Interested in Medical School? Start Early.

A friend of mine’s son is just about to graduate from high school.  He’s interested in medical school, and his mom asked me what advice I would give to help him pick a college knowing that he has an interest in medicine.

Keep in mind: I am not a counselor or an advisor.  I am a physician, and this is what worked for me.

My advice:

  1. If you’re interested in medicine…. start early.
    • The college and medical school application process are getting more competitive.  Students are bright, prepared, and eager.  Let’s start with the basics.  Are you sure you’re interested in medicine?  Like really interested?  Sure, the media portrays some glamour lifestyles for physicians… but it’s not all glitz and glam.  You’ll put in at least a decade of extra work vs. your peers who get a job right out of college.  While they’re building their nest egg, you are not.   
    • Luckily, I stumbled upon my interest in medicine at an early age when my family practice physician encouraged me to pursue it.  He proved to be a great mentor as I was able to shadow him and really get a feel of his day and what he does.
  2. Once you’ve decided medicine in your passion… solidify that decision.
    • Volunteer at the hospital.  Observe your physician.  Volunteer to help people.  If this excites you, you’re on the right track.  Put yourself in situations where you can get involved in medicine.  Read and research what medical school is like.  Reach out to a medical school and see if you can get more information: chat with a medical student, find out if anyone needs help with a research project.
  3. Do well in school.
    • This is a must.  Applicants are incredibly competitive and intelligent with tons of extracurriculars on their resumes.  Get good grades.  Do well on your SAT/ACT and then do well on the MCAT.  Your grades and your test scores are the most basic comparison tool for schools to compare applicants.  Doing well gets you noticed.
  4. Get involved and signup for extracurricular activities.
    • Once you’ve put in the work for good grades and test scores… get involved.  This could be anything: sports, clubs, arts/music, babysitting/caring for loved ones, volunteering, job in a lab, travel/cultural growth.  The key is to show that you’re well-rounded and multifaceted all while achieving the good grades.  Once the colleges and med schools have seen your test scores, they’ll next use your extracurricular activities to help separate out the different applicants.  The key is maintaining good grades while all these other activities are happening.  AAMC fact sheet for medical schools.

If you’re in high school and interested in medicine:

  • Get good grades and do well on SAT/ACT (consider college prep courses to help)
  • If you’re able to take honors classes or AP classes and do well, definitely sign up for these.  It’s another way to separate yourself from other applicants.
  • Volunteer at your local hospital and/or doctor’s office
  • Get a job at a research lab or hospital
  • Get involved in extracurricular activities
  • Talk to your high school counselor about career paths
  • Attend career fairs (my school offered a career night in medicine where we got to go into the operating room) and college fairs on getting into medical school
  • Ask a college pre-med what they’re taking and how to do well in college
  • If you’re torn between two schools on your college list, consider taking a good look at the college that may also be linked to a medical school.  There’s a good chance that some of the medical school professors will be teaching some of the upper level physiology or anatomy college courses.  Some of the professors may also sit on the admissions committee to medical school.  Lastly, it may be easier to get involved in clinical research or scientific studies that the medical school professors are working on… and that would be a great way to introduce yourself to medical school staff as well as get a stellar recommendation letter to show off your work ethic and dependability.

If you’re in college and interested in medicine:

