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Caffeine Reset

As I set to begin my clinical rotations next week, I’ve decided that I could use a coffee reset.

Caffeine withdrawal is actually listed in the DSM V and I may experience some of the symptoms:

According to DSM-5, symptoms of caffeine withdrawal include fatigue, headache and difficulty focusing.

https://newsfeed.time.com/2013/05/31/caffeine-withdrawal-is-now-a-mental-disorder/

The…

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Project "Moula-Height"

Project “Moula-Height”

Undertaking a new hobby: trying to make content in Khmer to explain common medical topics for the purposes of seeking to improve future patient education and partnership in their care.

‘Moula-height’ means cause in Khmer. The reason for this project was the fact that I felt like there was a lot of misinformation on health topics that my parents were sharing and I wanted to see what could be…

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Forest Bathing 2020

Shinrin in Japanese means “forest,” and yoku means “bath.” So shinrin–yoku means bathing in the forest. https://time.com/5259602/japanese-forest-bathing/

It was a nice change of pace to the concrete jungle of DC.

There was a sense of normalcy and a reminder that despite everything going on in our world as we know it, life is still going on for earth, the skies, the little critters, and…

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Where is your next meal coming from?

Read the Full Article Here

The emergency department is chaotic, loud, and untidy. But if there is a common character trait of everyone, the patients, and the staff, it would be that everyone endures. They endure the long wait hours, the endless bureaucratic lists to check, and the uncertainty of what comes through that door. Some patients have to endure what happens outside of the ED: not…

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[Tools for School] Thinkpad X1 Carbon 7th Gen: 2 Months Later

Thinkpad X1 Carbon Gen 7: Smooth Typing and Stockpiling Rubbing Alcohol to Clean the Fingerprints

After finishing my USMLE Step 1 Exam, and after 6+ years of use, my Macbook Pro Retina 2013 (Now “Obsolete”) battery was draining empty every 2 hours. It was time for me to make a decision: stay with Apple and get a Macbook, or take a chance and go back to Windows Laptop.

I just felt like I…

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Trying to See 20/20 in 2020: Finding My Compass

In this time of uncertainty, I’ve wanted to reaffirm the values that make up who I am.

My true north:

It is my desire to: serve my future patients with my knowledge of medicine and Khmer, shed light on how to address health disparities through research, and appreciate the everyday things along the journey.

Things may not always go according to plan, but I’m thankful that I can always…

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intrainingdoc

Asian-Americans are often seen as model minorities. We are expected to excel in all areas regardless of our backgrounds creating a high-stress environment with a relative lack of support.

“Obtaining a detailed patient history and recognizing nonverbal cues are essential when interviewing and counseling Asian-American patients. Asking about cultural practices, values, beliefs and coping patterns as they pertain to the patient is equally important. While there is an emphasis on the physician-patient relationship as a partnership, Asian-American patients may still see their physicians as authority figures and only share information they are asked to give. Furthermore, feelings of shame, embarrassment and guilt may preclude them from sharing critical information regarding their mental health. Therefore, in order to better serve the Asian-American community, it is important for health care providers to pay attention to cultural nuances, approach patients with a non-judgmental attitude, validate their concerns and encourage them to directly confront their mental health problems.“

A look at culture in medicine, by Jennifer Yoo at University of California, Riverside School of Medicine

ucsdhealthsciences-deactivated2

Just in Time for the New Year: How to Live Longer (if You’re a Cancer Cell)

UC San Diego School of Medicine researchers have found a new mechanism cells use to keep themselves from systematically shutting down and dying. The mechanism is important, they say, because it allows cancer cells to survive, even without nutrients.

This story involves two main players — the molecule sphingosine 1-phosphate (S1P) and the enzyme atypical protein kinase C (aPKC). The researchers discovered that S1P activates aPKC, which in turn stops the death process, called apoptosis. This is a previously undescribed mechanism for preventing cell death, and it introduces the possibility that new drugs could be developed that disrupt the S1P-aPKC interaction and release the brakes on apoptosis, forcing targeted cells (such as cancer cells) to die.

