Caesar Tin-U

Ms. Hicks

AP English Per. 2

16 February 2008

Poem Analysis Re-Write

Emily Dickenson and Robert Frost’s poems, “We grow accustomed to the Dark” and “Acquainted with the Night,” are poems of loneliness and how different people come to cope with loneliness in two different situations. Both poems are told from the author’s eyes, a first person point of view, but both are radically different in the sense of feelings associated with it. Dickenson’s poem conveys a sense of uncertainty and change while Frost is far darker, in the sense of having a stark meaning to the words that he put down on paper.

Dickenson describes her darkness such that her darkness is only presently temporary; knowing that at any time in the poem she can always turn back towards her friend’s house and go back towards the light. Even so with this fact in mind, Dickenson decides to continue on despite “Those Evenings of the Brain” otherwise known as a writer’s block. Dickenson’s poem conveys a more hopeful tone than Frost by how she is able to metaphorically “go around” obstacles as with her description of accidentally bumping into trees “Directly in the Forehead” but still being able to go on her way. Dickenson’s faith and ability to adapt to the situation also contributes to the hopeful tone of the poem that she will someday be able to see the light again, though contrasting sharply with Frost’s drudging throughout the streets.

Imagery is a very important part of both poems, though differing in presentation. Frost’s depicts his point of view in a more gothic fashion. He uses the imagery of walking in a dark, dangerous city to help the reader connect. "One luminary clock against the sky proclaimed the time was neither wrong nor right." This shows that he has faced depression and now he accepts his feelings, his chemical predisposition, though he doesn't mind the unfortunate connection. Dickenson on the other hand contrasts with Frost’s idea by how she fills her poem with images of uncertainty and doubtfulness of the road ahead of her by putting in images of her neighbor holding out the lantern at night, letting Dickenson to walk the path alone in the dark. Contrasting her from Frost though, is the fact that Dickenson inserts a glimmer of hope. She does this by saying that even though light may not be there, the moonlight luminescence will be able to guide one’s eyes when one has finally adjusted to it.

The structures of both poems place at a juxtaposition by how Frost takes on a more rigid, structural approach, consistently holding a ABAB rhyming scheme while Dickinson uses a free verse, frequently offsetting ideas with dashes, giving the poem a more thought feeling, as if the reader was with Dickenson in her thought processes.

Caesar Tin-U

Mrs. Pesin

HST Per. 5-6

10 February 2008

Journal Entry for the Week: (2/4/2008) – (2/8/2008)

(References: Courtesy of UpToDate)

Entry 1 | Tuesday, In 8:31 AM – Out 11:05 AM (2/5/2008)

Doctor Shadowed: Dr. Solomos

Pt 1: White-F-68 (Hemorritis)

Brief: The patient has multiple hemorrhages on her left leg that bleed and pus when irritated. “It itches tremendously” says the patient. Dr. Solomos recommended some over the counter Benadryl to counter the itchiness along with Epson salt and warm water to wash the wound out and stop the bleeding.

Pt 2 Whte-M-71 years (Neck Pain)

Brief: The patient complains of back and neck pain, along with a swollen lump that has been on the patient’s neck for years. Dr. Solomos, upon examination, says that the neck pain is caused by the lipoma, a benign tumor, that has started growing slightly again, and has created nerve compression in the patient’s upper neck.

Tylenol Extra was recommended for the pain, along with Omega 3 fish oils that not only have cholesterol lowering properties, but also clinically proven anti-inflammatory properties.

Pt. 3 White-M-62 years (Pain in R. Testis)

Brief: The patient came in complaining pain in his right testis, accompanied with tenderness while walking and pain while lifting. Dr. Solomos felt for the area of pain with assistance from the patient to direct him. When Dr. Sol located the region of pain, he diagnosed it as epididimitis; inflammation of the epididymis, the region right above the testis provides anchorage to the vas deferens that leads to the urethra.

Dr. Sol said that the reason for the inflammation was due to a bacterial infection that has settled in the testis. Antibiotics were prescribed.

℞: 1) Floxacin– ( Noroxin®), Norfloxacin is a DNA gyrase inhibitor. DNA gyrase is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition.

