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Tuesday, February 27th 2007

I'm A Red Bull Man Myself

Four Years Of Film School & It Still Looks Like A Chimp Made It

It’s the week before tests.

My life = Red Bull + fast food + little sleep.

And I’m only a second year medical student. I don’t want to think about the next six or seven (or maybe more) years (with the exception of my fourth year).

Watching medical education and training promote such poor habits the ironing irony is delicious. Especially considering my rants on how lifestyle choices contribute to America’s comparatively poor health quality measurements and to increased health spending in this country.

I drink a lot of caffeine (and not cause I’m suffering from apnea of prematurity*). Despite its (over)use around the world, Caffeine ain’t exactly completely benign. Granted it would take 136 Red Bulls to kill me me by caffeine toxicity. And of course millions (billions?) of people consume this stuff everyday. Still, take Rosenthal, et al [1]:

“[C]affeine-containing coffee increases the risk of myocardial infarction and that men who drink at least five cups daily may increase their risk by about twofold or more”

The research is pretty clear on the MI risk (see also: Coffee Use Prior To Myocardial Infarction…[2]) and the increase in blood pressure such as in two studies in Hypertension here [3] and here [4].

Try to take this post with a wink and a grin and not as too whiny. I got myself into this mess by filling out all those applications and hounding professors about letters of recommendation and flying to those interviews.

I Can Give Up Caffeine Any Time I Want…Right After This Last Drink

Medical students (some of us anyway) are notorious hypochondriacs. It goes something like this – you have a lecture on MIs, you go to study afterwards, you become convinced of a tingling sensation in your left shoulder, your panic grows, and then you’re sure your chest feels tight! Pretty soon you’re walking into the student health clinic demanding emergency thrombolytics!

Okay so a little less dramatic than that. But still, the phenomenon is definitely there. So maybe you can forgive me when I start worrying if I’m really looking at an essential tremor or if that heart palpitation is pathologic when I’m on four hours of sleep and five Red Bulls in.

Joking aside, there are real health and access to care issues with the stress of medical school. While deviating off my rant on the non-healthy living habits medical school forces me into, the most prominent health concerns are psychological such as in this study in Academic Medicine [5].

As well, a large study published in Academic Medicine found more than 50% of medical students had put off seeking health care because of time constraints [6].

I Can Feel The Sympathy Roll of the Eyes

Okay, so there are bigger problems in the world and the stresses on my health right now are by choice. I study by choice (except while writing this post); my eating and drug caffeine habits are nominally by choice I suppose. The choice will be less obvious as I move deeper into training. Consider the much more ballyhooed issue of lengthy resident shifts and the health implications of such including CV changes [7] and, more prominently, motor vehicle accidents following marathon shifts in an NEJM published study [8].

With that off my chest I’m back to the library…let me just grab a soda for the road…

* To be able to stick something into a post which will be on next week’s pharm test is awesome.

1) LYNN ROSENBERG , JULIE R. PALMER , JUDITH P. KELLY , DAVID W. KAUFMAN , and SAMUEL SHAPIRO, Coffee Drinking and Non-Fatal Myocardial Infarction In Men Under 55 Years of Age, Am. J. Epidemiol. 128: 570-578. [AbstractFull Text (Subscription)]

2) ARTHUR L. KLATSKY , GARY D. FRIEDMAN , and MARY ANNE ARMSTRONG, Coffee Use Prior To Myocardial Infarction Restudied: Heavier Intake May Increase The Risk, Am. J. Epidemiol. 132: 479-488. [AbstractFull Text (Subscription)]

3) Sun Ha Jee, Jiang He, Paul K. Whelton, Il Suh, and Michael J. Klag, The Effect of Chronic Coffee Drinking on Blood Pressure : A Meta-Analysis of Controlled Clinical Trials, Hypertension 33: 647-652 [AbstractFull Text (Free)]

4) William R. Lovallo, Michael F. Wilson, Andrea S. Vincent, Bong Hee Sung, Barbara S. McKey, and Thomas L. Whitsett, Blood Pressure Response to Caffeine Shows Incomplete Tolerance After Short-Term Regular Consumption, Hypertension 43: 760-765. [AbstractFull Text (Free)]

5) Dyrbye, Liselotte N. MD; Thomas, Matthew R. MD; Shanafelt, Tait D. MD, Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students, Academic Medicine. 81(4):354-373, April 2006. [AbstractFull Text (Subscription)]

6) Roberts, Laura Weiss MD; Warner, Teddy D. PhD; Carter, Darren MD; Frank, Erica MD, MPH; Ganzini, Linda MD; Lyketsos, Constantine MD, Caring for Medical Students as Patients: Access to Services and Care-seeking Practices of 1,027 Students at Nine Medical Schools, Academic Medicine. 75(3):272-277, March 2000. [AbstractFull Text (Subscription)]

7) Fialho G, Cavichio L, Povoa R, Pimenta J, Effects of 24-h Shift Work in the Emergency Room on Ambulatory Blood Pressure Monitoring Values of Medical Residents, American Journal of Hypertension- 2006 10 (Vol. 19, Issue 10). [AbstractFull Text (Subscription)]

8) Barger, Laura K., Cade, Brian E., Ayas, Najib T., Cronin, John W., Rosner, Bernard, Speizer, Frank E., Czeisler, Charles A., Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns, N Engl J Med 2005 352: 125-134. [AbstractFull Text (Subscription) – Editorial (Subscription)]