  • Get good grades and do well on the MCAT (consider prep course to help)
  • Get a major in something you’re interested in (you do NOT have to be a pre-med major… you just have to take the pre-med prerequisites to take the MCAT and apply for medical school).  Even though I majored in biomedical science (a pre-med major at Texas A&M), I would have done biomedical engineering if I had a do-over.  Science and math have always been my interests…the engineering major would have given me a nice background beyond my pre-med major.
  • Talk to your college counselor/advisor early (freshman year)
  • If you get into an honors program in college (usually based on your SAT/ACT scores), go for it.  Typically the honors classes are smaller and are a fantastic way to build report with your professor as well as get deeper into the subject matter.  Plus, being in the honors program will further help you standout on your application to medical school.
  • Volunteer at the local hospital.  Although you may start out as a volunteer, see if you can get into the OR (operating room) as well as outpatient clinics.  This will expose you to a wide variety of practices: surgery, anesthesiology, pathology, internal medicine, family practice, OB/GYN, specialties, etc.
  • Get involved in extracurricular activities in college.  There are a ton of clubs and interest groups in college.  If you don’t find one you like, start your own!
  • Need a job in college?  Consider getting one in the research lab or at a medical school or in a hospital.
  • Consider doing summer school to get some credits out of the way.  When I was in college, 12 credits was a full-time student.  I always took 15 credits because I thought I could handle it.  (Now I cannot recommend the following…) My junior year in college, I signed up for 21 credits to see if I could handle a medical school work load.  It was a tough semester, but I did it and got a 4.0.  I wouldn’t recommend that route because you need to focus on grades… but it worked for me.
  • Apply to a lot of medical schools (in-state and out-of-state).  I grew up in Texas and at the time they had a Texas match with 7 medical schools.  I only applied to the Texas (in-state) medical schools because I knew that was all I could afford.  Keep in mind your debt burden: a $9,000/yr education vs a $30,000/yr is a big difference.  I chose an option that made the most sense to me — I didn’t want to be in debt forever.  In fact, I highly recommend reading this book: The White Coat Investor: A Doctor’s Guide To Personal Finance And Investing.  If I had that available to me, I would’ve read that in high school… re-read it in college… read it again in medical school… and read it again throughout life.  Yes, I’m constantly revisiting this book because it is that good.
  • Interviews: honestly, I can’t remember if I interviewed for medical school or not (geez that makes me sound old!).  If you do have interviews… put your best foot forward and practice interviews with your friends/parents/professors/etc.  Be positive, engaging, and professional.  Interviewers DO judge a book by its cover.
  • Once you’ve applied to medical school, sit back and wait for your results to roll in.  Honestly rank the schools you would like to go that caters to your learning style/goals/etc.  My medical school (UTMB) was one of the first in the country to incorporate systems-based learning and problem-based learning.
    • Systems-based = learn subject material based on the different organ systems vs. separate anatomy, physiology, pharmacology, pathology, etc.  (I learned based on the cardiovascular/gastrointestinal/genitourinal/neurological system, which included the anatomy, physiology, pharmacology, pathology, etc related to that system.  I thought it was a more intuitive way to learn medicine) .
    • Problem-based learning involved small groups where we would discuss medical cases, labs, clinical problems, etc.  It was a nice environment to express yourself as well as work together in a team.  This is how the real-world works where you talk to your colleagues to work through various medical issues.  It supports professionalism and engages a teamwork mentality.
  • Lastly, thank the people who helped you get here.  It’s easy to overlook your mentors, friends, professors, and family.  As you enter the medical school/medicine world, your family will learn along the way that you made a commitment to a profession that will take priority over them.  You will miss weekends, evenings, date nights, holidays, anniversaries, etc.  Not only will you sacrifice a lot to get to medical school… you’ll continue making sacrifices once you’re out practicing medicine in the real world.

AAMC fact sheet for medical schools

My Training:

My Job:

Hormone stimulation for oocyte retrieval #eggs #fertility #hormones #professional #women

I’m a professional.  

On call in the hospital
On call in the hospital

What does that even mean?  My best guess is that it means I went to school for a long time and entered a career where I get to behave professionally and interact with people.  Fast forward 18 years after graduating high school and I have a successful career in medicine doing anesthesia.  I have met some fantastic people along my journey and I’ve traveled and experienced life to the fullest.

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So why this post?

Because I’m 35 and according to the OB/GYNs…I’m AMA (advanced maternal age).  In a nutshell, it means that after the age of 35, there are significant (possibly exponential?) risks of chromosomal abnormalities with my eggs or there could be serious problems with my baby at my age.  The older I get, the more I’d like the option of having a family… and that’s whether I meet the right guy or not.

From Wikipedia (James Heilman, MD): The risk of having a Down syndrome pregnancy in relation to a mothers age.

What’s it like to undergo hormone stimulation?

