Moving on..... and babies .... !!

Dear blog reader,

It has been a while since I wrote to you but here I am finally finding some time to share some thoughts. My realization this week was that life is all about relationships. And this does not mean physical or erotic relationships- it could be our relationship with absolutely everything e.g. our relationship with our work environment, my relationship with my laptop.... !!!!

As a result, this relationships are what drives our lives. These relationships is what makes us feel alive! This means we need to cherish and make the most of these relationships. We need to look after them, enrich them and make them better. In order to be in a relationship with something or someone you need to be able to understand the benefits of this relationship and also share something in order to maintain this relationship. For example, to maintain my relationship with my laptop I just need to keep using it day by day which I do so yay! My relationship is not going to give up on me! In our relationships with our friends it is rather different ( I hope you all recognise that or else something is wrong with you!). We need to make sure that we talk to our friends or make contact on a regular basis. We need to show them that we care for them and that we are interested in what they are doing in their lives. We need to rejoice in their success and not be jealous. If they are in trouble we need to stand by their side and support them, give them advice. If they are struggling, we should not abandon them- the main thing is to be by their side not only in times of need but even in times of happiness!

After some thinking I came to the conclusion that probably 'Friends are for life, whereas lovers are not'. I have recently experienced rejection in my personal relationships and that is something that hurts a lot and it just makes you question things. It is an experience that can be painful and you do suffer, but at the same time it makes you stronger as you hope you will not be doing the same mistake again. Althought, to be honest in relationships it is not as easy as you follow your heart and most of the times you act irrationally. You just get obsessed with a particular someone and even if they are ignoring you, you still hope and you pray they will change their ways and make a move or see you in a different light. If that does not happen, you get disappointed and then you wonder why you have spent so much time thinking about this person when you could just moved on and met new people that would probably be more interesting and could have been interested in you! Why do we do this?? Who knows? But then if you knew why everything happens in life , life would be rather boring!

So this week has been rather exciting! Before I get into the clinical side of things I woud like to get into the musical side of things! I have discovered a website that allows you to play latest hits and then encourages you to purchase them - but hey you can create your own playlists etc. Check it out: http://www.we7.com/#/playlists

Furthermore, I have discovered some artists that are worth listening to if you have not heard them before. These artists are mainly acoustic rock in the style of Jason Mraz and the like. One to definitely explore is the creator of 'Whisper Rock' . His name is Joshua Radin and he has some tracks worth listening to. Eric Hutchinson is amazing! His song 'Rock n Roll' is just pure genious and I really like his style! All these people are so young and fresh and they have so much to offer. I think that one day these names are going to have massive hits and get platinum albums etc. They totally deserve it! And last but not least make sure you check out this good-looking chap with the name of Justin Nozuka . What can I say! His music is brilliant as well! Wishing them all a great career!


I have just realised that if I do not write to you often I obviously end up with longer blogs! So much to talk about, so much to discuss. Yeah you have guessed right! This paragraph is going to be about babies! Well I have just finished my one week of paediatrics and I must say, I feel rather broody and want to have my own baby now! However, I do not see that happening in the near future- maybe in the distant? I do enjoy working with children but I had a bad experience at my previous paediatrics placement in 3rd year, which means I am still prejudiced and biased about paediatrics. I was not sure if I was going to enjoy it or not. Children are great to be around and play with when they are not ill. But when they are ill they are much more difficult to manage than adults! And also on top of that you have the stressed parent, who will expect you to know what you are doing because if you do not then it is not worth talking to you! Oh the joy of paediatrics!

Despite my negativity concerning the outcome of this week, I think the week overall went well and we managed to refresh our paeds knowledge. There were not as many children to clerk but in the end we learned about different conditions as we had some teaching by the SpR. One of the SpRs in particular was amazing as he spent so much time teaching us! It was unbelievable! I really appreciated his efforts ! He was great! However, since this was our last week in this placement I think I was not as enthusiastic as at the beginning of the placement! At the moment I am just thinking about the holidays and I cannot wait to lie by the beach and relax in the sun!!

However, there were some interesting cases that are worth mentioning. On the ward round the first day we saw this 6 year old with Asthma who was put on iv aminophylline and they were considering giving him iv magnesium. Magnesium is such a wonder drug! They seem to be using it for some different pathologies and it just makes you wonder how it works exactly but I do not think anyone knows to be honest with you! Apparently it is great for asthma, AF and generally cardiorespiratory conditions. For discharge this child would be having a steroid and a reliever inhaler. Inhalers come in different colours so - blue is the reliever (ventolin-salbutamol), brown is the steroid inhaler, green is salmeterol- a long acting b2 agonist and purple is a combination of a steroid and a bronchodilator. Also, if you do not want to put children on steroids, although apparently you still give them steroids in low doses so that decreases the risk of side effects significantly, you can give montelukast (a leukotriene receptor antagonist). Montelukast seems to work really well for children with asthma.

