My head hurts (welcome to pathology)

My head hurts.

Translation: Welcome to your Pathology rotation.

Yes boys and girls, despite me swearing after my med 4 pathology elective that I would not do pathology again, here I am back at it for the last 4 weeks of PGY2.

Pathology is neat.  I like knowing what things look like and seeing stuff that causes disease.  I really enjoyed my rotation in med school.

I do not like microscopes or formalin.

Neither does my head.

I had hoped that because I am on different migraine prophylaxis, off combined OCPs and in better shape this would not be as much of an issue.  It isn’t as much of an issue.  Day two and no migraines, which is shaping up to be better than the first time around where I had a migraine on day one or two and every couple days thereafter.  But, I have had daily headaches.  And those are still not cool.

I need to drink more water.  And maybe getting back to the gym will help.

Perhaps this is just a blip and it will get better.

I have already learned a bunch and I can sense I will enjoy this pathology rotation even more than my med school rotation by virtue of how much I have already learned and how many teaching sessions and interdisciplinary rounds are going on.  Plus, my learning is targeted toward oncology, not entirely randomness. I am okay with spending my evening reading about gastric cancer pathology reporting and staring in microscopes half the day when it means that I will better understand the disease in the end.

I will have a good rotation.  Even if my head is trying to disagree.

 

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Blurred

This week, I thought my studying brought on some weird hypochondriasis.

I was being the cool cat that I am studying neuroanatomy and neurology stuff and feeling like I am finally starting to make some progress in my figuring out where certain presentations originate in the central nervous system, when this image of the brain seemed out of focus.

So did some of the side margin boxes.  And the next picture of a brain.

I stared at it confused.

Then I looked around the room.

I have complex migraines, that can  include a slight diplopia (double vision) and other symptoms (unilateral facial paresthesias, scotoma) so getting a slight amount of altered vision from time to time isn’t the most crazy thing to happen.  The issue is that it didn’t feel like my usual aura and when I looked up, the vision change went away.

I looked back down and it was still weird looking.

It isn’t like I was studying for a long time (this particular episode… If you factor in my million years of schooling, then it is obvious I have ben studying for a long time).

Then, it hit me.

I was having a stroke.

No.  That was definitely not it, although strangely enough that was the topic of this particular chapter – cerebral bloodflow and stroke presentations.

There was some sort of printing error in my book.  As a result, a few images were blurred.  Not enough to make them useless, but enough to make the reader crazy.

This doesn't quite give justice to the blurred sensation the pictures give when looking at them in person.  From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

This doesn’t quite give justice to the blurred sensation the pictures give when looking at them in person.
From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

I showed Patrick to confirm and he has the same confused reaction.

From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

It makes me wonder how people can exist with the changes in function due to a stroke and not report to medical attention.  I mean, if you can’t see right, something must be wrong?

My mind has been blown on this service by the number of people with acute stroke who chill at home waiting for things to get better. Even when it isn’t their first stroke.  Time=brain, people!

And yet, I get it.  Because in this case, there was something else to blame.  We look for that something.  Anything that is less scary even if, at times, it is less plausible.  We hope the problem just goes away.  Sometimes we make it worse when we wait on things like that.

The scary part is that I used this same textbook to study neuro in med school and I only very vaguely remember this problem.  I think I realized the pages were blurry because of printing, but it isn’t a clear memory.

The highlights are proof that I did read these pages before.  Again, the picture takes away from the blurriness that is experienced in person. From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

The highlights are proof that I did read these pages before. Again, the picture takes away from the blurriness that is experienced in person.
From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

In retrospect, that was before my migraines were controlled, so it wasn’t unusual for me to have an aura in which I couldn’t see proprerly, so maybe I just chaulked it up to my weird brain.  Or maybe I blamed it on too much reading.  Or maybe I just wasn’t paying that much attention (although the highlighting on the page tells me otherwise).

Clearly, I need to learn my own lesson and pay attention both to my body and my books.

This also brings to mind a song that was popular this summer that I quite disliked, except for this version by Jimmy Fallon and The Roots…