The study, published January 1 in Science Signaling, was led by Alexandra Newton, PhD, professor in the Department of Pharmacology at UC San Diego School of Medicine, and Taketoshi Kajimoto, PhD, a scholar visiting her lab from Kobe University in Japan. Here Newton describes the study:

What motivated this study?

We were motivated to understand if there are any other molecules, second messengers, that regulate the function of aPKC. Identifying such a regulatory mechanism had remained elusive because of the lack of appropriate tools. So the first thing Kajimoto did when he came to our lab was develop a biosensor to read out aPKC activity in the cell using technologies pioneered by our longtime collaborator, the late Roger Tsien, PhD, professor at UC San Diego School of Medicine and 2008 Nobel Laureate.

What did you find?

Once he had the biosensor in hand, Kajimoto was able to investigate how aPKC activity was influenced by various treatments and inhibitors. He found that S1P — a lipid mediator with well-characterized functions outside the cell but with few known targets inside the cell — stimulated the activity of aPKC.

To get insight into how S1P might bind aPKC, Alisha Caliman, a graduate student in the lab of Andy McCammon, PhD, also a professor in the Department of Pharmacology at UC San Diego School of Medicine, then did some computer modeling to simulate the docking. Functional studies by Kajimoto then showed that S1P’s ability to activate aPKC controls the baseline level of cell survival, allowing cells to avoid cell death.

This work combined computation, biochemistry and cell biology to identify not only the long-sought-after second messenger for aPKC, but also a new cellular target for S1P.

Where do you hope this finding might lead?

Protein kinases like aPKC are great druggable targets once their biology is correctly understood. The S1P-aPKC pathway can now be targeted by drugs that inhibit the binding of S1P to aPKC, thus promoting cell death. This could have therapeutic values in cancer.

What’s next?

Next we will determine which of the two aPKC enzymes is the dominant mediator of the S1P effects and which cancers depend most heavily on this mechanism to promote survival. A better understanding of the biology will enable appropriate therapeutic strategies to be designed.

mymedlife

Merry Christmas

A Letter to Myself August 2021

Dear 2021 Heng,

Congrats! You’re about to start 4th year and I hope that you’re well on your way into deciding what specialty you’ll apply to. This is you, back in the week before the beginning of your medical school career. You know the time period when the Lakers were irrelevant, mom was recovering from cancer surgery, and you were writing this instead of getting data analyzed from Cambodia. It has been a crazy year where you felt so many emotions.

But I hope that by the time you read this in your transition into residency, that:

Starting medical school at 27 doesn’t bother you anymore. You’ve spent the 4 years prior to starting medical school earning money to support yourself and your family, and had the opportunity to make an impact in Cambodia. All of which wouldn’t have been possible if you were “successful” in getting into medical school right after college.

You’ve chosen a field that meets at the intersection of your talents and needs (and Step 1 Score):

In 2017, these were your results from UVA medical specialty aptitude test:

In all seriousness, I hope you remember the struggles you had thinking of what specialty to choose back in 2017. On one hand, you wanted to be an innovator in Primary Care, finding ways to help disadvantaged older patients manage their chronic conditions through technology, community, and love. But on the other hand, you also wanted to do a specialty that makes immediate impacts whether it be: emergency medicine or some surgical specialty. You even dared to say to your cousin in Cambodia... “I want to help develop emergency medicine in Phnom Penh” Will you do this by trying to solve the “Last Mile” problem in healthcare? Will you do this?

Most importantly, you remember the man and physician you are called to be as you:

Love God, your loved ones, and yourself.

Are accountable for the knowledge you study, because your patients count on you ‘do your job’ -Bill Belichick

Be willing to try and fail in practice (To the whiteboard) so you don’t fail when it counts (On the boards and wards)

Have humility when you listen to your patients, empowering with the knowledge and the opportunity to live healthier lives

Remember to give back through mentorship as the GEMS Program has been so invaluable to your success.