Appart from asthma the first day we received teaching on Bronchiolitis, Croup, Acute Epiglottitis, and the differentials of Croup. So when a child presents with upper airway obstruction the main differentials are : Acute Epiglottitis, Croup, Acute tracheitis, Retropharyngeal abscess, Foreign body swallowed causing obstruction. It is important in this case to exclude Acute Epiglottitis as it can be life threatening. The most common organism that causes this is Haemofilus Influenza b, but this is not as common today due to the Hib vaccination against this organism.

Also, the ward round to SCBU ('scabu')- Special Delivery Baby Unit! taught is important facts about neonatal medicine and saw some interesting cases of babies most of them pre-term presenting with Necrotising Enterocolitis (NEC), hydrocephalus, hypoglycaemia and pyrexia of unknown origin (PUO).

Also how to feel for an 'olive' mass and red currant jelly stools- a sign of intussusception. This is when one part of the bowel telescopes into the other and it can cause necrosis of the bowel of it is not managed as an emergency.

Baby checks where rather fun as we got to watch a video of how to do baby checks and I think the most challenging bit is testing for 'clicky' hips with the Ortolani's and Barlow's tests. The rest is pretty straightforward really - do it from head to toe and check for any scars, any spina bifida on the back, measure their heads, check for red reflex, measure their fingers and their toes, check their anus for any anal fissures, make sure their tummy is non-tender and soft and also check the genitalia.

It did make me feel rather broody I admit! It just felt like I would not mind having my own baby now- apart from the fact that it is such a long process to have a baby and they cry all the time! Apart from that they are the miracle of life-! They are a gift from above!

The 'loneliness' factor

Have you ever wondered how much time you spend all alone in a day? I guess this time figure varies for every single one of us. How much time do we need to be spending by ourselves in a day? Some people will argue I do not have enough time to myself..... I am always surrounded by people.. I need some space and privacy ... Others will say I spend so much time alone it is starting to get miserable ... I feel I have no friends... So is there an ideal time? Is there a middle way? If there is and you know it, please let me know too!!

Well, there are times when I can understand that I have had too much time to myself as I start eating without being hungry ... yeah I think you are right - it is called 'comfort eating!' ! I guess it is just boredom; you have nobody to talk to but you still want to move your mouth and exercise the mastication muscles (did you know when you talk they get toned??) so you eat instead. However, eating does make you pile on the pounds, whereas talking does not as only air goes down! SO better talk than EAT!




Another way to realise that you feel all alone, is when you are surrounded by a million people (like it happens to me when I am in London!) but you do not know anyone and you feel all alone and that even increases the feeling of loneliness.... Also, if you start having negative cognitions and start thinking everything is going wrong and life is not treating you well, then maybe what you need is to overcome your illness....

So how do you resolve this loneliness factor??

In my opinion, the only way to do it is to open yourself to people, talk to them, interact with them and just care for them. In the gospel of John, Jesus tells his disciples to love each other as He has loved them. So love everyone as God loves us and then you cannot go wrong. Life is all about relationships. We can help the homeless, the hungry, the rebels, the prostitutes, the lost but just engaging with them and building relationships with them. Everyone deserves to be loved, and anyone can be loved by us!

Today at church the pastor asked: So what is your relationship with God? How is your relationship with God going ?? People can say GOOD as I read my bible and I pray.. BUT do you actually practice what the Bible teaches in your daily life?? That is the most essential thing about being in a relationship with God. Practising what he taught us in our daily lives. He is not there only to be remembered on a Sunday. He is there for us every day and we need to communicate with him everyday. We also need to please Him with our actions every day by loving other people as He loves us and also by loving our neighbours as ourselves.

Traction!

Warning ! This is not top gear! This is traction in medical terms, something that actually equals pain! Today was another day in the Accident and Emergency Department for me. The day started smoothly as I saw a man with haematuria (blood in urine), who had a long term catheter due to a history of haematuria and retention eight years after his radical prostatectomy (diagnosed with low grade prostate cancer). He tried to drink in order to get clear sample (no blood) and dipstick his urine but that was not possible as the catheter bag was full of blood. Differentials of this case could be infection due to catheter, trauma (irritation) again due to catheter and there would be a need to exclude bladder cancer. As a result, doctors decided to do a blood test on him (FBC and U&Es). I attempted to take blood off him but I was not successful in my attempts. Another 5 people tried and it seems that he was a difficult candidate unfortunately. In the end, after a lot of stabbing they managed to get blood off him. Around this time I was off to see someone else, so not sure what happened to him and how they managed him exactly which is a shame. However, I had a read about haematuria and that was very interesting. There are so many causes for it. I think the most sinister cause is bladder carcinoma, however it is wise to think of it as macroscopic and microscopic and think possible causes for both types of haematuria. One thing I learned is that I will start associating it more with kidney stones, which are rather common. Apparently food high in oxalates could be a reason for kidney stones. Foods high in oxalate include rhubarb, tea, spinach, nuts! Just goes off to show how diet is important in our lives and our physical health. Gout is another disease that is associated with foods high in purine which include beer (alcohol), yeast, meat, legumes, cauliflower etc. Gout is not a nice thing as I saw a man today with knee joint swelling that was causing him a lot of pain. The acute treatment of gout is NSAIDs such as naproxen or diclofenac. Before giving NSAIDs make sure you answer about allergies and also if there is risk of ulcers of some form. The long-term of preventitive treatment for gout is allopurinol.

