9/26/22 VA NTC

Today we had a fantastic case presented by our amazing med/peds resident Dr. Uju Nwosu of an older male presenting with acute onset total body weakness and confusion. We started by considering diagnostic schemas for generalized weakness and acute encephalopathy. He had a history of metastatic cancer treated with immune checkpoint blockade and was found to be hypotensive with hyponatremia and low AM cortisol. Based on his presentation and further lab workup, we discussed a possible unifying etiology of immune check point-induced hypophysitis causing hyponatremia and secondary adrenal insufficiency. Thanks to Dr. Nwosu and our amazing clinical problem solvers for thinking through a fascinating case!

Hypocalcemia

Usually we see hypercalcemia, but today we talked about the nuances of hypocalcemia with Dr. Mullaney in a patient who was post parathyroidectomy.

Courtesy of GrepMed.com

Physician Suicide Discussion–Tue 9/20 6pm via Zoom

Dear UCSD IM Family,

It is with sorrow that we reach out to you to acknowledge the tragic loss of a fellow internal medicine intern at our sister program at Highland General Hospital in Oakland.  Although I did not personally know her, I know that many of you did and I am deeply sorry for your loss, and the loss to our entire community.

In the coming days, we will have opportunities to mourn, debrief, and discuss.  I know there are no easy solutions to the many factors that contribute to a tragedy like this.  I want to remind you that we are all here to support and help one another.  If you are struggling in any way, please reach out for help—to one of us, or one of your classmates.  If you are concerned about a friend or colleague, please also reach out to us. Know that this will be handled carefully and with utmost respect for confidentiality.

There will be a voluntary open Zoom meeting to help us process this loss, share feelings, connect with colleagues, ask questions about physician suicide or simply listen. It will be led by members of the Healer Evaluation Assessment Referral program tonight at 6pm. Please join if you are able.

http://zoom link is: https://uchealth.zoom.us/j/83100025066

We also want to remind you of the resources that we have including our HEAR program:  https://medschool.ucsd.edu/som/hear/Pages/default.aspx 

GINGER:

https://www.ucresidentbenefits.com/ucsd/get-care/virtual-behavioral-health

UCSD Chaplaincy: 619-290-1560 

San Diego Access & Crisis Line: 888-724-7240

National Academy of Medicine Resources for Clinicians: https://urldefense.com/v3/__https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-well-being-resources-during-covid-19/

National Suicide Prevention & Crisis Hotline: 1-800-273-TALK 

National Voter Registration Day 09.20.22

Today, September 20, 2022, is National Voter Registration Day. If you are new to the San Diego area or not sure if you are registered to vote, please click the links below. All registered voters in California will get a mail-in ballot which is a great option with our busy schedules! Tag your voting pictures with the @ucsd_medicine handle on Instagram to be featured.

Register in San Diego: https://registertovote.ca.gov

Register in US: https://nationalvoterregistrationday.org/register-to-vote/

Request a mail-in ballot: https://www.nass.org/can-i-vote/absentee-early-voting

Sign up at https://vot-er.org to get a badge tag that patients can use to register to vote.

To get involved more, reach out to Lainey with AHEAD.

9/16 Friday School

Today our seniors started with a fascinating EQIPS case led by residents Drs. Guzdar and Hansen. We discussed optimizing care of vulnerable patient populations in our safety net hospital. Dr. Eduardo Grunvald, director of the UCSD Weight Management Program, then shared novel interventions for the management of obesity, including recent data on tirzepatide. Our senior residents then wrapped up the afternoon with a fantastic lecture by endocrinologist Dr. Kristen Kulasa on management of DKA/HHS. Meanwhile, our interns started a new high-impact block, covering inpatient delirium with psychiatrist Dr. Aaron Meyer and blood products with transfusion medicine specialist Dr. Elizabeth Allen. Thanks to all of our incredible faculty and residents for a great afternoon of learning!

Battlefield Acupuncture for Pain!

Last night we had a hands-on integrative medicine session where the residents got to learning about the data behind acupuncture and how to actually do it! Thanks to Dr. Kristen Bell for all the teaching and leading such a wonderful program at the VA!

9/13/22 VA NTC: Dyspnea

Today our wonderful resident Dr. Courtney Keilman shared a case of an older male presenting with acute onset, progressive dyspnea. We worked through the case in small groups, firing up our clinical reasoning by refining our problem representation, diagnostic schema and differential diagnosis after each aliquot of history and data. Kudos to our enthusiastic clinical problem solvers, scribe Dr. Flatow-Trujillo and our amazing VA faculty who shared several clinical pearls!

NTC 09.12.22: Sometimes chest pain is shingles!

Today we worked through a case of an elderly male presenting with chest pain. Unfortunately, history was limited due to major cognitive disorder so we practiced an Anatomic Diagnostic Schema for chest pain. The patient ended up having zoster (confirmed by swab) which may have explained his chest pain. Shout out to Alex Tong (CMR) for the amazing scribing!