Pt. 4 White-M-49 years (Physical)

HOPI: Allergens, repaired hernia

Brief: The patient, after his physical, had a conference with the doctor about the various TV ads that he has seen and what Dr. Sol’s opinion was on the validity of those advertisements. Dr. Sol explained that the drug companies and advertising agencies who produce those TV ads have to cram as much as they can in those 30 seconds they have, and therefore explain the absolute minimum of what needs to be said, thus giving the “vague” train of thought that the medication works, and works like it should.

As with any medication, “works like it should” is only a saying that varies from patient to patient…

Pt. 5 White-M-60 (Physical)

Brief: The patient just came in for a checkup of his self for the annual physical. Everything was normal except for the fact that the patient has been off of his medication for quite some time since the patient was not able to get his prescription refilled. Dr. Solomos made sure to fill the patient up so that he was good for another whole year.

℞: Zocor – Chemically known as Simvastatin, it is a is a methylated derivative of lovastatin that acts by competitively inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes the rate-limiting step in cholesterol biosynthesis.

Pt. 6 White-M-46 years (Head Trauma)

Brief: The patient unexpectedly came into Dr. Solomos’s clinic for head trauma. His forehead was covered with two bandages and gauze that covered the gash made by his van’s sliding door. It was a simple skin wound that had no major complications. Sometimes, patients question whether or not to go to the ER or not… so I am guessing they came to Dr. Solomos in doubt.

Entry 2 |Thursday, In 8:34 AM – Out 11:06 AM (1/30/2008)

Doctor Shadowed: Dr. Sandoval; Dr. Solomos was busy with administration work.

Pt .1 White-F-41 years (Physical / WWE)

Brief: The patient came in for a well woman exam, and medical counseling for sexually transmitted diseases. The patient was slightly obese, which is an important factor in diagnosis of any possible diseases that the patient can be predisposed to.

Dr. Sandoval pointed out that the patient’s neck appeared chap and rough, precursors to that of diabetic patients, though the cause of this rough neck is unknown. With this in mind, Dr. Sandoval advised the patient to monitor her diet and exercise more frequently.

Pt 2 Hispanic - F - 18 years (Anorexia / bloodwork)

Brief: The patient is an 18 year old female that attends Lamar high school. 2 months ago, she has been clinically diagnosed as anorexic with an eating disorder, though the eating disorder has been in occurrence for well over five years.

Talking to the patient, Dr. Sand learned that since the 7^th grade (13 years) she has always had been chubby, and was frequently poked fun at because of her chubbiness. She had tried to stop eating, but would get hungry; eating as much as she can (binging) and then vomiting it all up so that she will not get fat from the foods that she has eaten. (due to the fact that she “felt guilty” for what she has done and what she is trying to accomplish)

Upon first look, one can see that the patient’s teeth are eaten away from the gastric juices that the patient has had pass though her mouth by induced vomiting. Other than that, she looks like a perfectly normal teenager from the outside, with a normal weight (110 lbs) and normal body tone. Only thing abnormal is her stunted height (5’2’’) which is probably genetic rather than growth deprivation.

The medication she is currently on is Fluoxetine, an anti depressant, and an anti-reflux pill that is a beta blocker to enable to her eat and keep her food down. Because of her 5 year habit, her body has a habit of vomiting anything that she eats.

℞: Fluoxetine – (U.S. BRAND NAMES — Prozac® Weekly™; Prozac®; Sarafem® ) It works by inhibiting CNS neuron serotonin reuptake, a hormone involved in controlling the emotions of the human body. It tries to stabilize and balance the effects and reception of this hormone. The FDA has just recently posted a request that all physicians must also take into account that this drug has suicidal properties if administered incorrectly. This request involves extending the existing box warning concerning suicidality in children and adolescents to include young adults 18-24 years of age during therapy initiation (generally first 1-2 months).

Pt 3 Hispanic-F-42 years (Medical Counseling)

Brief: The patient came in for advice on what to do about her urinary bladder problems. After having bladder surgery to correct her dropping bladder, she now has trouble holding urine, especially when she coughs, or does certain movements on impulse, such as sneezing or lifting heavy objects.

Dr. Sandoval referred her to an iridologist.