Tues, March 3:  I’m currently on day #5 of injections and I still feel normal (i.e. no crazy hormonal emotions or anything; no bloating; no weird experiences, etc.). I don’t have any emotional drama; no crazy hormonal thoughts or outbursts. I actually feel pretty normal.  No bloating, no PMS, etc. I don’t know what I’m supposed to feel bc I feel just normal… like a normal day without the injections.  Now, the injections –> I’m starting to dread the 7pm hour bc these injections are starting to hurt!  I’m a pretty tough cookie… don’t be fooled by the smiling youngish face.

The meds and my mini sharps container
The meds and my mini sharps container

Fri, March 6: I’m bloated.  Cravings are starting to kick in, but maybe it’s just stress at work?  No crazy emotional stuff.

Sat, March 7: The bloating continues.  In fact, my ovaries are pretty sensitive — any big bounces in the car or if I sit down hard is painfully noticeable.  The Ganirelix stings a little bit more than the others on injection.  No big hikes or active things: no trail running, no running (period!), no elliptical, no jumping.  I’m starting my couch potato life and getting stir-crazy!  But, I did do a 7 mile flat hike today — I couldn’t help it!

Sun, March 8: The bloating continues.  I definitely feel the pull/sensitivity of both my ovaries.  Even when I empty my bladder, the pressure/tug release is definitely present.  Huge mishap today: I underestimated how much Follistim I had!  Today, I was supposed to go up on Menopur, but I didn’t have any extra, so I was told to take my standard 150 dose.  Yet, they told me to go up to 300 on Follistim today and I barely had any when I stuck the needle in! I remembered I had an extra vial with just a small amount left and injected that.  it was only 150.  3 injections in one night is no fun.

Mon, March 9: Gave myself an additional 150 follistim this morning once the pharmacy opened.  15mm follicles are looking good!  My left ovary has a ton!  The right ovary is doing alright as well.  Just waiting to get the estrogen level up.  Same bloated feeling.  No physical activity or heavy lifting.

Tues, March 10: Estrogen is finally above 1,000! Apparently after many years of birth control pills, it suppresses estrogen… on track!

Thurs, March 12: All systems go for Friday retrieval. 🙂  My last injection was this morning.  I’m incredibly happy to be done with those!  The indomethacin makes my head cloudy — not sure I like the feeling.

Fri, March 13: yes it’s Friday the 13th. But I’m not superstitious. Showed up at 6 am and proceeded with paperwork. Estrogen and progesterone levels were fantastic. Went back to the OR around 7am. A little propofol and fentanyl for my MAC case. I requested no versed. Some Toradol in the pacu to help with cramping. Had a fine relaxing day after. Took some tylenol for cramps. They retrieved 13 eggs. 6 mature ones and 5 not quite mature ones.  Wonder what we do from here. I’m still super bloated and my doc said no physical activity for 2 weeks.

Tues, March 17: The bloating is getting better.  There wasn’t much cramping or pain or spotting after the retrieval.  Maybe I am lucky?  I only took Tylenol twice since Friday.  The bloating was extremely intense Saturday, Sunday, and Monday.  I feel that it is better today.

Wed, March 18: I was thinking more about the numbers of eggs retrieved and came upon a couple of different articles and resources.  I haven’t chatted with my doc yet.

Taken from Wikipedia
Taken from Wikipedia

Here’s the replay of my series of events:

  • Wed, Jan 28: Ultrasound to assess # of follicles.  Start antibiotics (5 day z-pak).  Start taking prenatal vitamins, vitamin D, and baby aspirin daily.
  • Sun, Feb 22: Stopped birth control pills per Fertility Doc who had me start and stop these a couple of times.
  • Thursday, Feb 26: Morning blood draw and afternoon ultrasound.
  • Fri, Feb 27: Start Menopur 150IU SQ and Follistim 150 SQ @ 7-9pm
  • Sat, Feb 28: Menopur 150 IU, Follistim 150
  • Sun, Mar 1: Morning blood draw. Menopur 150, Follistim 150
  • Mon, Mar 2: Morning blood draw. Menopur 150, Follistim 200
  • Tues, Mar 3: Morning blood draw. Afternoon ultrasound. Menopur 150, Follistim 250
  • Wed, Mar 4: Morning blood draw. Menopur 150, Follistim 250
  • Thurs, Mar 5: Morning blood draw. Afternoon ultrasound. Menopur 150, Follistim 250.
  • Fri, Mar 6: Morning blood draw. Menopur 150, follistim 250.
  • Sat, Mar 7: Morning blood draw and ultrasound. AM Ganirelix start. PM Menopur 150, Follistim 275.
  • Sun, Mar 8: Morning blood draw.  Ganirelix. Menopur 150, Follistim 300 (but I only injected 150 bc I ran out!).
  • Mon, Mar 9: Morning blood draw and ultrasound.  Ganirelix, Follistim 150.  Menopur 150, Follistim 300.
  • Tues, Mar 10: Morning blood draw and ultrasound. Ganirelix. Menopur 150, Follistim 275 (ugh! i ran out again!).
  • Wed, Mar 11: Morning blood draw and ultrasound.  Ganirelix. Indomethacin 50 tid. Lupron 0.8ml @19:30. Pregnyl 1000U IM.
  • Thurs, Mar 12: Lupron @ 7:30a. Morning blood draw. Indomethacin tid. NPO after 10pm.
  • Fri, Mar 13: Oocyte retrieval @ 7:00a. Doxycycline 100 bid.  No heavy lifting (>10 lbs for a couple of days — better yet I was told two weeks!).
  • Sat, Mar 14:  Doxycycline 100 bid.  Restart baby aspirin, prenatal vitamins.
  • Sun, Mar 15:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Mon, Mar 16:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Tues, Mar 17:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Wed, Mar 18:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Thurs, Mar 19: Could this be my first normal day??? Holy cow!
  • Fri, Mar 27:  They said they got 13 eggs… but they didn’t tell me 6 were mature and 3 were intermediate. When i had my initial consultation… i told her i wanted 2-4 kids possible.  If i assume wcs (worst case scenario), which i should in this case… that would mean at best only 1 or 2 kids.  I was completely deflated. so i am going to do a second round.  it’s not what i want to do, but it’s my best chance.  She thinks it’s bc i’ve been on bc pill for so long, so i can’t take those from now until my next go.  She’s aiming for July 2015.  She saw plenty of follicles (which is good)…. but my hormones had been suppressed so long bc of the bc pill.  I’m sad bc i have to do this again…. and it was hard enough the first time.
  • In this whole process, I met a wonderful man. We are looking at doing embryos for a higher success rate.
  • Mon, July 13: Prolactin level is 38 on re-draw from fri. 😀 that is normally where I hang out. We decided no repeat MRI (I had been getting them annually for 5 years after surgery to assess growth — I think last was 2010). No growth with drawing prolactin at those times as well as checking for visual field defects annually still. All points to good signs. She’s going to reach out to my endocrinologist and I’m going to get back on bromocriptine (to make my prolactin normal). I wanted to normalize prolactin first before getting on an estrogen stimulating med (that can grow the old prolactinoma). So… I also told her about you and that we’re looking at a possibility of embryos instead of just eggs. She felt very positive about that bc she said I had plenty of follicles and that would ultimately a higher success rate. And she also knows about my prior long use of birth control pills for regulating periods (bc of prolactinoma). All of this points to a good sign that things are normalizing and we have a plan. She said she’d like to see me on bromocriptine for about 3months and would be getting another prolactin draw 6mo after starting that med.

When I was a kid and had to get immunized, my dad used to tell me “don’t be a chicken shit.”  And I wasn’t.  When I was 4, I vividly remember putting my arm out voluntarily when I had to get a shot.  What’s more odd, is that at the tender age of 4, I would watch the needle placement into my arm and not look away.  It was single-handedly one of the best lessons my dad ever taught me.  Face your fears directly.  So, my present-day self is perhaps a bit more squeamish giving my own shots into my abdomen.  The injections are given subcutaneously, which means that it goes into the fat layer below the skin but above the muscle.

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Why Am I Doing This?

I wanted to preserve my fertility and not feel so rushed to find “Mr. Right For Me.”  To be honest, I never thought I would be taking this journey… let alone by myself.  I always envisioned being with the love of my life and starting a family once I achieved my career.  But nature and the biological clock don’t stop.  That’s life.  So I’m making the best of my situation and hoping to preserve my future and share it with someone who will explore and share this journey of life with me.

