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Broken bone attorney1
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Broken Bone Attorney Los Angeles | Hand, Leg and Foot Fracture Injury Law Firm

If you suffered a fracture or broken bone in a Slip & Fall, or Car Accident contact our Los Angeles Personal Injury Attorneys to schedule a free evaluation  
downtownlalaw.com
over 7 years ago
Preview
1
36

Update on funding for the NHS Bursary in 2013/14

Marion Matheson, Co-Chair of the BMA's Medical Student Committee, gives an update on funding for the NHS Bursary for the 2013/2014 intake - and the government's foot dragging on what support medical students may get in their final years of study.  
audioBoom
about 7 years ago
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1
22

Joints of the Foot

Joints of the Foot by Dr. Fabian  
YouTube
about 7 years ago
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1
15

Ligaments and Tendons of the Foot

Dr. Fabian explaining the ligaments and tendons of the foot  
YouTube
about 7 years ago
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39

Examination of the foot and ankle | Arthritis Research UK

With the patient on a couch and their feet overhanging the end of it, look at the feet, comparing for symmetry. In the forefoot look for nail changes and skin rashes. Look for the alignment of the toes and any evidence of hallux valgus of the big toe. Look for clawing of the toes, joint swelling and callus formation. Look at the underside or plantar surface for callus formation. Look at the patient’s shoes for asymmetrical wearing of the sole, the presence of insoles or other signs of poor fit.  
arthritisresearchuk.org
about 7 years ago
Www.bmj
1
44

A patient with type 2 diabetes and a burning sensation in his feet

A 64 year old man with type 2 diabetes diagnosed nine years earlier attended the outpatient diabetes clinic because of suboptimal diabetes control. His glycated haemoglobin over the past five years had been 64-77 mmol/mol (8-9.2%; optimal value <53 mmol/mol (7%)). He was being treated for diabetes with gliclazide and metformin. He also received simvastatin and enalapril for dyslipidaemia and hypertension, respectively, and 75 mg acetylsalicylic acid daily for the prevention of primary cardiovascular disease.  
bmj.com
over 6 years ago
Www.bmj
2
31

Management of soft tissue defects of the foot

A 57 year old man presented to his general practitioner with a pigmented lesion on the heel of his left foot. He had not previously sought medical advice about the lesion but had recently become worried that it was growing in size. He was fit and well with no medical history of note.  
bmj.com
over 6 years ago
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1
39

Managing the difficult ankle and foot with Prof Gino Kerkhoffs - Part 1 of 2

Stream Managing the difficult ankle and foot with Prof Gino Kerkhoffs - Part 1 of 2 by BMJ talk medicine from desktop or your mobile device  
SoundCloud
over 6 years ago
8
1
62

Renal MCQ

A 42 year old man develops a sore throat. He does not consult his GP but takes some over the counter painkillers and an anti-inflammatory. 1 week later he has a non itchy rash starting on his feet then spreading to his trunk. The rash has the appearance of tiny teardrops. He is correctly diagnosed with guttate psoriasis. The patient is put on penicillin orally 250mg QDS for 1 week. He then starts passing small volumes of urine. His urine is described as "orangey brown" . He continues taking a non steroidal anti inflammatory drug (ibuprofen 800mg TDS). What is the most likely explanation for this? a. Post infective glomerulonephritis b. Rheumatic fever c. Secondary to penicillin d. Interstitial nephritis secondary to anti inflammatory medication  
Af Del
almost 8 years ago
Foo20151013 2023 2njk5o?1444774020
4
1355

