Penn Medicine News Blog Posts by Jessica Mikulski

Climatologists recently predicted that the 2012 allergy season might be one of the worst on record and based on my own experiences so far this spring, I’m inclined to agree. I’ve been hit hard by congestion, itchy eyes, and worst of all, chronic bouts of uncontrollable sneezing. So when I learned that researchers in the Perelman School of Medicine Department of Otorhinolaryngology: Head and Neck Surgery are in the midst of some interesting research looking at the biology of sneezing, I was quite curious to get the inside scoop.

It might seem obvious -- allergens attack (in the form of pollen, dust mites, and pet dander) and our immune system feels compelled to expel these foreign invaders through a powerful sneeze. But it’s much more complicated than that, especially for patients who already have chronic sinus issues, says Noam Cohen, MD, PhD, assistant professor of Otorhinolaryngology: Head and Neck Surgery. Dr. Cohen is the senior author of a new study, out in the May issue of the Journal of the Federation of American Societies for Experimental Biology , that examined the biology of the effects of a sneeze on the inner structures of the nose.

“Very little is known about the effects of sneezing on the cells within the nose and sinuses,” he says. “As a matter of fact, almost nothing is known about sneezing.  As an ear, nose, and throat physician who deals with problems of the nose, frequent sneezing is a very common complaint I encounter from my patients.  So we wanted to know: why do people with problems with their noses, such as the common cold, chronic sinusitis, or allergies, sneeze more than people with no problems in the nose or sinuses.”

The Perelman School of Medicine, and other schools from around the University of Pennsylvania, has partnered with an innovative new learning platform to make Web-based courses, taught by some of the world’s foremost experts, available free to the general public.  The platform, Coursera, is the first to host content from multiple world-renowned universities (including Princeton University, Stanford University and the University of Michigan) at one online destination.

"We are delighted to participate in this innovative collaboration that will make high-quality learning opportunities available to millions of people around the world," said Gail Morrison, MD, senior vice dean for Education at the Perelman School of Medicine. "Expanding access to medical science and technology is an invaluable opportunity to better educate the public at large about the true art and science of medicine.”

The online courses include video lectures -- available to anyone, anywhere in the world, with an internet connection -- that feature interactive quizzes, mastery-building interactive assignments and collaborative online forums. Beginning in June, Perelman School of Medicine faculty will provide courses on a variety of medical topics, from cardiac resuscitation to neuroscience.

Approximately 12 million Americans are seen in U.S. emergency departments each year for mental health-related symptoms. Of those patients, around 650,000 are evaluated for suicide attempts. For many of these people, it’s a frightening stop on the long and painful road of suffering that results from depression, anxiety, and substance abuse.

The usual care for these suicidal patients seen in the ED and other emergency settings is to assess their level of risk in terms of how likely they are to actually harm themselves and then refer them to the appropriate level of care. Typically, when suicidal patients are evaluated in the ED and hospitalization is not determined to be necessary, they are provided with information for outpatient mental health treatment and sent home. But that approach doesn’t necessarily meet the needs of patients or their physicians, who may worry about discharging patients in the midst of a crisis.

“This  ‘assess and refer’ approach can be disconcerting to patients and their families,” says Gregory K. Brown, PhD, research associate professor of Clinical Psychology in Psychiatry in the Perelman School of Medicine. “It can also leave clinicians feeling like they didn’t do enough due to the dire consequences associated with suicidal thoughts in patients.”

This week, the Supreme Court will hear oral arguments in perhaps one of the most hotly debated cases in recent memory -- whether or not the 2010 Patient Protection and Affordable Care Act ("ACA") – which effectively provides universal health care -- is constitutional.

The law, also referred to frequently by its critics as “Obama Care,” is a major national legislative effort to provide health insurance to more Americans.  At the most basic level, it aims to extend insurance coverage to millions Americans through an expansion of Medicaid and by subsidizing the purchase of private coverage.  Americans would also face a new requirement in 2014 -- to have health insurance coverage of some kind, or face a penalty.

