Hear 4 U Always

Quick update on Year Four

2012-01-29T11:00:00.003-07:00

I can't believe I'm almost half done with my fourth-year clinical externship. As I wrote in my previous blog post, time seems to go by faster as you get older. Can you believe February is nearly upon us? Where did January go?

My fourth year has definitely been an interesting ride thus far. Interesting good or interesting bad...that's debatable. I will admit it's been good to be at clinic full time unlike as a second-year student where clinic was once a week and as a third-year student where clinic was 2-3 days a week. The site that I'm at is a hospital setting where the audiology clinic sees about 50% adult patients and 50% pediatric patients. That's an excellent ratio to break things up and also to retain skills in testing children.

The mission of the hospital is to provide access to the highest quality health care regardless of ability to pay. A fact sheet for this hospital states that it cares for "the special health needs of the entire population with services ranging from trauma care to the [omitted] Poison and Drug Center, and the needs of special populations such as the poor, uninsured, mentally ill, pregnant teens, persons addicted to alcohol and other substances, victims of violence, the homeless and those with AIDS". The audiology clinic also treats prison inmates; they come cuffed and with at least one guard. Yup, it's a challenging patient population at this site. Very different from what I've encountered in private practice settings. I consider this to be both good and bad for reasons I won't get into.

There are 3 full-time audiologists and 2 fourth-year student doctors of audiology. The audiology students see the majority of the patients so clinical experience can be gained, and the full-time audiologists serve in a supervisory role. The audiology clinic sees their own patients and also Ear Nose Throat (ENT) patients. The patients range in age from newborn to 100 years old. Services provided by the audiology clinic include case history, otoscopic evaluation, audiometry (air conduction, bone conduction, speech), tympanometry, acoustic reflexes & acoustic reflex decay, otoacoustic emissions (OAE), unsedated auditory brainstem response (ABR), videonystagmography (VNG), and amplification (consult, fitting, and follow-up on hearing aids & assistive listening devices). Two of the full-time audiologists on occasion provide intraoperative neuromonitoring (aka monitoring the functional integrity of certain neural structures during surgery). About three years ago when I first learned about intraoperative neuromonitoring, I assumed audiologists only monitored the VIIth & VIIIth cranial nerves (facial & vestibulocochlear nerves respectively) during surgery. But it can be more than just that. For instance, I had the opportunity to sit in on two thyroidectomies -- one surgery was done by an ENT physician and the other was done by a general surgeon. Nothing like seeing a grapefruit-sized tumor being extracted from someone's neck after lunch.

Below is a picture of me before the 2nd surgery of the day; decked out in green scrubs minus surgical cap (nice bouffant kind ;-P), surgical mask, shoe covers, and gloves.

This is the last quarter where I am taking a class. I'm glad for that, because I'm about burnt out on academics. I can't complain - - 1 class with 5 days of clinic is better than juggling 3 classes with 3 days of clinic like I first had to when moving to this state last spring.

I'm "Hear 4 U Always"...and getting closer to being a full-fledged Doctor of Audiology. It'll be nice to start earning a paycheck for all the work. All right -- gotta prep for Monday's class session and also prep for a Grand Rounds presentation I'm giving at clinic this week (the clinic I'm at video-conferences monthly with another hospital/audiology clinic). Work is never done...c'est la vie. Work hard and play hard, readers. Oh yeah, I should take my own advice. ;-P

Happy New Year 2.0

2012-01-22T16:00:00.007-07:00

Happy New Year! I apologize I'm three weeks late in wishing that, but tis better late than never. Or maybe I was just waiting for the Lunar New Year which is tomorrow (aka New Year 2.0 ;-P). Anyway, I can't believe it's already 2012. I know it's been said that the years seem to go by faster as you get older, but man, 2011 went by so fast that it was a blur.

My apologies for not posting anything for a couple of months. Clinic and class keep me busy. Also undergoing/underwent some personal difficulties. Hopefully the Lunar New Year gives my 2012 a second chance to make a first impression. Fingers crossed.

As I hopefully get my blogging groove back, I leave you with two audiologically-related tidbits:

"Switched at Birth" made its winter premiere on 3 January 2012. The show airs on Tuesday nights at 8/7c on ABC Family. I mentioned this show back in June 2011 when the show first premiered. The following is a description of the show from the ABC Family website: "Switched at Birth tells the story of two teenage girls who discover they were accidentally switched as newborns in the hospital. Bay Kennish grew up in a wealthy family with two parents and a brother. Meanwhile Daphne Vasquez, who contracted meningitis and became deaf at an early age, grew up with a single mother in a working-class neighborhood. Things come to a dramatic head when the families meet and struggle to learn how to live together for the sake of the girls. This season, the families must deal with the arrival of Bay's biological father Angelo, inflaming old passions and creating new rivalries. During their lawsuit with the hospital, the Kennishes find an unlikely ally in Angelo. But can he be trusted? Everyone struggles to navigate the complicated family dynamics as the girls clash in a love triangle with Emmett."
Can't stress the importance of seeing an audiologist for your hearing health needs (diagnostics, treatment/rehabilitation, etc.)!!! An article about a hearing aid exploding near a man's face was forwarded to classmates & me by an audiology professor early last month. Mind you, this hearing aid was bought on-line for about $22. Two giant red flags in that last sentence...hearing aid bought on-line & $22. For the full article, go to http://www.12ktrv.com/Global/story.asp?S=14310896.

I'm "Hear 4 U Always"...even if my lack of on-line presence may seem like that I'm not. Feel free to contact me anytime via e-mail if you need a dose of "ear geek speak" (totally coined that term just now!) or have any questions. It's been very pleasing in recent months for friends to reach out to me with their audiologically-related questions e.g. a college friend had a baby & wondered how his baby's hearing was screened at the hospital, etc. I can't believe I'm graduating this year and finally earning the doctoral degree I've been working on for the last few years. Four Januarys ago, I never imagined that this is the path I'd be on. Life works in mysterious ways. That's part of the beauty of life...the unknown. May your life be full of wonderful surprises, readers! Happy 2012!

You've seen eye candy, right? ;-)

2011-10-31T18:30:00.001-07:00

Heard of ear candy? Only an ear geek would walk down the Halloween candy aisle at Walmart and stop to check out a bag of candy because an ear caught her eye. Heh heh. That was me last Friday. I wound up buying a bag of Butterfingers instead. ;-)

I got an ear lollipop from the other Au.D. extern at clinic today. There was a sliver of paper attached to the stick and it read "Ear's to a Happy Halloween!". I think she said her mom & her sister (who is also an audiologist) came up with that cute greeting. I wish I got excited for holidays like I once used to. Halloween had been a favorite as a little kid...hello, free candy! Ever since starting work full-time at age 22 and the line of work that I did, I started to view holidays like any other day. Maybe if I ever have kids of my own, the kid in me will come back out to play. ;-)

I'm "Hear 4 U Always"...hoping you satisfy your sweet tooth. And keep your ears sweet...uh, by practicing healthy hearing habits like listening to music at safe levels & wearing hearing protection if busting out the leaf blower. :-)

Auditory trick...or treat...

2011-10-05T17:50:00.012-07:00

The following is a dialogue that occurred between the other Au.D. extern at clinic & me yesterday during our lunch break...

FRIEND: If I don't dress up for Halloween this year, it'll be the first year that I haven't dressed up for it.
ME: What were you for Halloween last year?
FRIEND: A dental aide.
ME: Cool.
FRIEND: Yeah, I wore a white shirt. I had yellow fabric on the front. And I also had red jewels for paprika.
ME IN MY HEAD: Huh? Paprika? Oooookay.
FRIEND CONTINUES: I also wore heels and horns & a tail.
ME IN MY HEAD: HUH?!?!
ME TO FRIEND: Um, what were you for Halloween?
FRIEND: A deviled egg.

Hey, anyone know of an audiologist? ;-P Ha ha, kidding! Maybe you had to be there, but that confusion had me cracking up to the point of tears when she said "a deviled egg" and it all made sense to me. That's actually a really cute Halloween costume idea. Good thing she didn't tell me about having been the tooth fairy for Halloween two years ago first, because if she started off with that, I don't think I would have asked her to clarify what she dressed up as last year since 'teeth' would have seemed to be a theme with her & costumes. Heh heh.

October is National Audiology Awareness Month and National Protect Your Hearing Month. Guess I should get my hearing checked. ;-) A number of people get an annual eye exam. Why not get your hearing tested yearly too? Particularly if you notice a decrease in hearing. Per the American Academy of Audiology website, approximately 36 million Americans suffer from hearing loss. Please check out www.audiology.org/resources/consumer/audiologyawareness for fact sheets, etc.

I'm "Hear 4 U Always"...and hoping to avoid any more auditory 'trick' situations. Treat your ears well by not putting anything in your ear (yup, don't use Q-tips!) and turning the volume down when listening to music on the radio or MP3 player. Hope the 10th month of the year is a 10 for you, readers!

Rock on!

2011-09-29T22:00:00.005-07:00

Happy Autumn! Almost a week late wishing that but better late than never. ;-) Before the month of September closes out, thought I'd post a blog entry. There are so many audiologically-related happenings that go on, but I don't get a chance to write about them all. Today marks one month that I've been at my fourth-year externship site. See -- writing about my clinic site for my fourth & last year of the Au.D. degree program is something I need to do. That will have to wait for another blog post. ;-)

Last Friday I went to my very first concert! :-) Well, honestly I've seen Celine Dion perform live on four different occasions...three times in Las Vegas and once in Phoenix. However I was informed by a friend I knew back in college that ol' Celine doesn't count as "having been to a concert". Heh heh. So he bought tickets to see one of his favorite rock bands play at a local dive bar and took me along. I had contemplated taking ear plugs to protect my hearing, but I sacrificed the outer hair cells of my inner ears to get the full experience of a rock concert. And get the full experience I did...I nearly got sucked into the mosh pit. That thing is insane! So I sacrificed my outer hair cells AND my toes, because I did get my footsies stepped on pretty good a couple of times even though I was on the outskirts of the crazy mosh pit.

There were three bands that performed at this venue. My favorite of the three was actually the opening band. When they were on stage, ear geek me was totally checking out their ears and noticed they were not protected. :-( Same with Band #2. Then the headlining band started to set up, and my friend noticed the more expensive drum set compared to the first two bands. Guess that's because he's a bit of a musician by night. As for me, when the band members took the stage in a cloud of smoke & multicolored strobe lights, I noticed that each band member had on musicians earplugs. :-) That's how I ascertained that this band had money...for guy friend, it was the drum set. Heh heh. For more information on musicians earplugs, check out http://www.etymotic.com/hp/erme.html. I totally was like "hmm, I wonder if they wore ER-25" to my friend in the car after the concert. Other "ear geek" moments at the concert included trying to guessimate at what decibel the music playing was at (you know, without a sound level meter ;-P) and thinking to myself "OMG! TTS!" constantly throughout the night. For non-ear geek folks, TTS is 'temporary threshold shift' in which hearing improves after initial impairment following exposure to high-level sounds. Noise-induced hearing loss is 100% preventable, but there is no method for reversing it once it occurs. So protect your ears!

I'm "Hear 4 U Always"...and even rocking out on occasion. Next time though I'll be sure to bring some hearing protection devices. :-) Tidbits from military life such as "lead by example" apply in my new 'professional' life. Oh, and ear geek is the new chic. :-)

License to...

2011-08-22T23:00:00.028-07:00

Hurrah! Today I found out that I achieved a passing score on the licensure exam for audiology. I took the exam last month, and it was announced that scores wouldn't be available until 4 weeks after the exam date. So this afternoon it dawned on me that 4 Saturdays had passed and maybe my score report was available on-line. It was! You'd think a notification e-mail would have gone out. Oh well. I know how busy computers can be. ;-P

I'll admit that I was cringing before opening up the score report. When I did finally open up the score report, I was pleased to have passed and on my first attempt. So the $130 fee wasn't a waste and no need to retake it (for another $130...). Whew!

I'll also admit that I didn't study for this exam as much as I would have liked. It was futile to try and study during Spring Quarter with post-Year 3 Comps burnout and juggling clinic & 3 classes. So I had a lovely 6-week study plan drawn up for after Spring Quarter since Summer Quarter consisted of the same amount of clinic & only 1 class. Well, let's just say that 6 weeks turned out to be more like 6 days of studying. I didn't stress out like I did for Comps. I just told myself that if 3 years of classes & clinic to date didn't prepare me to pass the licensure exam that I didn't deserve a license to practice. I figured the exam questions were written by audiologists and that they weren't out to trick us students. AND if I was to not pass, then I had the opportunity to retake the exam later in the year. So I went into the exam cool, calm, and collected. :-) I gave my best, answered according to my clinical intuition, and did not second-guess myself. I had a few minutes leftover at the end of the exam period, but I didn't double-check my answers to argue with myself & change any answers (most likely to the wrong ones...). My score was above the required passing score of 600 (in addition to being above the median score of 1,360 examinees in a 35-month period), but I wished I had scored higher. Suppose I should stop being so hard on myself and celebrate, right? ;-) Well, actually I already had a celebratory lunch on the same day that I had taken the exam. A friend took me out even though I told him it was premature. Luckily I was able to text my friend today and let him know that the celebratory lunch wasn't a sham. ;-) Ah, sweet is the taste of success...literally and figuratively. Heh heh. And I wrote the friend who sent me an Edible Arrangements fresh fruit bouquet as good luck for the exam that it was all the fruit that nourished my brain that allowed me to do well.

I'm "Hear 4 U Always"...and edging ever closer to becoming licensed to practice as a doctor of audiology. My 10-year college reunion is next month, and here I am still getting my nerd on. Career #2 in my 30s...a healthcare career...something desired many moons ago. It just goes to show that life is what you make it. If you're passionate about something, you'll do anything to achieve it. And it's never too late for new beginnings. After all, there's no time like the present. Okie dokey...I think you HEAR me on the point I'm trying to make. ;-) May all your dreams come true, readers. XOXO

Eureka!

2011-08-08T16:45:00.002-07:00

Hello hello! No, I haven't struck gold or even fool's gold. And no, I haven't decided to leave the office job of a clinical audiologist (per the picture of me...took a pic of myself with my cell phone while I was on a group tour in a gold mine just last week). The only canals I traverse are external auditory meatus aka ear canals. A headlamp can be worn to assist the audiologist in cerumen (earwax) removal, but hard hats are unnecessary. And since I didn't find any gold during my lil field trip, suppose I shall stick with the second chosen career path. :-) Speaking of which, the last day of Summer Quarter of Year 3 was on Friday, 5 August 2011. That means I'm officially a fourth-year student doctor of audiology. And less than 360 days until graduation. So guess "WOO HOO!" is more appropriate of a blog entry title than "Eureka!". ;-P Did you know there is about $50 million worth of gold in this mine but it would take about $75 million to get it out so the gold has been left alone? I'm "Hear 4 U Always"...and expanding my horizons but never forgetting Priority #1 which is providing excellent hearing & balance health care.

Anything but frigid...

2011-07-29T22:00:00.209-07:00

Since being on my own and making my own money for the last 14 years, I'd buy whatever I wanted or needed when I wanted or needed it. I didn't wait for the winter holidays or my birthday for family & friends to get me things. My best friend has even said that it's hard shopping for me because I seem to have everything that I want or need. And for me, material things are unnecessary...to be loved & appreciated are all that I ask of my family & friends. To add to that, I consider myself a simple & low-maintenance person in that I don't require a lot of things. I've gotten only one mani & pedi in my life (and yeah, I'm a girly girl though ;-P). I've never owned a smartphone and barely got into texting the earlier part of last year. I want a sports car but will instead buy the practical car. The list goes on.

With that said, today I was surprised...not once but twice. My contract with the current clinic site ended today (insert huge sad face!). I was not expecting anything but a 'normal' clinic day when I went in to work. I had bought a small gift as a token of thanks for my clinical preceptor, Dr. R. But Dr. R had other plans. ;-) We were working ENT clinic so no patients specifically for audiology were scheduled. There was a lull, and Dr. R says "I want to show you something" so I follow her to the staff lounge. I see a cake on the table which I recognized as a mocha chocolate icebox cake, and I was excited to see that Dr. R had made it. You see, I've turned into a Food Network junkie in the past few months and saw two different cooking shows with a recipe for an icebox cake. I thought it was really neat to make a cake without even baking it in the oven! And as a full-time grad student, I'm always looking for an easier means to make delicious food. Anywho, I had never heard of an icebox cake and then found it interesting to see two different recipes for it on TV in the span of like a month. Dr. R and I lunched together just about every day that we were at clinic together. So we'd chat about a lot of topics. Yes, non-audiological stuff like cooking. :-) I asked her if she had ever made an icebox cake, and she told me that she hadn't. So I e-mailed her the recipe for the mocha chocolate icebox cake that I saw Ina Garten make on her cooking show, "Barefoot Contessa". This recipe calls for a springform pan which I did not own at the time. I had asked Santa (uh, my parents ;-P) in May for a springform pan, a mini muffin pan, and cookie cutters. Those were items that I didn't have but didn't exactly need, so I knew I could continue living without them. But if Santa needed a hint or two on what to get me, I had a little list ready. Well, it turns out that Christmas came early for me since Santa got me the requested items in June.

Apparently Christmas for me spilled over into July. :-) Dr. R didn't bring in the mocha chocolate icebox cake just to show me that she had made it. She had made the cake specifically for me for my last day of clinic! In addition, the springform pan she used to make the icebox cake was also for me! This springform pan is especially spiffy because it has a glass bottom. I was floored. I rarely get surprised, and it happened twice today. Plus refer to the previous blog entry regarding my surprise last week of an Edible Arrangements fresh fruit bouquet. I am spoiled and blessed! My oh my.

Pictured is the superb chef AND superb doctor of audiology. She was about to start cutting us a slice of cake when I shouted for her to stop as I ran back to the office to grab my cell phone to take pictures.

Here's a shot of the inside of the cake. You can see the layers.

The recipe calls for thin, hard chocolate chip cookies. I'm so glad that Dr. R told me she used chocolate Teddy Grahams. Otherwise I would have been freaked out to see a tiny face looking up at me while I was eating. Can you see a smiling Teddy Graham head in the picture below?

If you're not familiar with a springform pan, below is a picture of a cheesecake made with this pan and you can see the glass bottom. This is the awesome pan that I now own! :-)

Thank you so much to Dr. R for her thoughtfulness and kindness! Not just today but for the past four months. It's really special to find someone you click with on a professional AND personal level. I'm honored to call her a friend. I'll miss working with her and seeing pediatric patients 100% of the time. But as the saying goes, "all good things must come to an end". And as another saying goes, "when one door closes, another door opens". It was a rough time in my life for awhile there (refer to the 24 May 2011 "See no evil, Hear no evil..." blog entry if needed), but thankfully my life has been anything but frigid lately. :-)

I'm "Hear 4 U Always"...and happy as a clam. Oo - clams...maybe I'll try a recipe with those next like linguine with white clam sauce. Yum. And if you're wanting the mocha chocolate icebox cake recipe, go to http://www.foodnetwork.com/recipes/ina-garten/mocha-chocolate-icebox-cake-recipe/index.html. You have gotta try that recipe. The cake is soooo good. It tastes like tiramisu. Bon appetit! Take care of your ears and your tummy.

The Cat's Meow

2011-07-19T18:30:00.010-07:00

Hello, reader! And Hello Kitty! I only worked half a day at clinic today, and luckily so because I was able to be home for a special delivery. I have never received or even been in the same room as an Edible Arrangements fresh fruit bouquet, and today that changed. :-) I have a big audiology-related event coming up (no, not graduation...one more year to go!), and this was to wish me good luck. How sweet, huh?! Literally- and figuratively-speaking...

Pictured is my very thoughtful friend and me when our deployments to Iraq overlapped and we saw each other in the sandbox. A time when my friend & I were "Hear 4 U Always" in a different sense...

Friends for seven years and counting...he was nice enough to make it out to my White Coat Ceremony.

I'm "Hear 4 U Always"...and apparently I have a friend who is here for me always. :-) I hope you are blessed with such great people in your life. Now that I've noshed on fruit for nourishment, time to hit the books and study, study, study. But as my wise friend wrote in the card, "remember to take time to smell the roses". That thoughtful suggestion should be adhered to by all of us all the time. :-)

"Switched at Birth"

2011-06-27T22:00:00.008-07:00

{Photo from http://abcfamily.go.com}

I can't believe it's already been three months since I moved to a new city/state (no, not a city-state like Monaco...don't I wish ;-P). And I moved into my new apartment two months ago. Generally I don't bother with getting a landline phone set up or cable TV. Attempts at being a frugalista. All the TV shows I like to watch such as "Grey's Anatomy" and "Desperate Housewives" could be accessed at no additional cost with rabbit ears/antenna & a digital converter box (yes, for shame, I don't have an HDTV yet ;-P). Well, when I called the local company to get Internet service set up in my new apartment, I was astonished that the monthly fee for that is $59.99 plus tax. I'm used to paying like $19.99 or $29.99 a month for Internet. So at the time of this phone call, I thought it was a wise decision to just bundle and get cable, landline phone, and Internet for just a wee bit more. Oh, cable TV, you will be the end of me. Especially the Food Network channel. ;-P

Where am I going with all this? If you couldn't tell by the picture above, there's a new TV show on ABC Family called "Switched at Birth". The following is a description of the show from the ABC Family website: "Switched at Birth, a one-hour drama, tells the story of two teenage girls who discover they were accidentally switched as newborns in the hospital. Bay Kennish grew up in a wealthy family with two parents and a brother, while Daphne Vasquez, who lost her hearing at an early age due to a case of meningitis, grew up with a single mother in a working-class neighborhood. Things come to a dramatic head when both families meet and struggle to learn how to live together for the sake of the girls."

The show premiered on 6 June 2011, and tonight the fourth episode aired. I'm voluntarily watching this show as part of my 'professional development'. I've only taken a couple of classes on communication sciences and disorders, but I had a really great professor for those classes and learned a bit on Deaf culture. It's interesting to watch what may be Hollywood's twist and society's perception of those who are hard-of-hearing, particularly the younger population. The show has proven to be both educational in a sense and entertaining. In addition, I may not have been switched at birth, but I was adopted at a young age yet old enough to remember it all. I actually know my biological family and remember having to leave them. I didn't speak English at the time so that didn't help matters. I took ESL (English as a Second Language) for a year in grade school, and now years later, I'm a blogging fool. ;-P Heh, heh. Anywho, it's also been interesting watching the dynamics of the two families and what the two girls are going through.

You can catch full episodes of "Switched at Birth" on-line at http://abcfamily.go.com. And you can catch me here where I'm "Hear 4 U Always". Ah - gotta love Google...found a picture of my favorite animal signing the word 'love'. Sending y'all love and best wishes (insert Paula Deen's voice ;-P...I did say I've been watching A LOT of Food Network...heh heh...Paula sends y'all "best dishes"!).

Picture 'Scroll' - Part Trois?

2011-06-15T21:00:00.029-07:00

Generally I do a blog entry known as "picture 'scroll'" displaying different photos of my life both professionally- & personally-related from the past few months or year. Well, since last summer, I did not accumulate many photos...not very many Kodak moments. Or none that I wished to capture on film. C'est la vie. So this year I will do a picture 'scroll' with photos of the clinic site that I'm currently at.

Note the doors - - one patient said that they looked like jail doors. I've worked with a number of sound booths with similar doors and that thought never crossed my mind. This patient had recently visited a prison. And kids say the darnedest things. ;-)

A view of the inside of the sound booth (the 'diagnostic' side) - - it's probably the largest/roomiest sound booth that I've ever worked with. The first sound booth that I've ever worked with was about the size of a telephone booth.

The view of the sound booth from the inside sort of looking out.

I'm at a pediatric site - - this is the little set-up inside the sound booth for conditioned play audiometry (CPA). CPA is a type of behavioral test technique used to evaluate hearing in children who have a cognitive age of 30 months or older.

Toys are a key component of CPA. Also toys are needed in general for kiddos to keep them entertained during their appointment.

Inside the sound booth is a tympanomenter. Also there is equipment for otoacoustic emissions (OAEs) and auditory brainstem response (ABR) & auditory steady-state response (ASSR) testing.

The purple recliner is used as an extra seat in the office area for parents & patients to sit in during appointments. It is also moved into the sound booth and used for unsedated ABR & ASSR testing.

A view of the office area - - it's the 'treatment' side where counseling & fitting for amplification occurs (hearing aids and bone-anchored hearing systems).

I'm glad this site has an audiometer that I'm familiar with which is the GSI 61.

I'm starting to get used to working with the Audioscan Verifit, a hearing instrument fitting system, which provides objective measures of a hearing aid.

