Spend less than you earn. There will be temptation to live beyond your means, particularly in the early years of practice. Pay off debt as quickly as possible.
David Juurlink, Advice for Physicians in Training: 40 Tips From 40 Docs, The Winnower 2:e142006.67645 (2014). DOI: 10.15200/winn.142006.67645
ESPN recently released a short documentary as part of their “30 for 30” shorts called “The Sweat Solution” about the creation of Gatorade. This athletic drink that is universally recognized is credited to Dr. Robert Cade who completed medical school at UT Southwestern and his residency in internal medicine at Parkland Memorial Hospital. He trained closely under the tutelage of Dr. Donald Seldin in nephrology. Dr. Cade then joined the IM faculty at University of Florida and worked on developing an oral solution to give their collegiate athletes that competitive edge. This led to the creation of Gatorade and the rest is history. Dr. Cade passed away in 2007 and is recognized as a brilliant physician scientist who made a significant impact.
Check out this fascinating video below!
Check out this article from UT Southwestern about honoring Dr. Cade’s work in 2004:
Today at Parkland Morning Report we had a great discussion about cobalamin (vitamin B12) deficiency. Below is a quick synopsis and link to a review article!
- Cobalamin is necessary for DNA synthesis and is found in sardines, shrimp, calf’s liver, and other animal meats.
- Cobalamin is released from food by gastric peptidases and is then absorbed in the ileum through intrinsic factor.
- Because of the large hepatic reservoir and efficient reuptake by the enterohepatic system, cobalamin deficiency due to decreased PO intake takes several years to develop.
- Etiology: Malabsorption – pernicious anemia, inflammatory bowel disease, celiac disease, bacterial overgrowth, pancreatic insufficiency
- Pernicous anemia is due to antibodies directed at hydrogen potassium adenosine triphosphatase in the parietal cell membrane causing parietal cell atrophy and reduced intrinsic factor levels
- Clinical Presentation:
- Glossitis, weight loss, pale yellow skin, abdominal pain secondary to gastritis
- Loss of vibration and propioception which can progress to spastic ataxia, hallucinations, dementia, psychosis
- Peripheral smear can show hypersegmented neutrophils, basophilic stippling, oval macrocytes
- Hemolysis, thrombocytopenia, and leukopenia are other common lab findings due to inefficient hematopoiesis
- Elevated homocysteine and methylmalonic levels; high methylmalonic levels are more sensitive and specific in diagnosing cobalamin deficiency than actual cobalamin levels
- Parental: 1000mcg daily for 1 week, 1000mcg once a week for 4 weeks, 1000mcg every month for rest of life
- Oral: 1000mcg-2000mcg PO every day. Recent research has shown PO regimens to be comparable to parental as it is thought that the presence of a second, lower efficiency transport system for cobalamin which does not require intrinsic factor or a functioning terminal ileum can be utilized
(image courtesy of ACP MKSAP 16 Online)