Hello Everyone, I know it has been forever since I have written, so I guess I should fill you in on some things. :) I took my PANCE Jan 10th and found out a week later that I passed. It was a huge weight that was lifted off my shoulders. I had interviewed for a job on Jan 4th and felt like I nailed my interview. However, the acceptance of that job was of course riding on my board scores. So was the PANCE hard? You betcha. I walked out of that exam feeling defeated and worried and not knowing how I did at all. I am a "poor" test taker in general. I tend to second guess my answers and not go with my gut. There were answers I knew right off the bat, and there were things they would ask and I would have no earthly clue! Endocrinology was my worst subject in school, and it was my worst on the PANCE, so at least that reflected. I don't want to say much about the PANCE but to each their own. So I got my job, I work in surgery. To be more specific, I work in ortho, robotics, gyn, and general surgery. I cover about 15 hospitals and work with about 50 different surgeons. It is a pretty cool job. It has its ups and downs with any job. Somedays are longer than others..just depends on my case load. I can have anywhere from 1-8 surgeries in a day...just depends on the speciality. I have been working in this job for 6 months now and feel like I have learned so much and will continue to learn. Surgery is definitely a beast within itself. Not only do you not learn certain surgical skills in PA school, you lack knowing the steps to a surgery in PA school as well. I have learned multiple techniques to the same surgery, because every surgeon is different. I have learned sterile technique, draping techniques, instruments and their names and what they do, I have learned how to prepare an ACL graft from a cadaver or from the patient, I have learned robotics (also a beast in itself), I have learned how to be a good first assist, and to think outside the box and the list goes on.. So, since I dont update this blog as much as I would like, please feel free to ask me any questions. I will be happy to answer them! Blessings, A

I am officially signed up to take my boards exam..the PANCE on January 10th, 2013. Words can't really describe how much my emotions are like a roller-coaster ride. Some days I feel I am fully prepared for this exam...that the last 27 months I have been preparing myself. Then other days I am anxiety ridden with feelings of failure and that I know absolutely nothing! I still have so much more to learn as I go down this path of medicine. I graduate on December 15th of this year. I am so excited and so thankful that I made it this far. I have one last exam to take on Monday that is a total of 240 questions that is a "mock" boards exam. I'd be elated if I scored an A on this exam because I would finish this semester with straight A's. I have to score at least a B on the exam to graduate with honors. Even if I don't graduate with honors, I will still be proud to call myself a physician assistant. It's weird, because during rotations I would sign my name PA-S. I don't think it will hit me that I am an actual PA until I pass the boards. I have a few interviews lined up, but passing the boards is my number one main concern. I can't work until I pass..so this is my main goal. I will try to post my PANCE study schedule soon and a list of books/websites I have been using for anyone that may need some advice. xo Ash

One patient that stays in my mind was a 21 year old female who was 38 weeks pregnant and had a chief complaint of nausea and anxiety. She was also concerned if she would be discharged in enough time to make it to the methadone clinic. Immediate concern washed over me for her soon to be child. I wondered how I could still show sympathy and compassion for my patient who I knew was taking a life threatening drug. Methadone could cause serious fetal defects for her baby. I was upset on the inside that she would take such risks to harm her baby. On the other hand, I had to find sympathy for her and her current condition—she was on methadone to stop her opiate drug abuse. It was really hard for me two separate the two situations. I know this won’t be the only time in my life where I will come across this situation. No matter what the situation is, as PAs, we are not to judge a patient’s current situation or past.

One of the hardest things about medicine is knowing how to come up with the best treatment plan for each individual patient. A patient that suffers from diabetes may not always be well controlled on just Metformin. Being that this rotation was internal medicine, many of the patients had the same problems: diabetes, hypertension, hyperlipidemia, and overall pain. Patients aren’t always compliant with their medications, but a medication that may be working well, may also give them side effects. I know once I start practicing, I will soon find the medications I like working with, but I am not there yet. What may work for one patient, may not work for another.

Working with veterans was such a great experience. I loved being able to listen to the their stories about their times in war. Working at the VA is different from other hospitals. First, working with a patient population that is dominant in elderly males rather than a mix of male and females was quite the change. I saw more inguinal hernias during my time there. You are also working with patients that have sacrificed their time and lives for our country. A sacrifice many of us haven’t made. Many patients would talk more about their times in war more than their medical problems. I am still learning even now how I can give the appropriate time to listen to the patient’s stories, but get a history and physical done in an appropriate amount of time. As always, some patients will need more time than others. Some patients just want and need someone to talk to. Sometimes, listening is the best dose of “medicine” you can give to your patient.