Because in the end, happiness deserves to be shared.

Another gal’s journey and exploration


Updated Nov 1, 2015 from the NEJM

Teaching Topic
Cryopreservation of Oocytes
CLINICAL PRACTICE

G.L. Schattman

CME Exam   Full Text Audio  Comments

In the United States, more than 100,000 women of reproductive age receive a diagnosis of cancer each year, and they are at risk for diminished reproductive potential or infertility as a result of treatment. The freezing of oocytes has become a clinically viable option for women who wish to have a child in the future but are facing either an age-related or iatrogenic decrease in the quality and quantity of oocytes.

Clinical Pearls
Clinical Pearl  What is currently the preferred method for cryopreservation of oocytes?

The large size and high water content of oocytes make the formation of ice crystals and subsequent cell injury or death difficult to avoid during the cooling process. Vitrification has replaced the slow-freeze method as the method of choice for cryopreserving oocytes, since it minimizes ice-crystal formation and results in higher rates of cell survival, fertilization, embryo development, and pregnancy. As compared with the slow-freeze method, vitrification involves exposure of oocytes to relatively higher concentrations of cryoprotectants for a shorter duration, followed by ultrarapid cooling either through direct immersion into liquid nitrogen (in so-called open systems) or with the use of small, volume-sealed straws (in closed systems). Once vitrified, the cells can be stored indefinitely in liquid nitrogen.

Clinical Pearl  Is there an association between cryopreservation of oocytes and subsequent congenital abnormalities?

Oocyte cryopreservation by means of slow freezing or vitrification has not been shown to increase the incidence of aneuploidy or congenital abnormalities in children, although long-term studies involving large numbers of births resulting from thawed oocytes are still lacking. Collection of data on long-term outcomes by the Society for Assisted Reproductive Technology is under way.

Morning Report Questions
Q. What factors are central to the likelihood of achieving a live birth using cryopreserved oocytes?

A. In determining the probability of achieving a live birth with the use of cryopreserved oocytes, the two most critical factors are the woman’s age at oocyte collection and the total number of oocytes available. Rates of embryo implantation decline as women age, owing to increased embryo aneuploidy; this risk applies also to cryopreserved oocytes obtained from older women. Whether cryopreservation further damages the oocyte beyond the normal age-related decrease in oocyte quality is unknown. In a prospective study evaluating the efficiency of oocyte vitrification, the proportion of vitrified oocytes that resulted in a live birth was 8.2% (12.1 oocytes per live birth) in women 30 to 36 years of age and 3.3% (29.6 oocytes per live birth) in women 36 to 39 years of age. In a multicenter observational study that assessed predictors of outcome when oocytes were vitrified, the live-birth rate decreased by 7% for every year of increase in the age of the woman. For every additional mature oocyte, the delivery rate increased by 8%.

Q. What are the guidelines of the relevant professional societies concerning oocyte cryopreservation?

A. The American Society for Reproductive Medicine suggests that oocyte vitrification and warming should be recommended to women facing infertility due to chemotherapy or other gonadotoxic therapies. The American Society of Clinical Oncology recommends that “even if women are ambivalent” about having children, they should be referred to a reproductive endocrinologist. However, the guidelines of the American Society for Reproductive Medicine also recommend caution regarding the use of oocyte vitrification to circumvent the effects of age on the reproductive potential of healthy women. These guidelines specifically state that “ . . . there are no data to support the safety, efficacy, ethics, emotional risks and cost-effectiveness of oocyte cryopreservation for this indication.”

Table 1. Reasons to Consider Cryopreservation of Oocytes.


ROUND 2

Cycle day 1- Call doc to schedule a BASE US and blood draw for cycle day 3.
Begin checking for ovulation surge with ovulation predictor kit on cycle day 8.

Call me when the surge is positive.

o Doc will make me a calendar when I surge that maps out the rest of my cycle

6 days post surge you will begin taking Estrace for about 2-3 weeks

After Estrace course you will begin stimulation with Menopur and Follistim again or Menopur and Clomid

Stimulation takes approx 10 days

Retrieval two days later