Yes!! I got rid of the enormous picture. Shay 1, Internet 0.

This week I thought I would treat myself and write the newsletter at a restaurant like all the cool writers (at least this is how I played it in my mind). Long story short, after postponing this cool-Shay-sitting-in-a-restaurant-with-his-laptop-writing-his-newsletter from Friday (surgery ended really late), to Saturday (finished studying at 1 am) to Sunday, I finally got to the restaurant on Sunday evening with my laptop. Well, let’s just say that a half hour later, I was again in the hospital, and now I’m finally home. It’s a Sunday night, and not-so-cool-Shay is sitting on the not-so-cool kitchen table, drinking not-so-cool-capsule-coffee (which totally contradicts our main article today), writing his cool newsletter. World 1, Shay 0.

Perhaps next time…

A letter to the editor

🗞 I’m the editor. The letters (emails) are from you.

(Note: when you write me, please mention if you want your name to appear in the newsletter when I respond to it).

Some of you commented that you would like to read more about the day-to-day experience here in Boston.

🏞 So the scenery is lovely, streets and buildings are eye-catching, with nice parks and places to go out. Car traffic is pretty terrible, so I use public transportation. I know people in Boston don’t think highly of their public transportation, but my commute time is pretty similar to the drivers’, and I use my time to get things done instead of concentrating on the road.

🏃🏻‍♂️People jog in Boston. A lot. Even before 5 am, you see joggers in the streets. As for myself, I haven’t gone for a run ever since coming here. My days are exhausting, and it’s hard to sleep 4 hours instead of 5 to squeeze in a run. On weekdays I get up at 4:20 am and return home around 5-6 pm. Some days the surgeries end later than that. I should find a way to put jogging back into my schedule, but I have different priorities now.

📦 Amazon is great. Absolute Bliss. I purchased almost everything I had to buy here (from towel hangers to a bed and mattresses) from Amazon. It takes some time to choose your product because they prioritize Amazon’s products over other sellers’ products, while I find the others superior and cheaper. But once you get the hang of it, you will find excellent products which arrive at your doorstep in a day or two (or even hours). Amazon credit card is a whole different story. I applied for it but got rejected. Probably because my credit history in the US is nonexistent… This card gives you 5% cash back (equals to a 5% discount on almost everything), but I guess I’ll use my regular credit card from a typical American bank.

🌡 The weather here has been extremely hot lately, around 36-39 degrees, But now it is back to normal. (sorry Fahrenheit people, I’m not going to convert that. Celsius is way more logical: Freeze at 0, boil at 100. What is yours? 32 and 212? That’s just weird*).

As you can see, I hadn’t had too much of the Boston experience until now. Yet, I’m sure it will pick up after my family arrives, so hang tight.

Before we dive into our main article for this week, check out this video. I have a soft spot for self-taught people, especially when they are children...

If you want to do something, don’t conform to the old ways, and don’t listen to what everyone says. Believe in yourself. Just do it!

“If you can find something everyone agrees on, it’s wrong.” -Mo Udall

Sleep

🥱 Sleep is one of the most important things our bodies need, and according to the National Sleep Foundation, adults require 7-9 hours of sleep per night. However, many of us only get 6 or less, which may lead to several problems, including obesity, heart disease, and diabetes. It can also make concentrating difficult and increase the risk of accidents.

🧠 A good night’s sleep allows the brain to rest and recharge, which is essential for optimal performance. Furthermore, studies have shown that people who get a good night’s sleep are more likely to be able to focus, remember information, and perform better at tests.

👀 Sleep is not simply a period of unconsciousness. Sleep is an active state that has distinct stages, including both REM (rapid eye movement) and non-REM sleep.

💭 In other words, you need REM sleep to put all your important thoughts and experiences in order, and you need non-REM sleep to eliminate your junk thoughts and forget unimportant experiences.

