time:

1. Do not play computer an hour before sleep. I will be going to be no earlier then one.
2. Drink decaf tea before sleep.

These are easy rules to live by, but tonight I chocked. As I lay here, awake and aware of every cigarette smoking bastard sitting on the buildings stoop, I had a realization. The cup of tea!

There are other important things to stay awake for, for example MoneyBall. I am reading this baseball book by Michael Lewis and I have never been a bigger A's fan. All of a sudden Terrence Long striking out with bases loaded, game five of the ALDS, to the Red Sox and Derek Lowe is a little sad. Baseball is run by traditional baseball players, not by rational calculated men. This is changing, but it seems that many teams are miscalculating opportunity, overvaluing junk, and undervaluing spunk. How is this possible? We have a billion dollar industry wasting opportunity to win.

I can see why the "way it is" mantra remains. Even while I read this book, to believe the author I either need a leap of faith that a best seller is factual or have a solid background in statistical analysis. It will much easier to overlook this quaint story and go back to the trust I have in my team. Is bunting really a waste of an out and is stealing an unnecessary risk? I compare this argument to one made by Paul Farmer about Haiti's government. While the importance of arguments differs, the skepticism both received are similar. If you ever have a chance to glance at Dr. Farmer's texts, such as The Uses of Haiti, note the number of citations he uses to prove his case. Despite his thorough, perhaps complicated, documentation of facts, Dr. Farmer is labeled a leftist and a radical. I once opened up a book by Rush Limbaugh and read praise of America's well distributed wealth as judged by the fact that most houses have two television sets. No citations were needed, and no references provided. I will do the same, but have a leap of faith and trust me.

I am applying to medical school right now. Aside from the cup of tea, this could be why I can not sleep. The application is a selfish one. I am constantly asked "Yevgeniy, why are you so amazing?", in fact SUNY Upstate recently said to me, "you feel good? cause you look great." We commonly have to write what makes us unique. What could the thousands of other applicants be writing? Does it matter?

My current essay topic is the following: If you have had experience doing research or other scholarly work, please describe your experience, including the question you pursued and how you approached it, your results and interpretation of the results, and any thoughts about what this experience meant to you. In addition, please add your thoughts about why this research experience has motivated you to consider a career as a physician investigator.

I will jot down some thought.

My senior thesis involved a single question: can we make a cyclic molecule out of naturally occurring amino acids? There were various questions to consider. Which amino acids to use (alanine and tyrosine were available in the lab), how big should the ring be (four amino acids had not yet been synthesized, and seemed feasible based on rough computer analysis), what synthetic tools should we use ("click" chemistry techniques contained reactions that overcame strain through thermodynamics) and why should we do this (cyclic tetrapeptides have been found in bacteria and fungi and might be use full as therapeutics. In addition,there was no cyclization method that allowed for selection of any amino acids. Reactions were limited because they required a cysteine to be used due to the need for a disulfide bond.)

Quick shooters: Started project from conception (read papers, troubleshot with professor, started on errant paths) and finished with white powder that symbolized nine months of work. Thesis presentation was an unbelievable experience (I was pretty amped and passionate about this work.) Partner blew up the chemistry building (literally - do not heat 0.5L of diethyl ether on a hot plate). Blast to the future (After college, I was involved with spinal muscular atrophy research. Various reports have shown that histone-deacetylase (HDAC) inhibitors might have some therapeutic value in this neurological disease. Interestingly enough, some of these HDAC inhibitors have a cylic tetrapeptide base.)

Hours and hours were spent in the lab and with analysis. It was at times harder to confirm the product then to make a product. It was also eye opening to realize the amount of work synthetic chemistry, the backbone of medical advancement, takes to move forward. Most importantly, I liked the scene of science. There is something cool about working in the lab at 11 at night, starting a reaction, and running a 400k NMR machine. We formed a science crew in those last days.

This experience meant a finished project. It was something with an start and finish, a conclusion with merit that might one day contribute to something.

A joke at every end:

Why did the chicken cross the road?

Because it thought it was a turkey.

Auction Thursday

A wonderful lecture: A Professor's Life Lessons.

Today I went to an auction. A real life, edge of your seat, money flying everywhere auction. "We got 2 going 3, 3 bid 4, 4 whose got 5." Next thing I knew I was the owner of a 3000 dollar table. We had to redo that round.