This little guy is the newest addition to the office. It was a gift to my clinical preceptor from another audiologist who recently took a trip to the Galapagos. This bird is a Blue-footed Booby. I had forgotten the name of the bird and called it a Booty. My preceptor was all "no, it's Booby". Cute bird...goofy name. It should give you an indication of how my preceptor is. ;-)

Generally we rotate clinic sites each academic quarter. But this year I'm at one clinic site for Spring and Summer Quarters. I'm not complaining at all since I love the audiologist I'm working with and I love working with kids. Even when it can get tough emotionally like encountering & testing my first blind patient. I can't believe my rotation is more than half over. Heck - I can't believe it's mid-June! I'm "Hear 4 U Always" whether time flies or crawls. Hope you're enjoying the summer.

See no evil, Hear no evil...

2011-05-24T23:00:00.000-07:00

Hello, hello! Since the end of the world did not occur this past weekend, thought I'd start back up again with blogging. Okay, bad joke. ;-) I know I can be uber cheesy, but that was just bad. Guess I gotta find my groove again so bear with me.

I started this blog back in late Summer 2008 around the time that I was starting the four-year journey to earn a clinical doctorate in audiology. Then in Summer 2009, I became a Student Blogger for A.T. Still University (ATSU) where I'm attending grad school. Unfortunately in Summer 2010, the Admissions and Communication & Marketing staffs collectively decided to discontinue the blog initiative for ATSU's website. Thank goodness I had the foresight to not transfer all my blog entries here from 2008 on to the ATSU Blogs site and write from ATSU Blogs. Instead I had written one ATSU Blogs entry that contained a link to this blog. The ATSU Blogs officially ended in December 2010 (http://blogs.atsu.edu states "This website is no longer available").

The termination of ATSU Blogs in no shape or form had anything to do with my recent hiatus from seemingly being "Hear 4 U Always". You may or may not have noticed that (1) I have not written a blog entry in almost five months and (2) my blog had not been accessible for awhile. I had considered no longer maintaining this blog. I know that the marginal note states that this blog is a place for me to "sound off". However if I did just that, I'd be writing a book. I know e-books are now in ;-), but no one wants to read the mad rantings of a former military Officer/current doctoral student/future audiologist. And mad I had been.

Being a graduate of the U.S. Air Force Academy with six years served on Active Duty in the Air Force, to include a combat tour doing convoy sercurity missions in Iraq for half a year, I am no stranger to extremely difficult times & daunting challenges. But to sum up the past 18 months in my "professional" life, things on a few occasions got to be so bad for me that I seriously considered quitting this journey to become an audiologist. And I'm no quitter. I'm also not a public whiner, and thus I did not share every devastating disappointment I faced since the latter half of Year 2 from people to events. As the saying goes, "if you don't have anything nice to say, don't say anything at all". Or as I titled this blog entry, "See no evil, Hear no evil". *sigh* For too long, I lost the heart & passion for this pursuit. There was no one to turn to and help me reignite the fire.

I am a firm believer that everything happens for a reason...the good AND the bad. Life happens as it should. Hindsight is 20/20. And no man is an island, but sometimes you are the only person you can turn to.

Two months ago today, I left Arizona for clinical rotations out of state. New city & state, new apartment, new clinic site, new preceptor, back working with & helping the pediatric population -- it's been so refreshing! It's still been a trying quarter with not moving into my new apartment until the middle of the academic quarter, increased hours & days in clinic, juggling three on-line classes, and getting sick a lot more than usual. But I'm determined to turn over a new leaf and enjoy the journey.

The reason why I started this blog was threefold. One, when I was researching various healthcare routes to pursue as a second career back in 2007-2008 from getting a second bachelor's degree in nursing to getting into medical school, I remembered Googling "audiologist+blog" in hopes of finding a personal perspective to this career field which the U.S. Department of Labor publications couldn't provide. ;-P There were none...well, none that talked about the experiences of an audiology student or clinical experiences of a practicing audiologist. Two, it was intended for family & friends to keep them apprised of my audiological/grad school experiences. And three, it was also for me -- to act as an academic/professional journal to refer back to years from now...and see how far I've come. I had never heard of audiology until Spring 2006 when I became a volunteer Neonatal Hearing Screener at a local hospital. Even then, I thought audiology was a specialty you picked after getting into medical school. I didn't know that becoming a doctor of audiology had its own route. So like a baby getting his/her first tooth or taking steps for the first time, I'm like a baby in that everything in audiology was a new experience from doing a pure tone hearing test to taking an ear impression (now those things are old-hat to me...wink wink). And unlike actual babies, I could write about and share the experiences via this blog.

So peek-a-boo, I'm back.

If I have to, I'll grab a bull by its horns.

And if all else fails, I'll pray that this is my magic bean like Jack & the Beanstalk.

I guess I'm one bear that overslept my hibernation this past winter. ;-P I'm "Hear 4 U Always"...but no longer in Chicago if you could discern that from the pictures. I was in the Windy City in April for AudiologyNOW! 2011, the annual convention put on by the American Academy of Audiology. It was my first time in Chicago, so I had to take a day to go sightseeing & totally be the camera-wielding-and-snapping tourist. :-) Gotta go study & take three final exams so ta-ta for now. It's good to be back. May is Better Hearing (and Speech) Month. The month is coming to a close, but efforts to maintain better hearing shouldn't take a vacation. Don't forget hearing protection (yes, ear plugs!) if going to one of the many summer concerts. Even when doing yardwork (the noisy kind, not just pulling weeds...). Happy Almost Summer!

Happy New Year!

2011-01-01T13:00:00.007-07:00

And Happy New Decade! The last decade was quite the eventful one. I have a feeling this decade will be a bit more mellow for me; that is, after graduating from the Au.D. degree program next year (!!!).

My apologies if it seemed that I closed up shop on my blog the past couple of months. And I've come out of my black hole (uh, more like supernova with all the stuff going on in my life!) long enough to say I'm going on hiatus for about the next three months. I'm in the full swing of Winter Quarter of Year 3 which consists of three courses & 16 hours of clinic (100-mile round trip drive 2 days in a row!) with weekly Grand Rounds. PLUS I have to study for Year 3 Comps (Comprehensive Exam aka Comps consists of a 5-hour lab practical exam & also a 100-question written exam). THEN I'm moving to another state for a clinical rotation. I thought things were supposed to get a smidge easier after Year 2 Comps last spring. No one warned me about the crazy Fall Quarter in Year 3 with the added stresses of applying & interviewing for Year 4 clinical externships in addition to the crazy Winter Quarter in Year 3 getting ready for Comps all over again followed by a long-distance move. I knew it was coming, but still...geesh.

I'm "Hear 4 U Always"...but taking an extended break from blogging. That silly picture of me in the harness of a CDP (computerized dynamic posturography) test equipment shall have to wait. ;-P For now, I leave you with a silly picture of me wearing Winnie-the-Pooh earmuffs (picture was taken over the much-needed two-week Winter Break so I don't look razzle frazzle as I am now). How do you think they'd look as supra-aural earphones?! Pediatric patients would go nuts for a hearing test, don't ya think? :-) Well, wish me luck with school & schtuff. And I wish you a most awesome New Year! See ya on the flip side of this academic quarter!

Veterans Day

2010-11-11T23:00:00.001-07:00

"Hearing damage is the No. 1 disability in the war on terror, according to the Department of Veterans Affairs, and some experts say the true toll could take decades to become clear. Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones [Iraq and Afghanistan] are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said." "From World War II and well through Vietnam, hearing damage has been a leading disability." Those are excerpts from an on-line article I read before I was even accepted into the Doctor of Audiology degree program back in Spring 2008. For the full article, go to http://www.military.com/NewsContent/0,13319,163557,00.html.

And for my thoughts on Veterans Day, refer to my blog post from last Veterans Day (http://hear4u-always.blogspot.com/2009/11/freedoms-not-free.html). "A Veteran is someone, who at one point in their life, wrote a blank check payable to the United States of America for an amount up to and including their life." I'm a Veteran, and it was & is my honor. November 11th isn't the only day of the year that you should thank those who are serving or have served our country...Home of the Free because of the Brave. Thank you, thank you, thank you 365/24/7 to all my brother & sisters in arms. They are "Hear 4 U Always".

Fundraisers & Fun on Founder's Day

2010-11-07T22:00:00.004-07:00

Yesterday the university celebrated Founder's Day with a slew of events from a 5K fun run/1 mile fun walk to a free picnic lunch. From http://www.atsu.edu/: "History of Founder's Day = On December 12, 1919, a memorial service was held to honor the school's founder, Dr. Andrew Taylor Still, who had passed away on December 12, 1917. The presidents of all the classes met with Dr. George Still to plan the event, a brief ceremony in the assembly hall and a floral wreath placed on the statue of A. T. Still. It was decided then that a similiar ceremony would be held each year to honor the founder of the school, and that was the beginning of Founder's Day. Ceremonies have been held each year thereafter and enable all of us to gather to renew old ties, to make new acquaintances, and allow us to evaluate and enjoy the progress the University has made in meeting the demands of each new day." A.T. Still University in Kirksville, MO aka Kirksville College of Osteopathic Medicine (KCOM) was founded in 1892 and was the first institution of osteopathic education in the world. A.T. Still University has grown to have a campus in Arizona and home to the Arizona School of Health Sciences (ASHS), Arizona School of Dentistry & Oral Health (ASDOH), and School of Osteopathic Medicine in Arizona (SOMA).

The A.T. Still University Chapter of the Student Academy of Audiology (ATSU SAA) held two fundraisers -- Earmold Fundraiser and T-Shirt Fundraiser -- in conjunction with Founder's Day events. The T-shirts we're selling are not specific to Audiology. Embroidery on polos and such are available to all the degree programs on-campus which are Audiology, Athletic Training, Occupational Therapy, Physical Therapy, Physician Assistant Studies, ASDOH, and Osteopathic Medicine.

Below is the flyer containing information & pictures of the various hearing protection devices that we offered for the Earmold Fundraiser.

Page 2 of the flyer...these flyers were used for distribution when the 2-week long Earmold Fundraiser occurred back in September. After the Earmold Fundraiser was over, we kept getting inquiries if we were going to hold another Earmold Fundraiser so it was decided to hold another one for one day only on Founder's Day.

Below one of the third-year Au.D. students is taking ear impressions on a first-year Au.D. student.
No, that is not a large glob of pink bubble gum & dental floss in her ear! It's silicone impression material and the string from the otoblock. :-)

A lot of the ATSU SAA members who were available on Saturday signed up for an hour-long volunteer shift to either man the booth outdoors (first-year Au.D. students) or to take ear impressions indoors (second- and third-year Au.D. students). Some members stayed for the duration of Founder's Day events which went from 9:00am to 2:00pm.

Being the President of the ATSU SAA and with the co-faculty advisors of the ATSU SAA absent, I wound up staying the 6 hours for the fundraisers from set-up to answering questions to tear-down. I did get to break away for a half hour to do the 'free picnic lunch' with my parents. Yes, I invited my parents out to the Founder's Day events. ;-) It was after all open to students, faculty, family & friends.

There was also a Dodgeball Tournament. The Au.D. students had two teams playing.

Below is a picture of the first Au.D. team to play in the dodgeball tournament. It was THE shortest dodgeball game in history...lasted less than 30 seconds. They get an 'A' for effort. :-)

Below is a picture of the second Au.D. team composed of all second-year students. They called themselves the "Scorpions" which were printed up on T-shirts. They fared better in their dodgeball game, lasting almost 2 minutes. I think the two dental teams we went up against must have practiced beforehand while we went cold-turkey.

I'm "Hear 4 U Always"...trying to put the FUN in FUNdraisers. Unfortunately the turnout of people wasn't as great as anticipated in comparison to last year's Founder's Day attendees. C'est la vie. As a friend used to say to me upon leaving and I feel it appropriate to use now, I'm outta here like a fat kid in dodgeball!

Medical Mission in Mexico

2010-11-04T16:00:00.008-07:00

Back in the spring, I applied to be a member on the medical mission team to Guaymas, Mexico. I found out in late summer that I was selected to go. It was nice to (1) have more of a heads-up of selection than last year's 3-week notice since I had been waitlisted and (2) to know what to expect having participated in this amazing program last year. The program is called "Ayudame A Escuchar" (Help Me To Hear) and sponsored by the Mesa Baseline Rotary Club of Mesa, AZ. Each year a group of specialists volunteer to go and conduct hearing tests & medical examinations, fit & dispense hearing aids and earmolds, fix hearing aids, and provide consultations on matters related to aural rehabilitation & education of students with hearing loss. All services are performed at no charge. Donations of hearing aids, batteries and supplies have come from various manufacturers and audiologists, as well as patients of audiologists in the United States. Donated hearing aids are reconditioned before being taken to Guaymas, Mexico.

This is the 18th year that this medical mission has taken place, and we just went two weeks ago. Of the 28-person team of audiologists, student audiologists, otolaryngologist, and translators, only 6 people were new to the team this year. I don't know if that was why we were perhaps a well-oiled machine...meaning we saw nearly 400 patients in 2 days this year!!! That's over 100 more than we saw last year! Incredible! Last year the otolaryngologist unfortunately did not make it on the mission due to illness, so it was nice to have him on the team this year along with the medications he dispensed to those patients needing them for ear infections and such.

Once again, I did not bother to take my camera with me on this trip since I came to work and help. But below are some pictures I either took with my phone or got from another team member. I've captured all that I needed to visually in my mind and in my heart (call me corny but it's true!). I've seen humankind at its worst (combat in Iraq) and at its best (Mexico medical mission). From giving out candy ("Quiere dulce?") to those patients traveling long distances & waiting hours to be seen to doing hearing tests on children & adults ("Cuando escucha los sonidos, levanta la mano. Esta bien?"), the people I encountered in those 10+-hour long days will stay with me forever.

Pictured are the roadside chefs of carne asada and what not. We ate lunch at this cafe after crossing the border into Mexico by bus.

One of the audiologists took this picture...clearly without me knowing. He had written the caption on his Facebook page of "Tammie - not sure what she just ate!". Ha ha. No one got sick on the trip this year so that's good. Last year we had 3 people with gastric ailments, to include me. Note to self if I go next year: bring fiber supplements (in addition to Imodium AD & Pepto Bismol). Enough said.

Look! I do know how to smile! :-)

The view from the condo I was staying in...how gorgeous!

Too bad we only had a half hour in the morning each day to enjoy the beach before going off to work. Some team members even saw dolphins swim by! I saw some from afar one morning. Very cool.

I worked in "Audio Area #1" again this year. Pictured is the 4-person team that made up that work station. We conducted diagnostic tests. On Day One of work, I knew that we'd only be seeing children, so I am donning my SpongeBob scrub top that I had bought last fall when I was in the Pediatric Audiology course (refer to http://hear4u-always.blogspot.com/2009/10/who-lives-in-pineapple-under-sea.html). My very last patient that day also wore a SpongeBob shirt - - instant bond! ;-)
This year I primarily worked outside of the "shag booth" (the sound-treated booth seriously has red SHAG carpet on the walls, ceiling, and floor!). But when I did have to test in the sound booth, I made sure to not get dinged by the door like last year in which I got what I coined my "Guaymas souvenir" (large bruises on my backside).

This picture was again unknowingly taken by a fellow team member. I believe I'm in the middle of saying "si" which occasionally was said to let the patient know that "yes" they indeed did hear a very soft sound (test conditions outside of the booth was only "moderately quiet"; "quiet" of course is ideal).
If you would like to read up on last year's medical mission to Guaymas, Mexico and view some more pictures, please refer to http://hear4u-always.blogspot.com/2009/10/ayudame-escuchar.html and http://hear4u-always.blogspot.com/2009/11/thank-you-gracias-merci_26.html.

I'm "Hear 4 U Always"...and hope to be involved in more humanitarian audiology. It makes me smile "ear to ear" on my face and in my heart to help others, particularly those in need.

Snack 'n' Fact

2010-10-30T23:15:00.013-07:00

Yesterday the A.T. Still University Chapter of the Student Academy of Audiology (ATSU SAA) did a baked goods give-away known as "Snack 'n' Fact" as part of October's National Audiology Awareness Month & National Protect Your Hearing Month. I have a rather full plate as full-time doctoral student, applicant for several clinical externships, ATSU SAA President, and other extracurricular activities. So thankfully one of the ATSU SAA members took on the responsibility of being the point person and coordinating this event.

This is the "Before" picture meaning "before" all the baked goods disappeared!

Most of the baked goods had a toothpick with an audiology fact on it. Hence the event's name of "Snack 'n' Fact". ;-)

Having just returned from a 4-day medical mission to Mexico with clinic, classes, applications, and a Grand Rounds case presentation to prepare for, I unfortunately did not have time to make any baked goods to donate. :-( I had wanted to make cookies. Instead I had suggested at the 8 October 2010 ATSU SAA General Membership meeting that we give out earplugs for free in conjunction with the Snack 'n' Fact event since it is after all also National Protect Your Hearing Month, not just National Audiology Awareness Month. So we had a number of earplugs in stock to give out, and they were quickly scooped up by many of the dental students (all that drilling!). Also I helped with set-up and loaned out the thing used as the 'donation bucket'...if you've been to McDonald's in the last couple of weeks for a Happy Meal, it may look familiar. ;-)

By far the most awesome baked goods donated by one of the Audiology Department staff members. They're mini pumpkins and spider brownies. Almost too cute to eat!

"What?! They're free?" - - And the masses swarm to the tables of baked goodies & audiology knowledge on sticks. ;-) A number of monetary donations were made in support of the ATSU SAA...thank you, supporters!

I'm "Hear 4 U Always"...to remind you that October is not the only month to be aware of audiology and protecting your hearing. It's a year-round thing!!! 24/7 for 365...unless it's Leap Year, then it's for 366. ;-) Eat, drink, be merry...and wear hearing protection if you're going to be exposed to loud sounds e.g. at a concert, fireworks show, etc. Even when vacuuming! I do! Noise-induced hearing loss is no laughing matter, my friends.

"Flexibility is the key..."

2010-10-18T22:00:00.001-07:00

When I had been in the Air Force, the saying was that "flexibility is the key to airpower". A one-liner lesson learned from the likes of General Billy Mitchell, General Giulio Douhet, General Claire Lee Chennault, etc. Well, I'm sure you are fully aware that flexibility is the key to anything and everything. Seriously! Today was no exception at clinic.

I had a four-year-old patient whose audiological case history I knew nothing of. My clinical preceptor was really busy, and she was comfortable enough in my skills to have me see the patient without 100% supervision. This patient appeared normal so I assumed that this patient was developmentally capable to complete a hearing test using conventional audiometry. I will not bore you with the differences in audiometric testing approaches. But let's just say that this patient was not comprehending that I wanted the patient to raise their hand when they heard the tones. I instructed in English and I also instructed as best as I could in Spanish (the mother accompanying the patient only spoke Spanish). I also found out that the patient communicates sometimes in American Sign Language (ASL), so I had to dig deep to remember a few signs to supplement my verbal instructions. I will admit that I got a little frustrated in the communication breakdown in addition to feeling bad for the patient & mother for taking longer than necessary to complete a hearing test. I went to look for my clinical preceptor for some assistance since she knows Spanish and ASL a heck of a lot better than me. But she was in the middle of an important phone call. So I turned around and went back to the sound booth to try another approach to obtain hearing thresholds. Since I had the patient in soundfield (aka speakers), I could not do conditioned play audiometry, or CPA, without a test assist. I was all by my lonesome. And yes, there was a reason why I was only testing in soundfield and not utilizing insert earphones or supra-aural earphones...twas medically-related. So what other test approach could I take in soundfield that's not conventional? Visual reinforcement audiometry, or VRA. And that is what I did to obtain thresholds at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. Soundfield testing does not give ear-specific information. I had done tymps on the patient before audiometric testing and knew the ears were A-okay to do otoacoustic emissions testing on to confirm peripheral hearing sensivity with the audiogram & get ear-specific info.

Moral of the story is to "be able to think on your feet and be flexible!". I'm "Hear 4 U Always"...tap-dancing my way through clinic & trying to be like Gumby (yes, the green bendy figure from TV Land back in the day). Speaking of old TV shows, if I could "Dream of Jeannie", I'd wish to be trilingual and be fluent in English (thank you...learned that as a second language back in the day & now fluent ;P), Spanish, and American Sign Language. I'm no genie of any lamp, but I'm going to cross my arms now & blink my eyes...POOF, I'm gone. ;-)

October is National Audiology Awareness Month...

2010-10-17T23:00:00.006-07:00

...and National Protect Your Hearing Month! Since this blog's inception over two years ago, two Octobers have come & gone and I have failed to mention this little fact. So I'm telling you now. :-) Although I unknowingly wrote something in line with 'Audiology Awareness Month' last October in dispelling a couple of misconceptions about hearing loss (refer to http://hear4u-always.blogspot.com/2009/10/hearing-loss-101.html).

The following information was taken directly from a fact sheet on the American Academy of Audiology website (www.audiology.org):
* Audiology is a highly recognized profession and has been ranked by U.S. News and Word Report as one of the Best Careers in 2006, 2007, 2008, and 2009.
* What is an audiologist? = Au-di-ol-o-gists: Audiologists are the primary health-care professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children.
* Most audiologists earn a doctor of audiology (AuD) degree. Some audiologists earn a doctor of philosophy (PhD) or doctor of science (ScD) degree in the hearing and balance sciences.

Regarding the last bullet, if you were wondering how long it takes to get your Au.D. degree, it's 4 years for most Au.D. degree programs such as the one I'm currently enrolled in. And not to insult your intelligence, but this is 4 additional years of school after earning a Bachelor's degree. So that totals 8 years of schooling post-high school. I feel as if I had to make a plug on this, because I would be a millionaire if I had a dime for every time a patient (or patient's spouse, friend, etc.) would ask me if I'm in school for 4 years after high school or college to get my degree in audiology (aka clinical doctorate).

Off that soapbox and now onto another one in honor of National Protect Your Hearing Month. ;-) The ATSU Chapter of the Student Academy of Audiology (ATSU SAA) recently had an Earmold Fundraiser in which custom-fit hearing protective devices were provided. Most of the funds raised help ATSU SAA members attend AudiologyNOW!, the annual convention for the American Academy of Audiology. You may remember seeing & reading about the custom molded ear plugs that I got back in the 2008 Earmold Fundraiser (refer to http://hear4u-always.blogspot.com/2009/08/85-decibels.html). Well, this year I decided that I wanted to get a pair of custom earbuds.

Below is a picture of my iPod with the custom earbuds attached to the earphones. I couldn't decide which color to get, and a classmate said to go with purple. So I did, and I'm pleased. They're pretty. :-) Because that's what's important, right? ;-P Not!

Below is a picture of what the custom earbud attached to the earphone looks like in my ear. If this Au.D. degree doesn't work out, maybe I can be an ear model? ;-) Again, not!

The custom earbuds were advertised as follows: "The acoustic design of [the] MP3 earbud molds optimizes the sound quality of standard in-ear headphones that come with MP3 players or iPods (the round earbuds that sit in the outer ear) and other audio equipment. The acoustic design makes lower volumes more satisfying to protect the hearing, while a secure fit keeps the earbuds in place during exercise or movement."

Above is a picture of the volume setting on my iPod without the custom earbuds attached. Below is a picture of the volume setting on my iPod with the custom earbuds attached. See the difference? There is a dramatic decrease in loudness level with use of the custom earbuds for listening comfort.

My personal feedback on this product = I was originally going to order the custom earbuds in the Ultraflex material since it is soft, and I figured that a soft material would be more comfortable on the ear. I wound up ordering the custom earbuds in the Lucite material which is hard, because some classmates who already owned custom earbuds told me that the soft material had a tendency to stick to your ear. After having worn my custom earbuds made with Lucite for a half hour on the treadmill yesterday and also prolonged wear of the custom earbuds while not getting my fitness on ;-), I can say that the Lucite material is perfectly comfortable to wear in the ear. I will admit that there is a tradeoff of sound quality versus intensity. I'm no musician but I've been a choir member for a few years and also have been able to play pieces of a song on the piano by listening to it (although reading the music sheet makes it much easier...). So I know what music is supposed to sound like, and having the custom earbuds attached to the earphones does take away just a smidge from the high fidelity the earphones provided without the custom earbuds. I choose to maintain my level of hearing sensitivity for as long as possible, so I'm going to continue using the custom earbuds and listen to my music at a lower intensity. And I'm not just saying the last line because I'm an aspiring audiologist. Honestly! Once you damage those hair cells of your inner ear from noise exposure, those hair cells don't grow back like the hair on your head. So protect your hearing, my friend.

I'm "Hear 4 U Always"...and keeping you ever aware (it's National Audiology Awareness Month!). Can't decide what to be for Halloween this year? Earplugs can be a fashion statement and a statement to others to protect their hearing (it's also National Protect Your Hearing Month!). You can't get much cooler than that. :-) Ear geek signing off...