Now I will take these principles and show you how I put them into practice, using 5 examples:

🧑‍🏫 Learning - I learned how to ride a bicycle at the age 40. For real. So I watched a few YouTube videos about how to ride your bike and took my dear wife out on our street to teach me. What became clear to me was that during each practice, I experienced a very slight improvement between the beginning and the end of the same practice. However, when I compared the end of a practice to the beginning of the next, I experienced a dramatic improvement! Let me rephrase that - I improved more while not riding the bicycle than while riding it. And this is precisely the greatness of sleep. All the relevant neurons working together during the bike ride established their permanent connections during the sleep after the practice (“neurons that fire together, wire together”). To test if it happened during my sleep, I experimented - I went for a nap after a bike ride and returned on the bike shortly after. The improvement was noticeable. During my day-to-day studying, I use this concept quite a lot. Whenever I can, I spread my learning as much as possible to allow as many sleep nights during the learning period (i.e., I will study a subject for 30 minutes a day for six days instead of 1 hour a day for three days). Simply put - I incorporate passive learning into my schedule, so my sleep does half of the studying for me. Easy, right?

☕️ Coffee - Coffee is one of the most popular drinks in the world, and it’s also a go-to for many people trying to get a quick energy boost. But coffee can also have some negative effects on your sleep, which means that drinking coffee late in the day can make it harder to fall asleep at night. So how do I put this into practice? First, since studies showed that even coffee in the afternoon could negatively affect your sleep, I rarely drink coffee after 1 pm. After witnessing this effect firsthand, I concluded: Even if I drank coffee as late as 3 pm, I noticed a rise in my heart rate during sleep of about 10 beats per minute, which is substantial. The same for alcohol… And as my sleep heart rate gets high, I am less energetic and less sharp the day after. Try it out! 

And now, grab a coffee for our coffee break:

Eminem, who was banned by the industry for so many years (although ranking highest in objective numerical values), performs and receives a standing ovation from the same industry that once rejected him. 

“Behind every successful person lies a pack of haters” -Eminem

My take - Lose yourself, and always be true to yourself!

Back to our main article:

💤 Power nap - A power nap is a short sleep taken during the day, usually lasting no more than 20 minutes. You can take a power nap at any time of the day, but it is most effective when taken in the early afternoon. I find that my sweet spot is between 15 and 20 minutes. More than that and you will wake up tired. What does it mean exactly? Well, don’t expect to feel dramatically rejuvenated after a power nap, and waking from a power nap is sometimes a nightmare. However, a few minutes after waking up from it, I don’t feel tired anymore. Not exactly energetic, just not tired. However, I do feel sharper. If I take a power nap in the middle of a study day, my performance is significantly better after the power nap. Sometimes I combine it with coffee - I drink coffee and immediately take a power nap of 15 minutes. The coffee kicks in when I wake up, and I get a double effect—highly recommended!

🌈 Blue light is a type of light emitted from screens such as phones, computers, and TVs. This light can damage sleep by causing the body to produce less melatonin. Melatonin is a hormone that helps the body regulate sleep. When the body produces less melatonin, it can make it harder to fall asleep and stay asleep. To counteract this effect, starting at 8 pm and until 7 am, my devices are programmed to reduce the blue light automatically (it is called “night shift” in Apple’s system, and different variations of “blue light filter” in Android’s system). If I must study/work late on my computer, I also turn down the lights in my house or even turn them off completely. The warmer light does take time to get used to, but it is more pleasant on the eyes.

🛌 Sleep environment - Your bedroom should have a bed and some furniture, without a television, and no more using your phone in bed! The bedroom should be COMPLETELY dark, and the temperature should be slightly cold. Your body needs to be accustomed to the idea that bed = sleep.

In summary, aim towards 8 hours of sleep a day, regardless of age (as long as you’re an adult). The notion that older people require less sleep is a myth! Use sleep to boost your learning, take power naps with coffee, but no coffee after 1 pm. Turn on the blue light filter on your devices, and keep your phone out of the bedroom.

Tell me how it worked out for you!

Also, let me know if you think the main article is too long. If so, do you want “part 1, part 2” spread over 2 issues, or a single shorter article?