Pt 4 Hispanic-M-47 years (Physical)

Brief: Basic physical. Please cough, breathe normally, hold tight, but relax, your prostate is smooth, thank you. Only twist of this examination was that its whole entirety was that it was in Spanish.

Pt 5 Hispanic-F-57 years (Physical / WWE)

Brief: Another, but lengthier physical. Again its whole entirety was in Spanish. I learned a few new words though: Traigue – swallow, respite – resperate, otro vez- again, and others that do not currently come to mind.

℞: Zantac – clinically known as Ranitidine. It is a over the counter reflux medication that works by the competitive inhibition of histamine at H₂-receptors of the gastric parietal cells, which inhibits gastric acid secretion, gastric volume, and hydrogen ion concentration are reduced. The important thing to note and keep in mind for the patient is that it does not affect pepsin secretion.

Relation to school: During these clinical rounds, I met a lot of Hispanic patients who preferred to speak only Spanish when with their doctors. Understandably enough, I had to know, to some degree, some Spanish so that I can keep up with the patient – doctor conversation. If I had not known any Spanish at all, I would be completely lost, and if I was confronted with such a case in the future with my own patients, I would be rendered a “fool” for not being able to communicate with my own patients. Knowing how important it is to overcome a language barrier with patients, I now know how important it is to pay attention to my Spanish class so that I can do a better job in the future.

Caesar Tin-U
Mrs. Hicks
English Per. 2
5 February 2008
Hamlet Film Response

After watching Hamlet in class I was able to finally understand most of the plot and attitudes depicted by Shakespeare and those actors that tried their best to imitate the attitude that Shakespeare had intended for each character they played. What I liked especially was the acting of the protagonist actor, Hamlet, which supposedly let me see how in a real life production how Hamlet would have acted when he was feigning / was in madness. The movie also let me bring forth the characters from the text to a being, a moving picture, which enables me to better remember the character based on names and faces. The movie also helped me clarify certain aspects of the textual play that remained vague to me when I was reading the play, such as exactly where Polonius was murdered in the Queen’s chamber. At first I thought that Polonius was slain with Hamlet thrusting his sword through the bed curtains while he was in bed with the Queen, but after watching the movie it was shown that he was killed while still in hiding. Watching the film Hamlet is a very good experience that was provided since it enabled us students to learn about the various customs and traditions that had taken place during the time setting of the play that was not mentioned in the textual component of the play, but rather in the background of the motion film. Such customs and cultural aspects is the freedom of kissing on the lips within a family, a custom that is frowned upon in today’s society, the often violent duels that had taken place during the time, and the wonderful architecture of the castles that royalty lived in. The beautiful landscape that was overlaid in the background was also a wonderful supplement to the plain white background of reading black text on paper. All in all, watching the film Hamlet provided a supplemental learning experience to the textual bore of a lesson that constituted of only the book.

Caesar Tin-U

Mrs. Pesin

HST Per. 5-6

3 February 2008

Journal Entry for the Week: (1/28/2008) – (2/1/2008)

(References: Courtesy of UpToDate)

Entry 1 | Monday, In 8:34 AM – Out 11:05 AM (1/28/2008)

Doctor Shadowed: Dr. Solomos

Pt 1: M-AA-67 (Diabetes checkup)

History: Diabetes, HBP, HCholestrolL, inflammatory neuropathy*

* Peripheral inflammatory neuropathy is a disorder of the peripheral nerves of any cause. It typically is characterized by symmetric distal sensory loss, dysesthesias such as burning, or weakness. Most peripheral nerve disorders in children are hereditary.

Brief: The patient came in for a check up on his diabetes. He was on his medication for about two weeks but then stopped working after that, thus increasing his sugar levels. Dr. Solomos did an eye ear nose throat checkup to see if any anomalies had arisen. None was found, and the patient was determined at “relatively healthy” other than the bad test readings.

Dr. Solomos decided to increase the dosage of the medication and told the patient to come back in two weeks to see how his sugar levels have changed.

℞: 1) Actiol – Chemically called: 2-[[3-(trifluoromethyl)phenyl]amino]pyridine-3-carboxylic acid, is an acid that helps calcium absorbtion.