"Kicking & Screaming"

2010-10-12T20:30:00.005-07:00

{Photo from www.imdb.com}

First "Julie & Julia" and now "Kicking & Screaming". Are you asking yourself if I've gone from aspiring audiologist to mediocre movie critic? Ha, ha. No, of course not. It's just coincidence that I would have two back-to-back blog posts that have a movie related to my current life in some way. Even if by a stretch. ;-)

Today at clinic, I had a 3-year-old patient who was both a kicker and a screamer. Hence, the blog post's title of "Kicking & Screaming". ;-) It was quite the hour-long appointment; this patient had the initial stim of their cochlear implant (CI) today! The patient seemed to take to hearing sounds (electrically, as opposed to acoustically...) pretty well. Even if the patient did not seem to want to keep the headpiece on; the patient kept reaching for it to yank off. That prolonged the CI programming process.

If you wish to learn more about cochlear implants, you can visit the website for any of the 3 major CI companies which are Advanced Bionics, Cochlear, and MED-EL. I'd rather refer you to one of those websites than to try and explain the parts & workings of the cochlear implant myself. The websites have animated video clips to help illustrate how normal hearing works and how the CI works. A picture (or picture in motion aka video ;-P) is worth a thousand words...and I'll spare you (and me) a thousand written words. ;-)

I'm "Hear 4 U Always"...even as a human punching bag for kiddos. :-) I also had another patient pull my hair a few times during their appointment today while I fitted the patient with a new set of hearing aids. Working with and helping children who have special health care needs (more than hearing loss) has certainly humbled me. I love pediatrics! You won't find me "Kicking & Screaming"! Speaking of which, I did not enjoy that movie as much as I thought I would have. I saw it in May 2005. It was the first movie that I saw in theaters in the U.S. after returning from Iraq. My emotional state was awry; I ceased to laugh much or cry at all. One too many funerals turned me into a robot...something incapable of feeling. However I still cry now if I think or talk about saluting a pair of combat boots & dogtag-slung M16 rifle which is a traditional farewell to a fallen & dearly departed sister/brother in arms. Anywho, I thought Will Ferrell could pull me out of my funk, but he did not deliver. I barely remember the movie, but I do remember that I don't find being mean as humorous which is what the movie contained. You know me...I delight in cheesy/corny humor. ;-) Cheesy/corny...is that 'foodie' humor? Chew on that whilst I go study for 2 midterm exams taking place tomorrow.

"Julie & Julia"

2010-10-09T18:00:00.005-07:00

{Photo from http://www.eatmedaily.com/2009/06/the-redesign-of-the-julie-julia-book-cover}

Some classmates saw my blog...this blog...for the first time yesterday. Even though it's been up for over 2 years. This is probably because I've tried to keep my blog a secret from people at school. About a year and a half ago, I was made aware that some "friends" on Facebook didn't like my school-related status updates. I'm human and I have feelings, so naturally I was a tad miffed. I knew I had real friends who delighted in keeping up to date with my life's occurrences whether they were academically-related or not. I remedied the "situation" by not letting the majority of my peers at grad school have the ability to view my Facebook status updates. And I vowed to keep this blog under wraps to these same peers...for as long as possible.

It has been awhile since I have posted a blog entry with pictures accompanying it. So many things happen to me in the Doctor of Audiology degree program, but I don't always remember to take pictures to capture the moments or can't due to privacy issues. Yesterday I was the test subject/mock patient for lab in the Vestibular Assessment and Treatment II course. Since I was in a harness in the CDP (computerized dynamic posturography) test equipment, I asked a fellow classmate to get my phone out of my bookbag to take a picture or two for my blog. And that's how my blog came out from 'under wraps'. No point in hiding it anymore. As a dear friend of mine always says, "meh"...an interjection to express indifference. ;-)

When I was finally released from the harness...or what I deemed the "CDP Jail" (hey, you'd call it that too if you're standing & strapped in one for an hour!), I was getting questions about my blog so I simply took my laptop computer out and plugged in the URL to show some of my classmates my on-line literary work. One remarked that I could be "like 'Julie & Julia'".

Speaking of "Julie & Julia", I had wanted to but hadn't seen the movie yet as of yesterday. Today however I finally allowed myself a break from my crazy busy life and gave myself some "me time" to watch "Julie & Julia". I had the DVD in a large stack of unwatched movies...all collecting dust. :-( What a charming & inspiring movie! But Julie or Julia, I shall never be. I'm not culinary-challenged as I was just 3 years ago, but a master chef I will never be. I make ear impressions, not boeuf bourguignon. And sure, I blog here & there, but I'm no self-proclaimed writer. I do have aspirations to one day write a book, but it won't be about audiology. I actually have two different book concepts...one that I've been sitting on for over a decade and the other for about 3 years. The New York Times' Best Sellers List is not what I aim for, but I would one day like to get one of my book ideas written...and published.

In the movie when Julie said "How am I gonna explain this? My readers are gonna be really upset. They were so into it...I never should've told everyone...This is a nightmare." after the no-show dinner guest of Judith Jones, I thought to myself "this is exactly why I don't write about things & events until after they happen". Meaning I have already had 2 phone interviews, 2 more phone interviews scheduled, and one trip booked for different clinical externships that I'm applying for...but I'm not revealing anything about this whole process until it's done and I know full-well where I've been accepted to & actually going to.

As for my readers, I suspect that I have no more than what I can count on my fingers and toes. And I'm fine with that. As a reminder, I started this blog to (1) keep family & friends updated on my grad school experience and (2) perhaps inspire someone to look into pursuing audiology or help a prospective student figure out if audiology is indeed what they want to do. Without this blog, I would have never known of Elizabeth aka "(e" and Megs (look under Followers). And my favorite Blogger user name thus far has been "scala vestibuli"...gotta be an 'ear geek' ;-P. I have no idea who she/he is, but hopefully she/he watched the episode of "Grey's Anatomy" last season with the patient who had superior canal dehiscence after reading one of my blog entries. :-)

Julia signed off with "Bon appetit!". Readers, how do I sign off? That's right...I'm "Hear 4 U Always"! Oh, and that blog entry on CDP and pictures of me in a harness will be posted at a later date. For now, I have 3 midterm exams to study for and take. Eeks! I'd much rather be toasting wine with friends at a dinner party wearing cutesy nametags like in "Julie & Julia". Au revoir!

Zombies and Trains?

2010-09-18T20:00:00.005-07:00

Hello, hello! My apologies for the unintended hiatus in blogging. But I suspect that the next six months will bring more gaps than blog posts. :-( Last night I dreamt about zombies chasing me. Freaky! I used to be big on Freud and dream interpretations back in high school. I still believe dreams hold hidden meaning, and so I looked up 'zombie' in an on-line dream dictionary. It stated that to dream of being attacked by zombies means that I'm feeling overwhelmed and under tremendous stress in my waking life. Bingo! I'd say that this dream intrepretation is pretty accurate. *sigh*

UPDATES:
I am officially a third-year student in the four-year-long Doctor of Audiology (Au.D.) degree program. Kind of like the "is the glass half full or half empty?" train of thought, I'm relieved to be half done with grad school but also feeling heavy-hearted to have half more to go. *sigh* I guess most third-year Au.D. students tend to slack off at this point knowing that they only have two more academic quarters of classes on-campus in addition to clinic, and then it's purely clinicals with zero up to two on-line courses per academic quarter until graduation. A professor warned us to not slack off before our Year 3 Comprehensive Exam in the Spring. He said that most third-year Au.D. students see the light at the end of the tunnel and think that they can coast by. But he said that the light is from a train -- "train's coming and it's me". Of course no one took that as a 'threat'. ;-P As for me, I'm just juggling a lot on my plate from classes to clinic to ATSU SAA presidential duties to other extracurriculars to applying for clinical externships for the latter half of Year 3 and for all of Year 4. I need an assistant to help me out with all that I have to do, but sadly I don't. My plate doesn't include just the basic things one must do to live day to day such as going grocery shopping, cooking meals, doing laundry, ironing clothes, etc. *sigh*

Fall Quarter of Year 3 consists of 14 credit hours. I am enrolled in the following courses: Basic Principles of Medical Imaging (aka Radiology 101), Educational Audiology, Vestibular Assessment & Treatment II (Part I was taken back in Spring Quarter of this year), and 16 hours of clinic with weekly Grand Rounds. I finally got pediatrics for my clinical rotation this quarter! Clinic is uber stressful not due to the patients rather the teaching methods of the preceptor, but I know I will be learning A LOT and that's what matters in the end. A good kick in the arse and being thrown into the fire can turn out to not be so bad. ;-P Heck - I've seen and done more in two days of clinic this past week (sedated ABRs! ear impressions on actual patients! etc.) than I have in clinic the past eight months. Advice given to me by my preceptor was to "fake it". Oddly enough, I heard that mantra several times over the summer while watching a new TV show - - "fake it till you make it". I've been through boot camp (not the one at a local gym ;-P) and combat, so all this should be a cakewalk, right? Ha, easier said than done.

I'm "Hear 4 U Always"...and hanging in there. :-) It's going to take a lot more than zombies and trains to stop me. What does have me uplifted among the heavy chains of current life is the Season 7 Premiere of "Grey's Anatomy"! Coming to a TV near you on September 23rd, the day after the autumnal equinox. Have a good Fall (as in the season, not from a potential vestibular problem)!

Protect what you have...

2010-07-27T22:00:00.006-07:00

Protect what you have...you're probably like "protect what?". Protect your hearing of course! Yep, I still wear earplugs when vacuuming (refer to http://hear4u-always.blogspot.com/2009/08/85-decibels.html for a refresher on one of my 'ear geek' ways...I mean, practicing what I preach audiologically ;-P).

It's been a few weeks since I last posted anything on here so I thought I'd post something related to the Occupational and Environmental Hearing Conservation (aka Industrial Audiology) course I'm enrolled in this quarter. After all, I gave some love to the Amplification III course in the last blog entry. Gotta share the love! ;-)

In class on 8 July 2010, our professor gave a lecture on hearing protection devices, or HPDs. From former military life to current audiological life, what life isn't filled with good ol' acronyms? ;-P In the least, texting "HPDs" is faster than spelling it out. Heh heh. Anywho, as part of the lecture on HPDs, our professor passed around various types of HPDs -- mainly earplugs and earmuffs. A little FYI - hearing protection devices are broadly categorized as earplugs, earmuffs, and helmets. Yes, helmets. :-) Bring it on! Protecting your hearing never goes out of style. :-)

This picture (Berger, 2000) was taken from one of the lecture slideshows; it gives a better visual of the different types of HPDs than any written description I could give. ;-) Who doesn't love freebies? :-) Our professor let us keep a set of the various earplugs that were passed out during class. Would you like yellow or orange? Or yellow? Or orange? ;-P

We didn't have any helmets to look at during class. But lo and behold - I've worn an HPD in the form of a helmet in my former life while in Iraq! I didn't know back then that it was a type of HPD. I just thought it was a new means of communicating with one another in the armored vehicle during missions. I say 'new', because prior to our unit acquiring some of the armored vehicles with the communication helmets installed, we just wore our Kevlar helmets (with ear plugs...for some protection from that random blast of a landmine or IED) and shouted at each other to communicate anything while on the road. I actually didn't like wearing the 'communication helmet', because the weight of having that on my head gave me bad headaches and hurt my neck (don't play that tiny violin yet... ;-P). Sometimes we'd be in the vehicle on a mission up to 18 hours straight. But now I say "two thumbs up!" for HPDs...in helmet form or not. :-) Helmets have the capability of being passive protectors (earphones in the helmet) and active protectors (active noise reduction electronics aka 'noise cancellation').

In closing, check out this video -- http://www.youtube.com/watch?v=kLSYq5kau_w. It's music to the ears! :-) Singer is Ben Jackson. Song is "Turn It to the Left". A tune with a message..."you only have one set of ears to last your whole life...protect your ears".

I'm "Hear 4 U Always"...trying to help you and me maintain good aural health. Continue enjoying the summer. Don't forget hearing protection if going to one of the many summer concerts! After all, "it ain't no fun, man, it ain't no fun when you're twenty years old but your ears are eighty-one." -- Ben Jackson

"Paging Dr. McDreamy, paging Dr. McDreamy"

2010-07-01T23:00:00.005-07:00

Summer Quarter of Year Two is in full swing. Can't believe it's already the end of Week 3! This quarter is one of the lighter course loads with just 10 credit hours but on a compressed schedule (normal academic quarter is 12 weeks long but Summer Quarter is only 8 weeks long). I am enrolled in the following courses: Occupational and Environmental Hearing Conservation (aka Industrial Audiology), Amplification III (aka Cochlear Implants and Other Implantable Devices), and 8 hours weekly of clinical practicum but no weekly Grand Rounds. It's nice to be able to breathe just a little bit after the high-stress Spring Quarter that my classmates and I went through. Although breathing in 110-degree weather is in two words -- "phew! hot!". ;-P Then again after 130+ degree weather in Iraq & Kuwait with full Kevlar on (vest and helmet) and the occasional sandstorm (so sand sticks to your sweaty skin), I can't complain with air-conditioned buildings and air-conditioned cars. :-) Oh, and those nice misters at outdoor shopping centers. It's all about appreciating the little things in life. :-)

Today was an exciting day in Amplification III. We had a representative from Cochlear Corporation come in on Tuesday to give us a presentation on their cochlear implants. Today we had a different representative from the same manufacturing company come in to give us a presentation on the Baha system. Baha was formerly known as BAHA and stood for 'bone anchored hearing aid'. But without going into details of insurance companies/third-party payers and what not, BAHA is now just the Baha system and not referred to as a 'hearing aid'. It's an implantable device after all. The fun really began during the hands-on portion of the presentation. We had the opportunity to drill holes in skulls and shave skin flaps on scalps. Mind you, not on real people...just practice models. In the U.S., these aspects of surgery for a Baha system is NOT in the scope of practice for an audiologist. But hey, things can change...or people may change and move overseas to where audiologists are more involved in the surgery. For the time being, I know a number of us won't be eating sashimi/sushi for awhile. Watching a video of a Baha surgery being done on an actual patient was a smidge hard to stomach. We watched a number of cochlear implant surgeries during the first week of Summer Quarter, and that's a walk in the park for us now watching surgical incisions on a head being clamped open, drilling a cochleostomy, etc. Today was bloody and 'chunky' (you had to be there...new meaning to the word 'chunky'...oh my).

Anywho, during class, I was thinking to myself that this isn't something we do everyday so I whipped out my camera phone and snapped away some. I don't think my classmates realize that I've been maintaining a blog of being an audiology student; I tend to be low-key on things. No need to make a fuss. ;-) The professor thought I was going to post the pics on the ATSU SAA (Student Academy of Audiology) fan page on Facebook. I didn't confirm or deny anything. ;-) Hope you like the pictures.

There are four quadrants on the practice model which demonstrates a different stage of the Baha surgery in regards to the incisions, removal of tissue, titanium implant, etc.
I so could not be a hand model. Yes, that's my left hand holding the 'skin flap' back to get a better view of the implant on the bone. And in the video, a real person's head really was that red (bloody!).
Below is a picture of the rep demonstrating how to use the razor to make a 'skin flap'...yes, on a nice piece of foam. No ears, scalps, or temporal bone were hurt in the making of this blog entry. ;-P
Below is a picture of the 'skin flap' I made on the left. My 'assistant' is holding the flap up with tweezers to show a clean shave...with skin flap still intact (I don't even want to think about a surgeon accidentally taking that bad boy entirely off! Talk about 'whoops!'...and uh, malpractice insurance please.) That was kind of my classmates to even give me a round of applause after completing that procedure. :-) The 'skin flap' on the right was done by a classmate; I think a little too much pressure was applied. We had a foot pedal to operate the razor, and you had to feel for how much pressure to apply for a just-the-right-thickness skin flap.

Below is a picture of K. working the drill to create a hole for where the titanium implant would be placed. K. is smiling because she had a funny incident occur last summer when she operated a drill. That was for a different Amplification class where we used a drill to make modifications on hearing aids. Let's just say her theme song audiologically is "You Spin Me Right Round". ;-P She and I even sang a little bit of the chorus while remembering days of last summer. Aw.

I didn't think to take pictures till after I had tried my hand at drilling and shaving. Classmates offered to take a pic as I posed for a 're-enactment'. ;-P I politely declined. But below is a picture of the skull I drilled on. My hole is on the far right in the top row. I am proud to say that I got the right depth in one try with the drill. The rep complimented me, so that made me happy. :-) A classmate was like "are you ready for Australia?". G'day, mate! ;-)

Below is a picture from the Cochlear Corporation website which shows what the Baha system looks like with the sound processor attached to the external abutment which is attached to the implant. For further information on the Baha system, please visit http://products.cochlearamericas.com/baha/introduction-to-baha

I was the second person to try shaving a skin flap, and a classmate was all "paging Dr. LeBlanc, paging Dr. LeBlanc" but then another classmate was all "don't make her laugh while she's doing it". ;-) We all had a great time in Amplification III class today. That was after having an exam at 7:30am for our other class. Wish we really could page Dr. McDreamy. ;-) Yes, some of us have "Grey's Anatomy" fever. Can't wait for Season 7 come fall! We'll be in Year Three then...scary and exciting!

I'm "Hear 4 U Always"...channeling Dr. McDreamy? ;-P Or I'm just dreamin'... Remember my very first blog entry in July 2008 -- never put an expiration date on your dreams. Dream big!

Picture 'Scroll'...an annual thing? ;-)

2010-06-11T23:00:00.003-07:00

Hello, hello. I know I haven't posted in about a month. Instead of a lot of written yaddah-yaddah, I thought I'd do another "picture scroll" (remember the one from last June...you can refresh the memory at http://hear4u-always.blogspot.com/2009/06/hurrah-spring-quarter-is-over-i-barely.html) and provide a mini update this way. I had deja vu re-reading last June's post. Don't mind me recycling what I wrote then..."Hurrah - the Spring Quarter is over! I barely made it out of there with a 4.00 GPA, but I did. Still putting the 4 in "Hear 4 U Always"." ;-) Heh heh. This Spring Quarter was worse since it started off with Spring Break spent studying hours on end for Comps followed by the 2-day exam during the first week of Spring Quarter. Anywho, on to the "picture scroll"...scroll away. ;-)

First the ABR pic of me. Then the VNG pic of me. Now it's the CAEP pic of me (cortical auditory evoked potentials). I don't think I can possibly look more ridiculous for school. ;-P And yes, ladies & gentleman, I have brainwaves above the brainstem. ;-) I had to get unhooked during testing to run to the loo; a classmate made the comment that I looked like an Avatar with the braided cords for the electrodes attached to my head. ;-) For audiology geeks, this was for an AMLR (auditory middle latency response) with temporoparietal placement for noninverting and mastoid placement for inverting.

The Summer Games for Special Olympics Arizona was at the beginning of May 2010. This is my second year participating in the hearing screenings as part of the Healthy Athletes initiative. A wonderfully rewarding experience!

This is me doing a tymp screen on a classmate. Another classmate was getting a flat tymp on her, so I also tried a tymp on E. to make sure the equipment was working properly.

Pictured are the student volunteers from A.T. Still University for the Healthy Hearing event.

Our class went on a field trip in May 2010. Woo hoo - a field trip in grad school. ;-) We went to Tucson to check out the Werner Institute for Balance and Dizziness as part of the Vestibular Assessment and Treatment I course. We got to see a vestibular audiologist in action and working in concert with physical therapists. Pictured is a classmate in the Epley Omniax which is a $120,000 piece of equipment.

Pictured is a close-up shot of the computer program that is part of the Epley Omniax System. In the lower left is where the audiologist can monitor the patient's eyes from the VNG goggles along with some other stuff. ;-)

Pictured is the equipment for computerized dynamic posturography (CDP). Hopefully when I take the second Vestib course in the fall (I'll be a third-year student then!) that our university will have a CDP in place since it's finally been approved a few weeks ago to get one. :-)

Pictured are some of the equipment used for rehabilitation/treatment.

I haven't had a break since December 2009. Pictured is me, my sister, and my niece. It was nice to visit and relax with family. Don't I look tired? Just got done with four days of final exams (with little sleep in between...).

I'm "Hear 4 U Always"...but going off to enjoy the last two days of my one-week break. Then back to the grind. Happy Summer, everyone! Don't forget the SPF as you frolic in the sun! ;-)

No love but worth a mention...

2010-05-13T21:30:00.006-07:00

For those who watch "Grey's Anatomy" and are an ear geek aka audiologist or audiologist-in-training, I've got three words for you from the latest episode of "Grey's Anatomy"...superior canal dehiscence!

How nice of a surgical resident in TV Land to diagnose this disorder via videonystagmography (VNG). Uh, yes, note the sarcasm. Speaking of VNG, I've gotta get back to studying for a big exam in the Vestibular Assessment & Treatment I course which takes place tomorrow. I was in a silly mood this past Saturday working on a Vestib lab at school. I gave one test subject the patient ID of "Geico Eyes Are Watching Me" as I proceeded to sing the song from the Geico commercial. No nystagmus present in this test subject, so that's a good thing. :-)

I'm "Hear 4 U Always"...for hearing AND balance. "I always feel like somebody's watching me"...only during VNG testing.

Back to the grind...

2010-04-19T22:30:00.002-07:00

Wow - time sure flies! Uh, when you're having fun? Or at least getting your nerd on as a doctoral student. ;-P I can't believe it's already been a year since I attended AudiologyNOW!, the annual convention put on by the American Academy of Audiology. This year the convention was held in San Diego, CA. San Diego is such a gorgeous (and close) location, and thus a lot more of the A.T. Still University crew attended the convention this year...mainly first- and second-year Au.D. students.

I just re-read the blog entry that I wrote on my first time to AudiologyNOW! last April (refer to http://hear4u-always.blogspot.com/2009/04/what-goes-on-in-dallas-stays-in-dallas.html). I do know a lot more about amplification as I had predicted, but I didn't visit with various reps of hearing aid manufacturing companies as I thought I would this time last year. The only hearing aid-related thing I did was check out the demo on the adaptive directional mic which is a new feature on the hearing aids by Siemens, and that was pretty neat to hear the difference/improvement from the traditional directional mic. I won't bore you with polar plots and cardioids and what not. ;-)

Anywho, other than the volunteer shift I worked as a room monitor, my time was spent attending a number of lectures from "Insurance 101: Understanding the Basics of Reimbursement" to "Neuro-audiology: How Cortical Evoked Potentials Can Be Used in the Clinic". A couple of the lectures were for a couple of the classes I'm taking this quarter, but the others were for my own curiosity. In addition, I did a little bit of networking with students from other universities and practicing audiologists so that was good since I didn't really do that last year. Also I may not have checked out many booths manned by hearing aid manufacturers, but I did check out several booths manned by manufacturers of vestibular testing equipment (such as the Omniax which I've heard costs over $100,000.00!!!).

Below is a picture of the posterboard that the president (me! ;-P), vice president, and secretary of the ATSU Chapter of the Student Academy of Audiology (SAA) took the time to make which was displayed with posterboards made by other SAA Chapters around the country at the San Diego Convention Center during AudiologyNOW!. The following is the second paragraph of the two-paragraph blurb that I wrote for the posterboard: "The ATSU Chapter of the Student Academy of Audiology (SAA) is composed of students in the campus-based program. In our inaugural year, the ATSU Chapter of the SAA has accomplished a number of activities. The organization reached out to a family in need during the winter holidays who had lost everything in a house fire, and we bought and donated clothes and toys in time for Christmas. The organization also held an Earmold Fundraiser, providing custom-fit hearing protection devices to conserve the hearing of many dental students (all that drilling!) at the Arizona School of Dentistry & Oral Health in addition to other faculty, students, and staff. The funds raised help ATSU SAA members to attend AudiologyNOW!. In addition, many of the ATSU SAA members participate in hearing screenings at local health fairs. We are excited to do even more for our profession and the public we serve!".

Below is a picture of the view I had while dining in San Diego on one of the evenings there. I love the Pacific Ocean! The word 'pacific' means of a peaceful nature, and for a few days, it was indeed 'pacific' for moi. :-)

"Random Offers of Convention Kindness" aka Audiology ROCKs is a program in which staff members of the American Academy of Audiology distribute items such as a restaurant gift certificate or a free Starbucks coffee as a thank-you for attending the convention. I had read about Audiology ROCKs on Wednesday night in the convention program book, and I had thought to myself "oh, that won't happen to me" (there were over 7,000 people at AudiologyNOW!...). Well, lo and behold, the very next day I got "ROCKed"! :-) I received a $10 gift card for Buster's Beach House Grill & Longboard Bar...and the blue ribbon to wear on my convention I.D. badge to show others that I got "ROCKed". I ate at Buster's that very night. :-)

Now it's back to the grind! It was a nice time in San Diego. But it's still no Spring Break attending all the lectures (and all the miles of walking to & fro at the humongous San Diego Convention Center in less-than-ideal walking shoes! I know a lot of audiologists...but is there a podiatrist around? ;-P). No (mental) vacation since Winter Break...c'est la vie. I'm "Hear 4 U Always"...and counting down the days till the one-week break in June. Tick-tock!