Still dare to dream big and refuse the rejections/obstacles like you’ve done before

Remember why you are doing this in the first place:

You’ve been given a shot out of life to parents that nearly escaped death countless times, you love listening to people’s stories, solving problems with your knowledge and hands, and this dream of yours is to live a life that pays it forward in the communities you grew up in, and the ones your parents fled. You live for those moments, just to make someone else’s day a little better. So when you’re bogged down in studying for shelf exams etc. you remember to see the bigger picture of why God made you the way you are and His plans for you.

Take it easy on yourself,

Heng

Year VII: Restoration and New Beginnings

Prayers from Last Year:

I pray that I am aware of the privilege that I have, being a(n): straight, Christian, child of two loving parents, college educated, English speaking, able-bodied, neurotypical, male so that I can learn to love better when this world is indeed broken.

To add on to this prayer for next year, I want to remind myself the privilege that I have to even make a tiny difference in someone’s life. These next 18 months will be challenging as I’ll be in my preclinical years mastering the basic sciences for STEP 1 in March 2019, an exam that will largely impact where I will go for residency training.

I pray to further develop my passion of teaching, Khmer, and science to empower others to be healthy. I pray to be less judgemental (Matthew 7:1-2). And to learn to embrace the moments even when I’m so focused on getting from point A to point B.

I pray I may find a nurturing community where I can be challenged by living with people of different backgrounds/views.

I don’t even know where to begin. This time last year, in the hot summer heat of DC, I was introduced to a group of students who share the same struggles I have, some with even had even bigger struggles they overcame. We supported each other through some rough times, and I’m thankful for the people here (plus Sanj, Wendy, and Dean Taylor not pictured). Here’s to the next 4 years as we strive for our M.D. and strive to be physicians for the communities that have given so much to us.

I pray for us to love ourselves and focus on what’s important while we’re in school and not get caught up in what others may think about how “different” we may be from the medical school class.

I pray against the stereotype threat, that any insecurities about being a Cambodian-American, not living up to the “model minority” myth can be resolved by the fact I DO BELONG here and CAN SUCCEED.

Me at the board, actively recalling glomerular filtration rate, a measure of renal function. I still remember the times I was called to the board, I would be asked question after question testing my knowledge. I remember being anxious at first, but as the year went on, I grew to appreciate the questioning. If I fail everyday in answering some question, that’s another opportunity to get the question correct on the exam.

There’s no magic sauce to this, or superiority complex to adopt. To succeed in medical school, I need to put in the time and effort. And I’m thankful for the GEMS program for allowing me to demonstrate that. I pray that I won’t forget this. I pray to have a heart of learning, where I listen with humility and speak with confidence.

I pray that my relationships with my family and friends back home will continue to grow, that there is a spiritual covering over my family especially in the responsibilities I have to let go.

What was supposed to be “pneumonia” with an infiltrate in January 2017 turned out to be a mass. If the urgent care physician didn’t mention that this “could be something” then, I don’t know if my mom’s lung cancer would have been caught in time. A repeat chest x-ray in March revealed that it was not pneumonia and could be a mass. A CT scan, biopsy, and lung resection later, I praise God for my older sister and her fiance for taking the mental load of fighting for my mother while I was in DC in this time preoccupied with school. What this whole ordeal is teaching me is the fact that I can’t be superman. I have to rely on others for help, and that I have to fight for what is right.

I pray for strength in my mother as she goes in for more treatment. I pray that my family can coordinate what is more effective for my mom’s treatment. I pray that her anxiety about this can be eased, that there is nothing that she can’t overcome as a Khmer Rouge survivor who has been through so much already.

I pray that I will be able to enter Georgetown Medicine fall 2017 prepared.

Praise be to God.

And lastly but not least:

I pray for Christ to continue being present in my family’s life. I come up short trying to emulate His Grace and Love, but I pray that He heals our brokenness and my mom’s cancer.

#medschool #praisebetogod

Cambodia 2017

Phnom Penh, Cambodia Neurology Outreach Program Cambodia I’ve had the extremely fortunate experience of traveling to Phnom Penh, Cambodia every summer for the past 3 years (2015-2017) to help build a postgraduate neurology residency training program at the University of Health Sciences in Cambodia. While there are currently no dedicated neurology residents in Cambodia, we have been working with…

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