University of Nevada Reno School of Medicine Match Day 2019. An Alice in Wonderland themed Match celebration with each medical student opening their gold clock. Inside the clock was a note with their residency specialty and location.
What is “Match Day” for medical students? Match Day is a monumental milestone for all graduating fourth-year medical students. There are almost 12,000 residency and fellowship training programs in the US. There are 20,000 medical students graduating with MDs yearly. The match process matches the medical students with the specialties and destination of choice. First there is an application and interview season (October – January) and all training programs create a rank list. This lists the medical students from most desirable to least. AND, each medical student applicant makes creates a ranked list of their desired training programs.
How does the match happen? A computer (with a Nobel Prize winning algorithm) matches medical students and program interest. The algorithm favors the student’s choice. On Match Day, the results are known by all. Nearly 75% of students receive one of their first three choices.
What happens if a medical student wants to match with another medical student? This was the case with my now-husband and me 25 years ago. We “couples matched.” This adds an additional level of difficulty where an even more complicated algorithm balances the training objectives of the two students. The students each decide which medical specialty they want to train in and how far apart they are willing to live. This is all reflected in their joint match lists.
When is Match Day? Friday, March 20th. Every medical student in the country has their “reveal” time at the same time. Noon Eastern Standard Time and 9 am here in the West.
Medical school is actually the beginning of a physician’s education. Physicians train for an additional 3-10 years AFTER medical school, depending on their specialty.
Add this to one more medication that may cause birth defects… There is a study just released with over 100,000 patients which shows that when macrolides (antibiotiocs like erythromycin, azothromycin, and clarithromycin) are used in the first 13 weeks of a pregnancy, may increase birth defects.
Compound this with the thought that most women do not know they are pregnant until they miss 1-2 menstrual periods. So, I urge you to be aware of your menstrual calendar when your physician prescribes you antibiotics.
And, while you are thinking of it, take a prenatal vitamin daily. It’ll help the fetal spinal cord and may make you feel better.
Lower incidence of heart disease, type 2 diabetes.
Live longer. Consider that your time exercise may be paid back to you later in life in longevity.
Better circulation
Ward of depression
Makes you more creative, have more focus, and increase productivity
Helps you sleep better
Move your body!
25% of adults are sedentary. Lack of exercise is one of the top modifiable risks to decrease cardiovascular disease.
Exercise can be split up throughout the day. Aim for 20 minutes of moderate exercise every day. This can be a walk around the block… or walk from the far end of the parking lot.
How to build this into your day? Make a plan! Have gym shoes in your car ready to go. Like to listen to music or podcasts? Pair your exercise with something you enjoy and have your headphones ready. Bad weather coming? Have a backup plan (walk the mall or big box store). Need a partner? Make a standing date with a friend or get a dog! Make it convenient: get a treadmill desk or pace when talking on the phone. Do you want to monitor your progress? Get a tracker.
What kind of exercise is beneficial? 3 different kinds of exercise are beneficial: aerobic, resistance, and stretching.
Aerobic is raising your heart rate (swimming, walking, bicycling).
Resistance training is using weights or resistance bands.
Stretching is just that. Try yoga or pilates if you would like to take an organized group to learn how to stretch, or find stretching regimen on youtube!
Most benefit is from going from zero to SOME exercise. This will impact your overall health. Get a move on….
Why is it important to eat a healthy diet? Eating the right foods can keep you healthy now and later on in life.
Which foods are especially healthy?
●Fruits and vegetables – Eating fruits and vegetables can help prevent heart disease and strokes. Fruit may also help prevent certain types of cancers. Try to eat fruits and vegetables at each meal and for snacks. If you don’t have fresh fruits and vegetables, frozen or canned ones can be substituted. Physicians recommend at least 2 1/2 servings of vegetables and 2 servings of fruits each day.
●Foods with fiber – Eating foods with a lot of fiber can help prevent heart disease and strokes. Fiber can help control your blood sugar. Foods with a lot of fiber include vegetables, fruits, beans, nuts, oatmeal, and some breads and cereals. You can tell how much fiber is in a food by reading the nutrition label. Physicians end eating 25 to 36 grams of fiber each day.
●Foods with folate – Folate should be taken by all females of child-bearing age. Folate helps the fetus form an intact spinal cord. Folate is found in many breakfast cereals, oranges, orange juice, and green leafy vegetables.
●Foods with calcium and vitamin D – Babies, children, and adults need calcium and vitamin D to help keep their bones strong. Calcium and vitamin D helps to prevent osteoporosis. Osteoporosis is a condition that causes bones to get thin and break more easily than usual. Often we don’t get enough calcium and vitamin D in our diets and a supplement may be needed. Supplements are pills, capsules, liquids, or tablets that have nutrients in them.