Virtual Reality

2010-03-25T22:00:00.006-07:00

I am giving up school to live in a virtual reality. I wish I looked cooler doing it than what is seen in the picture. Guess virtual reality isn't utopia. ;-P Ha, ha. Okay, seriously I'm still in school full-time. :-) If you thought the ABR pictures were goofy-looking (refer to http://hear4u-always.blogspot.com/2009/09/halloween-already.html for blog entry on Auditory Brainstem Response testing & pictures), you haven't seen what's up with VNG aka videonystagmography testing. Guess what? Audiologists do more than just work with hearing-related issues. Audiologists also work with balance-related issues such as dizziness and vertigo. And VNG testing is one of many tests to help with diagnosis which will then assist with treatment protocol.

Today was the first full day of classes for Spring Quarter. Spring Quarter of Year Two consists of 16 credit hours. I am enrolled in the following courses: Methods of Data Analysis, Practice Development I, Auditory Processing Disorders II (Advanced Electrophysiology and Management), Vestibular Assessment and Treatment I, and a clinical rotation with weekly Grand Rounds. I am not too happy about my clinic site being 110 miles roundtrip, but at least my clinical preceptor seems pretty great. He has excellent rapport with all his patients, and I like that the patient's well-being/best interest is more important than making a hearing aid sale. I know that I'm going to be learning a lot from this audiologist and look forward to that.

As for the goofy picture of me above, it was taken today during lab time in the Vestibular Assessment and Treatment I class. One of my classmates was gracious enough to take that pic of me with her camera phone and texted it to me...to end up here. ;-P There's 14 students and only 2 VNG test equipment, so originally I was just an observer. But my group could not get one of the cameras to lock on the mock patient's eyes. It could have been due to her wearing contact lenses or having on eye make-up. I do not wear contact lenses or eye make-up, so I wound up being the next guinea pig. ;-) What is sitting on my head are VNG goggles which has a camera above each eye (the tubes on my forehead) and this contraption is connected to a computer. Eye movements are controlled by the vestibular system, and there are a number of tests that are done to maneuver the head and/or body and track how the eyes react. This information can tell us whether a problem is peripheral (i.e. inner ear), central (i.e. could be a tumor), or multifactorial. I won't go into much more detail than that. After all, I don't want to bore you. ;-) And it's only been Day One of the Vestibular Assessment and Treatment I class. :-)

I'm "Hear 4 U Always"...still willing to look goofy in the name of science. I don't know if that's unfortunate or not. ;-P What is unfortunate is that all this vestibular/dizzy talk has made a certain song stuck in my head..."you spin me right round, baby, right round like a record, baby, right round round round". Crazy song stuck in my head - - is that an auditory hallucination? ;-P Kidding! Hope the song isn't now stuck in your noggin.

Floating like a balloon

2010-03-22T19:00:00.004-07:00

Hello, hello! Happy Spring! And a happy one it is thus far for me. I'm floating like a balloon! No, not like some airhead. ;-P I'm floating on Cloud Nine. Whee...come join me! :-)

I may not have logged 2010 hours of study time for Second-Year Comprehensive Exams aka Comps which took place the latter part of last week. But I logged a lot of hours. Comps was bigger than the SAT, GRE, or the semester in college where I had 7 final exams in 3 1/2 days. I have never been so nervous for an event in my life. And trust me - - I know pressure & stress...from days as a competitive gymnast (Level 10 and collegiate level) to days in combat in Iraq.

The written exam of Comps was on Thursday, and it covered material from 23 courses taken in 6 academic quarters. I took my time in answering the 100 questions since I was running on about 3 hours of sleep. I could not get myself to sleep most nights last week, and I picked up a bad temporary habit of living on Venti-sized drinks from Starbucks each day (I usually never order anything bigger than a Tall and I don't get coffee everyday). A score of 75% was needed to pass the written exam, and I left the test feeling fairly confident that I passed. But I'm a perfectionist and wanted to do better than just a 75%.

Full-blown stress hit me on Friday which was the day of the lab practical exam of Comps. Five hours total...one hour per professor. We were tested on a number of things from hooking up electrodes to a 'patient' & performing an Auditory Brainstem Response (ABR) test to looking at an audiogram & counseling the 'patient' on what hearing aids would be recommended based on their hearing loss. I have never known myself to react so strangely physiologically to stress. I managed to dehydrate myself in Hour One of the practical exam from sweating profusely on my forehead to having my eyes well up with tears. Also my legs were shaking like I was Bambi learning to walk for the first time. Geesh!!! Talk about being a hot mess. ;-P

Thankfully my tale has a happy ending filled with a Congrats balloon from my parents. I passed both the written and the practical portions of Comps (even squeaked out a 99% on the written exam...whew!). And good things must come in threes...I recently ran for the office of President of the A.T. Still University's chapter of the Student Academy of Audiology and I won!

I'm "Hear 4 U Always"...giddy as can be. But going to come down from Cloud Nine since Spring Quarter has already commenced. No rest for the weary. Apparently I've lost my momentum in blogging the last couple of months, but I will try to gain it back. So stay tuned...

"Auld Lang Syne"

2010-01-01T13:00:00.002-07:00

Happy 2010! Just wanted to write a shortie stating my likely absence for the next couple of months. I need to stay focused either on studying for the current academic quarter or preparing for Comps (refer to http://hear4u-always.blogspot.com/2009/12/winter-blues.html to learn what this academic quarter entails or what Comps are). I'm "Hear 4 U Always"...but taking a break from blogging because I'm about to log something like 2010 hours of study time. Ay caramba! Days of fun & being carefree...talk about 'auld lang syne' aka 'long long ago' or 'days gone by'. Wish me luck with school. And I wish you a happy, healthy, honeysweet New Year!

New career path?

2009-12-18T19:30:00.002-07:00

I'll admit I've been stressed like crazy since Year Two commenced. But I'm not about to pick a new career path. Maybe just a new hobby. Oh wait. I don't have time for hobbies! :-( Anywho, yesterday when I had a big lab assignment in Auditory Processing Disorders class to do and the first major exam in Tinnitus class to study for (both due/occurring earlier today), I instead found myself playing Santa's Helper. I cannot believe I invested 6+ hours baking & icing cookies, assembling compartment boxes, writing labels, equally dividing out various candies, etc. I made 24 treat boxes for classmates, professors, and a couple of neighbors. I did one up on Santa, meaning I gave out treat boxes to those people who are actually on the Naughty list. *gasp* I know what it feels like to be left out from my days growing up so I don't like doing that to anyone...unless absolutely necessary. And the holidays are not one of those times. I will most likely never take on such a holiday endeavor again...unless I get paid. ;-P I must admit that it was fun being creative. I don't get to be creative as a student audiologist from looking in an ear to running an electroacoustic test on a patient. Although I may accidentally create a new procedure doing a hearing test via puretone audiometry (must share bloopers another day ;-P...oh dear).

I'm "Hear 4 U Always"...as a jack of many trades such as baking and hopefully will be a master of one. Audiology, that is. :-) And insert 'doctor' for 'master'...Doctor of Audiology. One day. Till then, I slave at school and also occasionally in the kitchen. All in the spirit of the season...the season of giving! Happy Holidays!

Food for thought...

2009-12-15T19:15:00.004-07:00

Okay, so no food here, just thoughts. ;-) For one of my classes, we had an on-line Open Discussion recently. The question posed to us by the professor was: "Science has advanced us to newborn hearing screenings. How do you feel that this matter-of-fact science influences a parent's grieving process? How are you sensitive to their fluctuations of emotions?".

My answer was whipped up in five minutes since I don't think we're getting graded on our Open Discussion postings (and there are other classes to tend to...blah). But I stand by my answer which is as follows:
"Not everything in life is black and white. For some people, science is wonderful. For others, science is evil. I generally fall into the mindset that science is wonderful, and I think that science advancing us to newborn hearing screenings is terrific. I think that this matter-of-fact science in the end positively influences a parent's grieving process. "The early bird gets the worm" may be a cliche, but catching hearing loss 'early' is never a bad thing, especially if intervention/treatment quickly follow. I think it would be more heartbreaking to find out a child has hearing loss at age 3, 4, 5, etc. than as a newborn, because I would regret all the time that the child 'lost' out on neurodevelopmentally in learning language/being able to communicate. [Side note: Here I am trying to make reference to the plasticity of the human brain. For hearing people, a lot of what we learn is through incidental learning which is through hearing. But speaking words is not the only means to communicate, and I respect that. I am a believer in that it is the child's choice (whether consciously or subconsciously) to decide which means he/she wants to communicate. That could be oral, American Sign Language (not the same as Signed English...ASL has its own syntax & grammar), another form of manual communication, etc.]

Whenever a hearing loss is made known to parents, it doesn't matter at what age the child is...the parents have every right to grieve. We as audiologists need to be mindful of the various emotional states that the parents (and child) will be going through. Our job is not to dismiss their feelings but to be present as a guide, a sounding board, a shoulder to cry on. The role of nonprofessional counselor coincides with our role as the audiologist. [Side note: A 'professional' counselor would be a psychiatrist, psychologist, social worker, etc.]

Seeing is believing, and even with the science & technology available to us from OAEs [otoacoustic emissions testing] to ABRs [auditory brainstem response testing], it is still hard for a parent to grasp that their child has hearing loss...because hearing loss is 'invisible'. I remember when an audiologist confirmed the news of moderate hearing loss to the parents of a one-month-old baby. The parents had already seen 5 other audiologists, but they still wanted a 'second opinion'. It was hard watching the mother hold her child and rubbing her baby's beautiful ear, because I knew in the mother's eyes that she was looking at a perfect baby...ten fingers, ten toes, cries, squirms. I'm sure she was still in disbelief that her baby couldn't hear like her other child.

Science may be insensitive, but that's why people such as audiologists exist to add sensitivity to the science." -TL

Every person born is a miracle. I'm "Hear 4 U Always"...having given my thoughts and now going to get some food. ;-) Bon appetit to me! Au revoir for now!

Winter Blues

2009-12-01T21:00:00.006-07:00

Hurrah - I have survived yet another academic quarter (and continuing to keep the 4 in "Hear 4 U Always"...yay!). The last quarter has been different in comparison to the first four quarters. I feel like I spent more time doing assignments (i.e. labs, reports, papers, etc.) that were constantly due than I did studying. Other quarters I would review lecture slides, do some reading of articles and textbooks, etc. This quarter the studying would come just prior to the exams. It wasn't just me that was different. I approached school differently, because new demands in the form of weekly assignments in multiple classes were required (a lot of weeks 3 major assignments would be due all on the same day!). I think this is the new norm for Year Two. Thankfully my narcoleptic episodes in undergrad no longer occurs (professors used to make me stand up in the back of the classroom to stay awake...and I had mastered falling asleep while standing!), and thus my learning comes during class time. I guess my learning has shifted from visual learning (reading & reviewing) to auditory learning. Seems appropriate being an audiology student, eh? ;-)

Anywho, Winter Quarter of Year Two commenced yesterday. I think I'm so stressed out subconsciously with what Winter Quarter entails along with Comps occurring in a couple of weeks after the end of Winter Quarter that I have been having trouble sleeping. I know the reason I did not fall asleep till 2:00am the night before first day of classes for the new academic quarter and then tossed & turned & woke up every hour till 6:30am was NOT from excitement. No, siree. So what does Winter Quarter of Year Two entail, you ask? And what the heck is Comps?

Winter Quarter of Year Two consists of 16 credits which is 1 credit hour less than last quarter but that mathematically does not equate to less stress. I have picked up one extra class so that I am taking a total of 5 classes plus clinic & weekly Grand Rounds. Last quarter had consisted of 17 credits but 4 classes plus clinic & weekly Grand Rounds. Anywho, I am enrolled in the following courses this quarter: Research Methods & Design, Manual Communication I, Audiological Rehabilitation for Adults, Tinnitus Evaluation & Treatment, Auditory Processing Disorders I, and 8 hours of clinic with weekly Grand Rounds. This quarter at my new clinical site I should be gaining more experience with aspects of amplification. I really enjoyed my last clinical site & my clinical preceptor, but it will be a good shift away from purely diagnostic audiology to focusing on working with patients & hearing aids. In a future blog entry, I shall have to share some bloopers I committed being a second-year Student Doctor of Audiology in a clinical setting. (insert blushing face here ;-P)

In addition to classes & clinic (and extracurriculars!) this quarter, I have Comps to fret about and study for. Comps is short for Comprehensive Exam. Comps are administered in the Spring Quarter of the second year of studies and also in the Spring Quarter of the third year of studies in the Doctor of Audiology degree program at ATSU. Two days are set aside for Comps. One day consists of a 100-question written exam in which we are given 4 hours to complete. The second day consists of a 5-hour practical exam. Year Two Comps covers material from the first quarter of Year One through the second quarter of Year Two. Below is a picture of one shelf of one bookcase I have. Before starting this degree program, I never knew anything beyond a 3-inch three-ring binder existed. Now I basically have stock in 5-inch three-ring binders. Whoa Nelly! The six binders in the picture are just Year One stuff.
And don't forget about the textbooks! Talk about your brain overload... :-(
I fear my head may explode from all the intracranial pressure. Okay, maybe not. ;-P But if I get the "winter blues", it may be from being burrowed in a textbook or one of my binders and not seeing the light of day. I know vampires are 'in' right now so guess I'm 'in' too. Or just 'in'doors? ;-P Well, wherever I am -- in, out, or all about, I'm "Hear 4 U Always"...with no thirst for blood. ;-P Wishing all a most joyous holiday season! Ho, ho, ho! Or in my case, it's more like "Oh, oh, oh!" or "No, no, no!". Santa, I had better be on the Nice list 'cause I've been good this year! ;-)

Thank you. Gracias. Merci.

2009-11-26T00:15:00.001-07:00

Happy Thanksgiving!!! It shall be Christmas in the blink of an eye. So don't blink yet! ;-P Kidding. Uh, not a lot of action shots but thought I'd share a few more photos from the medical mission to Guaymas, Mexico that occurred a little over a month ago. If you haven't read about it, you can catch up at http://hear4u-always.blogspot.com/2009/10/ayudame-escuchar.html.

Okay, so this isn't exactly Thanksgiving fare. We did lunch at a roadside stop in Mexico on our way to Guaymas. Talk about tongue-numbing, fiery salsas!

Us ladies had to get some margaritas before dinner. ;-)
This was about 60% of the volunteers -- a mix of audiologists, student audiologists, and translators.

This is one of my favorite memories of my short time in Mexico; a group of hearing-impaired & special needs children signed the entirety of Michael Jackson's "Heal the World".

One of the ASU doctoral students & me in the sound booth I worked at before the masses came on Day One.

The little girl in the picture has Pfeiffer Syndrome. We replaced her softband BAHA (bone-anchored hearing aid). At first she cried, and it broke my heart to hear her whimpers via her trach (tracheostomy tube). She got used to the change by the next day and was happy.

"Ayudame a Escuchar" aka Help Me to Hear

A 4th-year doctoral student doing cerumen removal

We're all still smiling after working a 13-hour day! No dinner till 10:30pm! (And lunch had been at 2:00pm!) Caring knows no hunger.

Ah - my favorite ladies...these were my roomies in our condo. We were first on the bus that morning! :-) And we always seemed to be waiting on the guys...I think they were doing their hair & make-up. ;-P

"Heal the world,

Make it a better place

For you and for me

And the entire human race.

There are people dying.

If you care enough for the living,

Make it a better place

For you and for me."

Let us give thanks for the things we're blessed with...family, friends, health, etc. And let us help those in need. I'm "Hear 4 U Always" and I give you -- the reader -- thanks for allowing me to share a part of my life with you. Thank you. Gracias. Merci. Have a gobbly good day!

"Freedom's not free..."

2009-11-11T17:00:00.012-07:00

Today is Veterans Day. It's weird to think that I'm not just a veteran of the U.S. military but an Iraq combat veteran. Whenever I think of veterans, I think of those who served in World War II, the Korean War, and the Vietnam War. Not me. I don't want to say "Happy Veterans Day", because I do not find anything happy about this day. This day and Memorial Day are quite depressing days for me. Veterans Day 2004 was one of the worst mortar attacks that I lived through and the closest that I came to losing a limb or my life that day. Memorial Day 2005 was supposed to be a happy day with 30 May 2005 being the day the U.S. Air Force Academy's Class of 2001 was promoted to the rank of Captain. But it turned out to be a very tragic day when two of my college classmates/friends, Capt Derek Argel and Capt Jeremy Fresques, passed away in a plane crash during a training mission in Iraq. I was supposed to do dinner with Derek the summer prior before news of my deployment came short-notice. Dinner plans got postponed. I returned to the U.S. after my half-year in Iraq thinking that I'd meet up with Derek, but then I found out that Derek himself was now deployed to Iraq. So I figured we'd do dinner and catch up when he returned to the U.S. Three cell phones later, I still have the cell phone that has his phone number in the Contact list. Never put off the people who mean most to you. Family. Friends. As I always say, you regret more the things you didn't do than the things you did do.

To read a little more about Capt Derek Argel and Capt Jeremy Fresques, check out the article at http://www.usatoday.com/news/nation/2006-05-25-memorial-day-cover_x.htm. As we say in the Air Force, "here's a toast...". Gone but not forgotten...

Below is a picture of the flag that had names added to it after the loss of a member of the 7th Transportation Battalion which I was a part of. Sadly more names were listed after the taking of this photo. Gone but not forgotten...

Thankfully my arse safely made it out of Iraq. Below is a picture of me as the driver on a reconnaissance mission while on break in Kirkuk, Iraq. My primary job was Company Executive Officer, but I also served as driver, truck commander, gunner, and assistant gunner on a number of convoy security missions. If you look closely, you can see that I'm wearing green foam ear plugs. :-) Funny how life turns out...planned and unplanned. Audiology would be a foreign term to me until two years after this picture was taken.

I know this blog entry wasn't audiologically-related as 99% of my blog posts are. But hey, it's my blog and a place to "sound off". :-) Thank you for reading. Please take care and never forget & be thankful of the men and women who serve or have served in our U.S. military. I'm "Hear 4 U Always"...having protected our freedom and now working to protect our hearing. I salute you.

Third time's the charm?

2009-11-07T17:00:00.006-07:00

Take #1: Last December I was caught off guard when a professor said "we have a star in our class" during the Anatomy and Physiology of the Auditory-Vestibular System course and was referring to me. I knew a photo of several Student Ambassadors representing each program at A.T. Still University from the Arizona campus was taken in November 2008, but at the time of the photo shoot, I didn't know what the photos were going to be used for. It would have been nice to be given a heads-up that we would be appearing on an e-card sent out to faculty, staff, and alumni for the winter holidays. Below is part of the Winter Holidays 2008 e-card. Everyone from Athletic Training, Dental, Occupational Therapy, Osteopathic Medicine, and Physician Assistant Studies (Physical Therapy is not represented) looked great! I represented Audiology, and it's not my best shot since this was taken at 5:00pm after a long day & the sun was getting in my eyes as it was setting. Bah humbug. And one classmate stated that I shouldn't have worn my lanyard with I.D. badge in which my professor said "everyone's a critic". Well, I'm my own worst critic. :-(Take #2: I know in my last blog entry (refer to 3 November 2009 "In the news...sort of...") that I wrote about a photo of me unknowingly showing up on a website (ADVANCE for Audiologists). I appear in #6 of 9 at http://audiology.advanceweb.com/Article/At-Still-University-Photo-Tour.aspx.

Take #3: Well, yet again I was caught off guard when I saw a photo of me along with a quote in a school brochure this morning. Instead of getting excited, I got freaked out...like the last two times. Probably by that element of surprise. Back in July 2009, I was at a photo shoot for a picture to use on the "Blogs at A.T. Still University" website (http://blogs.atsu.edu/). Then I was sent an e-mail asking me to answer the question of "Why did you choose to go into healthcare? Why ATSU?" to possibly be printed in a view book as a quote along with my ATSU blog photo. I never heard anything more on this, so I assumed that I wasn't going to be in the university view book. Once again, it would have been nice to be given a heads-up. Argh. My heart skips a beat and not in a good way when these incidents occur.

Below is a picture of the display case in the lobby of the main building at the Arizona campus that contains information sheets on each degree program and university brochures. Here is where the view books with yours truly in it were found.

This is the front cover of the 22-page view book.

Information on the Doctor of Audiology degree program is found on Page 6 of the view book. I guess 6 is becoming my number since I was on Photo #6 of a photo tour on the ADVANCE for Audiologists website and now I appear on Page 6 of the view book. I am not a photogenic person, but I thought one good shot could have been taken in like 10-20 frames. I really don't like this photo of me. :-( Buggers. My quote is as follows: "I chose ATSU, because I was drawn to the whole-person approach to healthcare. When I become an audiologist, a patient is not going to simply be a pair of ears to me. From diagnostics to treatment & counseling, ATSU is great at preparing students to incorporate the holistic approach to patient care." The other photo on this page is of a fourth-year student working the GSI 61 clinical audiometer.

Below is a somewhat better photo of me. It was taken today at the Founder's Day event at school. I'm in scrubs since I worked for over an hour for the Earmold Fundraiser that the ATSU chapter of the Student Academy of Audiology put on. This photo was taken because I was uber excited about getting to devour a thing of cotton candy. :-) I haven't had cotton candy in at least 10 years...dare I say, even 25 years. (Yes, I'm getting old as dirt... ;-P) You really only find cotton candy at like state fairs or carnivals. But that's fine, because it makes it that much more special. Pre-packaged cotton candy that you can find in grocery stores is just not the same. At least I managed to eat the blue cloud without turning into a Smurf with cotton candy all over my face & hair like I had a tendency to do when I was a little kid. ;-)

I was able to stay anonymous with this blog and not pop up in other places (websites, media publications, etc.) for a good 10-month run (28 July 2008 to 2 June 2009). As mentioned in a previous blog entry, I would describe myself as a fairly private person. Guess I need to crawl out from under my rock... ;-P After all, I'm "Hear 4 U Always". Hello, world! ;-) Well, actually bye-bye for now. Must work on final projects & papers and get ready for final exams coming up in a week. Wishing everyone nothing but good health, particularly this flu season!

In the news...sort of...

2009-11-03T21:00:00.011-07:00

Today during my first class of the day, the professor addressed C. (a classmate) and me. He was all "You two are in Advance for Audiologists." C. and I looked at him with confused looks. I thought he was trying to tell me that C. and I were enrolled in some course called 'Advance for Audiologists' (that I hadn't signed up for ;-P). Then the professor said something about pictures of C. and me. So then I was trying to rack my brain of when pictures of C. and me were taken. I remembered the university photographer being at the Golden Gate Health Fair back in July 2009, and C. & I had both been volunteer hearing screeners at that event. Then the professor explained a little more of what 'Advance for Audiologists' was, and he pulled up a web link. Looks like an article on A.T. Still University was posted on the ADVANCE for Audiologists website, and there is a link for a photo tour in which yours truly makes an appearance. So I may not have signed up for an imaginary course called 'Advance for Audiologists', but I also didn't sign a photo release & consent form. Not that I can remember. Oh well. ;-P

The link for the article is http://audiology.advanceweb.com/article/AT-Still-University.aspx. The link for the photo tour is http://audiology.advanceweb.com/Article/At-Still-University-Photo-Tour.aspx. To make sure you're not scared when I pop up on the photo tour, I'm on #6 of 9 and it's a candid shot. ;-)

Just an FYI on 'ADVANCE for Audiologists', their mission statement is as follows which gives you an idea of what they're about: "ADVANCE for Audiologists provides strategies for business profitability and growth to audiologists and other hearing professionals. It promotes the profession of audiology by providing information on practice management, professional trends, hearing technology and research, marketing methods, business and finance topics, industry news and product information."

I'm "Hear 4 U Always"...here and elsewhere in cyber space. ;-) Back to the academic blackhole...cue The Twilight Zone theme song here...doo du doo du.

"Ayudame A Escuchar"

2009-10-25T17:45:00.009-07:00

About three and a half weeks ago, I got a phone call asking if I wanted to go on a medical mission to Mexico. I had applied for this medical mission back in March 2009, but I had written it off in August 2009 since I hadn't heard anything on whether I was selected or not to go. A number of people dropped out of the medical mission in September 2009 due to various reasons i.e. health, safety concerns, etc. To decide to miss 3 days of school plus clinic on semi-short notice was a big deal to me...being a planner & Type A aka anally retentive & not a fan of spontaneity in scheduling. ;-P Anywho, I got all my professors' permission to miss class & clinic, got a seasonal flu shot (would have gotten the H1N1 vaccination if it had been available), did the homework assignments that were due on the days I would be gone from school, packed my bags, and off I went to Guaymas, Mexico on 21 October 2009. Hurricane Rick wasn't going to stop us! ;-)

The medical mission team traveled by bus, and it took us about 8 hours. Several condominiums in San Carlos were offered up for our short stay. I was most impressed. I've roughed it in my days in Iraq with sleeping on top of ammo cans or the hood of a Humvee, so to sleep in my own room on a queen-size bed was most pleasant. And we were right by the beach. Absolutely gorgeous views!

