PNWU Health Blog

How Do Bones Heal?

May 26, 2017 | 11 a.m.

It all started in Valdez, Alaska, where I was employed as a deckhand on a salmon fishing boat...

elijah-hiett-251983.jpgTaking advantage of a long-awaited day off -- I had spent the entire previous day rocking back and forth on the boat -- I decided to sleep in. When I awoke I hopped on my bike and headed around to the other side of Valdez harbor to have a shower at a fish processing plant that purchased the fish we caught.  With the exhaustion -- and salmon scales -- of the previous day washed away, I climbed back aboard my bike feeling fresh.

Crisp Alaskan air swept by as a grocery bag filled with my towel and dirty clothes swayed gently from my handlebars. As I peddled, I felt a click. “My gears,” I thought, looking down to investigate.  

BOOM!  

It felt like someone had shot me. Still standing upright I had somehow come to an abrupt stop.  I could barely breathe and I had no idea what happened. As the pain began to flood in, my mistake became obvious…

Because Valdez receives an average of over 25 feet of snow each year, the town’s fire hydrants are extra tall, and I had come in full-contact with one.

The stilted steel spout grazed my head and crashed across my left shoulder, stopping me dead in my tracks. If I had been riding three inches farther to the left, the center of my helmetless head would have smashed straight into the hydrant.

Three inches to the left and I probably wouldn’t be here to type this.

Instead, the entire force of the collision was taken by the center of my left collarbone. The bone snapped like thin fishing line, but thankful didn’t splinter and go deeper, where it could have poked holes in the lung below.

I like to say that, at that time, I had three collarbones: two broken pieces on the left and one intact on the right. Like my collarbones, there were three steps in the process of making my two left collarbones one again. Thanks to that three-step process, which I’ll explain below, my arm works a lot better now.

Let us venture away from the cold steel of the hydrant and below my skin, through fatty layers and muscle, all the way down to the bone, where armies of cells in my body, which are there to respond to any incoming problems, began working to stabilize the situation.

Imagine the process of building a bridge across a river...

adrian-207619.jpgWhen my bone broke, it is likely that several little blood vessels also broke.  As a result, blood filled up the space between the broken bone, pressing into the muscles and tendons that are right next to the bone. My body had to build a bridge between the bones, across the river of blood that flowed between.  

During the first stage of building a bridge, the river bottom is stabilized and the banks are cleared.  Similarly, cells from my body’s immune system -- along with builder cells known as fibroblasts (because they make fibers) -- entered the site of the broken bone, repairing the jagged surface so it could be built upon.

The second stage of building a bridge between my bones involved the construction of temporary scaffolding.  The fibroblasts that came in during the first stage were now responsible for producing a building material called collagen, which acts as a temporary scaffolding between the bones.  Collagen -- similar wooden structures that bridge architects first install in the river -- is flexible and rather weak, but serves a vital role in initially bridging the gap. With the collagen in place my bone was well on its way to being fixed. If I were a regular tobacco user, however there may have been trouble up-river.

Imagine a cluster of giant logs floating down on the river’s current. As a tobacco user’s body works to heal the bone these logs often flow in, knocking out the piers that their cells are scrambling to install.  You see, while the bones of smokers or other tobacco users are trying to heal, Nicotine interferes with the body’s natural ability to build with collagen. This is why tobacco users sometimes have difficulty healing from broken bones. Thankfully, I did not fall into this category.

As time passed, the collagen fibers connecting my bone were replaced by bone material, which is analogous to the temporary wooden bridge being paved.  There was now a solid connection between the two previously-divided pieces and the bone began to be functional again.  It hadn’t, however, reached its maximum strength just yet. First, remodeling needed to occur in the third and final stage.  

In bridge building, engineers will test the bridge (hopefully not to the point of collapse!) and will suggest certain areas to be strengthened, adding support structures to high-stress areas.  In the body, adjustments are made to the bone structure as cells that live within your bone work on the temporary bridge of bone to make it stronger.  