●Foods with protein – Protein helps your muscles stay strong. Healthy foods with a lot of protein include chicken, fish, eggs, beans, nuts, and soy products.
Some experts recommend a “Mediterranean diet.” This involves eating a lot of fruits, vegetables, nuts, whole grains, and olive oil. It also includes fish, poultry, and dairy products, but not much red meat. Eating this way can help your overall health, and may lower your risk of having a stroke.
What foods should I avoid or limit? To eat a healthy diet, there are some things you should avoid or limit. They include:
●Fats – There are different types of fats. Some types of fats are better for your body than others.
Trans fats are especially unhealthy. Avoid margarines, many fast foods, and some store-bought baked goods. These can raise your cholesterol level and thereby increase your chance of getting heart disease.
The type of “polyunsaturated” fats found in fish seems to be healthy and can reduce your chance of getting heart disease. Other polyunsaturated fats might also be good for your health. When you cook, choose oils with healthier fats like as olive oil and canola oil.
●Sugar – Limit or avoid sugar, sweets, and refined grains. Refined grains are those in white bread, white rice, most pasta, and packaged “snack” foods. Whole grains, like whole-wheat bread and brown rice, have more fiber and are better for your health.
Avoiding sugar-sweetened beverages, like soda and sports drinks, can also help improve your health.
●Red meat – Red meat can increase your risk of certain health problems, including heart disease and cancer.
Can I drink alcohol as part of a healthy diet? People who drink a small amount of alcohol each day might have a lower chance of getting heart disease. But drinking alcohol can lead to problems. Men should drink 2 or less drinks on average per day, women 1 drink.
How many calories do I need each day? The number of calories you need each day depends on your weight, height, age, sex, and your activity level.
Do you suspect dementia in your loved one? There are many ways to investigate if dementia is present.
Your physician may give a screening test like the Mini Cog, the General Practitional Assessment of Cognition, or the Ascertain Dementia 8-item informant questionnaire. These will help determine if further investigation is needed.
Blood work may also be needed to rule out other causes of mental confusion. A blood count to rule out anemia, Vitamin B deficiency, hypothyroidism, vitamin B12 deficiency, diabetes, and liver and kidney insufficiency/failure. To view the brain, magnetic resonance imaging (MRI) without contrast is the preferred test to exclude other intracranial abnormalities such as stroke, normal-pressure hydrocephalus, subdural hematoma (blood pooling in the brain) or a mass.
Thyroid cancer. Should we screen for this? There are organizations who look over all the known data and update us, physicians, on what screening tests are beneficial to the population as a whole. The U.S. Preventive Services Task Force (USPSTF) does this.
The USPSTF recently delineated the guidelines for thyroid cancer screening in asymptomatic adults. There is not enough evidence to show that screening for thyroid cancer is helpful in those without symptoms. Thyroid cancer is rare and observational evidence shows no change in mortality over time even after introduction of a mass screening program for thyroid cancer. There are also harms in overdiagnosing possible thyroid cancer. These patients undergo additional tests or biopsies or surgeries which can cause laryngeal nerve damage or vocal cord paralysis.
Saline irrigation of your nose decreases the severity of allergy symptoms. You buy the nasal irrigation (like a Neti Pot) once and then it washes away allergens in your sinuses.
Allergic rhinitis is the nose reacting to allergens with an immunoglobulin E-mediated hypersensitivity reaction. You may feel this as nose running, nasal itching or sneezing. Allergic rhinitis can also impair sleep quality and social interactions.
Nasal irrigation may be similarly effective as when oral antihistamines or intransal steroid spray are used. But, with nasal irrigation, it is essentially non-pharmacologic and you buy the irrigator once and then it’s free.
We have begun using progetogens to reduce the risk of miscarriage. This significantly decreases the rate of miscarriage compared to placebo.
How common are miscarriages? Miscarriages occur in 15 to 20% of pregnancies. A “threatened” miscarriage is defined as any vaginal bleeding (with or without pain) in a pregnant woman with a closed cervix and an otherwise viable fetus inside the uterus.
What is NOT found to help? Bed rest, pelvic rest (nothing in the vagina meaning no sex, douching or tampons), vitamins, uterine relaxants, and administration of beta HCG. Progestogens (medications that mimic progesterones) may help. A meta-analysis of 7 research studies with nearly 700 women showedthat oral administration of progestogens had a lower risk of miscarriage compared to those receiving placebo.
The National Institute for Health and Care Excellence is currently developing a guideline with regard to progestogens and miscarriage. More research is definitely needed.
Dr. Leslie Greenberg's Blog 
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