The Great American Company, an appropriately beautiful name, is in charge of many such auctions. They take all your materials and sell these goods (I assume at no cost to you). Then they charge a ten percent premium on the amount you pay. Kind of like the house in blackjack except more.

Hospitals are not just a health source they are a life source. The auction was selling all items from St. Vincent's Hospital. They had the usual tables and instruments but also a pizza oven, a fridge, a gym, and a Honda passport with 143,000 miles. I could have started a town today. Instead, I sat for a long time and watched characters do their thing. The greasy men with the glitzy watches, the brothers with the huge beards, the Russian lady buying the metaphorical house. What a world. I guess we need to remember about these things, maybe one day we will all be back.

In other news, and there is so much news, Medicare reimbursement will soon be based on a departmental division in medical treatment. Meaning, the reimbursement rates will not increase or decrease in unison for all doctors, but will be based on the type of medicine you are practicing. Proportionally, internist pay can now show a slower growth then surgeons. By the way, what is Medicare prescription plan part D?

Warfarin, a popular blood thinner used during transplant surgery, has been shown to have a greater affect in patients with two specific genetic variations. The genetic test controversial because the medical field does not yet understand the exact change in dosage that should accompany such genetic variability. In addition, Warfarin is often needed on a moments notice, and science has not yet developed a fast enough testing method.

Bisphenol A, a compound found in many plastics including most baby bottles, has been shown to be safe and unsafe by two different agencies. The National Institute of Environmental Health Sciences (NIEHS) showed that Bisphenol A is dangerous in low dosage to rodents and potentially humans. The Center for the Evaluation of Risks to Human Reproduction (CERHR) didn't. Different strokes for different folks. Long story, but I think NIEHS might be right. Check out www.cen-online.org for more info. But wait you need a password. Still a good site.

By the way, sunscreen will soon have star ratings YAY! 1 star = little UVA protection, and 4 stars will mean great UVA protection. I guess 15 or 45 does not mean as much as we thought.

A joke at every end:

In progress

The Future

In the ideal doctor's office there would be a desk neatly stacked with a prescription pad, two pens, a notebook, small laptop and a cordless connection to a projector that faces a white board. The patient walks in with their lab results and with the stroke of some keys the relevant variables pop up, history and all, as a beautiful excel graph. Each dot representing the patients history, letting the doctor see trends, letting the patients see work. With each question, another graph can pop up: this is HHV-6 level two years ago, this is your CD3/CD4 ratio twenty years ago. We prepare for our biochemistry presentations more than we do for our patients.

The future also has drugs, drugs and drugs. But not just drugs, pictures of drugs flying on that white board. With those same keystrokes, the doctor sees all the current medication that the patient is on and with another stroke the counter indications come up. Perhaps, in my ideal world, the structure floats through the blood brain barrier and binds to a pretty receptor on a membrane, and all of a sudden a cyclic AMP floats off and hits a DNA strand. How fascinating the mechanism of action is, what if we played some two drugs together, would they ever bump.

The best students are those who want to cure or those who want to be cured. Their life is worth an education. The medication will relieve the symptoms but the knowledge will cure the ailment. Oh the future does look so bright.

A joke at every end:

What did the DNA strand ask the other DNA strand?
"Do these genes make my butt look fat"

Fifth knowledge

Happy Labor Day - the city is quiet with all the sleeping bodies getting ready for parades and beer filled baseball afternoons. Pedro Martinez makes his 75 pitch return today in Cincinnati, a truly exciting day. The Caribbean parade will bring three million people to Crown Heights. No matter, though, where one is today there is always knowledge to learn.

Diagnostic notes:

Cerumen is the medical term for earwax.
Floaters are sometimes found in your eye.
The doc might hear a sound from your heart. It might be mitral regurgitation, abnormal leaking through the mitral valve in your heart. Chronic mitral regurgitation can be asymptomatic.

Supplements:
It is sometimes unclear what vitamins one should add as supplement to a general diet.
A, D, E, and K are fat soluble vitamins and are dangerous in access.

The following are essential amino acids:
isoleucine, leucine, lysine, threonine, tryptophan, methionine, histidine, valine and phenylalanine. (Wikipedia remembers them like this: I Like Licking Toads That Make Hallucinations Very Possible). These amino acids can not be synthesized in your body and should be ingested as part of your diet.

A joke at every end:

What do you call a man who never farts in public?
A private tutor.