As I began using my bone again and adding stress to certain areas, my body strengthened the parts of the new bone that experienced high-stress.  By gradually increasing the force I exerted on my healing bone (without breaking it again!), my collarbone became fully-functional again. 

A broken bone can be a life-changing experience, and I’ve been unlucky enough to go through the experience three times, always my own fault!  If you were to take any other item, such as a baseball bat or a pencil, and break it like I broke my collarbone it would forever be two pieces. Thankfully, our bodies have a really cool built-in bone healing process, and I’ve been blessed to go through that process three times as well. Bones have the amazing ability to heal, so be patient and let all your little cells build that bridge!

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John Scott
Osteopathic Medical Student - 2nd Year (OMS II) 
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences


 

Graduation Season Has Arrived!

 May 19, 2017 | 9 a.m.

CafferyPhoto-3029.jpgI LOVE this time of year. 

Not only do graduations allow us the opportunity to celebrate years of hard work and tremendous accomplishment, but they also give us a chance to enjoy what are often some of the most influential, funny, and inspirational orations of our time: commencement speeches.  

I get so excited for these speeches every year that I often make an effort to listen to all of them via the National Public Radio Link. And the more commencement speeches I listen to, the more I discover a common thread; the lesson that it is never too late to stop and pause to think about your future.

I will always remember my high school baccalaureate speaker who used Fleetwood Mac’s “Don’t Stop" as a theme song. You know the one…

Don’t stop thinking about tomorrow,

Don’t stop, it’ll soon be here,

It’ll be better than before,

Yesterday’s gone, yesterday’s gone.

Every time I hear that song, no matter where I am, I remember that speech, recalling those yesterdays and doing exactly what the song says; envisioning tomorrow. One of those “tomorrows” became another commencement speech I’ll never forget at my first college graduation at Ohio University. 

My commencement speaker was Matt Lauer, who was also graduating with our 1997 class. Lauer spoke on his journey from a rural area of Ohio to making it big as the morning host of the Today Show for NBC. He instilled the idea that, despite his successes, he never allowed himself to get too big for his own good. He displayed this commitment by returning and finishing his bachelor degree, even after making it big.

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As I reflect back on graduation day at Ohio University, my memories drift to a very special moment for me: standing in the grass, donning my graduation cap and gown as I held my oldest nephew. We were both so young, with boundless dreams and no way of knowing what our futures held. Looking at where we both are now, I don't think either of us could have even dreamed of the challenges we'd face or the blessings we'd receive. 

In my next “tomorrow,” I’ll be participating in my first ever graduation for Pacific Northwest University of Health Sciences, where I’ll witness 133 new physicians cross the Capitol Theatre stage and into the world of medicine. I could not have imagined that I would be living in such a beautiful part of the country. I could not have dreamed that I would play a part in contributing to the important mission of supporting access to quality healthcare for our rural and underserved communities. 

My nephew — who was barely old enough to walk when I held him at my graduation — will himself be graduating from the Air Force in San Antonio later in June. I don't believe he could have imagined he’d be following in the footsteps of his great grandfather, grandfather, father, and uncle who served our country before him.

So, to all of the new graduates — especially to the PNWU graduates who I’ll watch walk across that stage on Saturday — and to all of the people supporting them, I offer this advice: think about tomorrow, but be present today! 

Celebrate each other! These commencement ceremonies are not just a celebration but a moment of appreciation for the journey and for the people we love that helped us along the way. It is these moments of being together and celebrating life that create the foundation to help us during the difficult times we often find tossed at us on our journey toward our ultimate destiny. 

We may have visions and goals for our future, but the future may hold destinations and accomplishments beyond our wildest imaginations. Your life is not on hold until you accomplish these goals - your life is now. Yesterday may be gone, but the memories of it will live on, tomorrow and forever. 

Congratulations to all!

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Michele McCarroll, Ph.D., CCRP, ACSM-CCEP, FAACVPR
Chief Research Officer 
Professor of Clinical Medicine,
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences


 

Dr. Mom, D.O. Adventures of Parenthood in Medical School 

May 12, 2017 | 10:00 a.m.