On 22 October 2009, we did what we came down to Mexico to do. The program is called "Ayudame A Escuchar" (Help Me To Hear) and sponsored by the Guaymas Rotary Club & the Mesa (Arizona) Rotary Club. This is the 17th year that this medical mission has taken place. The day kicked off with a lovely ceremony. One particular performance gave me goosebumps and nearly made me cry. A group of hearing-impaired/special needs students from Guaymas signed the entirety of Michael Jackson's "Heal the World". After the ceremony, we worked about a 10-hour day. We were divided up into multiple workstations from check-in/triage to hearing aid fitting to counseling. I worked in "Audio Area #1" which entailed doing tympanometry, otoacoustic emissions screenings, and air/bone/speech audiometry. Day One consisted of seeing just children. It was more important to catch hearing loss in children and to fit the hearing-impaired children with binaural hearing aids (two hearing aids).

On 23 October 2009, we worked about a 13-hour day. Day Two consisted of primarily seeing adults along with some children. It was sad that we were running out of hearing aids by late afternoon, and we had to fit the hearing-impaired adults with just one hearing aid (monaural). Since I worked the diagnostic aspect of things, I didn't really get to see the end result of what a patient went through. But we did get backlogged on Day Two, so I went to one of the last couple of workstations -- "Hearing Aid Fitting Area" and "Counseling Area" -- to see what was going on when my workstation had seen/tested all patients that we were supposed to. I saw one elderly man walk away with a behind-the-ear hearing aid with a full shell earmold in his left ear and a big smile on his face. We all knew the smile was because he could hear better. :-)

All in all, our 24-person team of audiologists, student audiologists, and translators helped nearly 300 people in 2 days. How awesome is that! This was a most wonderful experience, and I really hope I get to go back next year. I didn't take my camera on this trip, but I took a few pictures with my phone. I'll post more pics once other team members/friends start e-mailing them to me.

View from the condominium -- ¡Que bonita!

Tympanometer at Audio Area #1 -- the upside-down 'V' thing on the screen is a "snapshot" of my right middle ear status (did a biologic check of equipment on myself ;-P)

Hand-held otoacoustic emissions screener

Audiometer at Audio Area #1

Sound booth at Audio Area #1 -- the red stuff is carpet (sound booths generally do not have carpet on all four walls, ceiling, and floor! One audiologist will always remember me for calling it the "shag room"...I called it that for its shag carpet but one can imagine what this dude found funny about my comment...¡malito!)

This is a picture of what I call my Guaymas souvenir...I got two bruises on my left backside from one of the doors of the sound booth :-(

I'm "Hear 4 U Always"...en los Estados Unidos y también en Mexico a veces. :-) ¡Buen salud a todos siempre!

I swear...like a sailor? ;-P

2009-10-18T16:00:00.004-07:00

Oath of Office - May 2005:

I, Tammie [omitted], having been appointed a Captain in the United States Air Force do solemnly swear that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office upon which I am about to enter. So help me God. [to date, still in effect]

Doctor of Audiology Oath - October 2009:
As a Doctor of Audiology, I pledge to practice the art and science of my profession to the best of my ability and to be ethical in conduct, remembering always that my primary responsibility is to the health, safety, welfare and dignity of all human beings. I will respect and honor my teachers, and also those who forged the path I freely follow. Accordingly to their example, I will continue to expand my knowledge and improve my skills. I will collaborate with my fellow audiologists and other professionals to assure compassionate and effective care of patients. I will, to the best of my ability and judgment, evaluate, manage, and treat my patients. I will keep in confidence all information made known to me about my patients, except where I am authorized to impart such knowledge. As a Doctor of Audiology, I agree to be held accountable for any violation of this Oath and the ethics of this profession. I pledge this oath with sincerity and on my honor. Thank you to all my family and friends who took the time to attend my White Coat Ceremony. I was more excited to see you all than donning on what I deem the "cloak of responsibility". ;-) I am truly blessed! I hope to continue to make you proud. To one particular person who could not attend, it was like you were there for you were with me in thought & in my 'full-sized aortic pump'. All my love to those precious to me...thank you for being a part of my life. I'm "Hear 4 U Always"... under oaths and not. :-)

Hearing Loss 101

2009-10-15T21:30:00.003-07:00

I was talking to a non-audiology friend yesterday, and a question asked prompted me to write this blog entry to dispel a couple of misconceptions about hearing loss.

* Not everyone who is hearing-impaired are deaf. Note that also there is a difference between big D 'Deaf' and little d 'deaf'...it's a cultural difference. Books could be written on this so I shall stop myself here.

* The majority of patients that an audiologist sees are not "Deaf" or "deaf". Hearing loss is not as black & white as in hearing versus not hearing (hearing normally versus being profoundly deaf). Think of vision. Vision is not as black & white as in seeing versus not seeing (seeing normally versus being completely blind). Visual problems can be anything from myopia to far-sightedness. Hearing problems has variations also from a noise-notch to a high-frequency precipitously sloping hearing loss.

* Hearing loss can be categorized by type, degree of loss, and configuration. For more information, check out http://www.asha.org/public/hearing/disorders/types.htm.

If you have further questions, please do not hesitate to contact me. I've been going through the Doctor of Audiology degree program for about 14 months now, and I didn't realize that I could go on & on about this subject matter. ;-) Last summer I didn't know any better. I thought a hearing aid is something you stick in your ear to amplify sounds so that you can hear almost 'normal'. Now I know that there is so much more going on in the sensory organs of hearing (aka 'ears') along with the auditory pathways of the brainstem and on up to the auditory cortex. For example, there's a phenomenon known as the "upward spread of masking", and if you amplify the low frequencies at the same amount of amplification as the high frequencies, you could mask out the sounds of high frequency. Sounds of high frequency includes speech sounds, particularly the consonants. Another point to consider - - did you know that you really hear with your brain and not those things hanging out on the sides of your head (aka 'ears')?

I'm "Hear 4 U Always"...as Student Doctor of Audiology and as an educator if need be. ;-)

"What's yellow & black and goes 'zub-zub'?"

2009-10-10T13:00:00.011-07:00

The question is "What's yellow & black and goes 'zub-zub'?".

The answer is "a bee flying backwards". ;-)

That is one of like five actual jokes that I know. Friends will tell you that I'm a funny gal, and I can tell you that I don't get that characterization by my joke-telling i.e. "A frog was talking to a horse one day...blah blah blah". ;-P Anywho, that bee joke came into mind on Tuesday (6 October) when I was in the role of test subject for Auditory Brainstem Response (ABR) testing. We have Auditory Evoked Responses class lecture followed by in-class lab time on Tuesday afternoons this quarter. This particular Tuesday, we were running ABRs and experimenting with the different stimulus rates using a stimulus intensity of 80 dB nHL. The slowest rate used was 11.7/sec, and slow indeed it was to get through the usual 2000 sweeps. The fastest rate used was 77.7/sec, and the stimulus introduced in my ear sounded like a buzzing bumble bee. Hence, the corny bee joke. ;-)

It's been quite a week with 2 major midterm exams, 15 patients tested at 8 1/2 hours of clinic, a short paper, 2 labs to perform with write-ups for each, my first hearing aid workshop (very informative & impressive presentation by Widex), and my very first Grand Rounds presentation! Grand Rounds piggybacks off of our clinical rotations, and it's a weekly forum in which first-, second-, and third-year Au.D. students provide a case study presentation on a patient from their clinic site. Fourth-year Au.D. students are at clinic for 40 hours a week and generally are out-of-state, so they do their own Grand Rounds on-line via chat & postings. You are in the bucket to present come your Spring Quarter of Year One. Presenters were selected alphabetically and we don't have Grand Rounds in the Summer Quarter, so I knew my time to present would be Fall Quarter of Year Two. It was just that Friday, 9 October 2009 was like the worst day of the quarter to present due to midterms week. But hey, no biggie...who needs sleep? I joke that I will sleep when I'm dead. ;-P Anywho, don't mean to toot my own horn, but I gave a good presentation on a patient who became a cochlear implant candidate/recipient. What made the case study more interesting is that this patient had/has autoimmune inner ear disease which is basically where the body's immune system attacks cells in the inner ear and causes hearing loss & potentially vestibular (balance) problems. Autoimmune inner ear disease is a rare disease, and thus it is often mistaken for Meniere's disease due to similar symptoms (i.e. hearing loss, vertigo, tinnitus). After 4 years of college & 6 years as a military officer, I grew out of my shy phase, and so I wasn't worried about presenting to my peers. What I was worried about and did as much research as I could to be prepared was fielding questions from the professors. After my presentation, one classmate was like "whoa, the professors were coming at you" and mimicked boxing punches. But I'm proud of myself for holding my own and being able to intelligently answer my professors' many questions & still not lose a beat in continuing with my presentation. So now I should be off the hook for a quarter or two in presenting during Grand Rounds. ;-)

Another proud moment for me this week was on Thursday (8 October). A professor handed me back the case file that my group had put together in testing a 5-year-old boy two weeks ago in our first lab in Pediatric Audiology. I opened the folder up and was wondering why there was only one case report in the folder. I thought there should have been 5 since there had been 5 people in the group for that particular 'patient'. We turn in one folder with all the test results i.e. 1 audiogram, 1 printout of tymps, etc. as a group. However we each submit a case report electronically. Anywho, only my case report was in the folder with the pediatric audiologist's signature on it. A third-year Au.D. student who is a T.A. overheard my confusion and said "you're the chosen one" meaning only one person in the group gets their case report selected to be signed & placed in the folder to be filed away in the audiology department's filing cabinet for future use/reference. Below is a photocopy of that case report with minimal editing by the course professor and signed off by me (student audiologist) and the pediatric audiologist. Suh-weet. :-)
Granted today is Saturday, no time for rest. I woke up at 7:30am to head to school for over 3 hours to work on a lab for the Auditory Evoked Responses class. This lab entailed running ABRs and changing the stimulus intensity to see the effects on the waveform. While an MRI is a test of structure, an ABR is a test of function. For instance, an ABR could show normal function but an MRI could reveal a tumor. And vice versa - - an ABR could show abnormal function but an MRI could show negative for any masses/tumor. I won't bog you down with more info than that for ABR testing. ;-) Below is the first page of a 3-page printout/report of an ABR test done on me by a classmate at stimulus intensities of 30 dB nHL, 60 dB nHL, and 90 dB nHL in both ears (left/blue is left ear; right/red is right ear). Yes, amazingly I still have brainwaves. ;-)

I'm "Hear 4 U Always"...and unfortunately busy as a bee. I'm probably the bee that would fly backwards. Zub-zub, my friend, since I'm lacking "zzzzzz's" in my buzz. :-( C'est la vie. Tiring week but overall a good week.

Feedback...in general, not from a hearing aid ;-P

2009-10-05T12:00:00.004-07:00

As mentioned in the 28 August 2009 blog entry titled "Blogs at A.T. Still University", I started this blog last summer to keep family & friends apprised of my academic/professional experiences as I journey through 4 years of grad school to earn a clinical doctorate in audiology (Au.D.). Generally I am a fairly private person, but I decided to keep this blog open to the public in hopes to help one person in the world somewhere become aware of audiology and perhaps pursue becoming an audiologist. Since the age of 5, I grew up wanting to be a pediatrician and never knew of audiology till the age of 27. Prior to starting this degree program, my only experience in audiology was my 1+ year as a Neonatal Hearing Screener. As I was contemplating the decision to pursue the Au.D. degree in late 2007/early 2008, I Googled in search of a blog that could give me some insight to what being an Au.D. student was all about. Unfortunately I did not find any helpful sites. Most 'audiology'/'audiologist' blogs I encountered were of a personal rather than a professional nature with wedding pictures & what not.

What prompted this monologue is that yesterday I got a comment on my last blog entry from a person named Elizabeth. Her comment is as follows: "This is great. I'm a first year in the AuD department at Vandy and I stumbled on your blog while researching Clinical Masking. So funny/interesting to read about someone else's experience! Liz". I thought that was cool. I later Googled "clinical masking" and sure enough my "Hear 4 U Always" blog popped up on Page 1 of the Search Results since I wrote an entry titled "Clinical Masking...and Masking Fatigue" on 19 September 2009.

To Liz: Thanks for reading! Good luck with your studies and maybe I'll see you at an audiology convention one of these days. For me, understanding of clinical masking truly comes during practicum time at clinic and seeing it firsthand during testing. But the 'conductive hearing loss simulation' was helpful too. :-)

To all: Thanks for reading! I know some self-censorship must be exercised (more on some days than others... ;-P). But I'm a no-BS kind of gal and will tell things to you straight. Hopefully this blog has been an interesting read for you. Especially now that I'm getting better at posting pictures to complement the word. ;-) After all, "a picture is worth a thousand words".

I'm "Hear 4 U Always" and pleased with feedback (uh, that's not squealing from a hearing aid ;-P) so feel free to comment. Ah - now I'm off to study for midterm exams. Happy, happy, joy, joy! ;-P Ha.

"Who lives in a pineapple under the sea?"

2009-10-01T18:30:00.020-07:00

Two weeks ago I decided to go to a scrubs store to buy kid-friendly scrubs for the Pediatric Audiology course this quarter since each Thursday we will be doing lab in which we do audiological evaluations on actual kids. Below are pictures of what I purchased...one Blues Clues top with sky blue pants and one SpongeBob top to go with a pair of black scrub pants that I already owned. I really wanted to buy this Hello Kitty top, but I refrained since I would be buying with me in mind and not the kids. ;-P The scrubs store I went to did not have a large selection of kid-friendly scrubs, and I chose Blues Clues & SpongeBob SquarePants since I figured they're both appealing to boys & girls.

Audiology is already quite specialized, but there are various subspecialties within audiology. I really love working with & helping children, so thus my interest in pediatric audiology has been & still is up there. But I am keeping my options open since I haven't explored all areas of audiology. As mentioned in previous blog entries, I see the challenge in testing the hearing of children; thus the benefit of taking the Pediatric Audiology course in which we learn various techniques in doing behavioral audiometry such as VRA (visual reinforcement audiometry) and CPA (conditioned play audiometry).

Last week I donned the Blues Clues scrubs. We had 3 children show up to our Pediatric Audiology lab, and our class broke up into groups to test our first kid. I was in a group that tested a 5-year-old boy. It's not the optimal way of learning how to test a child when there's so many of us in a group. It's like that saying of having "too many cooks in the kitchen". But you have to do what you can with the situation you're in and make the best of it. One member took the case history from the mother. Another member did otoscopy, tympanometry, and OAE (otoacoustic emissions) testing. Another member was the test assist and sat in the sound booth with the child being tested. Another member was behind the audiometer to get spondee thresholds, and my role was to get behind the audiometer to screen the child's hearing at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz employing CPA. My professor was not kidding about knowing your audiometer. Doing CPA with the test assist in the booth was fast-paced & crazy. I had to know how to work with 2 channels on the audiometer since the child could listen with insert earphones and the test assist could listen with the supra-aural earphones. If I wanted to talk to the test assist, I had to remember to get off of "interlock" or else I was talking to the child too. But then I had to remember to switch back to "interlock" when resuming testing so the test assist could hear what auditory stimulus I was introducing so she would know when to look for any response from the child (you can sometimes see it in the child's face that they heard the tone). I had to maneuver quickly between frequencies and intensities while testing, because I wanted to get some audiometric info before I lost the kid to fatigue or boredom and he no longer wanted to participate in testing. I will admit that my heart was racing in what seemed like a long time but was really only a matter of minutes.

Today I donned the SpongeBob scrub top with black scrub pants. I was in a group of 3 people testing a 3-year-old boy. This boy was the sweetest little guy. He was so patient with us as we fumbled occasionally in trying to get tymps or OAEs. My role today was to be the test assist. We did speech audiometry and tested one frequency in the sound booth before I got a "I have to go potty" from him. I knew to not insist on continuing testing (flashback of my then 3-year-old niece having a potty accident while on the Ferris wheel ride at Santa Monica Pier...poor baby!), but to unplug the little guy from his insert earphones and whisk him to his mother who assisted him to the bathroom. When he returned, we finished testing the remaining frequencies. As the test assist, you have to be very good at NOT giving the little patient any indications that you heard the tone (since you're also wearing a headset) and waiting on him or her to put the toy in the bucket indicating that he or she heard the tone. My 3-year-old 'patient' really likes basketball and he liked to have one ball in each hand to 'slam dunk' into the basket when he heard a tone. So at the end of testing as we were parting ways, I asked for a double-handed high-five and he was so great about giving me one. :-)

Outside of lab time, we are gaining experience in writing case reports. We take all the diagnostic information we obtained during lab/testing, and we build a file for the child/patient. Each member in the group types up their own case report that includes background information, test results, and recommendations. It's all good practice.

Yesterday at clinic, I saw my very first baby with confirmed hearing loss. I think my clinical preceptor was like the fifth audiologist that the parents of the baby has seen. Perhaps they hadn't reached acceptance and was in denial of the news that their one-month-old daughter has moderate hearing loss...I don't know. Their faces were concerned & hopeful at the beginning of the audiological evaluation. When we were running the OAE test on the baby, I immediately knew what the computer screen with the test results was telling me and my heart sunk. But I had to maintain a "poker face" until the audiologist went over the test results with the parents. That made me rethink being a pediatric audiologist. I want to help babies and young children to hear, and that entails identifying hearing loss first. I know it's nothing like being a medical doctor and losing a patient to a terminal illness or like being a surgeon and losing a patient on the table. But I wonder if my heart can handle over and over the identification of hearing loss in a pediatric patient and breaking the news to the parents. Hearing loss - - from mild to profound - - is invisible. My heart hurt as I watched the mother holding her baby and rubbing her baby's perfectly formed left ear as she was taking in what my clinical preceptor was saying. Early identification and intervention are wonderful, because the child has the capability of learning speech & language at the level of their normal-hearing peers. But again, that initial aspect of the process is rough...on the parents definitely but also on the audiologist. Guess time tells all tales in which path I shall take in my new career.

To end on a lighter note, know that I'm "Hear 4 U Always". Oh, and don't be surprised if you catch me singing the SpongeBob theme song. ;-) "Absorbent and yellow and porous is he!" I even sang that song in my days in the Air Force. ;-P In Iraq, it was just something silly to sing once in awhile to have my troops laugh at me since times were constantly stressful over there. And when I was promoted to Captain, I'd receive an e-mail from my bestest friend in the world with "Aye-Aye Captain!" in it and 'naturally' that SpongeBob theme song would pop into my head. "Drop on the deck and flop like a fish!"

"Be the change you wish to see in the world..."

2009-09-26T13:00:00.004-07:00

I recently received a "thank you" e-mail for volunteering at the 2009 ACT Kids Health Fair. I really liked the quote that was in this e-mail - - "Volunteers don't get paid, not because they're worthless, but because they're priceless."
I'm just in it for the free T-shirt. ;-P NOT!!! To help another human being is what is priceless. It seems so simple enough, but sadly it is not done enough. Life hasn't always dealt me a great hand. But no need to be spiteful or vengeful. To know that I've helped another person in some shape or form is my only wish in life. I get a smile on my face and in my heart knowing that a person's life is a teeny bit better because of something I did for him or her. And perhaps I'm doing something right, because I was nominated yesterday afternoon by my classmates to be the program's class rep (Audiology Class of 2012) for the Student Government Association. :-) I was up for the position against 2 other classmates. I am honored to have won & hold this position. I'm "Hear 4 U Always"...with a helping hand.

Pictorial Complement to "Golden Gate (the community center, not the bridge ;-P)"

2009-09-20T12:45:00.004-07:00

When doing volunteer work whether that was screening the hearing of newborn babies back in the day to doing hearing screenings at health fairs now and even when it's not audiologically-related such as coaching tumbling to a middle school cheerleading team (I'm a former Level 10 & collegiate gymnast along with being a former collegiate cheerleader...rah rah! ;-P), I never take a camera with me. I would love to be able to capture & store moments of these wonderful events beyond my mind's eye, but work/help comes first and not being an amateur photographer. Anywho, I recently had some photos of me taken at the 25 July 2009 Golden Gate Community Center Health Fair made available to me (a perk of being an ATSU Student Blogger ;-P). Photos are courtesy of A.T. Still University. The blog entry can be accessed at http://hear4u-always.blogspot.com/2009/07/golden-gate-community-center-not-bridge_28.html if you've not read it and would like to.

Below is a picture of me placing the supra-aural earphones on a child. Below is a picture of me ensuring the earphones are on properly.

Below is a picture of me most likely when I had asked how old she was ("¿Cuántos años tienes?") and confirming with my fingers that she's 4 years old.
Below is a picture of me while doing the hearing screening of the child via puretone audiometry. Her raised arm indicates that she heard the tone.

Below is a picture of me working the portable audiometer...the look on my face is that of concentration and not of constipation. These photos were all candid shots.

The camera doesn't lie. This was a good visual feedback for me, particularly in the last two pictures. I need to be more aware of my facial expressions and work on having my "concentration" face look more neutral. ;-P I'm "Hear 4 U Always"...whether that's on "Candid Camera" or not. ;-)

Clinical Masking...and Masking Fatigue

2009-09-19T17:00:00.016-07:00

Last night during the Amplification II class, a classmate inserted impression material using the impression gun (impression material for the gun versus the syringe has a different viscosity...) in my left ear to simulate a conductive hearing loss. The impression material was left in my ear, and I was led to a sound booth to have my hearing tested. I won't lie -- the impression material was already inserted semi-deeply in my ear canal and having the supra-aural earphones on pushed the impression material slightly further into my ear so I was in discomfort. But all in the name of science and assisting my classmate to fully understand how to do "clinical masking", the discomfort was worth it...sort of. It was good to be in the patient's role and "hear" masking being done. However what took me a half hour to do the same simulation on my classmate, it took my classmate an hour and 15 minutes (which didn't include the quick bathroom break I had to take after having sat in the sound booth for an hour). It took that long, because my classmate was not fully comfortable in knowing when & how to mask and thus we had the professor available to answer questions since this was being done during class time. But (1) I had a deeper insertion of impression material than I did on my classmate so it was more uncomfortable and (2) I had to endure the discomfort (which later induced a throbbing headache) for more than double the time that I put my classmate through. It's fine though because my role as patient helped my classmate understand this concept & procedure better which down the road will help the many patients she will be seeing.

Below is my audiogram done back in May 2009 in which my ears were clear of any impression material. The red color indicates my right ear and the blue color indicates the left ear. Normal hearing is 15 dB HL or better (better as in less than 15 dB). It's typical for me to have a notch (slight hearing loss) at 2000 Hz bilaterally, but I don't know why on this particular day in May that I had elevated thresholds in the lower frequencies. Below is my audiogram from last night when impression material was put in my left ear to simulate a conductive hearing loss. At several frequencies, the impression material in my left ear had my thresholds at 70 dB HL which is a moderately severe hearing loss. At one frequency, the left ear had a threshold of 80 dB HL which is a severe hearing loss. Craziness! I pray my hearing sensitivity doesn't reach such a stage until I'm like 80 years old...if I live that long. ;-P

Below is the audiogram that I did on my classmate. I put impression material not in her left ear as had been done on me but in her right ear. Also I did not put impression material in as deep as she had done on me. Granted we do not have identical hearing sensitivity before the 'conductive hearing loss simulation', you can see her thresholds for her plugged-up ear (right) were nowhere as bad as my thresholds for my plugged-up ear (left) so I did not have to do as much "masking" as she had to do on me.

Without going too much into detail on the concept of "clinical masking", let's just say that a phenomenon known as "cross hearing" can occur in which the nontest ear actually participates in hearing when the other ear (test ear) is being tested giving the patient a better threshold in that test ear than it truly is. Thus "masking" is done in which narrowband noise is introduced in the nontest ear while the other ear is being tested in order to "mask" & not have the nontest ear interfere with the true threshold of the test ear. If you don't get what I just wrote, no worries. That's why I'm going through school to become an audiologist and not you. ;-)

So I left school last night at 10:40pm, making that 3 Fridays in a row that I haven't been home from school before 10:30pm. Then this morning I got up to be at school at 8:00am to work on a lab assignment. It should have only taken me about 30 minutes at most, but 4 other classmates were present so we chit-chatted a lot while waiting for & taking turns at the computer to work on our lab assignment. So I didn't leave school till 12:30pm. I really, really, really need to get caught up on sleep. Unfortunately stress has me sleeping at night for only a few hours before waking up at a crazy hour like 4:00am completely awake. (sigh) I am no longer able to function on less than 4 hours of sleep like I very often could & did in my 20s. As for the gray hair count, I lost count after 32 back in July 2009. I told my classmates to let me know if they see prominent bald spots on my head since I haven't ceased plucking each gray hair that I encounter.