N xt patient a little girl that fell on her hand whilst playing tennis. The x-ray showed a greenstick fracture so the management was to put it in plaster for 6 weeks until it heals. In this case it was important to examine neurovascularly - check if pulse present, check sensation, check power and tone - and also check for tendon rupture by testing for the different flexor tendons in the arm, specifically FDP and FDS etc. She was neurovascularly intact so there were no worries there. The only problem with having her arm in a cast was that she was meant to be flying in 3 weeks so she was advised not to do any swimming whilst on holiday and get a fitness certificate (fit to fly). Some airlines have been rather funny with allowing people in casts to fly which can be reasonable. However, the SpR said that she could fly but she would need to have the cast split before she flew out, which could be an option.

Another little lady had a similar fall and injury to the one above but her's was a Buckle / Torus fracture, which is still within the greenstick type of fractures, but it is more like a ring fracture.

Finally, the most exciting bit of the day was an 81 year old lady with a wrist injury. Xray showed Colle's type of fracture. There was definitely impaction and some displacement. The wrist looked very swollen and tender +sore on palpation. It was sore when flexing or extending the wrist. As a result they decided the only option for her since she was 4 days post injury was to do a haematoma block (local anaesthetic) and traction. I was mainly supporting her arm during traction and that required some effort! However, it was exciting as it was the first time I was taking part in something like this!! After traction, she had an xray to see if it all went back to place but I had to go before the xray was taken as it was late.

Today, this young guy,only 19 years of age, came in and had two of his fingers amputated by holding onto a swing. I got to take history from him and then the SpR got to clean the injury site. He was in a lot of pain but they gave him some morphine for the pain. Also, to clean it we had to do a digital block by using a short acting and a long acting anaesthetic (lidocaine + bupivacaine). Sometimes, adrenalin is used in combination with a local since it causes vasoconstriction and prevents excess bleeding, but in this case/scenario it was not appropriate apparently. After that it was decided that he was going to be referred to a hand surgeon for terminalisation. At that time I had my assesment from one of the SpRs and learned how to do a hand examination although I still need to practise a bit to perfect my technique! Another thing I need to practise is knee examination too!

Oh well, this was my last A and E day and I must say I did enjoy it! Next week it 's paediatrics so hold tight for a series of paediatrics coming up!

Ciao for now ....

Have an awesome weekend ...!

P.S Quote of the week: 'l

'Love is not what you want, it is what you are. It is very important to not get these two confused.'

Vanilla Capuccino .....

Sometimes little things in life can offer us momentarily happiness. Today for me it was my discovery for vanilla capuccino! What a great coffee it is! It is rather milky but has a great vanilla taste that definitely does the job for me. I have always nurtured a preference for French Vanilla Coffee (if you have not tried it yet, it is a MUST try coffee!), which I discovered when I was working in New Jersey, USA over the summer. I was really disappointed that I could not find it in the UK (not even in Starbucks!). For a few years I settled in the idea that I could live without French Vanilla -it was not going to be the end of the world afterall. However, I recently travelled to Montreal, where I had French Vanilla and my passion for this type of coffee was reawakened. I remember my Canadian friend taking me to Tim Hortons, a well known place there for breakfast stuff and of course coffee! Shame we do not have Tim Hortons in the UK! Although I think my Canadian friend was saying that she did manage to find a place in the UK where Tim Hortons exists but it is not that popular as you can realise.