#NationalMeditationMonth #BetterSleepMonth #MothersDay 

Speaking with love to the anti-vaccine crowd. A letter to anti-vaccine parents.

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It is difficult to scroll through the internet without coming across articles about the horrors of vaccines.

They cause autism!

They contain dangerous chemicals!

We give too many too soon!

The list goes on and on, and I understand why…

I believe these articles are written by people whose hearts are in the right place. They don’t want to see children suffering and dying from diseases that have been eradicated, but they want what’s best for their children. If someone told you that a physician was going to do something harmful to your child, would you not want to advocate against that treatment?

As both a parent and a physician in training, I empathize with this mindset. But I write to you today not only as the individual in the white coat recommending treatment, but as a mother; a mother who has been up all night with a sick child, waiting hours in the emergency room and praying for the best outcome. I write to you as someone who has been that scared new mom, researching on the internet, worried that I am not making the best choices for my child. But I also write to you as a medical professional. 

I write this letter as a medical professional who has witnessed children suffering due to illnesses that could have been prevented with a vaccine. I write to you as a medical student who is afraid that I will one day have to treat an illness not ever seen by my supervising senior physicians. I am writing to you from a place of love in hopes that we can work as a team to make the best decisions for your child based on sound science.

I hope that you will listen.

Internet Warnings vs. Vax Facts

Vaccines cause autism!

In the late 90’s, Dr. Andrew Wakefield published a paper in the medical journal The Lancet that claimed to link the vaccine for measles, mumps, and rubella (MMR) to autism. This study was later removed from the journal because it was found that Dr. Wakefield’s conclusions were not only incorrect, but that he had been paid by lawyers that were suing the people that made MMR vaccines. In the years since the publication was released there have been several studies which prove that Dr. Wakefield was wrong.

Vaccines contain dangerous chemicals and toxins!

Mercury. Formaldehyde. Thimerosal.

When people speak of toxins in vaccines, these are often the three key figures. Let’s take a closer look...

Thimerosal (ethylmercury)

  • Why is it used? This mercury-containing ingredient has been used as a preservative in vaccines since the 1930s. Today, it is only found in vaccines for influenza. Preservatives are necessary for preventing dangerous bacterial or fungal contamination, but thimerosal has since become a major source of vaccine safety concerns.
  • Health concerns? While mercury is a naturally-occurring element found in soil, water, and food, large amounts of it can be harmful, especially for children. Back in 1997, children were receiving three vaccines that together contained more mercury than the EPA recommended limit (though not more than the FDA limit). This led to speculation that thimerosal in vaccines could be linked to autism or other conditions.
  • Is it safe? Years of research have reduced concerns here. The type of mercury found in thimerosal, ethylmercury, differs from methylmercury, the type commonly found in fish and known to be harmful in large amounts. Ethylmercury is broken down and excreted from the body much more quickly than methylmercury, and no scientific study has found a link between ethylmercury and autism or any other harmful effects.
  • Amount in vaccines? Nonetheless, several public health agencies and vaccine manufacturers agreed in 1999 to cease using thimerosal as a precautionary measure. Today, no vaccine contains Thimerosal except the influenza vaccine, and Thimerosal-free alternatives are available.

Remember: chemistry is important! Pure sodium explodes when you put it in water but sodium chloride is what regular table salt is made of! 

Formaldehyde

  • Why is it used? Formaldehyde has been used for decades in vaccines to inactivate viruses and detoxify bacterial toxins, ensuring they don’t result in sickness when injected.
  • Health concerns? The U.S. EPA classifies formaldehyde as a carcinogen, as does the International Agency for Cancer Research and the National Toxicology Program. Additionally, several studies have since linked strong, long-term formaldehyde exposure to certain types of cancer.
  • Is it safe? The potential for harm depends on the amount. Formaldehyde is always present in the human body as part of our natural metabolic process, but long-term exposure to high amounts can overwhelm our system and be harmful. Fortunately, the amount of formaldehyde found in vaccines is very small, most of it being diluted down to residual amounts during the manufacturing process. In fact, the FDA reports there is 50 to 70 times more formaldehyde present in an average newborn’s body than in a single dose of vaccine. In brief, current science shows formaldehyde in vaccines to be harmless.
  • Amount in vaccines? The highest amount of formaldehyde present in any vaccine is .02 mg per dose. An average two-month-old baby would have around 1.1 mg of formaldehyde circulating in their body, with higher naturally-occurring amounts for older children.