LWW: Case Of The Month - April 2013

This month’s case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e, with 15% off using the discount code: MEDUCATION. The case below is followed by a quiz question, allowing you a choice of diagnoses. Select the one letter section that best describes the patient’s condition. The Case A 28-year old woman has an unremarkable pregnancy through her first 28 weeks of gestation, with normal weight gain and no serious complications. She has no previous history of diabetes, hypertension of other systemic disease before or during her current pregnancy. During her 30-week checkup, her blood pressure measures 128/85, and she complains about feeling slightly more “bloated” than usual with swelling in her legs that seems to get more uncomfortable as the day goes on. Her obsterician recommends that she get more bed rest, stay off her feet as much as possible and return for evaluation in one week. At the one-week follow-up, the patient presents with noticable”puffiness” in her face, and a blood pressure of 145/95. She complains she has been developing headaches, sporadic blurred vision, right-sided discomfort and some shortness of breath. She has gained more than 10 lb (4.5kg) in the past week. A urinalysis on the patient revelas no glucose but a 3+ reading for protein. Her obstetrician decides to admit her immediately to a local tertiary care hospital for further evaluation. Over the next 24 hours, the patient’s urine output is recorded as 500mL and contains 6.8 grams of protein. Her plasma albumin level is 3.1 g/dl, hemacrit 48%, indirect bilirubin 1.5mg/dl and blood platelets=77000/uL, respectively. Her blood pressure is now 190/100. It is decided to try to deliver the foetus. The expelled placenta is small and shows signs of widespread ischmic damage. Within a week of delivery, the mother’s blood pressure returns to normal, and her oedema subsides. One month later, the mother shows no ill effects of thos later-term syndrome. Question What is the clinical diagnosis of this patient’s condition and its underlying pathophysiology? A. Gestational Hypertension B. Preeclampsia C. Gestational Diabetes D. Compression of the Inferior Vena Cava Answer The correct answer is "B. Preeclampsia". The patient’s symptoms and laboratory findings are consistent with a diagnosis of Preeclampsia, which is a condition occurring in some pregnancies that causes life-threatening organ and whole body regulatory malfunctions. The patient’s negative urine glucose is inconsistent with gestational diabetes. Gestational hypertension or vena caval compression cannot explain all of the patient findings. The patient has three major abnormal findings- generalised oedema, hypertension and proteinuria which are all common in preeclampsia. Although sequalae of a normal pregnancy can include water and salt retention, bloating, modest hypertension and leg swelling (secondary to capillary fluid loss from increased lower limb capillary hydrostatic pressure due to compression of the inferior vena cava by the growing foetus/uterus), oedema in the head and upper extremities, a rapid 10 pound weight gain and shortness of breath suggests a generalized and serious oedematous state. The patient did not have hypertension before or within 20 weeks gestation (primary hypertension) and did not develop hypertension after the 20th week of pregnancy with no other abnormal findings (gestational hypertension). Hypertension with proteinuria occurring beyond the 20th week of pregnancy however is a hallmark of preeclampsia. In addition, the patient has hemolysis (elevated bilirubin and LDH levels), elevated liver enzyme levels and thrombocytopenia. This is called the HELLP syndrome (HELLP = Hemolysis, Elevated Liver enzymes and Low Platelets.), and is considered evidence of serious patient deterioration in preeclampsia. A urine output of 500 ml in 24 hours is 1/2 to 1/4 of normal output in a hydrated female and indicates renal insufficiency. Protein should never be found in the urine and indicates loss of capillaries integrity in glomeruli which normally are not permeable to proteins. The patient has substantial 24 urine protein loss and hypoalbuminemia. However, generally plasma albumin levels must drop below 2.5 gm/dl to decrease plasma oncotic pressure enough to cause general oedema. The patient’s total urinary protein loss was insufficient in this regard. Capillary hyperpermeability occurs with preeclampsia and, along with hypertension, could facilitate capillary water efflux and generalized oedema. However myogenic constriction of pre-capillary arterioles could reduce the effect of high blood pressure on capillary water efflux. An early increase in hematocrit in this patient suggests hemoconcentration which could be caused by capillary fluid loss but the patient’s value of 48 is unremarkable and of little diagnostic value because increased hematocrit occurs in both preeclampsia and normal pregnancy. PGI2, PGE2 and NO, produced during normal pregnancy, cause vasorelaxation and luminal expansion of uterine arteries, which supports placental blood flow and development. Current theory suggests that over production of endothelin, thromboxane and oxygen radicals in preeclampsia antagonize vasorelaxation while stimulating platelet aggregation, microthrombi formation and endothelial destruction. These could cause oedema, hypertension, renal/hepatic deterioration and placental ischemia with release of vasotoxic factors. The patient’s right-sided pain is consistent with liver pathology (secondary to hepatic DIC or oedematous distention). Severe hypertension in preeclampsia can lead to maternal end organ damage, stroke, and death. Oedematous distension of the liver can cause hepatic rupture and internal hemorrhagic shock. Having this patient carry the baby to term markedly risks the life of the mother and is not considered current acceptable clinical practice. Delivery of the foetus and termination of the pregnancy is the only certain way to end preeclampsia. Read more This case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at (lww.co.uk)[http://lww.co.uk] when you use the code MEDUCATION when you check out! About LWW/ Wolters Kluwer Health Lippincott Williams and Wilkins (LWW) is a leading publisher of high-quality content for students and practitioners in medical and related fields. Their text and review products, eBooks, mobile apps and online solutions support students, educators, and instiutions throughout the professional’s career. LWW are proud to partner with Meducation.  
Lippincott Williams & Wilkins
over 8 years ago
Foo20151013 2023 zpmqsc?1444774026
3
3929

Assessing Types of Burns and their Severity

This is an excerpt from "Wound Care Made Incredibly Easy! 1st UK Edition" by Julie Vuolo For more information, or to purchase your copy, visit: http://tiny.cc/woundcare. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at http://lww.co.uk when you use the code MEDUCATION when you check out! Introduction A burn is an acute wound caused by exposure to thermal extremes, electricity, caustic chemicals or radiation. The degree of tissue damage caused by a burn depends on the strength of the source and the duration of contact or exposure. Around 250,000 people per year sustain burn injuries in the UK (NBCRC 2001). Because of the specialist care burns require, they are considered here separately from other traumatic wounds. Types of burns Burns can be classified by cause or type. Knowing the type of burn will help you to plan the right care for your patient. Thermal burns The most common type of burn, thermal burns can result from virtually any misuse or mishandling of fire, combustible products, hot fluids and fat or coming into contact with a hot object. Playing with matches, pouring petrol onto a BBQ, spilling hot coffee, touching hot hair straighteners and setting off fireworks are some common examples of ways in which burns occur. Thermal burns can also result from kitchen accidents, house or office fires, car accidents or physical abuse. Although it’s less common, exposure to extreme cold can also cause thermal burns. Electrical burns Electrical burns result from contact with flowing electrical current. Household current, high-voltage transmission lines and lightning are sources of electrical burns. Internal injury is often considerably greater than is apparent externally. Chemical burns Chemical burns most commonly result from contact (skin contact or inhalation) with a caustic agent, such as an acid, an alkali or a vesicant. Radiation burns The most common radiation burn is sunburn, which follows excessive exposure to the sun. Almost all other burns due to radiation exposure occur as a result of radiation treatment or in specific industries that use or process radioactive materials. Assessment Conduct your initial assessment as soon as possible after the burn occurs. First, assess the patient’s ABCs. Then determine the patient’s level of consciousness and mobility. Next, assess the burn, including its size, depth and complexity. Determining size Determine burn size as part of your initial assessment. Typically, burn size is expressed as a percentage of total body surface area (TBSA). The Rule of Nines and the Lund–Browder Classification provide standardised and quick estimates of the percentage of TBSA affected. Memory Jogger To remember the proper sequence for the initial assessment of a burns patient, remember your ABCs and add D and E. Airway – Assess the patient’s airway, remove any obstruction and treat any obstructive condition. Breathing – Observe the motion of the patient’s chest. Auscultate the depth, rate and characteristics of the patient’s breathing. Circulation – Palpate the patient’s pulse at the carotid artery and then at the distal pulse points in the wrist, posterior tibial area and foot. Loss of distal pulse may indicate shock or constriction of an extremity. Disability – Assess the patient’s level of consciousness and ability to function before attempting to move or transfer them. Expose – Remove burned clothing from burned areas of the patient’s body and thoroughly examine the skin beneath.  
Lippincott Williams & Wilkins
over 8 years ago
Foo20151013 2023 y4lule?1444774066
1
2722