However, Vanilla Capuccino is not the only thing that brings excitement to my life these days! This week is my A & E week so I have started doing shifts there since Monday. I was there only for a few hours and learned so much. I saw a few patients and then presented to one of the middle-grades there. One of the patients had been climbing in Borneo and he presented with swelling at his elbow, specifically at his olecranon process. He presented Saturday and they decided not to drain it but just give him iv Antibiotics and send him home. However, on Monday when I saw him the swelling and the redness had spread down and up the arm and seemed to be really tender, red and swollen. He associated this with a possible injury 10 days before his presentation but apart from that he was feeling well in himself. In the differentials it was important to consider septic arthritis and malaria due to the recent travelling history. To assess septic arthritis it would be good to ask about pain in other joints, any FHx of arthritis and also if the pain was superficial or more to the bone. Most of that was negative in this patient. Furthermore, to assess for malaria it is important to ask about any sweats or fevers, any nausea or vomiting which was not occuring in this patient. Since this patient was previously treated with iv antibiotics specifically benzypenicillin and flucloxacillin, it was important to receive some more aggressive treatment. As a result, it was decided that he should be admitted and receive further iv antibiotics and if he was not progressing or getting better then they would have to take him to theatre, make an incision and remove the fluid surrounding his olecranon process. The impression/diagnosis was that of olecranon bursitis.

The next patient had groin pain that was coming on at monthly intervals for a few hours and then dissolving on its own without even any pain relief. He also had symptoms of prostatism such as dysuria, frequency and problems passing water. His GP was treating him for prostatitis and he was on antibiotics for a month, specifically ciprofloxacin. However, after 2 weeks he decided to stop the antibiotics as he was getting some side effects such as swelling of his joints and leg aches from them. A previous PR had suggested that his prostate was also enlarged but the prostate was smooth (not bumpy) which can exclude malignancy. Furthermore, there was a trace of blood in his urine. This presentation could be associated with a renal colic which could be due to a stone so we asked him questions to see if he was taking a lot of oxalates in his diet to increase the risk of a stone formation. Food high in oxalates is rhubarb, spinach, nuts and chocolate. So this patient was sent for an xray to identify the presence of any stones or obstruction to the kidney and then for an IVU to detect any stones.

A &E minors was getting even busier and my next patient was a lady with DVT. She described having calf pain that was rather burning, 5/10 and lasted for a year. The GP suggested she goes to A and E as they were worried about the possibility of a DVT. However, this was not an acute situation since the pain was not acute onset but was there all the time. The main risk factors that need to be assessed for a DVT are: previous DVT/PE, post-op, long haul flights (more than 4 hrs) recently , long periods of immobility/sedentary lifestyle, FHx of clots, obesity/Diabetes, smoking, on the pill or HRT. The only risk factor for this lady with the fact that she was taking HRT. However, she had of endometriosis and PCOs, thus she had her uterus removed at 38 and later on they discovered an ovarian mass so she had her ovaries removed too. The only way to exclude a DVT was to order a D-dimer test. This was done but the results from the lab took a while to come through.

As a result, I saw another patient. This guy was working at Tescos and was loading a case of wine bottles onto a track when it fell on his chest. When that happened he thought none of it but then when he went back to work he pulled a trolley and felt a really sharp pain around his chest area, rising up along his sternum so he decided to take time off work and see his GP. He was seen at a walk- in centre where he was examined and they were suspecting a possible rib fracture due to the bruising or haemothorax as he coughed a little bit of blood that morning. However, they did not have the facilities to do an xray of his chest and thus send him at A & E. When listening to this man's chest, it sounded clear and there was no evidence of reduced breath sounds or dullness which would fit into a history of pneumothorax. One thing I did not assess was 'flail' chest that occurs with rib fractures but this was not present as there was no evidence of asymmetry or paradoxical breathing. As a result, the Reg that saw him decided to sent him home without even Xraying him although I thought it would have been appropriate to Xray just to make sure there was not anything going on that we could have missed clinically.

So all in all, Monday was a rather educational day and Tuesday was filled with Simulation Teaching and Seminars on Primary Care which were rather enterntaining. We got to practise our acting skills and that was rather beneficial.

Till next time ,

xx

Burned Bread

I do not really like the smell of burned bread. Do you? Well, I learned a lesson today! Never microwave bread! It can get burned! And then it can make the whole kitchen and house smell and then it sets off the fire alarm and you panic as you cannot turn it off... Yes I am talking from experience! It happened to me today! Oh well, I have learned my lesson. Never do it again!

From the burned bread experience I got inspired to write this blog, so maybe I was meant to burn the bread. It happens to me loads of times where I say to myself that no matter how awful that thing that happened was, it was still meant to happen. What does meant to happen mean? Do you believe in destiny? Well, what I believe is that it is all God's plan. He has a plan and he can control most things. There are things that happen that are beyond my understanding and I assume your understanding too. As a result, I believe there is higher power, there is God who sent his son to die for us on the cross and save us from our sins! He also has his holy spirit that works through us and for us on Earth. There are times when I feel his presence and great things happen and I say to myself 'Lord you are Good' . Then there are times when I feel like everything is going wrong and maybe God has abandoned me and I get really agree at Him feeling as if he is not looking after me. In retrospect, I realise that God is testing me, He is testing my faith and at most times hardship is good as I learn from it. It helps me mature in soul and spirit and in the end of it all makes me stronger and able to deal with even worse situations.