(Information via publichealth.org)

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My unvaccinated child doesn’t pose a threat to your vaccinated child if vaccines really work!

One of the ways that vaccines work is by creating “herd-immunity.” No vaccine is 100% effective. If enough people are vaccinated, however, the disease will be less likely to occur, which helps to limit the chances of people who cannot be vaccinated getting the illness. Some children have problems with their immune system or are too young to get a vaccine. With these children sitting in the same clinic waiting rooms, at grocery stores, and parks, it is important not to be shedding measles or chicken pox virus.

We are giving way too many vaccines way too soon and it will overwhelm my child’s immune system.

Children are exposed to more immune challenges every day from the environment than from vaccines. In other words, a day at the park playground exposes your child’s immune systems to more challenges than a vaccine would.

(Source: https://www.nap.edu/read/13563/chapter/1)

The diseases that these vaccines prevent aren’t really that dangerous.

I sincerely hope for the best possible outcome should your child contract a disease that can be prevented with a vaccine or otherwise. I would never hope to see a child suffer just to say “I told you so” to a parent that disagreed with me. That would make me a horrible doctor and human being. With that said, we have these vaccines for a reason.

The diseases that they prevent can cause complications such as pneumonia (a lung infection), encephalitis (swelling of the brain), meningitis (an infection causing swelling of the brain and spinal cord covering), blindness, deafness, paralysis, and even death. I am not saying this to scare you into vaccinating your child, I am saying this because I want parents to really understand the risks of the choice that they are making and to make an informed decision.   

As your child’s doctor, I will respect your beliefs and wishes for your child.

As a fellow parent, I will empathize entirely with your desire to do what is best for them.

I will also advocate tirelessly for their health and best interests. I ask, in return, for your trust. I ask that you have faith in my training and education. Understand that I would never do anything to intentionally harm your child. I went into medicine to help, not to hurt, and good doctor-patient-parent relationship depends on this trust and mutual respect for each other.

The advantage of being a parent and a physician is having the ability to say, “That is what I would do if it were my child.” However, in the event that you decide that you do not want your child vaccinated, I will wish you all the best, but will politely decline to see your child as my patient. Those infants and children in the waiting room – the ones who cannot get the gift of immunity from vaccines -- they are my patients as well, and I’ll advocate for their safety as much as I would for your child or my own. 

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Sarah Green
Osteopathic Medical Student - 1st Year (OMS1)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences


 

Mela-NO-ma!

May 5, 2017 | 1:30 p.m.

 

#MelanomaAwarenessMonth #SkinCancerDetectionAndPreventionMonth #DontFryDay 

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May is finally here! A month full of sunshine! Full-blow summer weather just around the corner!

Who can deny the blissful feeling of the sun on your face? That beautiful bronzed glow we acquire by spending time outdoors in the summer? It’s arguably the most invigorating spirit of the season, if not of the year! It’d be hard to find anyone who wouldn’t welcome warm weather, soft grass, and copious amounts of bright sunshine after the winter we’ve had.

As you soak up your fair share of vitamin D from outdoor work or play, it is increasingly important to stay conscientious of exposure to harmful ultraviolet radiation.  So important that May has been rightfully deemed Melanoma Awareness Month.

As someone who was diagnosed with the beginning stages of melanoma, I can testify to the sneakiness of this morbid disease. 

Melanoma is a cancer that can go undetected for a long time—incognito as a mere freckle. By the time someone realizes there is something atypical with their “freckle,” the cancerous cells have likely spread to the deepest layers of their skin, often penetrating to blood vessels and spreading to lymph nodes. 

The best advice I can give anyone is prevention. We should enjoy ourselves during the summer. We earn these moments when we’re out shoveling snow and slipping on ice.  However, we can remove the concern and risk of skin cancer through a few simple preventative-measures.