Staying Active with Diabetes

Many know that engaging in regular physical activity and exercise will tremendously improve one’s health and overall well-being. This goes the same, if not tenfold, for individuals suffering with diabetes. However, before rushing in a high intensity or physically straining physical régime, consult with your diabetes care provider. Make sure to discuss your plans take note of any precautions that may be needed to be made prior or during these activities. It will be interesting to know that individuals with type 2 diabetes who do participate in some exercise (even at work) reduce their risk for heart disease. Remember that a physical examination that focuses on the signs and symptoms of diseases affecting the heart and blood vessels, eyes, feet, nervous system, and kidneys must be made in advance before any extensive work out plan takes into action. Any strenuous strength training or high-impact exercise is generally not recommended for people with uncontrolled diabetes. Such strain caused by these exercises can weaken blood vessels in the eyes of patients who suffer from the common diabetic complication known as retinopathy. High-impact exercise can also injure blood vessels in the feet. In fact, diabetes can contribute to foot problems in several ways: diabetic neuropathy; which is a nerve disorder that causes numbing and pain in the hands, legs and feet as well as damage to internal organs; also poor circulation to the feet is another problem that can be associated due to diabetes. Keeping this in mind it is imperative to keeping your feet healthy, investing in some great therapeutic footwear like these can be a great step in moving toward healthy feet! One thing is for sure, physical activity can increase the health in anyone’s life. Always make sure to take care of your body and take the extra precautions needed in order to maintain proper health.  
Camille Mitchell
over 8 years ago
Foo20151013 2023 w5wmg1?1444774074
16
742

Exam Survival Guide

1. Sleep (I realize I’m posting this at 12:30 am…) (http://www.helpguide.org/life/sleep_tips.htm) I know there’s a popular perception of sleep deprivation going hand in hand with working hard or succeeding academically. However, that is only true if you’re working very last minute, and don’t care about retaining the information–you basically just want to get through your upcoming test/assignment. I would like to clarify that, although learning about 10 months of material in 2 weeks is overwhelming, it is NOT last minute because whatever you’re working on right now, you’ll have to remember in 2 weeks for your exam. Besides the exam, if you’re studying medicine, you need to remember most of these things for the rest of your life. In order to retain that information, you need to stay alert, well rested and motivated. Prolonged sleep deprivation can make you feel very ‘CBA’ very fast. 2. Stay Energized Sleep is only one factor in staying motivated and alert; another is staying energized¬–in a healthy way. Simply put: if you feel well, you’ll work well. Eat well: difficult, I know, when you’ve got so little time to spare; but as much as you can, try to eat more whole foods (aka things that don’t come in wrappers or have their own commercial) and keep a balanced diet (too much of anything is usually not good). Everyone snacks while they’re doing exams, but try to find a vice that won’t put you in a sugar coma (some good examples include berries and other fruits, nuts, carrots with hummus to dip in, granola bars, etc). Note: drinking tea is also an excellent way to stay energized! Stay active: Again, I know something like this is difficult to keep up in normal everyday life, let alone during exam stress. Even if it is just for 15-20 minutes, some cardio (note: the more strenuous the workout in a short period of time, the more benefit you’ll get) is a fantastic ‘eye-opener’ (I learned that phrase while learning how to take an alcohol history and now I really like it)! No one wants to go for a run in the morning, but after you get past the first 2-3 minutes of wanting to collapse, your body starts to feel really grateful. This is the BEST way to stimulate your senses and wake yourself up. I promise it’s better than any energy drink or cup of coffee you could have. Take small breaks: SMALL breaks!!! About 10 minutes. Every once in a while, you need to get up and walk around to give yourself a break, have some fresh air, grab a snack, but try not to get carried away; try to avoid having a short attention span. 3. Make Lists I cannot stress enough how counterproductive it is to overwhelm yourself with the amount of work you have. Whether you think about it or not, that pile is not going anywhere. Thinking about it won’t wish it away. Stop psyching yourself out and just get on with it– step by step. Making a list of objectives you need to accomplish that day or week is a great way to start; then, cross them out as you go along (such a satisfying feeling). Being able to visualize your progress will be a great motivator. Remember: it is important to be systematic with your studying approach; if you jump around between modules because they’re boring you’re just going to confuse yourself and make it hard to remember things when that exam comes Note: I have a white board in my room where I write my objectives for the week. Some days it motivates, some days it I want to throw it out the window (but I can't reach the latch)… 4. Practice Questions Practice questions are excellent for monitoring your progress; they’re also excellent at scaring you. Do not fear! This is a good thing, because now you know what you’re missing, go back and read up on what you forgot to take a look at, and come back and do the questions later. Then give yourself a sticker for getting it right ? Practice questions are also great for last minute studying too because they can help you do what I call “backwards studying”–which is what I just described: figuring out what you need to learn based on what the questions look like. 5. Be realistic Set realistic goals for yourself; most importantly, set realistic daily goals for yourself so that when you get all or most or even some of them done you can go to sleep with a level of satisfaction. Also, you need to pick your battles. Example: if you suck at neuro, then one module’s loss is another’s gain. Don’t spend too much time trying to get through one thing, just keep moving forward, and come back to it later 6. ‘Do not disturb’ Facebook, twitter, instagram, youtube, whatsapp, texting, pinterest, meme websites, so many fantastic ways to kill your time… Do yourself a favor, save them for your breaks. If someone is dying or on fire, they will most likely call you, not text you or write on your wall; you do not need to check your phone that often unless you're expecting something time sensitive. 7.Don’t Compare Everyone studying in your program is going to be stressed about things; do NOT let it rub off on you. You know those moments when you hear a peer or a prof/tutor describing something you have never even heard of, then you start panicking? Yeah, don’t do that. It happens to everyone. Instead of worrying so much, just go read about it! Simple solution right? What else are you going to do? Plus, a lot of the time other students seem to know more than they need to about certain things (which I can tell you right now, doesn’t always mean they’re doing better than you; knowing random, very specific factoids doesn’t mean they can bring it in clinic. Everyone can pull a Hermione and know a book inside out, but this is not necessarily the hallmark of a good doctor), what’s it to you? Worry about yourself, be confident in your abilities, and don’t trouble yourself with comparing to other people 8.Practice for Practicals Everyone is afraid of practical exams, like the OSCE (at any rest station you're likely to find me with my head in my hands trying to stabilize my breathing pattern and trying not to cry). The best way to be ready is to practice and practice and practice and practice. It’s like learning to drive a car. At first you’re too aware of your foot on the gas, the position of your hand on the wheel, etc; but, after driving for a little while, these things become subconscious. In the same way, when you walk into a station, you could be so worried about how you’ll do your introduction and gain consent, and remembering to wash your hands, and getting equipment and and and and and; the anxiety affects your confidence and your competence. If you practice enough, then no matter what they throw at you, you will get most of the points because the process will be second nature to you. Practice on your roommates, friends, family members, patients with a doctor's help...when appropriate... Even your stuffed animals if you're really desperate. DO NOT leave practicing for these practicals to the last minute; and if you do, make sure you go through every thing over and over again until you’re explaining examinations in your sleep. NOTE: When I'm practicing for OSCE alone, I record myself over and over again and play it back to myself and criticize it, and then practice againn. 9.Consistency You don’t necessarily have to study in the same place every day; however, it is always good to have some level of routine. Some examples include: waking up/sleeping at the same time everyday, going for a run at the same time every day, having the same study routine, etc. Repetition is a good way to keep your brain focused on new activities because, like I said before, the more you repeat things, the more they become second nature to you. Hope these tips are of some use to you; if not, feel free to sound off in the comments some alternate ways to get through exams. Remember that while exams are stressful, this is the time where you build your character and find out what you’re truly capable of. When you drop your pen after that final exam, you want to feel satisfied and relieved, not regretful. Happy Studying ?  
Mary
over 8 years ago
Foo20151013 2023 1nuvntv?1444774080
2
891