There are two sides to this epic debate. On one hand, supporters of the ACA argue that affordable health care is something all Americans will need at some point in their lives and that requiring citizens to obtain insurance is as fundamental as paying taxes. Experts estimate that there are currently 50 million people in the US who don't have health insurance. The ACA would help to extend coverage to an estimated 30 to 32 million of those people.

On the other hand, some have argued that it is not an economic fact that all people require health care and that Congress exceeded its authority by requiring Americans to maintain health insurance or risk a penalty in the form of a tax.

David Grande, MD, MPA, assistant professor of Medicine at the Perelman School of Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, helps break down this complex case and where the legislation stands now.

It's the morning of Match Day and medical students across the country are eagerly awaiting their ceremonies. NPR reports on this exciting and emotion filled experience for these future doctors.

Perelman School of Medicine students will be reporting to Stemmler Hall at 12 pm to accept their match letters. Our bloggers share their thoughts on the final countdown! Good luck to everyone!

Tamara Bockow

It’s the night before Match Day.  I can’t believe it’s finally here; it’s almost surreal. I am trying to approach this with no expectations. I feel like wherever I match, that is where I am supposed to be. I have to know that things happen for a reason and I’ll end up where I should be. Every place that I ranked is great, and I know I’ll receive great clinical training at any of those places.  However, it would be nice to get my first choice (or maybe even my first or second choice).  I think your residency training shapes the kind of doctor you become. Each institution has it’s own philosophies, and nuance ways of practicing.  Where you train dictates the kind of medicine you will practice – at least to some extent.

Match day is all that everyone is talking about. Med students are making predictions and expressing fears.  All the talk is exciting, but at the same time, it makes me that much more anxious. It’s not like you can forget that it’s happening.

Tomorrow morning a few friends and I are going out for brunch. We all decided that we didn’t just want to sit home alone and “think” about what was going to happen in the next few hours.

I recently read that apparently, the process takes all of five minutes to match the approximately 17,000 med students in the country with all the residencies.  I also found out today that the programs have already been notified about their future residents. Precisely at noon, tomorrow, we will be handed our envelopes, one by one, that hold the key to our future.

 Ben Oshlag

I'm finally starting to get nervous this morning. I didn't really have the chance yesterday, which was jam-packed with moving out of my apartment in preparation for my elective in India, which I leave for tomorrow. Between driving back and forth across the city, and all the packing, lifting, and moving, any creeping anxiety about today was easily pushed to the back of my mind. It was only later last night, when I tried to start winding down, that I could really start to sense how close today was. I managed to get a decent night's sleep, surprisingly, though I am up much earlier than I normally would be on a day I don't have to be anywhere before 11. I'll be packing up one more car-full of stuff before heading over to campus for the match ceremony. Even now, though, I don't know that it's fully hit me that today is the day -- that will probably come when they start reading off names, and I wait for mine to be called. But I can feel the nervous excitement starting to build already, and hope the next few hours of anticipation go quickly, so I can finally find out where I'll be spending the next 3-4 years.

Jess Spivey

It’s Match Day morning, finally! My plans:

1. Find Nemo. First, I’ll probably go for a quick swim. I'm an incredibly inefficient swimmer, and focusing on technique takes major concentration. It’ll be a great way to keep from thinking too much about the match.

 

2. Get some sustenance. Match Day calls for a hot chocolate from Wawa.

3. Be lazy. I think I’ll lounge around on the couch for awhile. I might take a cat nap or I might watch The Price is Right, but I won’t feel like a true MS4 unless I make sure to waste some time.

4. Meander over to school. I’ll listen to music on the way. Before every test in medical school, I would listen to a song called “Auto Rock” by Mogwai, so I’ll probably just stick with that. It’s both calming and invigorating, which seems appropriate for Match Day.