I know it has been so long since I have updated. My apologies to the ones that check this blog out or have been following me. I have been busy with rotations, and then advanced didactic year is just around the corner! I wish I could make comments on every rotation, but I guess it would be easier to answer specific questions. I have almost completed 8 rotations..Psychiatry, Family Medicine, Pediatrics, Dermatology, Surgery, Emergency Medicine, Internal Medicine, and OBGYN. My most favorite rotations have been Derm, Surgery, and ER. I have realized I love doing procedures. I love suturing lacerations, I just love working with the human body. It has always been a goal of mine to make the patient feel at ease, and make them say, "wow, that was a great experience with a PA." I graduate in December, and will be done with my OBGYN rotation at the end of August. I know once advanced didactic starts, I will be in full on panic mode. Loans, Applying for jobs, PANCE preparation, etc. The list goes on and on. Not to mention writing my paper for my masters. :) I will try to make it my goal to post once or twice a week from here on out. I love helping people who have any questions. Feel free to click on the "Contact me" link and it will send an email my way.

I often wasn’t allowed in cosmetic dermatology patient’s rooms. “They are self conscious,” the doctor would claim. If a patient was having Botox done, or laser resurfacing, they were often embarrassed about their conditions. The PA would often tell me that people who suffered with skin conditions such as psoriasis, took their diseases harder than those with diabetes or hypertension. “You can see the their disease physically with your own eyes. Normally, people on the outside can’t see the physical effects of hypertension or other diseases.” While with the dermatology patients, it was my goal to make these patients feel as comfortable as possible. I would talk to them about their disease, and educate them. They also felt more at ease when you were able to touch their skin condition without being afraid. It’s amazing what the simple human touch can do to a patient’s outlook of their skin condition and the way it eases their discomfort.

My first patient at SJC hospital was an 8 year old male who was wheel chair bound. I was nervous because I have always had adult and adolescent patients. He seemed more fragile to me. He had a tracheostomy and a breathing machine because he was born without his left lung. He also had a gastric tube. These were two things I was not used to. “Good morning, my name is Ashleigh. I am the physician assistant student,” I say to the mother. I look down to the young boy and say “good morning” with a smile not even sure if he can even speak. He holds his arm out to shake my hand and greets me with a “Hello!” and a bright smile. After taking a history from his mother, it was now time to do a physical exam. I examined his head, eyes, ears, nose, and neck with no problem. I knew pulmonary, cardiac, and abdomen were going to be harder for me. He was fragile in my eyes and I felt he was too delicate to touch. I didn’t want to have him over exert himself during auscultation and I surely didn’t want to palpate his abdomen once I saw he had a gastric tube. “I have to press on your belly now okay? You tell me if it tickles or it hurts ok buddy?” He looks at his mom with weary eyes that made me more nervous. A giggle leaves his mouth and I start to become more at ease. I palpate more, “Ow, that hurts.” My first pediatric patient wouldn’t be my last pediatric patient to say “ow” or to cry. During my rotation at SJC, I would have many more children that would cry out in pain. All of these patients became fragile and delicate to touch in my time of care. In school, we learn to do a pediatric physical exam but you have to find your own flow of how you want to do your physical exam. Pediatric patients are different. They aren’t like adults, they don’t stay calm (most of the time), and they don’t understand that it will all be over in a mere few minutes. As delicate as they seem, a proper history and physical is critical for their health and for a correct diagnosis. It was hard to overcome the thought that I was causing them more stress and pain. It’s also not easy to hear heart sounds over a child that’s crying. Focusing in on those heart sounds or breath sounds, and performing a quick and thorough physical exam was something I had to adapt to. It’s not something that I mastered overnight, but something I gained experience in as the rotation progressed.

For those that have tried to use the "Contact Me" Link in my blog, it probably hasn't been working for you. I really apologize!! I have now updated it, and it should be working again if you have any questions! :) Depending on the browser you use, it should come up with some silly words you have to type in that are case sensitive. If you don't see those silly words, it won't work for you. You can always leave a comment with your email and I will get back to you that way also. Thanks everyone for reading!