Obesity Part 1 – Fat Kid in a Fat Society

Introduction to Obesity One of my favourite past-times is to sit in a bar, restaurant, café or coffee shop and people watch. I am sure many of you reading this also enjoying doing this too. People are fascinating and it is intriguing to observe: what they do; how they act; what they wear and what they look like. My family and I have always observed those around us and discussed interesting points about others that we have noticed. When I first came up to visit Birmingham University my family all sat in a coffee shop in the centre of Birmingham and noticed that on average the people walking past us looked much slimmer than what we were used to seeing back in south Wales. Now, when I go home it is more painfully obvious than ever that the people in my home region are much, much heavier than they should be and are noticeably bigger than they used to be even a short number of years ago. This change in the population around me is what first made me seriously think about obesity, as a major problem affecting the world today. Nowadays obesity is all around us! It is noticeable, it is spreading and it should worry us all. Not just for our own individual health but also for the health of our society. Obesity affects everything from the social dynamic of families, to relationships at school or work, to how much the NHS costs to run. Obesity is a massive problem and if we as a society don’t start getting to grips with it, then it will have huge implications for all of us! I am currently in my 5th year at medical school. While I have been here I have taken a keen interest in obesity. The physiology, the psychology, the anatomy, the statistics and the wider affects on society of obesity have all been covered in curriculum lectures and extra curriculum lectures. I have taken part in additional modules on these subjects and sort out many experts in this field while on hospital placements. Obesity is fascinating for some many reasons and I thought that it would be a great topic to write some blogs about and hopefully start some discussions. Warning For my first blog on the topic of obesity I quickly want to write a bit about myself and my battle with weight. Everyone’s favourite topic is themselves, but I like to think that’s not why I have written this and I hope it doesn’t come across as a narcissistic ramble. I don’t intend to try and make myself come off well or suggest that I have all the answers (because I know very well that I don’t) and I hope it doesn’t come across like that. I want to write a bit of an autobiography because I wish to demonstrate how easy it is to go from a chunky kid to a technically obese teenager to a relatively fat adult without really realising what was happening. Chunky Child to Fat adult While planning this blog I realised that my Meducation profile picture was taken when I was at my all time fattest. At the graduation ceremony at the end of my 3rd year at university after completing my intercalation I was over 19 stones. At 6 foot 2” this gave me a BMI of >33 which is clinically obese. I had a neck circumference of >18”, a chest circumference of 48”, a waist of >40”, a seat of >52” and a thigh circumference of >28” per leg. Why do I know all of these rather obscure measurements? Partly because I am quite obsessive but mainly because I had to go to buy a tailor made suit because I could no longer buy a suit from a shop that I could fit into and still be able to move in. The only options left to me where massive black tent-suits or to go to a tailors. After the graduation I sat down at my computer (whilst eating a block of cheese) and compared my face from the graduation photos to pictures I had taken at the start of university and the difference in shape and size was amazingly obvious. I had got fat! I realised that if I had a patient who was my age and looked like me with my measurements then I would tell him to lose weight for the good of his health. So, I decided that finally enough was enough and I that I should do something about it. Before I describe how I got on with the weight management I will quickly tell the back story of how I came to be this size. I have always been a big guy. I come from a big family. I have big bones. I had “puppy fat”. I was surrounded by people who ate too much, ate rubbish and were over weight themselves, so I didn’t always feel that there was anything wrong with carrying a bit of tub around the middle. When I went to comprehensive school at age 12 I had a 36” waist. I thought I carried the weight quite well because I was always tall and had big ribs I could sort of hide the soft belly. Soon after arriving at the new school I had put on more weight and for the first time in my life I started to get bullied for being fat! And I didn’t like it. It made me really self-aware and knocked my confidence. Luckily, we started being taught rugby in PE lessons and I soon found that being bigger, heavier and stronger than everyone else was a massive advantage. I soon got my own back on the bullies… there is nowhere to hide on a rugby field! This helped me gain my confidence and I realised that the only way to stop the bullying was to confront the bullies and to remake myself in such a way as that they would be unable to bully me. I decided to take up rugby and to start getting fit. I joined a local club, starting playing regularly, joined a gym and was soon looking less tubby. Reflecting (good medical jargon, check) on my life now I can see that my PE teachers saved me. By getting me hooked on rugby they helped get me into many other sports and physical activity in general and without their initial support I think my life would have gone very differently. Rugby was my saviour and also later on a bit of a curse. As I grew up I got bigger and bigger but also sportier. I started putting muscle on my shoulders, chest and legs which I was convinced hid how fat I actually was. I developed a body shape that was large but solid. I was convinced that although I was still carrying lots of excess weight I no longer looked tubby-fat. When I was 14 my PE teachers introduced me to athletics. They soon realised that I was built for shot putt and discuss throwing and after some initial success at small school competitions I joined a club and took it up seriously. At this age I had a waist of about 38” but was doing about 3-4 hours of exercise almost everyday, what with rugby, running, gym, swimming and athletics – in and out of school. My weight had by now increased to roughly 15 stones and my BMI was over 30. I was physically fit and succeeding at sport but still carrying quite a lot of fat. I no longer thought of myself as fat but I knew that other people did. Between the ages of 14 and 18 I started to be picked for regional teams in rugby and for international athletic competitions for Wales. My sporting career was going very well but the downside of this was that I was doing sports that benefited from me being heavier. So the better I got the heavier I wanted to become. I got to the stage where I was eating almost every hour and doing my best to put on weight. At the time I thought that I was putting on muscle and being a huge, toned sports machine. It took me a while to realise that actually my muscles weren't getting any bigger but my waist was! By the time I had completed my A-levels I was for the first time over 18 stones and had a waste of nearly 40”. So, at this point I was doing everything that I had been told that would make me more adapted for my sport and I was succeeding but without noticing it I was actually putting on lots of useless excess weight that in the long term was not good for me! During my first year of university I gave up athletics and decided that I no longer needed to be as heavy for my sports. This decision combined with living away from home, cooking for myself and walking