God does not really abandon us- He is there for us at most times, but we tend to get distracted in our everyday lives and shift away from his grace. It is something that we should not be allowing ourselves to be doing and I always pray that I will have time every day to worship and pray to God as that will give me inner peace and will allow me to keep on going! Dedicating time to God every single day in our busy lifestyles is crucial as

The LORD is near to all who call on him,
to all who call on him in truth.

Psalm 145:18 (NIV)

So we need to be true to him. We need to believe in him as 'we live by faith and not by sight'.
Today in church there was a pastor from the States that was meant to teach on Galatians 6 but in the end spent more time talking about his work in Zimbabwe and also Ephesians 6.

In Galatians 6 there are nice quotes such as that we should not be weary of doing good. Even if someone hurts us or does something bad to us, we should still keep praying for them and keep doing good for them. His teaching was big on LOVE! Only LOVE can change and transform people. Do everything you do in LOVE. A great quote is one which says that 'FEAR pushes away from our goals, but LOVE draws us into them'. It is something that I will greatly treasure. We are all afraid at various times and there are things that we do not dare do as we are afraid. We need to WAKE up and start doing everything in LOVE, as that will help us accomplish most things and will stir us in the right direction.

Do everything in LOVE and your life will be full of grace and peace!

Buteyko

No it is not chinese but it is an alternative treatment to asthma believe it or not! One of my GP's patients was suffering from Asthma and he decided to get some treatment for it. Thus, he discovered this alternative therapy known as 'Buteyko breathing exercises'. As a result he managed to deal with his asthma with no medication whatsover.

According to the website:

The Buteyko Method is a set of breathing exercises developed by Professor Konstantin Buteyko to develop healthy breathing patterns, which help to maintain the correct ratio of oxygen and carbon dioxide within the bloodstream.

This method was created by Russian medical scientist Dr K.P Buteyko around 1967 but it was not till 1980 that it was established in Australia and in 1994 it came to the UK. It seems like a great method to treat respiratory disorders without having to deal with all the side effects of medication. It is based on physiological principles and it seems to have been successful in most patients that try it.

I thought it was fascinating in this instance that the patient was actually teaching the doctor. The patient was also happy he got some alternative treatment and improved his breathing significantly drug-free.

Another case today was a lady who came at the surgery last week and was in tremendous pain in her back. She could not straighten her back from the pain and as the GP showed her to her chair she pleaded him not to touch his back. Apparently she had a hiatus hernia operation and she believed this pain was a complication of the surgery. The GP decided that it sounded more like neuralgia/neuropathic pain, this decided to treat with amitriptylline (antidepressant) and if that did not work he would be moving onto gabapentin (anti-epileptic). Amitriptylline seems to be ideal for neuralgia and it did have amazing results in this lady. She came to the surgery today and she was pain free! Also, since she was on diazepam and citalopram to deal with her depression, she stopped taking all those altogether and the amitriptylline which is an antidepressant in itself helped with that side of things. It was unbelievable how happy she was and how relieved that there was no pain anymore. I thought that was fascinating and rekindled my faith in the good we can do as doctors. This is the most rewarding part of the job and it can only happen in General Practise. In GP you have the time to create a lasting relationship with the patient and you get to folllow them through their illness/problem. This does not normally happen in hospital. GPs also know the gossip within the family and can be really nosy. Furthemore, GPs just live on biscutis, sometimes tea and have weekends off. So maybe GP training is something people need to consider when they are thinking about applying for specialties.

Lastly, I learned about subclinical hypothyroidism, as this patient was completely asymptomatic but her routine blood tests showed raised TSH, but T4 was normal. Apparently this can be a common phenomenon and is treated with thyroxine if TSH >10. This lady had a TSH around 9.5 and my GP decided that he wanted to treat her and review in a month. If TSH was further raised then further investigations will need to be carried out.

This was my last day at GP. I have enjoyed the past two weeks and I feel like I have learned a bit of everything but not sure if I will remember them again. GP is definitely one of the specialties to consider when applying to specialty training. The working hours are good and for ladies is even better as it is set to accomodate the fact we are going to have a family so we need some time off.