I'm "Hear 4 U Always"...still physically intact but feel like I'm falling apart. :-( As mentioned in my last blog entry, I know that "tough times don't last, tough people do". Hanging in there as always...from combatting enemy forces in Iraq back in the day to combatting stress & fatigue in grad school now. Since I'm "Hear 4 U Always", I shall try my darnedest to not go M.I.A. ;-P

Page Two...

2009-09-16T21:40:00.007-07:00

What a day! I saw 15 patients today at clinic. At previous clinic sites, I would see 15 patients in a 3- or 4-week period. Then again, back then, I was working half the number of hours. Last week, I saw 9 patients and had the opportunity to do the hearing test on the last patient. Today my clinical preceptor let me test starting with Patient #1! I was caught off guard internally, but I walked on over behind the audiometer, sat down, put the headset on, and didn't skip a beat externally. ;-)

I had a silently proud moment with the last patient of the day. Without divulging too much information due to patient's privacy, let's just say that my inquisitive mind & the need to ask questions to understand more of the patient led my clinical preceptor to run one more test that she probably wouldn't have had done otherwise to guide in the diagnosis of the patient's hearing problem. As one of my favorite professors always says, "you need to do some digging", and that I did. :-) All about helping the patients!

Good thing I brought some extra clinical log sheets with me for my clinical preceptor to sign off on. I saw so many patients that I needed to use a Page Two. That's a first...and probably not the last. ;-)

Wednesdays this quarter is great due to the experiences I'm getting at clinic & having a great mentor in my clinical preceptor. But I won't lie. Being up at 6:00am to get ready & be in Phoenix by 8:00am, clinic from 8:00am to 4:00pm or 5:00pm, and driving back to the East Valley for class from 6:00pm to 8:30pm is super exhausting. It's hard to come back home at almost 9:00pm to try to do any studying or homework assignments since the following 9-hour school day starts up again in 10 hours. As I learned during Basic Cadet Training at the U.S. Air Force Academy over a decade ago, "tough times don't last, tough people do". I'm "Hear 4 U Always"...through tough times and not.

ACTivating confidence...

2009-09-12T22:05:00.022-07:00

Today I woke up at 5:00am so that I could get to school by 6:00am to carpool with a professor & two classmates to the ACT Kids Health Fair in Phoenix, Arizona. Mind you that I didn't get home from school last night till 10:45pm because I was working on a lab assignment with a classmate for our Auditory Evoked Responses class. I am worried that I am going to get sick if I keep running around on E for empty. If only I could pump energy in me like one pumps gas into a car. Chug-a-lug.

Anywho, part of my soul did get re-energized today at the ACT Kids Health Fair. To date, I've worked 4 health fairs and this ranks pretty high up there in my book. My other favorite health fair experience has been the Healthy Hearing event at the Arizona Special Olympics back in May 2009. This is the 19th year that the ACT Kids Health Fair has been held, and I was most impressed with the organization of this event. The hearing screening volunteers were primarily students from the Doctor of Audiology degree program & Master's Degree program in Speech-Language Pathology at Arizona State University. Five students from the Doctor of Audiology degree program at A.T. Still University, to include myself, rounded out the hearing screening volunteer force. :-) Our audiological services entailed otoscopy, tympanometry, puretone audiometry, and otoacoustic emissions screenings. By day's end, we had screened over 600 children!

This event was a great learning experience for me in that I had to troubleshoot several of the equipment that I was working on. Each station was manned with one Audiology student and one Speech-Language Pathology student. I was at a station that provided otoscopy and tympanometry. Me being the Audiology student was to do otoscopy and the Speech-Language Pathology student was to do tympanometry. Well, it turned out that my partner was in undergrad and 15 months away from earning her bachelor's degree and eventually wanted to get into the Master's program in Speech-Language Pathology. This was good & bad. At first, I had to pull double-duty and do otoscopy & tympanometry. But after an hour or so, my partner got the hang of doing tympanometry. From this, I learned that I actually do have a great amount of patience (I know that I can be impatient but that's probably from my military background where being expeditious was key) and that I am actually not too bad in teaching (since I did have to repetitively teach my partner how to correctly screen the health of my middle ear with the tympanometer & I'd let her try the test on my ear multiple times).

Similar to the 25 July 2009 Golden Gate Community Center Health Fair, I had to utilize my minimal knowledge in Spanish. It was nice when I could tell in a parent's face that she or he appreciated that I was trying to explain what tests I was doing before doing them. And I'm sure the kids appreciated me informing them here & there of what was going on. For instance, before sticking the otoscope in a child's ear, I would kneel down to eye-level with the child sitting in the chair & say "Voy a mirar en el oído. ¿Está bien?" and I wouldn't proceed until I felt that it was okay to do so. Some kids were too cute! For example, I had several kids turn and offer me their other ear once they realized that I wasn't going to hurt them with the otoscope after examining the first ear ("No duele."). Another memorable moment was when I had two brothers start crying before they were even five feet of my station. Their mom wound up having one boy sit in her lap while I did otoscopy. When my partner was doing tympanometry, I started talking to the boy's brother and asked if he thought he had bugs in his ears. The boy answered with an emphatic "yes". Otoscopy showed no bugs in his ears, and the little boy informed me that they were hiding. :-) Oh, it was so much fun giving the kids a sticker after their screening. We had stickers of animals, so I'd act out the part of a monkey or elephant or fish as each kid pondered which sticker they wanted. Silliness on my part would get a sweet laugh out many of the kiddos. Loved it! Lastly it was really nice when I ran into a father of a child I had done otoscopy & tympanometry on like a half hour later outside and he once again said "thank you" to me.

If you wish to learn more about the ACT Kids Health Fair (ACT stands for Arizona Coalition for Tomorrow), check out www.actkidshealthfair.org. I very much look forward to working this health fair next year. I'm "Hear 4 U Always" and feeling good in having my confidence in providing audiological care ACTivated. :-)

Nines

2009-09-09T22:10:00.009-07:00

If it hadn't been for still being at school till 9:40pm tonight, this blog entry would most likely have been written at 9:09pm. ;-P After all, it's the 9th day of the 9th month of the 9th year of the 21st century. The '21st century' thing may throw off the "nines". But being a weird numbers girl (meaning I remember dates of events...personal events anyway quite well...it's a little OCD-like), I can make the '21st century' bit fit with the "nines" meaning 9:00pm is "2100 hours" in military time. How 'bout that? ;-P I'm such the weird girl that I still have my sports watch on military time, and I write appointments in my planner in military time. After having lived & breathed the military life from Basic Cadet Training to days as an Air Force Captain, military life composed a third of my life...10 years. So it's second nature.

Speaking of "nines" :-), I saw 9 patients today during clinic. Nine is fine! ;-) That was 8 adults and 1 child. With that one child, I did my very first full audio in clinic on an actual patient (and a 'pediatric' patient no less but this child was the sweetest & most compliant). I tested pure tone air conduction thresholds, pure tone bone conduction thresholds, and did speech audiometry! Man, even filing patients' case files after we were done testing and had a teeny tiny lull was exciting for me! I'm sure you're probably thinking "whoa, what a dork" or "whoa, girl, you need to get out more". ;-P But I don't care. Today was one of the most awesome 'audiological' days I have had to date (outside of my days of doing newborn hearing screenings) and no one can take that away from me. I saw more in one hour at this clinical site than I have in one year of clinical observation. AND I saw things that I've only seen in a textbook or on a PowerPoint slide (e.g. cholesteatoma, draining fluid in the ear, etc.). Dare I say that was 'ew-citing'? ;-P Kidding. Also I had a patient who had a malformation of the pinna on one of his ears which I didn't know since his hair was covering his ears. You need to pull the pinna up & back on an adult to do otoscopy for a good view down the ear canal and see the tympanic membrane (ear drum). The first ear I checked was fine, but when I walked to the patient's other side to pull back on the pinna, I was surprised to see a deformed outer ear. I hardly had any pinna to pull back on. Where I'm proud of myself is that I totally had a good "poker face". Inside I was like "whoa!" because I wasn't expecting this deformed outer ear and actually have never seen an outer ear malformation in person except for a pre-auricular tag when I had done hearing screenings at the Special Olympics. But on the outside, I remained expressionless and proceeded with doing otoscopy as best as I could. Thank goodness.

I was excited yet super nervous about my clinical site when I found out late last week, because I knew the site would be fast-paced diagnostic audiology. Also I'm not just a bump on a log sitting & merely observing as I had as a first-year Student Doctor of Audiology. I've entered Year Two and "practicum" time! True, it's only been one clinic day this quarter, but I don't think I'm premature in stating that I couldn't have asked for a better clinical preceptor for First Quarter of Year Two. I know my problems are that I tend to be a perfectionist, I hate screwing up, and I have been known to beat myself up (figuratively, not literally!) if I do screw up. I know that the point of being a student is to make mistakes so that we may learn from them. But still it's one thing to realize my problems, and it's a whole other ballpark to try & NOT allow myself to beat myself up for making mistakes & not being 'perfect'. And I did make mistakes today. Minor ones where a little white-out couldn't take care of it (I'd make an incorrect annotation or calculation in PEN on the audiogram of a patient's file...grr, me...). But again I have a pretty fantastic clinical preceptor, and I aspire to at least be half the Doctor of Audiology that she is. She not only has great clinical knowledge, but she has stupendous 'bedside manners'.

Last note, I mentioned ABR testing in my last blog entry (refer to 8 September 2009 "Trick-or-Treat!" entry). Well, below is part of a printout of my very first ABR test results...an ABR that was done on me, not by me.

So there you have it, folks...I'm "Hear 4 U Always" and with physical proof that I have brain waves. :-) Not to mention, I'm now dressed to the "nines"...in my PJs. ;-P About to hit the hay in an hour so night-night.

Trick-or-treat! ;-)

2009-09-08T20:40:00.009-07:00

I'm fully aware that Halloween is October 31st. Tell that to Walgreens & Target. I was at both stores some time in August, and I couldn't believe Halloween decorations & candy were already on display & for sale. I'll probably turn a corner next and see Santa Claus. ;-P Anywho, I was joking to a classmate today during lab time in our Auditory Evoked Responses class when I was acting as 'patient' & had electrodes stuck on me with medical tape that I should go on my next date sporting this stuff. I knew I'd get a "you're so crazy, Tammie" chuckle out of her, and she said that I'd might be able to get away with it on Halloween. Wouldn't that be a sight for sore eyes? ;-) Moo-ha-ha! <= That's my 'evil' laugh...not the laugh of a cow suffering from Mad Cow Disease. ;-P I know - - I'm in rare form today...probably delirious from stress. ;-P (sigh)

Anywho, when I was enjoying three glorious weeks of break last month, I did "Spring Cleaning" of my apartment and found the following cartoon that was given to me last year around the time when I started the Doctor of Audiology degree program. Although I think the cartoon is making reference to M.D.s, I suppose you could throw 'Student Doctor of Audiology' into the mix. Below is a picture of me acting as 'patient' for ABR (Auditory Brainstem Response) testing. This was my first time having an ABR test done on me ever...yes, a "Dear Diary" moment. ;-) I got a new cell phone last month, and the camera on it is pretty great. Being the geek that I can be, I was curious to see how the two electrodes were placed on my forehead so I asked a classmate to take a picture with my camera phone. I asked for just a close-up of my forehead, but somehow the rest of my face got in the shot. ;-P I figured since I had some pictures from school that I'd share them. I wanted to take some pictures of my 'patient' when I was acting as 'clinician'/'audiologist', but my 'patient' was like "Noooo! I don't want it winding up on Facebook". So off went the camera phone.

Below is a picture of an electrode on the back of my left ear. An electrode was also placed on my right ear. To add to this 'Halloween' look, I later had insert earphones in my ears. I was stylin' & profilin'. ;-)

Below is a picture of one of the two chairs we have in class for use for ABR testing. Rumor has it that this chair costs around $2,000.00! I'd rather spring for a good ol' reclining Lazy Boy. ;-)

The picture below was taken from www.dhss.mo.gov/NewbornHearing/. As mentioned before in a previous blog entry or two, I was a volunteer Neonatal Hearing Screener on weekends at a local hospital during my last military assignment. I'm posting this picture, because I never took any pictures of the newborn babies I did hearing screenings on due to privacy issues. Plus it was too busy in that job to stop & take photos. Anywho, the below picture is the best that I could find showing what a 'patient' looked like getting an ABR when I did it for newborn hearing screenings. The method I used entailed over-the-ear earphones and three electrodes (you can see one electrode in the picture of the baby...it's on the forehead partially hidden by the baby's hat).

I'm "Hear 4 U Always"...and willing to look silly in the name of science. ;-)

Year Two, Baby!

2009-09-04T23:45:00.006-07:00

Wow - it's 11:45pm right now and I just walked through my front door about a half hour ago. Today has been THE longest school day ever for me! I was in classes from 8:00am to 6:00pm with one hour for lunch. Then I went to dinner with a classmate which took up about an hour, and we returned to school to work on a lab assignment for one of our classes. The campus closes at 11:00pm, and I walked out of the main building at 10:58pm. Holy schnikey! The reason why I subjected myself to such a long day was because I am trying really hard to not fall into my old ways of waiting to the last minute to do things for school. Sure, habits are hard to break. And I was ingrained during my cadet days at the U.S. Air Force Academy that "if you wait till the last minute, it only takes a minute". But if I want to survive Year Two, I know I need to keep up. Plus with ever-growing classes of Au.D. students (Class of 2013 has 13 members) and my class just received one new member bringing the total to 14 students and the Class of 2011 with 10 members will be on campus for two more academic quarters, we have to fight for limited equipment to do a number of lab assignments.

So what does Fall Quarter of Year Two entail? 17 credits! I am enrolled in the following courses: Counseling in Audiology, Pediatric Audiology, Amplification II, Auditory Evoked Responses, and a clinical rotation with weekly Grand Rounds. The clinical rotation is no longer purely observation time as it had been for the entirety of Year One. Practicum hours start now and we go to clinic 8 hours a week where Year One only required 4 hours a week at clinic. My day for clinic is every Wednesday followed by an evening Amplification II class. That makes for a very long day -- 8:00am to 8:30pm, not including driving time since clinic takes me 30 miles away from home & I'll be going during both rush hours of traffic on the freeways. C'est la vie.

On a non-exhausting note, members of the Class of 2012 were sized for their white coat today after Grand Rounds. We were all beaming and helping each other out on our views of how well a particular size fit. I totally thought I was going to be a 'medium' but turns out I am an 'extra-small'. :-) We all definitely look forward to the White Coat Ceremony next month!

I'm "Hear 4 U Always"...well, "Hear 4 U" constantly at school anyway. And soon about to look the part. ;-)

85 Decibels

2009-08-31T20:00:00.008-07:00

Back in Spring Quarter, an adjunct instructor had asked the class if we had changed any habits (ear-related) after having been in the Doctor of Audiology degree program for two academic quarters. We mostly laughed & shook our heads 'no'. I knew we shouldn't be using Q-tips in the ears, and I did stop for two weeks but then went back to my weekly use of them. As mentioned in a previous blog entry, Q-tip use is advised against for ear wax is not a sign of a dirty ear. You could wind up pushing ear wax further into your ear and potentially put a hole in your ear drum & create a medical problem.

One time a classmate told me that I had ear wax in my right ear on the anterior portion after viewing my ears with an otoscope. So I went home from school that day and went into my right ear & did a down-up scoop (as opposed to my usual up-down...I figure gravity would keep my ear wax on the floor of my ear canal ;-P) to get the ear wax out & it did get out. Another time a classmate told me that I had a LARGE chunk of ear wax (well, everything looks larger with the otoscope since it's a magnifier...) and that really bothered me so again I went home from school that day & went after the ear wax with a Q-tip. I'm so nuts about getting ear wax out of my ears if I know it's there that classmates have stopped telling me if they see ear wax after doing an otoscopic exam of my ears for labs and such because they don't want to encourage my Q-tip use. You'd think Q-tip use was bad like a drug habit. ;-P

Anywho, today was THE day that I did something different from my usual habit for better hearing health. I wore ear plugs while vacuuming my apartment!!! I knew my vacuum cleaner was loud, and it was still audible with the ear plugs. But I felt much better about preventing any further noise-induced hearing loss from the 85 decibels or so that my vacuum cleaner kicks out acoustically. From a diagnostic test done at school for labs for a class last academic quarter, I knew that I already had some outer hair cell damage at certain frequencies most likely from noise exposure since I've been exposed to detonation of explosives, mortar blasts (receiving end...boo...), and personally shot several types of firearms (M9 pistol, M4 carbine, M16 rifle, M249 squad automatic weapon, M60 machine gun, and .50 caliber machine gun) from my military service. It could also be due to ototoxic medications taken in the past.

From now on, I will continue to wear ear plugs whenever vacuuming. :-) My next step for better hearing health would be to don some ear plugs while blow drying my hair. A hair dryer kicks out at least 90 decibels of noise. Anything over 85 decibels for extended periods can cause permanent hearing loss. I always advise my friends going to music concerts to wear ear plugs. Seriously.

Below is a picture of a pair of custom molded ear plugs/swim plugs that I purchased last October for $60 at an Earmold Fundraiser put on by the A.T. Still University chapter of NAFDA (The National Association of Future Doctors of Audiology...became inactive in late 2008 due to the creation of the Student Academy of Audiology which is part of the larger organization, American Academy of Audiology). That $60 was actually a reduced price specifically for the fundraiser; generally custom molded ear plugs cost $100 a pair.

The pair of custom molded ear plugs/swim plugs shown below are made by Westone and was provided for free as part of the Amplication I course taken in the Summer Quarter of Year One. They're called AquaNot since these ear plugs are swim plugs meaning you wear them while swimming to prevent water from getting in the ear. You don't know what's in the water that you swim so preventing water from getting in the ears can help prevent ear infections like otitis externa aka "swimmer's ear". These particular ear plugs have handy-dandy handles and the letter 'L' to signify the Left ear plug & the letter 'R' to signify the Right ear plug. I wish my green pair came with that since it took me several wears till I could figure out which was which. ;-P

I'm "Hear 4 U Always"...trying to practice what I preach audiologically and protecting my own hearing so that I may be able to hear you well & better serve you. :-)

Blogs at A.T. Still University

2009-08-28T12:30:00.007-07:00

Last September I applied, interviewed, and was selected for the position of Student Ambassador at the school I'm attending. The Student Ambassador program is comprised of students from the various degree programs at A.T. Still University (audiology, dental medicine, osteopathic medicine, physical therapy, physician assistant studies, etc.). Student Ambassadors attend monthly meetings and act as an approachable link between the university & the prospective student. I have personally participated in an Open House last fall, given several talks on audiology to various groups of high school students, did welcome e-mails & fielded questions from incoming Au.D. students through the Ambassadors Connectors Program, among other things.

Now I find myself taking on the task of being a student blogger for A.T. Still University. This "Hear 4 U Always" blog was originally intended for family & friends to keep them apprised of my audiological/grad school experiences. And also for myself...to act as an academic/professional journal for me to refer back to years from now & probably get a good chuckle (uh, recalling my first experience retubing an earmold...still cringing now but maybe I'll laugh later ;-P...refer to 8 August 2009 "Review of Summer Quarter-Year One" entry). I mention all this, because the "Blogs at A.T. Still University" are with WordPress (http://blogs.atsu.edu/). Instead of prospective students losing out on a year of the Au.D. experience AND also to not lose time myself transferring old blog entries to the ATSU Blog, I've written a blurb on the ATSU Blog and simply put a link for this blog on the other blog. I will still be exercising the First Amendment of the U.S. Constitution ;-) but there may be a different slant on things aka more self-censorship. Ha, ha. Probably not.

I'm "Hear 4 U Always"...with a potentially growing readership. Scary thought? ;-P

4-oh!

2009-08-21T16:00:00.006-07:00

Finally! My final exam grade in Amplification class posted today. I got 148.5 out of 150 for a 99%. Not too shabby. So "4-oh!"...I've maintained a 4.00 GPA for all four quarters of my first year in the Doctor of Audiology degree program. I'm not smart by any means. I just study hard and try to grasp the big picture...not merely study for what's on a test. This isn't about 'cram & dump' like in high school or college. The things we are learning are for our future profession as an audiologist and crucial to know to provide adequate (if not great) patient care. I am pleased that my studying has paid off & is reflected in my grades. The one thing I need to improve on is to not put off my studying aka STOP procrastinating. Life would be so much simpler & less stressful if I could just master that one teeny aspect. Here's hoping...particularly with Year Two being the hardest of the four years of the Au.D. program.

I'm "Hear 4 U Always" and never 2 Cool 4 School. ;-) I'm off now to enjoy this last bit of calm before the storm...school resumes in less than two weeks.

Review of Summer Quarter-Year One

2009-08-08T15:15:00.014-07:00

Ah - at last I can say "WHEW!" (refer to 4 August 2009 "Woo hoo! & Whoops!" entry). :-)

Still waiting on one course grade for Summer Quarter but I'm fairly certain I managed to pull off a 4.00 GPA. This past quarter was a lighter course load; I took 11 credit hours in comparison to Spring Quarter which had consisted of 17 credit hours. However, it was a compressed schedule for summer, being 8 weeks long instead of the usual 12 weeks. So this past quarter proved to be somewhat difficult...lots to learn & retain at a fast pace. I had a good experience at my clinical site and got an 'A' recommended from my clinical preceptor. Otoacoustic Emissions was taught well (since that particular professor loves the power of OAEs ;-P), and it was an easy 'A'. I had been doing well in Pharmacology and even rocked the midterm exam by only missing one question & earning a 98.3%. But then my performance in that class started to decline. I still ended up with an 'A' in the course, but I was not pleased with myself. Now just awaiting the grade in Amplification I. It was a great class and I had an 'A' going into the written final exam. Granted I earned a 103.5% on the lab practical final in that class, I confessed to my professor that I felt like a 'C' student in just that class and Amp proved to be one of the hardest courses I've taken thus far in the Doctor of Audiology degree program. She said that it is a lot of information to take in, technology is always changing, and that's why Amplification is spread out over 4 quarters (so there will be an Amplification II, III, and IV!). Then she was like "but you saw what you got on the lab practical, right?". And I was like "yes, but I don't feel like an 'A' in this class". Mind you that I have 3 weeks off from school, but you can bet my nerdy (& unconfident) self will be brushing up on material from Amp. Of course I will be resting up too. After all, Year Two is notorious for being the hardest year of this program. :-( (sigh)

I suppose I should start taking my camera to school, especially for lab work. But then again, I'm more focused on learning & doing lab work than being an amateur photographer. ;-P So for now, I only have still photos of my lab stuff. It would have been funny to see pictures of fellow classmates with gunk (impression material) coming out of their ears & a mouth prop when we were doing the open-jaw impressions. You have to give a paper towel to your patients when doing the open-jaw impression since drool occurs. ;-P I had one done on me, and it's not fun. Think of that stuff you get shoved into your mouth to bite down on at the dentist for X-rays. It's worse than that since the mouth prop is bigger and the process for an open-jaw impression for one ear takes between 5-10 minutes. Open-jaw ear impressions are done for those patients who have excessive jaw movement (did you know when you move your jaw that the shape of your ear canal changes? ;-P), discomfort from a hearing aid or earplug when the closed jaw impression was used, have a hearing aid or earplug that does not stay in their ear well when chewing or moving their mouth, and also for patients who play a musical instrument with the mouth in an open position.