Im in my second rotation now. I am currently doing family medicine at a FL health clinic in a rural area.

My patients are very sick, poor, and most of the time have no insurance, or very little money. I mostly see patients that have diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol), depression, and other various diseases.

Many patients will come in suffering from many issues, it is my job to sort out the most important ones. I wish I could spend an hour with every patient I see, but sadly it is not realistic when you have a schedule of 30+ patients.

The walmart and publix drug lists are becoming my best friend. If I need to prescribe anything, I try to go off the list so patients get their meds for free, 4$ or 10$. For you future students on rotation, put a list of these in your pocket. They are very useful and they are not just for the patients that have no insurance, everyone should put them to use.

I also recommend that you download some applications for your droid or Iphone. Some good ones are medscape, epocrates, ICD9 codes. Make sure you ask your preceptor in advance to use your phone. Some dont mind, and some mind a lot. I use medscape mostly especially for drug dosages. I'm getting to the point though where I keep using the same drugs over and over and I don't need the dosages at all...thank goodness! :)

I hope everyone is enjoying the fall and everyone is counting their blessings. God is good...God is love, hope, and encouragement.

My dad and I went shopping today. It happened to be at a place where Cory and I were at near the end of our relationship. It flooded my brain with memories of him. This past Friday, the 21st, marks 5 months since he has passed away. There is still not a day that goes by that I don't think about him.

His death doesn't get any easier. Do I know he is in heaven? Absolutely. I know our heavenly father called him to come to heaven at the young age of 25. Lately, it has been hard for me to have any patient mention the word "cancer." I can feel the tears welling up in my eyes because my mind immediately goes towards memories of Cory and his cancer.

Today, I sat in Nordstroms trying on shoes. I could see Cory a couple years back sitting with me and shaking his head while I tried on shoes. Cory thinking, "this girl is crazy! She loves shoes way too much." I happened to buy the same brand of shoes today that I bought with him. Which I didn't think about until now...

Having someone pass away is hard. As I have said previously, I will never get over it but I will get through it. It doesn't matter that Cory and me have been broken up for two years, he still holds a very special place in my heart.  He has taught me so many wonderful things that I hope to show and teach others. He is just that type of person that makes big impacts on a lot of peoples lives. I hope to do that too someday...

I miss you Cory

So when I first started reading about "pimping," I was not yet accepted into PA school. I thought what in the world does that mean? Getting pimped by a preceptor is when he/she will ask you medical questions. Sometimes you will know what they are talking about, and other times you will have no idea what they are asking. If you don't know just say, "I don't know but I will have the answer for you by tomorrow."

I got pimped for the first time last week by one of my preceptors. I thought I knew that answer, but I happened to be wrong. I was embarrassed at first, but then I got over the embarrassment because I realized there are going to be many more questions I don't know the answer to. Psych is going well, and I have some amazing people that are in the practice.

Everyone is so kind at the hospital and greet you or wave hello. The nurses are helpful and will show me things if I ask them where something is. Im learning as I go. So far I have been able to see patients on my own, write progress notes, and dictate.

I am very thankful and have been happy with this rotation. I only have 4 weeks left, and I will be sad to say goodbye to the people I have gotten to know.

Soldiers, firefighters, police and other public servants show great courage every day. They may feel fearful at times, but they overcome their fear and act with bravery and assurance when others are in need.

I give thanks for these heroes, past and present, who courageously performed their duties at great personal risk. I know that God is with them, now and always, just as God is with me.

Then an angel from heaven appeared to him and gave him strength.--Luke 22:43

Remembering 9/11/01

Hi everyone! Today was my first day at my first rotation. My first rotation is psychiatry at a local hospital.

Today, I just got acquainted with the nurse practitioner, the 2 doctors, and all the nurses. I also got a look at the computer system.

I see a lot of patients with depression, schizophrenia, paranoia, etc. So far so good but it is just my first day. I will update you on it more in the week.

The school requires us to log all of our patients so I started doing that. I need to read more about the Baker act and update myself on some psych drugs.

Hope everyone is having a great week!