over an hour a day to and from Uni soon began to bear fruit. By the summer of my first year at Uni, aged 19, I had for the first time in my life managed to control my weight. When I came to Uni I was 18 stone. After that first year I was down to 14 stone – a weight I had not been since I was 14 years old! I had played rugby for the Medical school during my first year but as a 2nd row/back row substitute. These positions needed me to be fit and not necessarily all that heavy and this helped me lose the weight. During my second year I began to start as a 2nd row and was soon asked to help out in the front row. I enjoyed playing these positions and again realised that I was pretty good at it and that extra weight would make me even better. So between 2nd year and the end of 3rd year I had put on nearly 5 stone in weight and this put me back to where I started at my graduation at the end of 3rd year. The ironic and sad thing is about all this that the fatter, less “good looking” and unhealthier I became, the better I was adapted for the sports I had chosen. It had never occurred to me that being good at competitive sports might actually be bad for my health. The Change and life lessons learnt At the beginning of my 4th year I had realised that I was fatter than I should be and had started to pick up a number of niggly injuries from playing these tough, body destroying positions in rugby. I decided that I would start to take the rugby less seriously and aim to stay fit and healthy rather than be good at a competitive sport. With this new attitude to life I resolved to lose weight. Over the course of the year there were a number of ups and downs. I firstly went back to all the men’s health magazines that I had stock piled over the years and started to work out where I was going wrong with my health. After a little investigation it became apparent that going running and working out in the gym was not enough to become healthy. If you want to be slim and healthy then your diet is far more important than what physical activity you do. My diet used to be almost entirely based on red meat and carbs: steak, mince, bacon, rice and pasta. Over the year I changed my diet to involve far more vegetables, more fibre, more fruit, more salad and way less meat! The result was that by Christmas 2012 I was finally back below 18 stones. The diet had started to have benefits. Then came exams! By the end of exams in April 2013 I had gone back up 19 stones and a waist of >40”. I was still spending nearly 2 hours a day doing weights in the gym and running or cycling 3 times a week. Even with all this exercise and a new self- awareness of my size, a terrible diet over the 3 week exam period had meant that I gained a lot of fat. After exams I went travelling in China for 3 weeks. While I was there I ate only local food and lots of coffee. Did not each lunch and was walking around exploring for over 6 hours a day. When I got back I was 17.5 stone, about 106kg. My waist had shrunk back down to 36” and I could fit into clothes I had not worn in years. This sudden weight loss was not explained by traveller’s diarrhoea or any increased activity above normal. What made me lose weight was eating a fairly healthy diet and eating far less calories than I normally would. I know this sounds like common sense but I had always read and believed that if you exercised enough then you could lose weight without having to decrease your calorie intake too much. I have always hated the sensation of being hungry and have always eaten regular to avoid this awful gnawing sensation. I had almost become hunger-phobic, always eating when given the opportunity just in case I might feel hungry later and not because I actually needed to eat. The time in China made me realise that actually I don’t NEED to eat that regularly and I don’t NEED to eat that much. I can survive perfectly ably without regular sustenance and have more than enough fat stores to live my life fully without needing to each too much. My eating had just become a habit, a WANT and completely unnecessary. After being home for a month I have had some ups and downs trying to put my new plans into action. Not eating works really easily in a foreign country, where it’s hot, you are busy and you don’t have a house full of food or relatives that want to feed you. I have managed to maintain my weight around 17.5 stones and kept my waist within 36” trousers. I am counting that as a success so far. The plan from now on is to get my weight down to under 16.5 stones because I believe that as this weight I will not be carrying too much excess weight and my BMI will be as close to “not obese” as it is likely to get without going on a starvation diet. I intend to achieve this goal by maintain my level of physical activity – at least 6 hours of gym work a week, 2 cardio sessions, tennis, squash, cycling, swimming and golf as the whim takes me. BUT MORE IMPORTANTLY, I intend to survive off far fewer calories with a diet based on bran flakes, salad, fruit, nuts, chicken and milk. I am hoping that this very simple plan will work! Conclusion Writing this short(-ish) autobiography was quite cathartic and I would really recommend it for other people who are trying to remake themselves. Its helped me put my thoughts in order. Over the years I wanted to lose weight because I wanted to look better. This desire has now matured into a drive to be not just slimmer but healthier; I no longer want to be slimmer just for the looks but also to reduce the pressure on my joints, to reduce the pressure on my cardiovascular system, to reduce my risks of being fat when I am older, to hopefully reduce the risk of dying prematurely and to some extent to make life cheaper – eating loads of meat to prevent hunger is expensive! I hope this blog has been mildly interesting, but also informative of just how easy it is for even a health conscious, sporty individual to become fat in our society. I also wanted to document how difficult it is to lose weight and maintain that new lower weight for any prolonged length of time. At some point I would like to do a blog on the best methods for weight loss but that may have to wait until I have found what works for me and if I do actually manage to achieve my goals. Would be a bit hypercritical to write such a blog while still having a BMI yo-yoing around 32 I feel! Thought for the day 1 - Gaining wait is easy, becoming fat is easy, losing fat is also technically easy! The hard part is developing AND then maintaining a healthy mental attitude towards your weight. The human body has evolved to survive starvation. We are almost perfectly made to build up high density fat stores just in case next year’s crops fail and we have to go a few months on broth. I will say it again – We are designed to survive hard conditions! The problem with the modern world and with modern society is that we no longer have to fight to survive. For the first time in human history food is no longer scarce… it is in fact incredibly abundant and cheap (http://www.youtube.com/watch?v=-Z74og9HbTM). It is no surprise that when a human body is allowed to eat want and how much it craves and then do as little activity as possible, that it puts on fat very quickly. This has to be one of the major ironies of our age – When the human race has evolved society enough that we no longer need to have fat stores in case of disaster, that we are now the fattest humans have ever been! 2 – The best bit of advice I was ever given is this: “Diets ALWAYS fail! No matter what the diet or how determined you are, if you diet then within 2 years you will be the same weight or heavier than you are now. The only way to a healthy body is through a healthy LIFESTYLE CHANGE! You have to make changes that you are prepared to keep for a long time.”  
jacob matthews
over 8 years ago
Foo20151013 2023 gvoh9v?1444774222
2
317