2) Cialis® - Erectile dysfunction: Oral: 10 mg. chemically known as Tadalafil. It does not directly cause penile erections, but affects the response to sexual stimulation. The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation and inflow of blood to the corpus cavernosum.

3) Amerol – Chemically known as Glimepiride, it stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites.

Pt 2 Hispanic-F-46 years (Annual Physical)

Solomos says: Even though a patient may look healthy upon first glance, make sure to look at a patient’s hands, for they convey other various signs that can show you what is wrong with the patient. In this case, the patient’s hands showed that she has fallen, because there is bruising on her wrists. Dr. Solomos treated the bruising accordingly. (Naproxen was prescribed)

℞: 1) Naproxen ® - Brand named Aleve® [ as a OTC]; Pamprin® Maximum Strength All Day Relief [OTC], etc… it is an antihistamine that competes with histamine for H₁-receptor sites on effectors cells in the gastrointestinal tract, blood vessels and respiratory tract. It is a NSAID.

**Toxicology / overdose comprehensive: Symptoms may include dizziness, drowsiness, and xerostomia, (Dry mouth. It occurs when the body is not able to make enough saliva.)

Pt. 3 White-M-56 years (Checkup)

Brief: The patient came in complaining of a dry hacky cough that has persisted for over a month now. He has taken previous medication that has not worked. (Zinthromax)

Tests: Chest X-Ray (Past and Present were compared) Dr. Solomos explained to me how his lungs in the chest x-ray looked radically different from each other. The x-ray that the patient had a year ago was a crisp clear picture of his lungs, and as Dr. Solomos pointed out, his diaphragm as well; noting that because the diaphragm’s image in the new x-ray is not as crisp and sharp as the previous picture, that there might be a fluid buildup in the patient’s lungs caused by some pneumonia bacterium.

℞: 1) Hydrocodone – (Vicodin®, etc…), as with other narcotic (opiate) analgesics, blocks pain perception in the cerebral cortex by binding to specific receptor molecules (opiate receptors) within the neuronal membranes of synapses. This binding results in a decreased synaptic chemical transmission throughout the CNS thus inhibiting the flow of pain sensations into the higher centers. Mu and kappa are the two subtypes of the opiate receptor, which Hydrocodone binds to cause analgesia.

Pt. 4 W-M-74 years (Physical)

HOPI: Herpes Zoster

Brief: The patient, after his physical, had a conference with the doctor about the shingles vaccine and how effective it is to protect him against it. Dr. Sol explained to him that it is a 50/50 chance of a vaccine that may help and may not help. The patient’s concern was from the fact that several of his neighbors have contracted shingles and he does not want to get it either.

Pt. 5 W-F-72 (Annual Check-Up)

Brief: The patient just came in for a checkup of herself for her annual physical. Everything was normal except for the fact that her blood pressure was lower-than her normal pressures. (Reading was 138/80 when Nurse Vassie took it, and then 124/70 when Dr. Sol took it.) Dr. Sol said that it was fine, and that it may have been resultant of the patient has increased exercise and better diet that she has implemented recently.

Pt. 6 White-M-73 years (Physical)

Family History: Congenital Heart Disease

Brief: The patient came in for his physical as well as a concern for his ear. He says that he can hear fluid rushing in his ear, and that it is sometimes paining for his to listen to certain T.V. shows. He thought he might as well get his physical while he was here for his ear check-up.

Dr. Solomos said that the patient had a minor ear infection, which is because the patient had not cleaned out his ears properly. There was a build up of wax.

During the prostate check, the patient had on a silly face, something more or less that represented constipation, something that made me loose my appetite later during lunch, since there was fecal matter on the glove of Dr. Sol when he removed it later. (This was the first time I have seen fecal matter upon Dr. Sol’s glove during a prostate exam)

Entry 2 |Wednesday, In 8:29 AM – Out 11:08 AM (1/30/2008)

Doctor Shadowed: Dr. Aggarwal; Dr. Solomos was busy administering.

Pt .1 Hispanic-F-26 years (Physical / WWE)

Brief: The patient came in for a well woman exam, and medical counseling for sexually transmitted diseases. Dr. Aggarwal recommended the HPV Vaccine. The HPV vaccine is recommended for 11-12 year-old girls, and can be given to girls as young as 9. The vaccine is also recommended for 13-26 year-old girls/women who have not yet received or completed the vaccine series.