The evolving OMFS

* OMFS = Oral and MaxilloFacial Surgeon

😷A whole section dedicated to the OMFS and all the OMFS-in-the-making-out there.

I will share my experiences as a student considering a residency, as a non-MD OMFS resident, as an MD OMFS, and as a fellow. Feel free to reach out and suggest subjects of interest to you.

For all of you who are not interested in that - feel free to skip to the following orange headline.

For the student who considers OMFS

👨🏻‍🎓 OMFS residency is quite different from other dental specialties. This residency is the opposite of monotonic, and it relies on teamwork and communication. The high amount of knowledge required can be challenging, but it is also what makes this specialty so rewarding.

For the OMFS resident

🏥 When it comes to presenting a case or operating on a case, there are three main pillars that you need to prepare yourself for: “Where do I cut?” “What is in my way?” and “What can go wrong (and when)”?

You need to know exactly where you’ll make your incisions, and I mean EXACTLY. There’s no way you are preparing yourself for a case and don’t know what to do with the blade. You also need to be aware of what is in your way while cutting, or, in other words, familiarize yourself with the anatomy. Finally, you need to know what can go wrong during the surgery, during the postoperative period, and how to react if a complication occurs.

By focusing on these three pillars, you will cover the most important aspects of any surgery.

For the non-MD OMFS resident

🩺 It is difficult for non-MD OMFS residents to bridge the knowledge gap between them and their MD-physician companions. Medicine is different from dentistry; in medicine, one must know less about more rather than more about less.

As a non-MD resident, it is important first to ask yourself, “what is the problem (diagnosis)”? Once you have a good understanding of the problem, you can move on to the symptoms and the possible causes. Finally, ask yourself how it can be treated and what you should expect if this patient is on your service.

When you have a patient with several medical issues, don’t dive into each medical issue! Don’t start reading the most recent data about the slight change in medication dose that brought to a 0.4% increased survival. You want to know the definition of all the medical issues, how to diagnose them, how to treat them, and what signs and symptoms should worry you.

Start by familiarizing yourself with titles and definitions, and only then dive deeper. For titles and definitions, Wikipedia and Google are your friends. There’s no benefit in reading a review cover-to-cover while not knowing which medication you should prescribe for your patients…

Tip for the relocators

💰 Paying your credit card bill - If you have a credit card in the United States, you need to be aware that your bill is not automatically paid monthly. You will need to log into your account and make a payment each month. You can set up automatic payments if you want, but you must ensure enough money in your account to cover the payment. Otherwise, you’ll be charged interest and late fees. Pay attention to your credit card statement to know how much you owe and when the payment is due.

Book I read

📚 In his book, Why We Sleep, Matthew Walker goes deep into sleep science and its importance to our health. He presents evidence and offers practical advice for getting better sleep. My article touched on some of these concepts, but there are many more in the book.

Show I watched

📺 House season 1 episode 21 - “Three Stories”. This is practically a lesson on how to take a patient’s history. It is also a realistic and vivid representation of the Doctor’s work. In my opinion, this is how students should be taught (minus the extreme remarks he makes towards the students 🤐).

Every medical/dental student can enjoy this one.

Gear I use

📱Ipad Mini 8.3 - Originally purchased to fit into my scrubs pocket during my medical internship, now a regular device in my bag/labcoat pocket. I used it to study for my USMLE, OET, TOEFL, and fellowship. Today I mainly use it for Anki, YouTube, Safari, Zoom, PowerPoint, and GoodNotes. Works great with an Apple pencil; I get things done while riding the bus/train.

I had several spontaneous meetings during which the iPad Mini served as my presentation screen. The camera and speakers are excellent, considering its small size, and it can serve you well for video calls. I can present a slideshow or access my data in a few seconds. I also purchased the original Apple folio case, which may seem expensive initially, but as time goes by, you realize that it’s very high quality and worth every penny.

Epilogue

So, not staying true to my main article (which, as a reminder, was written with a 10 pm coffee), it is now 2:30 am. These newsletters really take time to write, fact-check, and proofread…

So not too much sleep today, but it was fun.

See you next Friday!

Shay