A bit of 'piggie' flu, oculogyric crisis and restless leg syndrome

I think everyone is getting fed up with this 'swine flu' pandemic ! Whenever I even see it on a news website now I just do not want to read about it and I just want to avoid it! For GPs I must admit it is hard work. Guidelines change every single day and there is a lot of confusion in terms of managing this pandemic. People are treated blindly with a drug that is not really effective but is just a drug that has been stockpiled for some reason. It makes you wonder whether the pharmaceutical companies have a say in this or are they the ones spreading the bug to increase their profits? That sounds a bit like a 'conspiracy' theory but anything is possible in this 'messed up' world! We all agree it is a pandemic but it is flu and flu happens every year, it is nothing new. Most people do not die from the flu but from the complications the bug might cause such as pneumonia which can be fatal in some people. So should we even thinking about diagnosing swine flu or is it a 'red herring' in most cases distracting us from other possible diagnoses that could present in a similar way?


Now that is a scary thought! A little girl was taken to A&E with flu-like symptoms so she was prescribed Tamiflu. However, she deteriorated and seemed that she had lower lobe pneumonia in the end but nobody bothered to scan her in A&E so she got discharged home with no treatment for it! This girl should have been diagnosed with pneumonia initially and getting treatment for it in hospital rather than being discharged on Tamiflu! How ridiculous is that?

It was funny when one of the GP's today at the surgery called it 'piggie flu'! I wonder if all the different forms of flu that are evolving will be named after an animal. I cant wait for 'kitty' or 'doggy' flu to come along! It is a bit like having a name for each new year like the Chinese do- is this the year of the pig then?? How exciting! If it is the year of the pig then I think we all ought to get the flu to be trendy ! Another ridiculous thing are the 'swine flu' parties! People try to get each other infected ! Honestly if people think that spreading the swine flu is a way to make friends I think they got it totally wrong. However, the guidelines suggest that the person with swine flu should not be going to pharmacy but should have a 'flu buddy' who will go get the prescription for them! How ridiculous is that! Then their 'flu buddy' obviously will get it from them as they need to go and physically give them their Tamiflu!

Oh enough on 'piggie' flu and Tamiflu! Why do they even call it flu? Sounds a bit like 'loo'!! Anyways, let's not swine flu rule our lives. Another important learning point for me today was a lady who came into the surgery with 'restless leg syndrome'. This was something I had seen before as a side effect to antipsychotic medication. However, in this lady it was not initially drug induced, which suggested it being idiopathic. As a result, she was treated with anti-parkinsons drugs such as pramipexole. However, it seemed that drug was giving her even more side effects as she was getting involuntary movements around her abdomen and her eyes as well. So she had to stop that and move onto another medication such as clonazepam or an anti-epileptic such as gabapentin.

I did not even know that this syndrome existed and some people have it for life which can be very hard to deal with. It uses up so much for your energy and not being able to cure and having to be on medication all the time makes it a really frustrating condition!

Another important lesson today was one about 'oculogyric crisis' . No it is not all Greek to you, it is just a medical term for someone who presents with incredible restlessness, agitation, malaise, or a fixed stare. Then comes the more characteristically described extreme and sustained upward deviation of the eyes. In addition, the eyes may converge, deviate upward and laterally, or deviate downward. The most frequently reported associated findings are backwards and lateral flexion of the neck, widely opened mouth, tongue protrusion, and ocular pain. However it may also be associated with intensely painful jaw spasm which may result in the breaking of a tooth.

Most often apparently this happens on surgical wards post-op after the patient had stemetil or metoclopramide as an anti-sickness tablet. This tablets have a lot of side effects and can cause this 'oculogyric crisis' . The presentation can be rather upsetting for the houseman that has not seen it before. It can even lead to a psychiatric referral. However, all they need is to be given procyclidine, which is the antidote and can totally reverse the effects. It is effective in 5 minutes but in some people it can take up to 20 minutes to half and hour.


Lastly, another patient I saw today had a biceps muscle rupture. This was something I had never seen before and apparently it gives you 'popey's arms' ! I just love it in medicine that we use all these little tricks to remember things. It makes everything sound very entertaining!

So from 'piggie flu' to 'poppey arms' the world of medicine never stops to startle and excite me as well as entertain me! It is a definitely incredible world ! Hurray!

M.E.

First time one of my friends mentioned M.E was in the form of an online conversation and I thought my friend was talking about 'ME'. Then I was wondering why he used block capitals if he was referring to 'ME' and then I thought that it was a rude think to do!!

Then he explained that he was referring to 'Myalgic Encephalitis' otherwise known as Chronic Fatigue Syndrome or Post-Viral Encephalitis. As of yesterday, my GP seems to like the term Chronic Fatigue Syndrome. I was aware of this syndrome but I had never seen one with it and did not know much about it other than the fact that is one of the reasons people are tired all the time. Initially, I thought it would a diagnosis of exclusion like IBS (Irritable Bowel Syndrome) where all their tests come back normal and you just give them a diagnosis to make them happy, although there is nothing much you can do for them. So with M.E I thought it is just one way to give a reason for their tiredness despite all their tests being normal and you saying there is nothing much I can do to help you overcome this!