Socks, Kiwis and Surgical Removal

I’m a klutz. Always have been. Probably always will be. I blame my clumsiness on the fact that I didn’t crawl. Apparently I was sitting around one day and toddling on two feet the next. Whatever the cause, it’s a well-tested fact that I’m not good on icy footpaths. Various parts of my anatomy have gotten up close and personal with frozen ground on many an occasion. Not usually an issue for a born-and-bred Australian, except when said Australian goes to visit her Canadian family during the northern winter. During one such visit, I found myself unceremoniously plopped onto slick ice while my two-year-old niece frolicked around me with sure-footed abandon. I thought, “There has to be an easier way.” As freezing water seeped through my jeans, providing a useful cold pack for my screaming coccyx, my memory was jogged. I recalled that a lateral-thinking group of New Zealand researchers had won the Ignoble Prize for Physics for demonstrating that wearing socks on the outsides of shoes reduces the incidence of falls on icy footpaths. To the amusement of my niece, I tried out the theory for myself on the walk home. I don’t know if I had a more secure foothold or not, but I did manage to get blisters from wearing sneakers without socks. I love socks. They cover my large, ungainly clod-hoppers and keep my toes toasty warm almost all year round. You know the song ‘You can leave your hat on.’? Well for me, it is more a case of ‘You can leave your socks on, especially in winter. There’s nothing unromantic about that… is there? I’m not, however, as attached to my socks as a patient I once treated. As an intern doing a psychiatry rotation, one of my tasks was to do physical examinations on all admissions. Being a dot-the-i’s kinda girl, when an old homeless man declined to remove his socks so that I could examine his feet, I didn’t let it slide. “I haven’t taken off my socks for thirty years,” he pronounced. “It can’t be that long. Your socks aren’t thirty years old. In fact, they look quite new,” I countered. “When the old ones wear out, I just slip a new pair over the top.” I didn’t believe him. From his odour, I would have believed that he hadn’t showered in thirty years, but the sock story didn’t add up. He eventually agreed to let me take them off. The top two sock layers weren’t a problem but then I ran into trouble. Black remains of what used to be socks clung firmly to his feet, and my gentle attempts at their removal resulted in screams of agony. I tried soaking his feet. Still no luck. His skin had grown up into the fibres, and it was impossible to extract the old sock remnants without ripping off skin. In retrospect I probably should have left the old man alone, but instead got the psych registrar to have a peek, who then involved the emergency registrar, who called the surgeon and soon enough the patient and his socks were off to theatre. The ‘surgical removal of socks’ was not a commonly performed procedure, and it provided much staff amusement. It wasn’t so funny for Mr. Sock Man, who required several skin grafts! From my perspective here in Canada, while I thoroughly commend the Kiwis for their ground-breaking sock research, I think I’ll stick to the more traditional socks-in-shoes approach, change my socks regularly and work a bit on my coordination skills. References: PHYSICS PRIZE: Lianne Parkin, Sheila Williams, and Patricia Priest of the University of Otago, New Zealand, for demonstrating that, on icy footpaths in wintertime, people slip and fall less often if they wear socks on the outside of their shoes. "Preventing Winter Falls: A Randomised Controlled Trial of a Novel Intervention," Lianne Parkin, Sheila Williams, and Patricia Priest, New Zealand Medical Journal. vol. 122, no, 1298, July 3, 2009, pp. 31-8. (This blog post has been adapted from a column first published in Australian Doctor http://www.australiandoctor.com.au/articles/58/0c06f058.asp) Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
almost 8 years ago
Foo20151013 2023 3cqojv?1444774240
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102

Goodbye fear and ego, hello better patient care

The best doctors in the world still have bad consultation. Sometimes you just start off on the wrong foot. The patient leaving in a floor of tears is usually an indication that this has just occurred. On one of my medical placements I witnessed one such consultation. A young woman in the early stages of her pregnancy had a per vaginal bleed and wanted a scan to see if the pregnancy was still ok. Medically speaking, a scan wasn’t indicated as the pregnancy was too early on to detect any changes. The doctors noted the “agenda” as they later remarked, and was not going to “play the game” and send the young woman for a scan. She was not happy about this. The doctor felt that he couldn’t have done more. Medically there was nothing he could offer to the woman other than advice to go home and wait a little while before repeating a pregnancy test. To me, there was lots that could have been done. This woman was scared and worried and a sympathetic ear and a tissue would have gone some way to making her feel better. The doctor I was with couldn’t see this. They were blind sighted by the repeated requests for a scan and slightly frustrated that the unhelpfulness of this was not being understood. When the young woman began to cry I was waiting for the doctor to hand over a tissue. “Any second now...” I thought, but it never happened. I wanted to give the woman a tissue and put my arm around her but that would have meant physically placing myself between the doctor and the patients and interrupting a consultation I wasn’t really a part of. But the truth is. I was a part of that consultation. I might not have been the doctor in charge but I was another person in that room who could have made that situation easier for that patient and I didn’t. Hours later, on my way home, I was still thinking about this. I felt I had let that woman down. I could see what she needed and I sat there and did nothing. After the consultation I immediately told the doctor what I thought. I felt that the patient had been let down. They took on what I said and mostly agreed with it. All egos were put aside in that frank conversation and the doctor genuinely reflected on how they could have done better in that situation. It wasn’t about me or the doctor. It was about the patient. As a medical student it is easy to feel in the way in the hospital environment or in a busy clinic. When the consultant is running behind, it takes a lot to ask the patients something or butt in and add something you think is relevant that in the end may turn out to be a very trivial thing. But at the end of the day, it is worth it if it means that there is a better out come for the patient because when all is said and done they are the ones we are doing this all for. I regret not handing that patient a tissue and it’s a mistake I hope never to repeat again.  
Salma Aslam
over 7 years ago
Foo20151013 2023 vvr5q9?1444774253
5
193