Life...life is an amazing gift made by our almighty creator God. It happens in a flash..when a sperm and and an egg meet and start dividing by meiosis. Certain cells make specific things. Some cells form bone, some the eyes, some the muscle, some blood vessels. Each cell works 24 hours for 9 months to make a human being and they work the rest of our lives.

Then, life can be taken in an instant. The heart no longer beats and the lungs no longer breathe the fresh oxygen. Life can be taken from us at any moment.

I always think about that. That life can be taken at any minute. Were things said to that person that I would/wouldn't regret if they passed? Did I tell them how I felt about them? Did I say I loved them? Was I nice to them? Mean to them?

Our actions always have consequences.

I guess ever since I dated someone with a life threatening illness (cancer), I always thought about these types of things. I never wanted for us to go to bed angry at each other. So next time, when you want to get angry at a friend, have an argument, etc; think about your consequences. If that person died, would you be okay with how things were left off with them? It's time you will never get back...

Love fully, and remember we all have feelings and emotions. Don't be selfish, and put others before yourself because you never know when that person will be gone..

Shame on me for not updating since July 20th. I will hit all the major points that have happened since finals week.

Finals week-what a doozy. 6 finals in 3 days. I did well on all my finals, got A's on all of them except for emergency medicine which I got a B on. I ended up getting 8 A's and 1 B. I was happy with the outcome of the year. I can't believe that my didactic year is over. It felt so good to just be done with school work...I honestly still cant believe it. I know I wrote about the mock boards aka PACK-RAT. We had that the finals before finals. I ended up scoring a little above average which makes me feel more secure about the real boards--PANCE. Especially when I haven't even done rotations yet.

Vacation- I had a lovely vacation with my parents in siesta key. It was wonderful to have nothing to think about and nothing to do. We dined and wined and and had some beach time. There was also a ballroom competition in the hotel the whole week I was there. Overall, it was a much needed time off and I enjoyed every second of it.

Medical Spanish- We had a week of medical spanish. 8 hours a day for the whole week. By the end of the week we had to be able to ask a whole history in spanish. We also needed to be able to do 15 physical commands, and educate our patient in spanish about nutrition, stroke identification, taking their pulse, and how to reduce their stress. It was overwhelming at first because I haven't had a lick of spanish. By Friday, I was able to do what I needed to do, and pulled off an A in the class.

Clinical Orientation- Our first week was last week, and I can't say this week was the most exciting week of my life. It was a lot of talking, and being read to. Lets be honset, I can read, I am a big girl, but thanks Uni for reading to me. During the last couple days we got to do casting, IVs, Caths, and Respirators. I will post the pictures below.

I start rotations on the 29th! I can't believe it. I am not really nervous but excited. I think the Lord is just calming my heart and keeping me focused on learning as much as possible. This is the time to learn, time to enjoy, and time to evolve into a better future physician assistant!

Enjoy the pictures!! :)

3rd semester is winding down and I have finals coming up. We are in our last days of classes before finals hit. 6 days left and 8 more exams. I have a radiology final tomorrow, then we are taking a practice PACK-RAT. The pack-rat is like a mock boards in a way. It lasts 4 hours, and we dont get a break at all. It is supposed to gauge how you will do on the actual boards, so we will see. I am going to go over some cardiology and renal thursday night just to brush up on those concepts.

Next week we have two finals a day then a 10 day vacation. I can't wait for vacation..I am just really looking forward to no stress, no exams, and just relaxing. My family and I were going to go out of states, but my mother realized her passport wasn't updated. Then, we also had the issue of taking our dogs with us. I guess I was just not meant to go out of the country this time around. Everything happens for a reason right?

If everything pans out this semester, I may end up with 1 b and the 8 a's..I will take that. Not sure what my cumulative GPA with the other two semesters will be once everything is put together. Sadly, I am too tired to calculate it, so I will just wait until the school does that. :)

Today I am going to the dentist to get my tooth fixed. I went a few weeks ago and got a filling done and they didn't shave it down enough, so I am biting too high. I havent been able to eat on the left side of my mouth in a while. I am really excited to get it fixed. Oh the small things in life that make us happy right? While I am on that side of town, I am going to go try and find a kitchen table because I havent had one for almost a year now. I am tired of eating by sitting on the floor, couch, or bed.

I can't believe didactic year is almost over! It has been fun/hard/stressful/ but I am really looking forward to rotations. I am ready to get away from this classroom and meet new people and new faces.