Final 3rd year rotation - Family Medicine

**HONORS**

So I finished up my 3rd year with honors in 3/4 of my last rotations. I got a slow start, but things were really difficult even up until a couple of months ago, so I feel pretty good about this. I feel like things are really coming together and that I am performing at a Sub-I level in most things.
I did my family medicine rotation at the Bremerton Naval Hosptial with their FP residency, which is the top FP residency in the US Navy. The clinics and hospital are beautiful, and the faculty and residents were top notch. I really enjoyed my time there.
I am proud to say that I made a difficult diagnosis of a rare disease that had been puzzling the neurologist and FP doc who were taking care of a middle-aged woman. She came in to the hospital with a 5 day hx of severe headache and altered mental status. Her blood pressure was 170/100 (it usually lives around 110s/70s). She also had a history of early onset microvascular dementia, multiple TIAs, multiple lacunar strokes, associated seizures, HTN, HLD, DM II, and chronic B12 deficiency. She does not use alcohol, tobacco, or drugs. She had been worked up extensively for Lupus, Lyme disease, MS, and has had multiple stroke work-ups (carotid duplex scans, EKGs, echocardiography, stress tests) which were all negative. On CT, she had a new LARGE temporal lobe lesion. So the team called it HSV encephalopathy and began treating her with Acyclovir until we could get better images and get lab results back, particularly from her lumbar puncture.
I kept thinking about what could cause all of these things. I personally thought that it was some sort of vasculitis and mentioned that to the team. But they said she had been worked up extensively by the neurologist for several years and they hadn't found anything.
But then I dug through old records and found a VERY interesting family history. Mom died at the same age of "stroke or heart attack." Sister died much yonger of complications from "seizures." Now son has new onset seizures in his 20s. Sounds like something autosomal dominant to me. So I went home, Googled "vasculitis autosomal dominant tia stroke headache," and I came up with CADASIL - Cerebral Autosomal Dominant Angiopathy with Subcortical Infacts and Leukoencephalopathy. Well, sure enough, I nailed the diagnosis. They started calling me "House" after that. :)

Revised 4th year schedule

So there were some changes to my 4th year schedule, but here is the final version of my last year. It will be a blast!


There have been some modification to this schedule. I really wanted the rads rotation, because I think I would have learned a lot, but the sometimes-3-hour commutes (EACH WAY) were killing me, so I dropped it. I also switched out the rehab for paliative care. Not only do I think I will use the skills of working with dying patients and their families more (in addition to pain management), but it is in Tacoma. So here are the changes:
1). No Rads. -- Paliative care in that slot
2). Rehab switched to Paliative care
3. Opth switched to after post-match vacation
4. 10 days at the McDougall Center (nutrition and lifestyle medicine) in Santa Rosa, CA a couple of weeks prior to the capstone course.

---GOD, I LOVE 4TH YEAR!!!