5. Rip open a really important envelope. I’ll probably accidentally rip the letter a little bit too, since I’m usually hasty with things like that. I guess these hands were never meant for neurosurgery.  I’ll read the bold part first. If it’s anything like lecture notes, all of the important stuff should be in bold.

6. Relax for three months. Residency spot secured!

Isabela Wieczorek

My boyfriend asked, “how excited are you about March Madness?” I went ahead and made a bracket, but told him I won’t be able to concentrate on games and scores until I have Match Day off my shoulders. As much as I have tried to distract myself today, Match has managed to get rid of my appetite and make my hands shake. Sleep has also been eluding me and I don't think I'll sleep soundly until I know a bit more about what the next 4 years will look like.

I try to picture what will happen tomorrow: my name will be called, I will walk to the stage to receive my envelope, walk back to my seat, and probably have a friend open the envelope for me. When I was a college senior waiting for my MCAT score, my best friend was the one who logged onto the website and told me the grade. Strangely, the process of opening a webpage or an envelope just exacerbates the anxiety I feel.

Tomorrow morning, my boyfriend arrives from a red-eye flight, and my roommate leaves early to go take Step 1 (a very big day for her as well!). My plan is to get up and have breakfast and coffee at home, and then try to squeeze in a workout before the festivities begin. And it will be quite a celebration. After the ceremony we will have brunch and champagne outside of Dunlop auditorium. At 2pm we move on to a local bar for drinks and appetizers, and later many of us will go to dinner and end the night dancing.

13 different cities, 15 different programs… I know that wherever I end up, be it East or West coast, large or small city, warm or cold weather… it is going to be up to me to work as hard as I can to become like one of the brilliant and inspiring dermatologists I met on the interview trail.

Our medical student bloggers share their feelings on the days (hours and minutes!) leading up to the Match Day!

Tamara Bockow

Match day is around the corner. I know it’s a few days away, but I am still having trouble sleeping! I know there will be screams, tears and hugs. Penn has the nerve-wracking yet exhilarating tradition of calling students to the front of the auditorium one by one and handing each of us an envelope.  I suppose you can choose to open your envelope on stage or wait until you get back to you seat. I think I might open it at my seat. I want to preserve that tiny amount of privacy; I need to open it alone.

It’s weird to think that our future is so unknown right now. This will be the most important day of my future career thus far. Match day is the day that I will learn my fate; in fact, it’s the day my fiancé and I will learn our fate.  He is currently living in another city and is not in medicine. I am hoping to be close to him, geographically, so we don’t have to deal with a long distance marriage.

Match day is the culmination of years of work. It’s hard to believe that I am now 27, and I have been in school since I was 5! I have worked so hard to get to this day. From organic chemistry lab and MCAT studying to gross anatomy lab and Step 1 studying, it has taken so many steps and careful decisions to get to this day. I know I would never be here if it weren’t for the support and love of my parents.

Match day signifies the beginning of my transformation from a medical student to a neurologist. In about three months, we will begin our future jobs.

Ben Oshlag

Yesterday, I found out that I matched. I didn't find out where -- that comes Friday -- just that, come July, I am not going to be unemployed. The truth is, all we got was four words: "Congratulations! You have matched.", and then brief instructions about checking the NRMP website on Friday. Not the most elaborate or celebratory of announcements. Still, those four words, as simple as they were, helped me sleep last night. The uncertainty of the match process can be difficult, and after our rank-lists are in, everything is out of our hands, so it was a relief to finally start to close in on the finish line.

I enjoyed this past fall on the interview trail -- traveling around, getting to know the programs, meeting my future colleagues, trying to decide what kind of residency would best fit me. A smaller or larger program? Academic or community? Three years or four? Where did I want to be, and how important was that compared to everything else? The variety, especially in Emergency Medicine residencies, is astounding. Even among my top choices, there are major differences in the programs, and I know that where I end up will guide the course not only of my next few years, but likely my entire career. I know that no single program is "perfect", and weighing the pros and cons of each was often difficult, but by the time I got to the end, I had settled on a handful of programs I knew I would be very happy and excited to match into.

Since the end of interviews, I have done what I can to keep myself distracted, with rotations, and research, and planning a global health elective in India. But my mind has consistently returned to the anticipation of this week, of finding out what that next step will be. And so I wait, with 150 or so of my classmates, and thousands more across the country, for Friday morning, my fingers crossed with a mixture of nervousness and excitement.

Jess Spivey

For me, the start of fourth year brought about both uncertainty and freedom. To avoid becoming overwhelmed by the application process, I tried hard to capitalize on my newfound spare time and maintain a balanced life. I didn’t want to look back and feel I’d forgotten to enjoy my final year of school simply because I was so wrapped up in all of the uncertainty. As such, I’ve stayed active by working on research, keeping in shape, preparing (kind of) for some triathlons, and watching pretty much every free movie on Netflix. I planned some trips, and in April, I’ll be heading to California with some classmates to run a Ragnar Relay. Because of the relative freedom of fourth year, I’ve been able to foster my personal interests, and it has been so refreshing.

 Keeping myself busy, I feel fortunate that I’ve been able to keep from thinking too much about this whole match thing. I knew I would likely match, which was reassuring. Plus, every single program I included on my rank list impressed me, and having lived all over the United States, I felt open to the possibility of training at any of the programs. So up to this point, the thought of matching hasn’t been overly consuming. And when my family and friends have asked about it, I’ve typically minimized the importance of Match Day.

 On Monday, we all received an email outlining the list of Match Day festivities. There’s the ceremony, a reception, two class events, and a mixer the following evening.  My first thoughts were that this all seemed a bit excessive. But thinking about it, when you strip away the congratulatory indulgences, Match Day is about people realizing a longtime dream, and I’m no exception. As much as I’ve tried to downplay the significance of Match Day, the truth is that Friday will be a very meaningful experience. Regardless of where I end up, Friday brings confirmation that I will become an anesthesiologist, and that’s huge.

Isabela Wieczorek      

Keeping Myself Busy

Matching in Dermatology is no easy task. I knew I had to apply to a large number of programs and go on as many interviews as possible. Not only this, but I also had to apply to and interview separately for internship, the one year of internal medicine required before starting the 3-year dermatology residency.

November and December were distressing months - would I get enough interviews? The magic dermatology interview number is 8-10, where one can start feeling more comfortable about matching. I waited patiently for my interview invites, checking my e-mail multiple times a day, heart pounding each time my phone buzzed. My worries were assuaged once I surpassed the magic number, and I switched my focus to performing well on interviews.

Although the cross-country flights and long interview days drained me, I grew more and more excited about starting my career in dermatology. I met numerous inspiring, brilliant, and dedicated dermatology residents and attendings – I looked forward to having such top-notch teachers and colleagues. 

At the end of January, I finally settled back in Philly. During the past few weeks, I have kept myself busy with class, friends, and practicing for Spoof, the medical school play. This past Monday I found out I matched - now I wait until Friday to open the envelope that will tell me where I will be for internship and dermatology residency. Meanwhile, I am thankful for all of the distractions in my life that keep me from dwelling too much on Match Day!

 

Rhinoplasty, frequently referred to as a "nose job," dates back to ancient India but is infamous in popular culture due to the changing profiles of our favorite music and movie stars. The procedure generally involves surgically reshaping the structures of the skin, bones, cartilage, and nasal passages of the nose. 

Aside from the celebrity set, modern rhinoplasty procedures have become an increasingly common surgical procedure over the past few decades for a variety of underlying concerns, including functional purposes and cosmetic appearance. In fact, over 130,000 people undergo the procedure each year, according to statistics from the American Academy of Facial Plastic Surgeons.  As with many other surgical procedures, the technology and practice behind rhinoplasty has come a very long way, especially in the last 30 years.

Now, new research from the Perelman School of Medicine at the University of Pennsylvania indicates that the modern techniques used in rhinoplasty are showing excellent improvements in patients’ quality of life and function as compared to older techniques used for the procedure.

“Match Day” marks one of the most important days in a medical student’s career. Match Day is held annually to announce the results of the National Residents Matching Program (NRMP), which places graduating medical students with residency programs throughout the country. On March 16, 2012, the wait will be over for Perelman School of Medicine students who will open their envelopes revealing the location where they will spend their years of residency training.

Stay tuned over the next week as Penn’s medical students share their thoughts and perspectives during this exciting week of their lives – in their own written words, and on video – via a special Match Day blog and live tweets throughout the day. Family, friends, and news media can follow the excitement via the blog and by using the #PennMatch hashtag on Twitter.

Meet our 2012 Match Day bloggers!

Tamara Bockow

Tamara Bockow is originally from Seattle, WA.  Tamara graduated summa cum laude from the University of Pennsylvania in 2007. She majored in the Biological Basis and Behavior and minored in the Wharton Health Care Management program. Before starting medical school, Tamara spent a year working as a HealthCorps coordinator, teaching inner-city Brooklyn high school students about health, science and nutrition.

Tamara was named a 21st Century Merit Gamble Scholar and given a full tuition merit-based scholarship to medical school.  While in medical school, Tamara has co-authored a textbook chapter on gender differences in the brain. She worked as an associate editor and authored a chapter in a medical nutrition book. Additionally, Tamara founded a new organization and successful mentorship program for Penn medicine female faculty and students called the Elizabeth Blackwell Society.  She has been actively involved in student government all four years, and is the current president, and past co-president of the Student Interest Group in Neurology. Finally, Tamara has been actively involved in the Neuroscience Pipeline Program, a multi-tiered mentorship and neuroscience education program for West Philadelphia high school students. This year she is the head coordinator. Tamara will be matching in Neurology.

Ben Oshlag

Ben Oshlag is originally from Memphis, TN, and graduated from Tufts University in 2001, earning a B.A. in Computer Science and Philosophy. After college, he continued at Tufts, earning a M.S. in Computer Science in 2003, before spending five years working for the MITRE Corporation as a Network Systems Engineer. One career-180 later, while working on his post-bacc, he completed training as an EMT, and went on to teach for EMT courses at Tufts and Boston University, providing the initial spark for his interest in Emergency Medicine.

While in medical school, Ben has remained active in the community. He developed specific interests in working with both underpriveledged youth and the homeless population through the HEAL & NYAP programs and Penn's UCHC Clinic. He managed to combine those interests the summer after his first year when he participated in the Bridging the Gaps program, working at Covenant House, a local shelter for homeless 18-21 year olds, to promote healthy nutrition and lifestyle choices with the residents. He has also developed his interest in sports medicine, volunteering as medical staff at Penn Relays and other school athletic events, as well as focusing his scholarly pursuit project on sports-related concussions in children. Ben has also been active at Penn, serving on the Admissions Committee for the School of Medicine for two years, and as the Treasurer for both his class and the Medical Student Government. For relaxation, he enjoys playing in a number of local soccer and softball leagues, as well as attempting to turn his head full of useless information into discounted food at local trivia nights. Ben is applying in Emergency Medicine.

Jess Spivey

Jess Spivey is originally from Austin, TX, and graduated from Colorado College in 2002 with a B.A. in Biology. Following college, Jess volunteered for Americorps as a team leader for the Student Conservation Association. The team focused primarily on wildland fire prevention and suppression, and this experience led Jess to further pursue wildland firefighting. She subsequently became a member of the Midewin Interagency Hotshots, a U.S. Forest Service firefighting crew, and spent several years working on fires throughout the country. Though her interest in conservationism and environmental issues remains strong, Jess ultimately decided to leave the Forest Service to pursue another longstanding interest—medicine.