Below is a picture of the ear impressions using methyl acrylate via impression syringe and a cotton otoblock. The ear impressions in the photo are both of a classmate's right ear. I couldn't get the stupid cotton otoblock to fill the ear canal in this classmate's left ear so I gave up to avoid a blow-by if I proceeded & potentially causing medical problems like a perforated eardrum. This is the first set of ear impressions for a lab assignment where I didn't get any points marked off! :-) Hurrah! I can tell you that I will never be using cotton otoblocks when practicing audiology...unless I'm in a developing country e.g. Mexico, Nigeria, etc. and that is all I have to work with for otoblocks for ear impressions. Foam otoblocks are so much better! Cotton otoblocks might as well go extinct. As for the methyl acrylate which starts of as powder & liquid, the impression material can harden before or while in the syringe if you don't move fast. So that is its only downside in my opinion. Otherwise I like it. Oh, also methyl acrylate has a contraction ratio of more than 20% if too much liquid is used. That's not good, because the earmolds made off of the shrunken ear impressions won't fit the patient's ears. For silicone, the max shrinkage is 3%. Oh, and also impressions made with methyl acrylate need to be glued down in the box sent to the manufacturer with something like Duco cement. For impressions made with silicone, you don't have to do this.
Below are pictures of another finished product for a lab assignment. This is a hearing aid & earmold for a left ear (that was a tough one to figure out at first with the earmold due to its shape and I'm just unfamiliar with working with earmolds/hearing aids). The top picture is a lateral view of the hearing aid, and the bottom picture is a medial view of the hearing aid. We were each given a BTE (behind-the-ear hearing aid), two 13 Thick Wall tubing (the second tube was for just in case we messed up on the first tube), and a hard earmold (hard meaning it was either made of lucite or acrylic) that already had an old tube in it. We had to remove the old tubing, get the new tubing into the earmold through the sound bore, align the tubing just right before adding tubing cement to make sure that new tube stayed in place in the earmold, and then place it up to a person's ear to measure the other end of the tube & know how much to cut off before snipping & placing it on the earhook of the BTE. My first attempt was disastrous! I broke the tube puller and totally crimped up my first 13 Thick Wall tubing! I had my professor reinstruct me on procedures. We found that the 13 Thick Wall was too big for the sound bore of the earmold I had. I'm glad it was the sound bore's smallness that was really at fault and not really me. ;-P I mean, hello, if your professor gives you a certain-sized tube & earmold, one would assume that you'd be given a tube that would fit into your earmold. Right? Guess this is why I should stick to one of my sayings which is "assuming can be dangerous". Anywho, for my second attempt, I used a metal tube puller (instead of a fishline-looking thing) and a 13 Standard which has the same inner diameter but a smaller outer diameter than the 13 Thick Wall. I got 100% for my finished work on this lab assignment. :-) Hurrah again! I'm "Hear 4 U Always"...making mistakes but learning from them too. Another one of my sayings, "it's okay to make mistakes, just try not to make the same one twice". ;-)

Woo hoo! & Whoops!

2009-08-04T16:00:00.003-07:00

Woo hoo! The grade from yesterday's Amplification I lab practical final has already been posted. I got 87 out of 84! :-) I missed one point, and the extra points are from the one 4-point extra credit question I answered correctly. Suh-weet!

Whoops! Anyone who knows me would probably list "funny" as a characteristic. One classmate remarked that I'm the "quiet funny", meaning I don't blurt out funny stuff like I have Tourette's or something rather it's when you'd least expect it. I'm generally quiet at school. I suppose that's my "classroom behavior", because I'd say that my sense of humor is just random goofiness/cheesiness (uh, and it can be Tourette's-like...hee hee ;-P). Anywho, today I had to give a presentation in Pharmacology. The person who went before me presented on the drug, sildenafil, which has the brand name of Viagra. The drug I researched & presented on was bumetanide, a loop diuretic. I started off my presentation with something like "Viagra...that's a hard act to follow", and everyone started busting up laughing & it took me a millisecond to realize the goofy verbal 'whoops' I made. I try to do my presentation slides & notes keeping my audience in mind, so with this group, I know to add a joke here & there. That first funny was unintended. As a fellow classmate said, the unintended funnies are "the best ones". Another classmate commented that "something always happens in your presentations", which reminded me that in a previous presentation in our Embryology class that I did make another goofy verbal 'whoops' unintentionally. I won't relive that one for you all for it's a smidge embarrassing. [insert flushed face here ;-P]

Ah - guess you had to be there. ;-P Two items down, five more to go (1 lab practical final in Otoacoustic Emissions, 3 written final exams, and a term paper to finish writing). That makes me say another exclamatory W-word...WHOA! Wish me luck. I'm "Hear 4 U Always" and waiting to be able to say yet another exclamatory W-word...WHEW! (Not till this Friday though...)

Golden Gate (the community center, not the bridge ;-P)

2009-07-25T16:30:00.003-07:00

What a day! Just got back from doing a number of hearing screenings at a health fair held at Golden Gate Community Center in Phoenix, Arizona. This facility is located in a part of Phoenix of lower socioeconomic status. I believe the purpose of this particular health fair was to facilitate children of that area in getting ready for school i.e. physical exams, immunizations, etc.

The ability to hear is key in learning & academic performance, thus the necessity of a hearing screening. That's where two professors, four of my classmates & I came into play. Well, not play per se...work. :-) And on a Saturday. But all for a great cause! Our audiological services included otoscopy, puretone audiometry, and otoacoustic emissions and/or tympanometry as needed. We were able to screen over 100 kids. :-) I'm still fairly certain that I want to specialize in pediatrics within audiology. I love working with & helping the little kiddos, but I do see the challenge in testing them. And today proved to be a greater challenge since a lot of the kids and I didn't speak the same language. Thankfully we had two interpreters nearby. I did try out my minimal knowledge in Spanish here & there. "Me llamo Tammie." "Cuando escucha algo, levanta la mano... ¿está bien?"

Here's some information on the Golden Gate Community Center from their website, www.goldengatecenter.org:
Golden Gate currently serves over 6,000 children, youth, adults, and seniors annually through a wide variety of minimal or no-fee programs and services for tots to seniors for the surrounding neighborhoods. Services are provided in response to community need and serve family members of all ages. Because Golden Gate exists, thousands of children, teenagers, adults and seniors have affordable access to recreation and personal development activities, education classes, or preventive health services.

Free Health and Immunization Fairs during the year with various health services including: ~Physical exams for children and adults~Dental exams for children~Hearing Screenings for children~Vision Screenings for children~Infant inoculation and immunizations~Cholesterol screening~Glucose testing~Pregnancy testing~Information on Low-Cost health resources from agencies all over the valley

I'm "Hear 4 U Always"...and attempting to be bilingual so that I may be able to help a larger population of people. Gracias por leer (I hope I said that correctly...). ¡Adios!

Class BBQ

2009-07-19T20:30:00.012-07:00

Every year one of our professors -- Dr. T -- is kind enough to throw the first-year audiology students a class BBQ at his house. He's from Louisiana and knows his brisket, dirty rice, etc. Yesterday was the Class of 2012 BBQ at Dr. T's. All 13 of us showed, and even D. was present. Come fall quarter, D. will make #14 for our class. He was supposed to be part of Class of 2011, but he took a year off for family reasons. Having an XY in the mix will definitely make our class dynamics interesting. ;-P Interesting good or interesting bad...that has yet to be determined. Anywho, everyone brought a dish or something necessary like paper plates. I decided to be thematic (Southern cooking) and brought a red velvet cake with cream cheese frosting. I have never had a red velvet cake, so I went the safe route and didn't bake it myself but instead bought one from a reputable local bakery. Dr. T commented that the cake was "too pretty to eat...almost". ;-) The sign on the cake says "Thanks, Dr. T & Congratulations Class of 2012", because I wanted to thank Dr. T for being such a gracious host & cook and to congratulate my classmates & myself for being less than a month away from being second-year doctoral students. :-)

Hurrah - I'm getting better at taking and posting pictures to complement the written word. ;-P I'm "Hear 4 U Always"...working hard and occasionally playing hard. :-)

A Day of Firsts

2009-07-10T18:00:00.004-07:00

Today in Amplification I, we spent the majority of the day -- morning & afternoon -- doing lab work. I used a listening stethoscope and listened to my very first hearing aid! For the average Joe or Jane, I know it's not exciting. But since this is going to be my livelihood in three years (and also because I'm a bit of a geek ;-P), I found it to be an exciting moment. So just as a physician uses a stethoscope to listen for a heartbeat on a patient, I used a stethoscope to listen for a heartbeat on a hearing aid. Okay, just kidding. ;-P Nah - the stethoscope allows me to listen to a patient's hearing aid and check the integrity of it. Not that I plan on being fitted for a pair of hearing aids for many decades from now, it was pretty cool to have the listening stethoscope in my ears to check the hearing aid...and listen to my professor lecture here & there through the hearing aid via the stethoscope. My brain had to work less for a minute while I listened to lecture when sound was amplified. Also during lab, we learned how to retube an earmold, replace a battery compartment door, test hearing aid performance with a HIT (hearing instrument test) box & standard 2cc coupler, and made ear impressions using methyl acrylate which starts off separately as powder & liquid (the silicone starts off & ends as putty).

It was definitely a day of firsts. And with three more years to go in school, I'm sure I'll have many more of those. I'm "Hear 4 U Always"...and I know that the learning never stops. :-)

Pictorial complement to "A lasting impression..."

2009-06-23T21:30:00.008-07:00

Below are the earmold impressions I did on actual people on 19 June 2009. On the left is my very first earmold impression on a human being (as opposed to the little model ear); it is of the person's right ear. On the right is the second earmold impression I did; it is of the left ear of a fellow classmate. The gray foam piece is the otoblock; it is placed adjacent to the tympanic membrane aka eardrum so these are medial-lateral views of the ear canal.

These are the same earmold impressions as seen in the first picture. This is a side view, meaning the swirly blob is what you would have observed had this material been left in a person's ear.

We've gone pink! ;-) I did the pink-colored earmold impressions today. The pink impression material is still silicone. Instead of scooping out measured globs out of two separate jars with two separate scoops for the light yellow mixture, the light pink mixture originally started out in a pre-measured pack of white material & dark pink material. That was convenient to peel open the foil backing of the pre-measured pack and whip out the materials to mix on the splead pad. This view is from inside the ear going out. So if you were a teeny tiny person standing inside the ear canal and looking out, this is what you would have seen with the impression material in the external auditory meatus. ;-)

This is the view of outside looking in. Our professor wants us to avoid "worming" and make nice concentric circles with the impression syringe. My technique definitely still needs work. They vaguely resemble pink roses, yes? ;-)

Considering we use a spatula to mix materials just as we'd use a spatula for frosting a cake AND use a syringe to make the impression just as we'd use a syringe to decorate a cake, this cake that I made on Mother's Day 2009 should have been indicative of my skills as a student audiologist doing earmold impressions. Or not. ;-P Things that make you go "hmmm".

Candied decorations seem to be a safer bet in decorating a cake. I don't think we have candied decorations for earmold impressions. ;-P C'est la vie.

I'm "Hear 4 U Always"...Student Doctor of Audiology by day, amateur baker by night. :-)

A lasting impression...

2009-06-19T16:35:00.009-07:00

Talk about fast. I can't believe I'm already done with the first week of Summer Quarter! It being the Summer Quarter and only 8 weeks long as opposed to the usual 12, we are taking less courses/credit hours, but mind you, it is 12 weeks of material smashed into 8 weeks. Summer Quarter of Year One consists of Amplification I, Otoacoustic Emissions, Pharmacology, and 4 hours weekly of clinical observation but no weekly Grand Rounds.

At last, after three academic quarters of this program, we are now taking our first Amplification course. In Amp class on Tuesday, we had lab during class time and learned how to make an earmold impression. An earmold is an individually fabricated ear insert that channels the sound reproduced by the hearing aid receiver to the eardrum (Sandlin, 2000). An item called an otoblock is placed first in the ear. An otoblock is a small cylindrical foam piece with a strand of string attached to it, and its purpose is to stop any material from reaching & possibly perforating the eardrum. After the otoblock insertion, an impression syringe or a cartridge ear impression material injector (looks like a caulking gun) is used to place any number of earmold materials from silicone to ethyl methacrylate (aka acrylic) to make the impression of the ear canal & outer ear. It takes between five to ten minutes for the material to set/harden after which the earmold impression can be removed from the patient's ear.

On Tuesday, we had the opportunity to practice on model ears. My first earmold impression was disastrous in my opinion. A classmate teased me and said that my impression was for a CIC (completely-in-the-canal hearing aid). Today that first impression (long gone in the trash on Tuesday) was dubbed a "booger" because of its size (it was rather small compared to the size it was supposed to be...). After a little bit of lecture in the afternoon, we broke up into groups of 2 & 3 to work on making earmold impressions on the model ears again. I went first in my group and did much better than Tuesday. Then I was just standing around & waiting when my professor was like "did you do an impression on a model already?" in which I said "yes". And then she was like "all right - do you want to do one on me now?". My mind was screaming "NOOOOO!!!" for I was petrified, but I couldn't exactly say "no" to my professor and thus I timidly replied "okay". I did what I was just taught. I did an otoscopic examination of her right ear and next inserted an otoblock with a pen light & had a second-year student double-check my work with an otoscope to ensure that I had a deep enough insertion but not too deep (we don't want to damage that eardrum!). Then I scooped out a measured glob of white material & a measured glob of yellow material onto a splead pad and used a spatula to mix the two together, but I had to work fast since I did not want the mixed material to harden on the splead pad before it got in the impression syringe & into the mock patient's ear. When the two materials were the color that I wanted it to be which is a light yellow blend, I got the silicone into the impression syringe without ever touching it since I did not want to contaminate it (all about infection control!). Then I got the syringe and pushed away to get the material in the ear canal & worked my way out. All in all, my first earmold impression on a human being was not too bad. Not as scary as I had built it up to be in my mind. Then again, it helped that a second-year student was available during our lab time to assist and that my first "patient" for the earmold impression was somebody who had undergone this procedure countless times so knew by feel if I had gone in too deep in the external auditory meatus.

So that was my start from 'booger' to earmold 'royalty'. Some of my classmates were impressed that I was the first in the class to do an earmold impression on a real person and no other than our professor who is the Chair of Audiology at our university. I let a classmate do an earmold impresson on my right ear, and it was painful for a millisecond on a couple of occasions. This was probably due to the otoblock being on the bony portion of my ear canal (the ear canal has both a cartilaginous portion & a bony portion). Other than that, my classmate made a good impression of my ear. I did another earmold impression on a real person - - this time on a classmate and on the left ear. How I got dubbed the "Earmold Queen" was from doing the earmold impression on my professor AND for doing a kick-arse earmold impression on my classmate...this second impression I was able to fill the entire concha. When another classmate saw it, she was like "you're the Earmold Queen!". I later ran into her in the hallway after class, and again she was all "there she is...the Earmold Queen". :) I don't know about that...I feel more like an Earmold Jester. Practice, practice, practice!

I'm "Hear 4 U Always"...with impression syringe in hand to do that earmold impression. :-) May I leave a lasting impression...a good one, that is!

Picture 'Scroll'

2009-06-08T12:15:00.019-07:00

Hurrah - the Spring Quarter is over! I barely made it out of there with a 4.00 GPA, but I did. Still putting the 4 in "Hear 4 U Always". :-) Yay! Oh, and the gray hair count is now up to 26 as of this past Saturday. Boo. :-( Anywho, I'm on break for a week and then Summer Quarter starts. Since I have a little bit of free time, I thought I'd post some more pictures. You know, because I'm on a roll from posting an actual pic in the last blog entry. ;-P So enjoy the picture show...or should I say picture 'scroll'?

The 'old' me with a friend in Iraq...I traded in my gun for an otoscope :-)

Scrubs are a way more comfy uniform to wear...no ironing (unlike the military)

J. and me -- always by one another's side :-)

Some of the first-, second-, and third-year audiology students on Halloween Day 2008

Some of the first-year audiology students on Halloween Night 2008

One of several volunteer events I've participated in for 2009

E.'s last day of Grand Rounds...she went out of state for her clinical rotations

The A.T. Still University crew that attended the American Academy of Audiology convention in Dallas, TX...notice how we're all drinking & American Academy of Audiology is long for AAA ;-P

J. (a Physician Assistant student at ATSU) and me enjoying a day NOT studying; my shirt says "(ear)resistable"...get it? ;-P

This glass sculpture is called "The Sun"...J. called it 'Fertility' ;-P (think about it); it was my favorite of all the glass sculptures created by Chihuly on display

Anniversary...

2009-06-02T16:45:00.008-07:00

One year ago today I found out that I was accepted to the Doctor of Audiology program at A.T. Still University (the only Au.D. program that I applied to! don't worry I had back-up plans ;-P). What a joyous day it was to open up the mailbox & see a large manila envelope in there and then to actually open that envelope to read a letter stating "It is our distinct pleasure to inform you of your acceptance for admission...". Now 12 months, 25 gray hairs (all pulled out upon each finding!), and 7 pounds heavier (stress...comfort food...munchies...) later, I find myself still reaping joy from the path that I'd never imagined being on just two years prior when I was transitioning out of the military.

Finally a real pic to post on my blog! :-) This photo was taken on 29 May 2009 outside of Red Robin. We went to lunch there as a class. So this is us -- future Doctors of Audiology for the Class of 2012. We've come a long way in three quarters. We still have quite a journey ahead of us with 13 more quarters to go. We're "Hear 4 U Always". :-)

"Let the games begin..."

2009-05-01T18:15:00.003-07:00

Wow - what a fantastic day both on a personal level and a professional level! Today I had the opportunity to do otoscopic examinations and hearing screenings via otoacoustic emissions (OAEs) for a large number of athletes at the Special Olympics Summer Games. The free hearing screenings also included testing on the tympanometer and the audiometer if necessary. These hearing screenings are all part of the Healthy Athletes initiative.

From www.specialolympics.org: "By listening to athletes at events and conducting research over many years, Special Olympics leaders became aware of the lack of quality health care for people with intellectual disabilities and found it unacceptable. We found that people with intellectual disabilities have a 40 percent greater risk for health issues, and that health care professionals are not trained in or experienced with caring for people with intellectual disabilities. Healthy Athletes currently offers health screenings in seven areas: Fit Feet (podiatry), FUNFitness (physical therapy), Health Promotion (better health and well-being), Healthy Hearing (audiology), MedFest (sports physical exam), Opening Eyes (vision), and Special Smiles (dentistry)."

It's too bad that the stations for the health screenings were not located in close proximity to any of the athletic events taking place. That would have been a treat to watch. Being a former competitive gymnast, I particularly got excited in meeting some of the gymnasts. And I met a lot of gold medalists. :-)

I thankfully did not have any non-compliant patients when doing an otoscopic examination or running a test for OAEs. Sure, I had a couple of patients who cringed when I went to put the otoscope in their ear, but I quickly calmed them down. My favorite memory of today was meeting an athlete named Jenna. I was working at the otoscopy station, but our station hit a temporary lull. I turned to the OAE station and noticed one of my classmates had a patient who had started to cry big drops of tears & kept shaking her head that she didn't want an OAE done on her. The patient's mother didn't seem very helpful and was scolding her & telling her daughter to stop being a baby. I walked over to Jenna and told her to not be scared because we were only putting a "squishy marshmallow" (the probe tip) in her ear. I kneeled down to try and calm her down. My classmate was able to get the probe tip in Jenna's left ear, and it was so sweet when Jenna put out her right hand to me because she wanted me to hold her hand during the test. Getting an OAE done is completely painless; you just have an ear-plug-like thingie in your ear & you hear some beeps. That's it. I gladly took Jenna's hand, and she passed in her left ear. My classmate then put the probe tip in Jenna's right ear and again I held Jenna's hand. She passed again. Yay, for Healthy Hearing. I can't wait for this event next year!

I'm "Hear 4 U Always"...with a hand to hold.

"Can I tymp you?"

2009-04-17T19:15:00.022-07:00

Hurrah - I finished my Tympanometry lab assignment for the Essentials of Audiology II course late this afternoon. I was sitting at my desk during a break, and one of my classmates was all "Tammie, can I tymp you?". I was like "yeah - can I tymp you back?". Yes, the word 'tymp' has transformed from a noun to a verb much like the word 'Google'. ;-P

I love doing tymps, because it is a super fast diagnostic test. The last few lab assignments have greatly eaten into my Saturdays & Sundays with me having to go to school to use one of the audiometers for testing. Tympanometry is an immittance measure that is used to evaluate middle ear function and identify middle ear disorders. Middle ear disorders range from Eustachian tube dysfunction to otitis media to ossicular disarticulation or fixation. Running a tymp in both ears from probe insertion to hitting the "print" button takes 2 minutes tops. Love it! Especially in comparison to pure tone threshold testing & speech audiometry which can each take up to 20 minutes since we're still new at this (a seasoned audiologist takes 20 minutes tops for both!). I enjoy doing a full audio, but the hours add up when a lab assignment requires testing of up to 8 patients and when you also have to give your time in playing the role of the patient...and you have 5 other classes to worry about. (sigh)

So guess what? I finally have some pictures to post with my blog entry. :-) Nine months of maintaining this blog and it's been more journalistic than a visual display of my experiences...which probably bores some readers. :-( Well, don't get too excited. I don't have any pics of me per se...rather it's a "snapshot" of my middle ear function. ;) The top image is of my right ear; it's a Type A which indicates I have normal middle ear function. Same goes for my left ear which is the middle image. The bottom-most image is a tymp done on a fellow classmate who demonstrates a type that doesn't even have a name. There's Type A, Ad, As, B, C, and transistional/intermediate. We tease C. and call the tymp result of her left ear "Type M" or better yet as "The Buttcrack". :-) We don't know if her TMJ condition has anything to do with the oddity on the tymp result. She has normal middle ear function and no pathologies to be concerned about.

I'm "Hear 4 U Always"...and trying to jazz things up more with pics. Stay tuned... ;-)

What goes on in Dallas stays in Dallas...

2009-04-05T15:00:00.008-07:00

The convention put on by the American Academy of Audiology called AudiologyNOW! should really be called AudiologyWOW!. It was an amazing event. I was one of two first-year students to go from our university. Five professors, five second-year students, and one third-year student from A.T. Still University were also in attendance.

As a student volunteer, I was a room runner for two different sessions on marketing. They were both informative sessions, but I'm not interested in opening up my own private practice one day so it was in one ear & out the other (pun intended? ;-P). I was also a room runner for the student research forum, and that was really neat to see fellow doctoral students (both Au.D.- & Ph.D.-types) present their research. Again though, I know I'm definitely going to be a clinician and not go into research.

There were a lot of exhibitors at this convention. I only went this year to the convention to get a feel for it. I can't wait till I attend next year after having gained more knowledge, especially on amplification, so that I can be a more informed (student) audiologist when visiting with reps from Phonak, Oticon, Cochlear, Med-El, Widex, etc. I did leave the convention with a number of goodies, to include a free MP3 player. :-) The night life for many audiologists & doctoral students entailed launch parties, after parties, and a V.I.P. pass to a concert at Gilley's. Sugarland was supposed to perform but unfortunately were not able to at the last minute...much to the dismay of my hotel roomie. Instead Clay Walker & two other country singers performed. I was averaging 4 hours of sleep a night since Tuesday, so by Friday night, there was no way I was going to be able to attend the concert & get my drink on, only to come back to the hotel to pack & get up at sunrise the next morning to catch a plane.

That's the quick & dirty on the American Academy of Audiology convention. After all, what goes on in Dallas stays in Dallas. ;-P I'm "Hear 4 U Always"...with lips sealed.

"Say the word 'gin'..."

2009-03-29T17:15:00.011-07:00

It should be more like "give me some gin"! ;-P No, I'm not a lush. Seriously not. I've had only three alcoholic beverages since the doctoral program started at the end of August 2008 - - a Jell-O shot & one bottle of Smirnoff (which is barely alcohol ;-P) at a Halloween party and one mango martini on my 30th birthday. I've gotta keep what little brain cells I have left to finish school. ;-P

Since Spring Quarter started on 16 March 2009, I have been to school for 13 of the 14 days. The only day I didn't go to school was yesterday. Ten days of classes and three days to work on lab at school since all the equipment is there. We ran out of time in the winter quarter for the Essentials of Audiology I course to complete the Speech Audiometry lab, so our professor assigned it to us this quarter. We were paired in teams of two for this lab assignment, so our partner could monitor our voice inflections and what not during administration of testing using Monitored Live Voice (MLV). Testing can also be administered using a recording. Speech audiometry provides information concerning sensitivity to speech materials (spondee words...they're two-syllable words that have equal stress on each syllable) and understanding of speech at suprathreshold levels (monosyllabic words). I won't go into more detail than that so as to not bore you the reader. ;-P My partner and I went in to school today to test our last patient. We both stayed to serve as patients for some of our classmates who needed to finish up the lab assignment. It was weird that I had Speech Recognition Thresholds (SRT) at 15 decibels for my right ear & 20 decibels for my left ear on the GSI 61 audiometer, but my SRTs may have been affected also by how the student audiologist was administering the test. Last week I had SRTs of 10 decibels bilaterally. But today on the AC 40 audiometer, a different student audiologist tested me and I had SRTs of 0 decibel in my right ear & 5 decibels in my left ear. In-tuh-rest-ing. ;-P

I'm "Hear 4 U Always"...but "Hear 4 U Always" in Dallas, TX since I will be attending the American Academy of Audiology annual convention aka AudiologyNOW! 2009. I'm a student volunteer so I'll be put to work for a few hours during my 4-day stay in Dallas. This should be an exciting event. I've never been, so I'm looking forward to it and learning what this organization & event are all about. Yee-haw! (<= not a spondee word ;-P)

Observing surgery...