* Ideally, females should get the vaccine before they are sexually active. This is because the vaccine is most effective in girls/women who have not yet acquired any of the four HPV types covered by the vaccine. Girls/women who have not been infected with any of those four HPV types will get the full benefits of the vaccine. Mathematical models suggest that male vaccination may not be cost-effective for the prevention of cervical cancer in women

Pt 2 Hispanic - F - 25 years (Rash on neck)

History: Ringworms.

Brief: The patient complained of intense itchiness on her neck and chest areas – a migrating rash. Upon examination by Dr. Aggarwal, it was seen that the rash consisted of small raised bumps, as well as some long steaks of lines. After listening to the activities of the patient, which consisted majorly of physical activity and work, everything would have been normal with the patient except for the fact that the patient did not change clothes, wash self, nor keep good hygiene after physical activity.

Dr. Aggarwal explained that without having good hygiene with herself, she provides the perfect culture medium for those various fungal infections. (This corresponds with the areas of under her armpits, underwear linings and hair areas.)

Dr. Aggarwal took a slid sampling to confirm that her suspicion. Looking under the microscope, you can see a humongous hyphae ring worm that stretched all the way across the entire slide sample area; reinforcing Dr. Aggarwal’s diagnosis along with the patient’s previous history of ringworms.

Dr. Aggarwal told the patient to use antifungal powders, and creams as well as clean her house’s bed sheets, which may have been the causative factor in her reinfection.

℞: Calcium Sulfide cream and over the counter anti-fungal powders to keep the patient’s skin dry.

Pt 3 AA-M-30 years (Sick Visit)

Brief: The patient came in complaining of having a hard cough that would not go away after he had gotten over his flu. Dr. Aggarwal looked at his ears, eyes , nose and throat and said that the patient was congested and has a postnasal drip. The postnasal drip, she explains, is triggering the gag/cough reflex, which causes the patient to cough, despite having already gotten over the cold.

Simple over the counter cough syrup was recommended.

Pt 4 AA-F-32 years (Neck Pain)

Brief: The patient was previously in a car accident and is in the process of recovering. The patient complains of intense neck pain…. (which is typical of car accidents due to whiplash) and complains that the medication she is taking is not taking the pain away, but only making her sleepy…) (she takes ibuprofen, and that does not make people drowsy… (says Dr. Aggarwal, Dr. Solomos, Dr. Shelton, etc…)

Dr. Aggarwal changed the painkiller to that of Naproxen, (a derivative of ibuprofen) to make the patient happy, gave advice that healing takes about 2-3 months and that relief is not instantaneous. There was nothing else that can be done by Dr. Aggarwal.

℞: Naproxen – also known as Aleve® [OTC]; Anaprox® DS; Anaprox®; EC-Naprosyn®; Midol® etc… inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors.

Pt 5 AA-F-38 years (Abnormal Vaginal Discharge)

Brief: The patient has come in complaining of an abnormal and smelly vaginal discharge. The patient had already determined that it might have been Bacterial Vaginosis since she had contracted it frequently when she was younger, and Dr. Aggarwal did a vaginal examination / sampling to confirm it. After testing, it was confirmed that it was bacterial vaginosis.

Using normal saline to test for trichonomosis, and QH to test for bacterial vaginosis. Dr. Aggarwal prescribed Metronidazole gel to rid of the infection. The infection, as Dr. Aggarwal described, is caused by a change in the pH levels of the vagina, and because of that, the normal bacterial balance is disturbed within the vagina, causing an overgrowth of one type of bacteria that causes the infection.

℞: Flagyl ER®; Flagyl®; MetroCream® - all are known as Metronidazole, but are in different mediums, ranging from oral, cream, and gel. After diffusing into the organism, it interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death in susceptible organisms

Relation to school: Every occupation regardless of field or degree has its foundation in the rudimentary elements of school. When the institution of learning takes on programs that help the students interact with professionals who become role models, teachers, and mentors if you will, an incentive is set as the examples given by such adults encourage the students to gain strength and confidence in specific knowledge acquired or practiced through the duration of their collaborative study.