However, after doing some reading on it, there seems to be an organic cause to it. Apparently, it comes up after glandular fever or a viral illness and it presents with specific physical symptoms. These symptoms are swollen glands and aches all over the body similar to fibromyalgia in a way. On top of that there comes the tiredness which can be rather limiting. A lot of people need to take time off work and this has a major impact on their lives.

When I asked my GP if there are a lot of people who suffer from this, he said that he only has about 3-4 patients with this problem, and guess what ! Yesterday was my M.E. as I got to see two of them!!

For one of them it was a recent diagnosis, so it did not seem to affect her in a big way where she would need to take time off work. However, she mentioned how her social life has deteriorated as she comes back from work and then she just needs to rest and cannot go out or lead a normal social life. Furthermore, she deals with it by not leading a stressful lifestyle and giving more time to herself to do things. She has been on holiday recently and she enjoyed that without feeling very tired. Nevertheless, she was not sure about travelling for work. She seemed rather concerned as she was not sure whether that would get her very tired and could be potentially very stressful at a point where she will not be able to cope.

As this is an illness associated with a viral cause, there is no specific
drug treatment you can offer the patient.

The main things to consider is conservative treatment such as an M.E. service or support group where these patients can receive counselling. Furthermore, this patient mentioned that such a service exists in her area and they will hold yoga classes, something which proves to be beneficial for this condition.

The next patient was not a recent diagnosis so he looked into his illness and developed the 'traffic lights system' , a way to distinguish his bad days from his good days. Red light was a bad day where he would be incapable of doing anything and might just stay in bed all day. Orange light was a day where he could carry out minimal tasks, tasks that do not require much energy or strenght. Finally, green light meant that he felt good in himself and could do almost anything a normal human being could do. I thought this was an interesting way to look at things and keeping a diary was definitely benificial for both the patient and the GP.

It is important to note here that there is a psychosocial impact of this illness as tiredness can lead to frustration, as most people feel they are not able to do as much as they would like to be doing. This can lead to depression, which can have a lot of after-effects. My GP seemed to believe that a good treatment for people with M.E. seemed to be SSRIs (antidepressants) such as fluoxetine (Prozac).

This learning on M.E. has helped me understand this disease much better and definitely it would be something I would consider on a differential for tiredness. Also, I know now to look onto people with M.E. with more empathy and understand the limitations and psychosocial impact of their illness.

To make-up or not? Oh vanity !

Who would have ever thought that I would be so dependent on make-up? It sounds insane and very vain indeed! It is not easy for a woman to overcome her vanity. I go through phases where I do not really think about how I look. I manage to suppress my insecurities concerning my appearance at most times. How do I do it? I just do not think about them! I just lead my daily life without thinking that every day is a bad hair day or that every day is a facial spots day!
Being in the final year means being on placement all the time. As a result, the routine is going back home for the weekend and then returning to hospital accommodation on the Sunday night to enable yourself a few hours sleep before you start placement on Monday morning. This also means living out of a suitcase. Having some of your things at home and some on placement means that in the process you lose things as you transport from one place to the other or that you forget things.

This weekend I managed to forget my house keys which meant I could not get into the house! Fortunately, my housemate was at home so she let me in but then having no keys meant that once I was into the house I could not possibly leave the house without keys. My housemate was not going to be around all weekend long. As a result, I had to leave the shed door open and my room door open too, which was a scary experience as there was the risk of thieves getting into the house. I was only in the house for 2 days so this did not happen thank God!

Furthermore, apart from the house keys I had forgotten my student ID! As a result, I could not go to the gym ! In the end I told them I was already a member so they let me know, but they said if I forget it once more they might cancel my membership! Scary stuff!

Nevertheless, my weekend was very relaxing and I spent some time reading and finishing my book (yaya) and watching a film. On the way back to placement I thought I had packed all my stuff but little did I know when I got up on Monday morning and realised my make-up kit did not travel with me up to Guildford!!!!!

'What a terrible start to the day! Such a trivial thing but for me it was a big thing! How can I go to work without make-up cover?? I would be so spotty and look so untidy and not really myself! DISASTER!!'

BIG DISASTER! Then I started thinking how dependent we are as women on make up! Trying to cover all our spots and trying to look better for some reason. Why? Someone might say to attract the opposite sex , others just to feel good in ourselves. I think for me it could be a combination of things I guess! At the moment it is just my morning routine. I always need to have some time for my make-up or else something is not right. I thought that without it I would not be as confident and not able to face up to the patients. In the end it made no difference! I hardly even thought about it! My day went on as normal and nobody commented on the fact that I had no make-up!

Vanity is a big thing and I do not think I really like going through vanity phases. I always look back and thing that

'there are more important things in life than me looking pretty.'