Clinics - Making the most of it

Commencing the first clinical year is a milestone. Things will now be different as your student career steers straight into the unchartered waters of clinical medicine. New challenges and responsibilities lie ahead and not just in an academic sense. After all this is the awaited moment, the start of the apprenticeship you have so desired and laboured for. It won’t be long before these clinical years like the preclinical years before them, will seem just as distant and insular, so why not make the most of it? The first days hold so much excitation and promise and for many they deliver, however, it would be wise not to be too optimistic. I am afraid your firm head standing abreast the doors in a prophetic splaying of arms is an unlikely sight. In this new clinical environment, it is natural to be a little flummoxed. The quizzical looks of doctors and nurses as you first walk in, a sure sign of your unexpected arrival, is a recurring theme. If the wards are going to be your new hunting ground, proper introductions with the medical team are in order. This might seem like a task of Herculean proportions, particularly in large teaching hospitals. Everyone is busy. Junior doctors scuttling around the ward desks job lists in hand, the registrar probably won’t have noticed you and as luck would have it your consultant firm head is away at a conference. Perseverance during these periods of frustration is a rewarding quality. Winning over the junior doctors with some keenness will help you no end. What I mean to say is that their role in our learning as students extends further than the security of sign-off signatures a week before the end of the rotation. They will give you opportunities. Take them! Although it never feels like it at the time, being a medical student does afford some privileges. The student badge clipped to your new clinic clothes is a license to learn: to embark on undying streaks of false answers, to fail as many skills and clerkings as is required and to do so unabashed. Unfortunately, the junior doctors are not there purely for your benefit, they cannot always spare the time to directly observe a history taking or an examination, instead you must report back. With practice this becomes more of a tick box exercise: gleaning as much information and then reconfiguring it into a structured presentation. However, the performance goes unseen and unheard. I do not need to iterate the inherent dangers of this practice. Possible solutions? Well receiving immediate feedback is more obtainable on GP visits or at outpatient clinics. They provide many opportunities to test your questioning style and bedside manner. Performing under scrutiny recreates OSCE conditions. Due to time pressure and no doubt the diagnostic cogs running overtime, it is fatefully easy to miss emotional cues or derail a conversation in a way which would be deemed insensitive. Often it occurs subconsciously so take full advantage of a GP or a fellow firm mate’s presence when taking a history. Self-directed learning will take on new meaning. The expanse of clinical knowledge has a vertiginous effect. No longer is there a structured timetable of lectures as a guide; for the most part you are alone. Teaching will become a valued commodity, so no matter how sincere the promises, do not rest until the calendars are out and a mutually agreed time is settled. I would not encourage ambuscaded attacks on staff but taking the initiative to arrange dedicated tutorial time with your superiors is best started early. Consigning oneself to the library and ploughing through books might appear the obvious remedy, it has proven effective for the last 2-3 years after all. But unfortunately it can not all be learnt with bookwork. Whether it is taking a psychiatric history, venipuncture or reading a chest X-ray, these are perishable skills and only repeated and refined practice will make them become second nature. Balancing studying with time on the wards is a challenge. Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book. Keeping it varied will prevent staleness taking hold. Attending a different clinic, brushing up on some pathology at a post-mortem or group study sessions adds flavour to the daily routine. During the heated weeks before OSCEs, group study becomes very attractive. While it does cement clinical skills, do not be fooled. Your colleagues tend not to share the same examination findings you would encounter on an oncology ward nor the measured responses of professional patient actors. So ward time is important but little exposure to all this clinical information will be gained by assuming a watchful presence. Attending every ward round, while a laudable achievement, will not secure the knowledge. Senior members of the team operate on another plane. It is a dazzling display of speed whenever a monster list of patients comes gushing out the printer. Before you have even registered each patient’s problem(s), the management plan has been dictated and written down. There is little else to do but feed off scraps of information drawn from the junior doctors on the journey to the next bed. Of course there will be lulls, when the pace falls off and there is ample time to digest a history. Although it is comforting to have the medical notes to check your findings once the round is over, it does diminish any element of mystery. The moment a patient enters the hospital is the best time to cross paths. At this point all the work is before the medical team, your initial guesses might be as good as anyone else’s. Visiting A&E of your own accord or as part of your medical team’s on call rota is well worth the effort. Being handed the initial A&E clerking and gingerly drawing back the curtain incur a chilling sense of responsibility. Embrace it, it will solidify not only clerking skills but also put into practice the explaining of investigations or results as well as treatment options. If you are feeling keen you could present to the consultant on post-take. Experiences like this become etched in your memory because of their proactive approach. You begin to remember conditions associated with patient cases you have seen before rather than their corresponding pages in the Oxford handbook. And there is something about the small thank you by the F1 or perhaps finding your name alongside theirs on the new patient list the following morning, which rekindles your enthusiasm. To be considered part of the medical team is the ideal position and a comforting thought. Good luck. This blog post is a reproduction of an article published in the Medical Student Newspaper, Freshers 2013 issue.  
James Wong
over 7 years ago
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2
138

A Modest Man

The registrar's face was taking on a testy look. So enduring was the silence our furtive glances had developed a nystagmic quality. “Galactosaemia” came her peremptory reply. Right on queue the disjointed chorus of ahs and head nods did little to hide our mental whiteboard of differentials being wiped clean. At the time conjugated bilirubinaemia in children only meant one thing: biliary atresia. A fair assumption; we were sitting in one of three specialist centres in the country equipped to treat these patients. Ironically the condition has become the unwieldy yardstick I now measure the incidence of paediatric disease. Biliary atresia is the most common surgical cause of neonatal jaundice with a reported incidence of 1 in 14-16ooo live births in the West. It is described as a progressive inflammatory obliteration of the extrahapatic bile duct. And Dr Charles West, the founder of Great Ormond Street Hospital, offers an eloquent description of the presenting triad of prolonged jaundice, pale acholic stools and dark yellow urine: ‘Case 18...It was born at full term, though small, apparently healthy. At 3 days however, it began to get yellow and at the end of 3 weeks was very yellow. Her motions at no time after the second day appeared natural on examination, but were white, like cream, and her urine was very high coloured.’ 1855 was the year of Dr West's hospital note. An almost universally fatal diagnosis and it would remain so for the next 100 years. The time's primordial classification of biliary atresia afforded children with the 'noncorrectable' type, a complete absence of patent extrahepatic bile duct, an unfortunate label; they were beyond saving. Having discovered the extent of disease at laparatomy, the surgeons would normally close the wound. The venerable Harvardian surgeon, Robert E. Gross saved an enigmatic observation: “In most instances death followed a downhill course…” K-A-S-A-I read the ward’s board. It was scrawled under half the children's names. I dismissed it as just another devilishly hard acronym to forget. The thought of an eponymous procedure had escaped me and in biliary atresia circles, it's the name everyone should know: Dr Morio Kasai. Originating from Aomori prefecture, Honshu, Japan, Dr Kasai graduated from the National Tohoku University School of Medicine in 1947. His ascension was rapid, having joined the 2nd department of Surgery as a general surgeon, he would assume the role of Assistant Professor in 1953. The department, under the tenure of Professor Shigetsugu Katsura, shared a healthy interest in research. 1955 was the landmark year. Katsura and Kasai operated on their first case: a 72 day old infant. Due to bleeding at the incised porta hepatis, Katsura is said to have 'placed' the duodenum over the site in order to staunch the flow. She made a spectacular postoperative recovery, the jaundice had faded and there was bile pigment in her stool. During the second case, Katsura elected to join the unopened duodenum to the porta hepatis. Sadly the patient's jaundice did not recover, but the post-mortem conducted by Kasai confirmed the development of a spontaneous internal biliary fistula connecting the internal hepatic ducts to the duodenum. Histological inspection of removed extrahepatic duct showed the existence of microscopic biliary channels, hundreds of microns in diameter. Kasai made a pivotal assertion: the transection of the fibrous cord of the obliterated duct must contain these channels before anastomosis with the jejunal limb Roux-en-Y loop. This would ensure communication between the porta hepatis and the intrahepatic biliary system. The operation, entitled hepatic portoenterostomy, was first performed as a planned procedure for the third case at Tohoku. Bile flow was restored and Kasai published the details of the new technique in the Japanese journal Shujutsu in 1959. However, news of this development did not dawn on the West until 1968 in the Journal of Pediatric Surgery. The success of the operation and its refined iterations were eventually recognized and adopted in the 1970s. The operation was and is not without its dangers. Cholangitis, portal hypertension, malnutrition and hepatopulmonary syndrome are the cardinal complications. While diagnosing and operating early (<8 weeks) are essential to the outcome, antibiotic prophylaxis and nutritional support are invaluable prognostic factors. Post operatively, the early clearance of jaundice (within 3 months) and absence of liver cirrhosis on biopsy, are promising signs. At UK centres the survival after a successful procedure is 80%. The concurrent development of liver transplantation boosts this percentage to 90%. Among children, biliary atresia is the commonest indication for transplantation; by five years post-Kasai, 45% will have undergone the procedure. On the 6th December 2008, Dr Kasai passed away. He was 86 years old and had been battling the complications of a stroke he suffered in 1999. His contemporaries and disciples paint a humble and colourful character. A keen skier and mountaineer, Dr Kasai lead the Tohoku University mountain-climbing team to the top of the Nyainquntanglha Mountains, the highest peaks of the Tibetan highlands. It was the first successful expedition of its kind in the world. He carried through this pioneering spirit into his professional life. Paediatric surgery was not a recognized specialty in Japan. By founding and chairing multiple associations including the Japanese Society of Pediatric Surgeons, Dr Kasai gave his specialty and biliary atresia, the attention it deserved. Despite numerous accolades of international acclaim for his contributions to paediatric surgery, Dr Kasai insisted his department refer to his operation as the hepatic portoenterostomy; the rest of the world paid its originator the respect of calling it the ‘Kasia’. Upon completion of their training, he would give each of his surgeons a hand-written form of the word ‘Soshin’ [simple mind], as he believed a modest surgeon was a good one. At 5 foot 2, Kasai cut a more diminutive figure one might expect for an Emeritus Professor and Hospital Director of a university hospital. During the course of his lifetime he had developed the procedure and lived to see its fruition. The Kasia remains the gold standard treatment for biliary atresia; it has been the shinning light for what Willis J. Potts called the darkest chapter in paediatric surgery. It earned Dr Kasai an affectionate but apt name among his peers, the small giant. References Miyano T. Morio Kasai, MD, 1922–2008. Pediatr Surg Int. 2009;25(4):307–308. Garcia A V, Cowles RA, Kato T, Hardy MA. Morio Kasai: a remarkable impact beyond the Kasai procedure. J Pediatr Surg. 2012;47(5):1023–1027. Mowat AP. Biliary atresia into the 21st century: A historical perspective. Hepatology. 1996;23(6):1693–1695. Ohi R. A history of the Kasai operation: Hepatic portoenterostomy for biliary atresia. World J Surg. 1988;12(6):871–874. Ohi R. Morio Kasai, MD 1922-2008. J Pediatr Surg. 2009;44(3):481–482. Lewis N, Millar A. Biliary atresia. Surg. 2007;25(7):291–294. This blog post is a reproduction of an article published in the Medical Student Newspaper, April 2014 issue.  
James Wong
over 7 years ago
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Feet: the foundation for fitness and health

Feet are a part of the anatomy many exercisers ignore while pounding the treadmill or honing a headstand, but fitness experts say they are the very foundation of physical well-being.  
reuters.com
over 6 years ago