2009-03-27T18:30:00.010-07:00

...so I didn't observe a surgery live. But I'm still hoping to this quarter at clinic.

Nah - I just thought it was a weird coincidence that I looked in a patient's ear post-op from a tympanoplasty on Wednesday (refer to second-to-last paragraph of 25 March 2009 "The Waves" blog entry), and then today in the Acquired Pathologies of the Auditory-Vestibular System course, we watched videos of a tympanoplasty being done. I naively assumed all tympanoplasties were done via the ear canal...an outside-in approach. I believe some tympanoplasties can be performed through the ear canal, but what I observed with the one surgeon on the videos was an inside-out approach. That bad boy (the surgeon ;-P) just sliced the back of the ear open by the skull (a post-auricular incision). The surgeon extracted a layer of tissue to use for the graft aka 'harvesting of temporalis fascia graft' (the temporalis is a muscle). And then the surgeon kept going with the post-auricular approach to place the graft on the tympanic membrane & then pack the area up with Gelfoam which is an absorbable gelatin sponge used to stop hemorrhage during surgery. Then the surgeon showed off his needlepoint and stitched the back of the ear up.

In class, we also watched a few myringotomies being done via video. A myringotomy is a surgical procedure in which a tiny incision is made in the eardrum to relieve pressure caused by the excessive buildup of fluid or to drain pus. This is a procedure usually done to treat otitis media aka middle ear infections. Generally P.E. tubes (pressure equalization tubes) are placed at the time of the myringotomy to keep the eardrum open. In time, the tubes naturally come out into the ear canal as the eardrum heals & pushes the tubes out in the healing process.

There's nothing like watching a bunch of surgeries right after lunch. I don't know how many gushers we saw with the myringotomies (the fluid build-up in the middle ear comes pouring out into the ear canal once that eardrum is sliced open). But I will tell you that this was far more interesting & far less gruesome than watching an hour of cerumen removal (refer to last paragraph of 2 March 2009 "Peanut Butter Ban" blog entry). I'm "Hear 4 U Always"...with a non-queasy stomach & all. :-)

The Waves

2009-03-25T19:15:00.006-07:00

Today was my second day at my clinical site this quarter. I observed my first adult ABR (auditory brainstem response) & ECochG (electrocochleography) being done on a patient. For the audiologist running the test, it was 'blah' for her since she's done these tests many times over, but for me, it was exciting since it was my first time seeing these two tests being performed. We as students won't be taking the course on auditory evoked responses until the fall quarter of our second year of school. I specifically wrote "adult ABR", because I have performed ABR on babies when I was a Neonatal Hearing Screener for a volunteer job 2+-years ago (that's how I went from pursuing the M.D. route to the Au.D. route). Of course back then, I just did what I was trained to do e.g. hooking up electrodes on the newborn baby, knowing which buttons to click to run the test off of a laptop computer, etc. Now being more than a half year into the Au.D. program, it's neat to apply what I'm learning in the classroom and understand what is going on a little more in clinic rather than being completely clueless. ;P Rather than just going "oo - nice squiggly lines on the monitor", I knew we were looking at Waves I through V since we knew the patient had a sensorineural hearing loss based off of other tests already done such as a full audio. As I learned in Neurology last quarter, I remembered Waves I through V dealt with structures of the auditory pathway (aka central auditory nervous system) so the ABR results is one means of determining if the problems the patient is experiencing is retrocochlear. This patient would also need other workups done like an MRI, etc. Then the otologist would determine if he/she needs to correct the problem via surgery. The adult ABR was more involved than the ABR I did on newborn babies, because for the newborn babies, we do the ABR just as a hearing screening. This is not the case for an ABR for diagnostic purposes. As for the ECochG, the audiologist told me that it's only about 50% reliable, but the otologist she works with likes to have the ECochG results along with all other test results. I remember learning about action potentials & summating potentials of the inner ear in the Anatomy & Physiology of the Auditory-Vestibular System course last quarter, and the audiologist told me that the ECochG measures the waves for the summating potential & the action potential. I asked if this was to test the VIIIth nerve (there are 12 cranial nerves and the VIIIth nerve is the vestibulocochlear nerve which deals with hearing & balance), and the audiologist said that the results of this test would tell us if the patient had Meniere's Disease or not. I guess I will be able to tell you more on this come fall. ;P Oh, I know you'll be waiting on pins & needles. Ha, ha.

The only other exciting thing that happened to me at clinic was that I got to do an otoscopic exam on a woman who recently had a tympanoplasty done in her left ear. A tympanoplasty is reconstructive surgery of the tympanic membrane (TM), or better known to the world ;P as eardrum. I didn't know the woman's case history, so I don't know the cause of the perforation of her eardrum that caused her to need a tympanoplasty. The patient was seen by the audiologist so that her hearing could be tested post-op. Since her eardrum was still healing, I could view blood in her ear canal and around the TM through the otoscope.

Doing the 'wave' ;P and watching countless waves (on monitors for ABR & ECochG), I'm "Hear 4 U Always" and gaining more knowledge every day. :)

Spring (Quarter) Has Sprung

2009-03-20T19:35:00.007-07:00

Happy Spring! (The vernal equinox occurred today aka first day of Spring... ;-P) Hurrah - I survived my first week of classes of the spring quarter. Monday was brutal with being at school at 7:30am for some computer upgrade, and classes starting at 8:00am & going till 8:15pm with a 2 1/2-hour lunch break. I have worked 18-hours day in my short life when I was in the military, and I'd gladly take one of those over sitting on my bum for nearly 10 hours oversaturating my brain. Argh. And it should be illegal to hold classes past noon on a Friday. ;-P Today classes went from 8:00am till 5:00pm with just a one-hour lunch break. Thankfully the Friday afternoon classes are fascinating - - Acquired Pathologies of the Auditory-Vestibular System and Embryology & Congenital Conditions.

Oh, I found out I'm not as much of a Neurology dum-dum as I thought I was. Our Neuro professor visited us briefly during Embryology to give us our Neuro lab practical final to look over & then hand back in. I noticed two questions that I got marked off on which I clearly thought I got right. The questions dealt with eye movements & vestibular nuclei excitation/inhibition on a right head movement. I know that in a right head movement that the right vestibular nucleus is excited & the left vestibular nucleus is inhibited which ultimately leads to the contraction of the left lateral rectus & right medial rectus. Well, I just received a class-wide e-mail from our Neuro professor stating that she incorrectly marked us off on the two questions if we answered as I stated in the previous sentence. So I got 93 out of 95 on the Neuro lab practical final, giving me a 97.8% on that exam (NOT a 95.7% that I originally received...) and a 100.3% total in the course. As I mentioned before, an 'A' is an 'A'...whether that's a 92% or a 100%. I didn't care that I got points marked off. It's the principle of the matter - - that when you're right, you should not be marked off as "-1" aka incorrect. The core values in the U.S. Air Force are "integrity first, service before self, and excellence in all we do". And I still aim to uphold these values...nothing wrong in striving for excellence, right? :-)

Here's hoping for another 4.00 quarter. I'm "Hear 4 U Always"...with fingers crossed! :-)

Putting the 4 in "Hear 4 U Always"

2009-03-12T23:40:00.004-07:00

Aw - Spring Break is quickly coming to a close. (sigh) I spent a good portion of today creating folders on my laptop computer & downloading files from WebCT/Blackboard in preparation for the Spring Quarter. 17 credits! I am enrolled in the following courses this upcoming quarter: Communication Methodology for Hearing Impaired Children, Embryology & Congenital Conditions, Acquired Pathologies of the Auditory-Vestibular System, Essentials of Audiology II, Speech Perception, and a clinical rotation (still primarily observation time) with weekly Grand Rounds. I am really looking forward to my clinical rotation since I have been assigned to a single-specialty clinic focused on the treatment of ear and temporal bone disease which means I may be observing a surgery or two this quarter! Again I'm fairly certain that I will be going into pediatric audiology, but another specialty that audiologists go into is intraoperative neurophysiologic monitoring. Pretty cool! I just hope gas prices stay around where they've been (and not the insane $4.00+ per gallon of earlier last year!) since my clinic site takes me about 30 miles away from home.

By the way, the last of the grades posted today. I didn't do as well as I would have liked to on the final lab practical in Neurology...I got a 95.7% (91 out of 95 points). But I didn't do too shabby on the written exam of the Neuro final...I got a 98.7% (153 out of 155 points). Anywho, an 'A' is an 'A', yah? ;-P The verdict is in -- I earned a 4.00 GPA for Winter Quarter. Hurray! You know it...I put the 4 in "Hear 4 U Always"! :-)

Ahhh...

2009-03-05T19:45:00.003-07:00

In all my years of schooling, I have never been more happy & relieved for an academic quarter to be over. Finishing this quarter is up there with graduating from the U.S. Air Force Academy & returning from Iraq in terms of happiness/relief. That ain't no lie! I'm "Hear 4 U Always", but I'm definitely going on a much-needed vacation. So ta-ta for now.

Aw, snap!

2009-03-04T12:20:00.004-07:00

I'm snapping away with that "sixth finger" I grew yesterday from writing so much. I should never doubt myself...meaning I just found out that I got a 100% on yesterday's final exam in the Essentials of Audiology I course. Hooray! By the way, that sixth finger is dwindling down to a stump on my right middle finger. Extra finger or not, "Hear 4 U Always". :-) Now I'm off to Final Exam #4 which commences in less than 45 minutes...

Sixth finger

2009-03-03T14:00:00.007-07:00

Oh Nelly. I just had Final Exam #3 this morning which was in the Essentials of Audiology I course. This professor is notorious for his paper & pen/pencil tests (hello, it's 2009...) in addition to essay questions that require ridiculously long answers...because he takes points off for "errors of omission". Pooey! Today's final exam had five essay questions on speech audiometry. I have become infamous among my professors and classmates for tiny penmanship. Professors will comment that they need a magnifiying glass to grade my work, and students will remark "whoa - you do write small!" when seeing me scribble notes down during lab & it's a bit impractical to have a laptop computer out for note-taking among the cadavers (Human Anatomy) or brain slices (Neurology). So at the start of today's final exam, the professor hands out pads of lined paper for us to tear out and use for the exam. He recommended that we take about 6 or 7 sheets of paper. Of course, I got teased about my tiny penmanship, and it was said that I probably could write all my answers on one Post-it note. Ha, ha. Well, I started off with four sheets of paper, and you should have seen some of the astonished looks I got when I went to find a pad of paper to tear out more sheets. Yep - I wrote 8 pages! 8 pages to answer 5 questions...whew! I haven't handwritten that much for an exam since the Philosophy course I took in undergrad. But hello, that was Philosophy...you can go on & on and there's not a right or wrong answer. This is science! Well, I'm fairly confident I shouldn't be knocked off for "errors of omission" and should be getting a high 'A'. I doubt I can top the grade I got on the last exam in this course...100%! Woo hoo. Anyway, I hope the sixth finger I grew in about 3 hours on my right hand wasn't for nothing. "Hear 4 U Always"...apparently with extra appendages. ;-P

Peanut Butter Ban

2009-03-02T12:48:00.016-07:00

One final exam down and four more to go! I had the lab practical in Neurology this morning. Running on three hours of sleep was making me delirious! :-( My first station had a whole brain on a tray, and the question was "which color pin is the primary visual cortex?". I immediately wrote down "pink" since that was sitting at one of the end of the brain...which I thought was definitely the posterior end. Uh, no. It turned out to be the anterior end. I caught myself when answering another question and saw the cerebellum hanging out by the end of the red pin. Thank goodness for the thing called an eraser. :-P

Oh my gosh, I was super nervous for the part where we had to pull a piece of paper out of a cup and perform the neurological exam listed on the piece of paper on our Neuro professor. We had to do one random selection for coordination/cerebellar testing and another random selection for the tuning fork test. I pulled out "tandem walking" and had to instruct my mock patient, have the mock patient complete the test, and then I had to provide results / possible diagnoses (I pulled "hemiparetic gait" out of thin air it seemed ;-P along with Parkinson's Disease & cerebellar problem...all correct answers...yay!). That did not go badly. Where my lack of sleep and nervousness caught up to me was when I had to do a tuning fork test. I pulled "Bing" out of the cup, and then my mock patient told me that she had been experiencing problems with her right ear. There was a 256 Hertz tuning fork out, but I didn't want to use that low of a frequency so I asked if more tuning forks were available. There were, and I selected a 512 Hz tuning fork. I explained what I would be doing to my mock patient. Then I struck the tuning fork on my elbow (yes, a little ouch), and I heard the tone at a good intensity. I placed the tuning fork on the mastoid of the right ear (poorer ear) of my mock patient, and then after a few seconds, I had my mock patient plug up her ear by pressing down on her tragus. After a few more seconds, I took the tuning fork off her mastoid and questioned her if the sound was louder or softer when her ear was plugged up. She said that she did not notice a difference, and after a long silent "ummmmmm" (seconds felt like eternity...tick, tick, tick), I correctly diagnosed her with a possible conductive hearing loss & referred her on to an ENT aka otolaryngologist. I received full points for both tests conducted, but I'm pretty sure my Neuro professor must think I'm an idiot. ;-P Classmates were joking about how nervous they were post-exam. One student even said that she knew the bad ear was the right ear, but at first, she walked over to the mock patient's left side, paused for a minute, and then had to restrike the tuning fork before making sure she got the right "right" ear this time. ;-P Don't worry...we won't be like this in 3 1/2 years when we graduate & licensed to practice audiology.

Final Exam #2 is in about 75 minutes in the Infection Control & Cerumen Management course. Reading about cerumen management is one thing. Watching it being performed live is another. But there is something just not quite right with watching a video on it, and seeing ear after ear of having huge arse chunks of ear wax removed. I will definitely be laying off of peanut butter for awhile (yes, the two have the same consistency & appearance…the “wet type” anyway). Forget salmonella scares with peanut butter…watch a video on cerumen management techniques with procedures being done via video otoscopy and you’ll ease up on consuming George Washington Carver's invention too. I definitely should have skipped eating lunch before watching that video.

Play-doh Extraction

2009-02-24T15:00:00.009-07:00

The end of winter quarter is quickly approaching, and today was the last class for the Infection Control & Cerumen Management course. We had an hour of lecture followed by lab time. It will depend on who you work for and what state you're licensed to practice, but cerumen management/removal is within the scope of practice of audiology. I'm still just getting comfortable sticking the speculum of the otoscope into a person's ear canal. Now don't get me started with sticking a curette or forceps in addition to an open-head otoscope in a person's ear. Well, today was not that day...not on a real person anyway ;-P.

We had an ear model with the ear canal plugged up with green Play-doh in which the green Play-doh was representing cerumen (or in layman's terms, "ear wax"). We partnered up, and one person would practice cerumem removal while the other person held the ear model in place. I'm right-handed and thus only like to do otoscopic examinations using my right hand. The ear model was a right ear, and I proceeded to hold the open-head otoscope with my right hand as I went in the ear canal with the metal curette using my left hand (I mention this since my partner is also right-handed but she preferred to hold the otoscope with her left hand and extract with her right hand). And for the record, using the plastic curette proved to be worthless when working with Play-doh.

I had several unsuccessful attempts of removing any Play-doh. It's weird to hold the otoscope, try to maneuver the curette in the ear canal, look through the magnifier, hope you're not going in too deep in the ear canal (because if it was a real person, you could potentially perforate their tympanic membrane aka "ear drum"), and try to scoop the fake ear wax out of the ear. I'd extract the otoscope & the curette at the same time while trying to not slide the curette through the speculum as I'm pulling out after assuming I'd made good contact with the Play-doh and had enough to scoop out. My curette remained Play-doh-less for about 4 attempts. But I finally got a small chunk out on the next attempt, and then I blew my partner away when I was pulling out on the attempt after that and was like "I think I got some" & the entire wad of Play-doh came out on the curette. Nice! I had joked with my partner earlier that I would probably not do cerumen removal when I become a practicing audiologist, but after that bad boy came out, my partner was like "you have a gift". I replied with "that was just luck". She practiced on the ear model next, but she couldn't pull off what we coined "The Tammie" (meaning pulling the entire wad of Play-doh out in one-go ;-P). I got to practice again, and I was able to pull off "The Tammie" (my thing ;-P) on the second try. So maybe I do have a gift for cerumen removal (wink, wink). Oh, if only all patients could be like that ear model where I don't have to worry about ear drums or ossicles (three tiny bones in the middle ear). Yep, audiology is NOT child's play...or Play-doh.

For non-audiology types, please note that cerumen is a natural occurrence in your ears. It is not a sign of poor hygiene by any means. Q-tip use is advised against since you may actually further push in the ear wax in your ear canal. The reasons why audiologists do cerumen removal are in cases where the cerumen build-up may negatively affect test results and also too much ear wax in a person's ear(s) can cause a conductive hearing loss which is reversible with the removal of the impacted cerumen.

Maybe in the future, if a cerumen removal is needed, I can truly say I'm "Hear 4 U Always". :-) For now, I'll work with some Play-doh.

A week of screenings

2009-02-21T19:10:00.011-07:00

Okay, the title may be misleading in that I didn't have a full week of screenings, but this past week did consist of two days of screenings...in comparison to most weeks for me that consist of zero screenings. :-) On Wednesday the 18th, I accompanied my clinical preceptor to a local hospital to do free hearing & balance screenings for members of Senior Advantage. The physical therapists handled the balance screenings while I assisted my clinical preceptor in the hearing screenings. My clinical preceptor checked all the patients' right ear and would pass me the otoscope so I could do an examination of the patients' left ear. Talk about your ear wax. ;-P We saw a total of 13 patients. Only one patient could not do the hearing screening due to excessive cerumen, and we didn't have the proper tools on hand to do cerumen removal. I also assisted in placing the insert receiver in all patients' left ear, and my clinical preceptor again took care of the right ears. :-) It was quite an experience for me...being the newbie still. Since audiologists not only deal with hearing issues but also vestibular/balance issues, my clinical preceptor went over screening results with the physical therapists to pinpoint who may need rehabilitation. Discerning if there's a vestibular/balance issue is important for fall prevention. A broken hip is never fun. :-(

Today was the 2nd annual Free Family Health & Wellness Day sponsored by A.T. Still University. It was a free health fair for the community. There was a lot going on at the health fair in that dental students were doing fluoride treatments & making mouth guards, etc. and there were such screenings as a physical, vision, etc. I had the opportunity to volunteer to work this event, and I was one of 10 students from my program to do hearing screenings. I love doing hearing screenings since we only test at four frequencies at one intensity & it's just pass/fail. Doing a full audio is quite the to-do in comparison. ;-P I worked the afternoon shift which turned out to be slower than the morning shift. I got to do a hearing screening on a total of 4 children & 1 adult, and they all passed. Yay. Gosh, I love kids. Audiology is already such a specialized field, but there are subspecialties. I am trying to keep an open mind of what I may go into, but I'm still leaning towards pediatrics because of my love of working with & helping children. Guess time tells all tales. After each person got their hearing screened, they were given a coin which could be redeemed for a bag of groceries. I thought that was really neat. This was a great event, and I look forward to hopefully working at next year's health fair.

All right - the winter quarter is coming to an end meaning final exams are nearly upon us...uh, me. Five final exams to study for and hopefully ace. Wish me luck!

A "Dear Diary" moment

2009-01-28T13:40:00.013-07:00

Hello, hello! Happy 2009! I can't believe we're almost a month through with the new year. I felt the need to write a blog entry today to document a "Dear Diary" moment in my life as a Student Doctor of Audiology. I tested my FIRST patient at my clinical site today! I was totally not expecting it. Since I'm a first-year student, we generally only do observation during our clinical rotations. We typically don't start the practicum portion until our second year. So basically I act as a 'shadow'. :-) Occasionally I take notes on my clipboard that I carry around. Well, today my clinical preceptor was like "oh, the next patient needs a hearing screening so I'm going to let you do that". I was nervous but knew I was prepared since I have been learning the use of the audiometer this quarter in Essentials of Audiology I. I just completed my second lab assignment, so to date, I've done pure tone threshold testing on a total of 14 adults. The first lab assignment entailed measuring pure tone air conduction thresholds using supra-aural earphones. The second lab assignment entailed measuring pure tone air and bone conduction thresholds, and the bilateral air conduction testing was performed using insert receivers. Good thing I got comfortable using insert receivers doing that second lab assignment for six hours this past Sunday (yes, went to school on a Sunday all afternoon!), because that's what I had to use on the patient today. The patient was a wearer of hearing aids since she was an adolescent, and thus I had to introduce the familiarization tone at a higher intensity than I was used to when testing normal hearers. The clinical preceptor guided me on this after looking at an older audiogram on the patient. At this clinic, the hearing screening involves testing air conduction at 500 Hertz (Hz), 1000 Hz, 2000 Hz, and 4000 Hz. The patient even made a comment towards the end of her appointment that "you two are the only ones who didn't make my ears hurt", meaning the clinical preceptor didn't hurt her ears when programming her hearing aids and I didn't hurt her when I put the insert receivers in her ears. Yay!

To add to my "Dear Diary" moment, I found out yesterday that there are no final exams the Friday before Spring Break so I get an extra day off. Woo hoo! Also I took a written midterm exam in Neurology last Thursday. I was really scared that I had gotten a 'C' which is equivalent to failing. We actually have to maintain a 3.00 GPA in the program to graduate. I felt I did okay on the multiple choice questions and short answer questions. But I was not feeling like I wrote about anything that seemed like I knew what I was talking about in the seven essay questions. Long story short, I got 147.5 out of 150 points for a 98.33%!!! I was so stoked when I got home from school at 10:30pm (yes, you read right...10:30pm!) and checked my Neuro exam grade on-line. I had never been more nervous to scroll down a computer screen! When I saw my grade, I thought there was a mistake like the professor inputted someone else's grade into mine. (sigh) Perhaps I should learn to (1) not procrastinate and cram for exams and (2) be more confident in my intelligence. I really do feel like the LCD (lowest common denominator), so this high 'A' on the Neuro written midterm definitely lifts my spirits!

Okay, enough babbling. :-) Midterm week is not over yet. I still have the lab practical midterm in Neuro to study for (that's tomorrow!), and I also have an exam in Anatomy & Physiology of the Auditory-Vestibular System to study for (that's Friday). In A&P of the AVS, I got a 98.5% on the first exam, so I've set the bar high for myself. The last exam in that class was just on the outer ear and middle ear. This exam will be on the inner ear. Perilymph and endolymph and cochlea, oh my! (Think "lions and tigers and bears, oh my!" from "Wizard of Oz" ;-P). Gotta go study now!

"Gray" Winter

2008-12-17T18:45:00.011-07:00

Hola! It took a couple of months but it seems as if the blogging bug that bit me at the end of July wore off. That AND I've just been uber busy with being a doctoral student full-time. Whew. I can't believe that I've already completed one academic quarter and am now in the full swing of Winter Quarter. It's only been 2 1/2 weeks of this quarter, but Neurology, Anatomy & Physiology of the Auditory-Vestibular System, Essentials of Audiology I, Infection Control & Cerumen Management, and a clinical observation rotation at a new site with weekly Grand Rounds are collectively kicking my arse. I ended the Fall Quarter with a 4.00 GPA, so I've set the bar high for myself. Hopefully I can achieve the same success at the end of this academic quarter (fingers crossed!). Thankfully Winter BREAK :-) will be here soon. Yay! I need the break since I didn't really let myself rest during Fall Break last month. Seven months in a combat zone when I was in the military, you'd think I'd have gray or white hair from that experience. Nope. Three and a half months into this doctoral program, and I've already plucked out 8 gray hairs!!! Not talking about "Bob" here (reference 14 September 2008 blog entry to understand who "Bob" is if you don't know) but rather his "cousins"...brought on by stress, I'm assuming. So my winter is looking "gray"...on my noggin anyway. :-( Don't get me wrong - - I'm absolutely loving my experience as a Student Doctor of Audiology. Just today I met my first cochlear implant patient and observed my first cochlear mapping. The patient is 5 years old, and he uses American Sign Language to communicate. It was my first encounter of a person with profound hearing loss and also of a person who had incredibly poor speech intelligibility. But he was a great patient and I got down on the floor & drew smiley faces in a notebook with him. I can't wait till second year when we will take a course in Manual Communication. I plan on furthering my learning in American Sign Language after that course. Right now I only know how to sign the alphabet. Anywho, I need to study for an exam (surprise, surprise) so guess I should get off of my blog. :-) Hopefully I can provide a more in-depth update of the past few months during my upcoming break. So stay tuned...

Eleven

2008-10-16T21:30:00.002-07:00

11-second update...Nearly 11 hours spent on campus today! Two classes, a study session with a professor, brunch & lunch at the cafeteria, and 5 hours studying 4 different cadavers. At least no sign of "Bob" yet. :-)