However, as healthcare professionals we know that looking after oneself and looking good is part of the health package. Being healthy means looking after yourself and caring for yourself. Making sure you look good is part of that self-care. What is to be condemned, however, is going to extremes just to look good. Cosmetic surgery could be beneficial if it helps treat psychological problems such as depression and allows people to feel good about themselves. However, I think people need to realise that being self-centred and caring about how you look all the time is not healthy. Being balanced and not going to extremes is definitely the way to health.

So the message of this blog is to look after yourself, love yourself but everything in moderation. Do not become slaves of beauty and appearance but keep an open-mind and look after your spiritual well -being at the same time. This will set you free....

Why would anyone care?

Here I am succumbing into the temptation of creating my own blog. This is something I have been postponing for a while as I was thinking

'why would anyone care reading my blog? What do I have to offer to the world?'

However, having a blog I believe will help me being a more 'reflective' individual, a skill that we are not really taught but are told to adapt in medical school.....

As I start my final year at medical school, I have a word in my head that will torture me all year round 'FINALS!' Someone else put it in singing form, 'It's the FINALS countdown..!' .

Since this is an important year for me, I thought I will need a forum where to share my experience on a daily basis - to comment on things I see at the hospital and also 'reflect' on them. Note the word 'reflection'! A crucial word to consider! However, through this

'I want to nurture other interests in life apart from medicine such as music, sport (especially squash and swimming) , Global Health, politics, pub quizzes, volunteering and also God and religion'

I feel that it is important for me not to get lost in the world of medicine but still maintain an interest in other things in life as this will make me feel more fulfilled and whole as a person.

It has been 3 weeks since I have started my medical rotations and it has been rather varied. I have spent a week in MAU (medical admissions unit), one week in ITU (Intensive Care Unit) and one week in GP. The most exciting of those weeks was the first week back. In MAU I got to be the first one to clerk (take history and examine) the patients and also get my thinking hat on and comprehend what is wrong with them and why they might have the symptoms and signs they are presenting with. I have had a long break from clinical thinking and coming up with differential diagnosis was not easy at the beginning, but it got easier! Every patient in MAU was challenging even from the simple chest pain of a cardiac patient to the confusion of a stroke patient who was not able to give you a history! At the same time every patient was exciting and inspiring as it helped in stimulating my interest in my discipline. After I had seen a few patients I would go and read up on their case hoping that if I see a patient with the same presentation I would be able to diagnose them with confidence!

At most times you wish a patient was a typical textbook patient as that would have made your job easy! But that's hardly ever the case! Nobody has the typical textbook presentation but textbooks are good for some form of direction. In MAU, I managed to see a lot of chest pain, which helped in learning the Acute Coronary Syndrome pathway but also some overdoses, a pulmonary embolism (PE), a sickle cell crisis and a few stroke patients. It was a relatively good week and I managed to learn a lot in a relatively short period of time.

Then, it was ITU. I thought that would be a relatively interesting week and since I am interested in Anaesthetics I wanted to be positive about it. However, it did not go as smoothly and I did not feel I was learning a lot. I was impressed by the amount of Physiology someone needs to know to be able to work in ITU. However, dealing with very ill patients is rather depressing on most occasions. Furthermore, I felt like I was lost with all the machines they were using for organ support and all the high-tech equipment they were using. Also, some therapeutic pathways used for the very ill in hospital are beyong understand and explanation. I did manage to learn basic things and enjoyed being taught by the Consultant Anaesthetist on ITU for the week. However, I am not sure if this put me off from following Anaesthetics in the future or whether it actually stimulater my interest in it. I need to have a think about that.

The main thing I learned in ITU related to organ support and how to support someone who is very septic and cannot breathe, his kidneys are non functional. I learned a lot on Blood Gases and renal failure as well as SEPSIS. Furthermore, I learn about the 'Swiss Cheese Effect ' , where lack of communication and team working has led to fatal accidents in the aviation industry but it is something that is happening in the NHS but nobody bothers to do something about it or set a few rules to increase safety and efficiency in the medical profession.

After those two stimulating weeks of hospital medicine, there comes the time for GP and mainly family medicine. I was never very enthusiastic about doing GP and I was proved right! My GP was a nice man, Cambridge graduate, but seemed to think that by just sitting behind him and just shadowing or watching/observing I would learn by 'reverse osmosis'. This in itself can be nice for most medical students as they think they can sit back and relax and enjoy the show! but it was not working for me! I did learn a few things partly as I like reading on different illness and increase my knowledge but in terms of practical skills such as examination etc I did not manage to practise those.

This week is another GP week where I hope I have a more active role in the practise but not sure whether that would happen . I pray and hope that this week will be much more stimulating without being stressful at the same time! Wish me luck and thanks for reading my first blog !