In medical school, Jess is active as a class representative. She was a coordinator for Guatemala Health Initiative’s annual spring break trip to Santiago Atitlan, Guatemala. A Bridging the Gaps intern, Jess spent the summer after her first year working with a team that provided educational outreach to Latino immigrants in South Philly. Jess is interested in medical education, and served as a clinical course representative during clerkship year. She is also working with Dr. Jose Pascual on a study examining the utility of video review as an educational tool in the surgical intensive care unit. In her spare time, Jess enjoys cycling and soccer, and generally tries to spend as much time outdoors as possible. She completed her first half-Ironman triathlon in 2009 and is currently training for another in June. Jess is applying in Anesthesiology. 

Isabela Wieczorek

Isabela Wieczorek grew up in Brazil and Potomac, MD. She graduated summa cum laude from Cornell University in 2008 with a B.S. in Microbiology. While at Cornell, she served as a Vice President of the 2008 Class Council, earning an award for "Outstanding Team Player."

At Penn, she has been active in the Medical Student Government and planned numerous events for classmates ranging from barbecues to Penn's first Multicultural Fair. Isabela also served on the Admissions Committee for two years, and as a recruitment co-chair for the Latino Medical Student Association. After spending a summer in Brazil seeing the effects of skin disease on quality of life, and conducting research in cutaneous lupus erythematosus with Dr. Victoria Werth, she has decided to pursue a career in Dermatology.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

This month marks the five-year anniversary of Penn Medicine’s first implantation of a temporary total artificial heart (TAH) in a patient suffering from end-stage heart failure. See the full story here.  

In 2007, this device was viewed as a major breakthrough in cardiovascular surgery, used as a “bridge-to-transplant” for patients who were waiting for a donor human heart.  Originally designed as a permanent replacement heart, the TAH device is currently only being used as a bridge to human heart transplant for patients dying because both sides of their hearts are failing (irreversible end stage biventricular failure). 

The patient, a Philadelphia-area native, is still doing well.  While the device was only in place for less than a month (he went to receive a full heart transplant in March 2007) the technology proved to be a life-saving medical innovation. At the time, patients who received a TAH spent their days in the hospital, tethered to a rolling device weighing more than 400 pounds that required frequent monitoring, their artificial hearts ticking audibly in their chests. One HUP patient spent 310 days with the device implanted before receiving a transplant in 2009.

But in just the five short years since HUP’s first TAH procedure, cardiac-assist technology for heart failure has moved leaps and bounds. A separate class of devices, known as ventricular assist devices (VADs), have proven to be an invaluable tool in the ongoing search to replicate the very intricate and delicate functions of the human heart.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

It may seem thoroughly unromantic, but researchers at Penn Medicine’s Cardiovascular Institute are hoping for some broken hearts this Valentine’s Day.  But these broken hearts could wind up being the unlikely heroes in the ongoing search for new therapies to treat one of the most common health conditions in the world – heart failure.

According to the American Heart Association, about 5.7 million people in the U.S. alone suffer from heart failure. Statistics also show that, each year, 670,000 new cases are diagnosed and more than 277,000 people will die of heart failure.

Physicians working to understand and develop new therapies for heart failure rely on human tissues for their investigations. Many of these valuable tissues come from diseased or “broken” hearts that are replaced by transplantation or repaired by implanting medical devices that help keep the heart going. One of the world’s largest repositories for this type of tissue resides right here in Philadelphia, at the Penn Cardiovascular Institute’s Human Heart Tissue Repository.

The program, led by Kenneth Margulies, MD, professor of Medicine and research director for the Heart Failure and Cardiac Transplantation Program at Penn, allows surgeons, physicians and researchers to work together to understand why certain heart defects, such as heart failure, occur and how they can be more accurately treated.