Apply sunscreen.  It shields harmful UV rays and can prevent premature aging. It also moisturizes, often smells great AND fights off those nasty sunburns leave you looking like a lobster.

Wear Sunhats. They’re effective and EXTREMELY FASHIONABLE, people!

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Do NOT use tanning beds. That week-long, off-colored tan you acquire is NOT worth the lifetime of concern. Once you have been diagnosed with skin cancer, you constantly have to be on the lookout for another lesion appearing. Once you have it and (hopefully) get rid of a spot, it is even easier for another cancerous lesion to appear.

For me, I tanned a LOT in high school. I used tanning beds throughout long Alaskan winters to not only get color and vitamin D, but to serve as warm little mood-boosters. After about two years I stopped and never had an issue with cancerous lesions. Fast forward five years:

I spotted a dark freckle that had appeared on my abdomen and noticed that it grew in size pretty quickly. I eventually went to the dermatologist and asked for a skin check. The doctor did not seem overly concerned about my worrisome freckle, but she biopsied it anyway. The biopsy was sent to pathology and, about a month later, I received a call.

I had melanoma.

The news was surreal and only truly hit me a day later. It was terrifying to know that something was using my body’s own machinery to self-destruct. I was lucky to catch the cancerous lesion early, but there are an increasing amount of people who aren’t so lucky.

Avoidance is the ideal form of preventive medicine, but what if you’ve already spent a great amount of time in the sun? Lucky for all of us, skin cancer can be kept in check with the use of self-checks!

How do we determine worrisome lesions? Easy. Just remember your ABCDE’s…

A is for Asymmetry:
Look at your freckles and see if the spot looks the same on both sides – this is normal. If a lesion is asymmetrical (or not the same on both sides) when comparing one half to the other, you may want to consult your doctor.

B is for Border:
Edges should be even, smooth, and equal. If the edges are ragged or uneven, keep an eye on this spot.

C is for Color:
Color of a normal freckle should be consistent all over – if color is not the same all over or if it presents as different shades, ask your doctor about it.

D is for Diameter:
Look at the size of your freckles. They should be no larger than the end of a pencil eraser (six millimeters).

E is for Evolving:
This one is important! Watch your body – some spots will stay the same over time, and that is great! If you notice a mole or freckle that changes size, shape, or color, you need to consult your primary care physician or a dermatologist.

Use mirrors, a buddy, whatever you need to get a full and complete view of all of your skin. Do not forget hidden areas, such as your scalp, behind the ears and under your arms. Take pictures to compare over time – this is especially important for people like me who possess a LOT of freckles. Take a picture of yourself every 6-12 months and, over time, keep track of any abnormal spot progression. If you are ever in doubt, consult your doctor. It is always better to be safe than sorry.

Melanoma is one of the most serious forms of skin cancer, but there are many others. If you ever experience odd sites on your skin or feel enlarged, hard lymph nodes consult your physician. There are non-melanoma forms of skin cancer, like basal cell carcinoma, squamous cell carcinoma, Kaposi sarcoma (often of skin’s blood vessels, presenting as red or purple patches), Merkel cell carcinoma, and sebaceous gland carcinoma. Any firm, discolored, nodular OR flat lesion -- especially if it falls in one of the ABCDE categories -- is cause for concern.

YOU need to be responsible for your skin and your own health care. YOUR skin is seen most often by YOU, after all. I advise a self-check once every month. Keep notes of new growths, changing growths, or any spots that itch, bleed, change, or may not heal as they should – these are all alarming signs. And always remember that damage from one point in time may not present itself for months or even years.

If you have children, protect them! Young people and those with weakened immune systems are especially susceptible to skin cancer. Keep sunscreen on hand, invest in a cool baseball hat or a fashionable wide-brim and remember to cover up this summer.

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Enjoy this sunshine! You earned it! But enjoy it responsibly.

At the end of the day, when the sun sets, you’ll be happy you did.

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Kathryn Wanat
Osteopathic Medical Student - 1st Year (OMS1)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences