Fifth Week: Vision

First game of sport medicing went without many hitches. Our premier grade soccer team had a pre-season game last Saturday. I'll talk about the Saturday game of the previous week, in my blogs, to save confusion. I seized the opportunity to 'rub-down' some players lower backs, thighs and legs pre-game. During the game I was able to do some therapeutic massage to a players lower back and gluts and another player's thigh. One athlete had a knock to their ankle from the opposing team which created a giant knot in their calcaneous tendon - massage and stretching did not help, so he sat out the rest of the game with an ice pack. This week, we were taught how to strap the calcaneous tendon! Another player had cramp in his hamstrings - that was an easy fix. The team has talent on the field and I look forward to tracking their progress over the season. The result of the game was one - nil, to us (of course).

In the healthcare profession, physiotherapists are generally identified by their set of competencies and mannerisms set out by the professional code of conduct. But physiotherapists are known as other things, some colloquial and others just inappropriate. I'll list my top 5 (no doubt I'll hear more over my degree and career)...

1. Phlegm Specialists (yes, we'll have a look at the green mucus you coughed up)
2. Granny Draggers' (assisting geriatric patients onto their feet - we don't drag them, haha)
3. Physical Therapists (an American term for physiotherapist)
4. Back Crackers (no, no, no... they're chiropractors - but we can do that too)
5. PT (personal trainer or physical therapist... don't mix these up)

The theme of the week is vision. We have covered many aspects of vision in the previous classes (particularly in neuroanatomy), and this week it was physiology's turn. We now have a good understanding of how reading glasses are prescribed! Like in previous posts, I'm going to direct this theme to something other than the content we learn in class... My 'vision' of physiotherapy: why I want to be a physiotherapist!

1. Lifestyle: depending on where the therapist works, they will usually have a set 9am-5pm job or work on a roster/shifts - which changes every other week (this will probably include night shifts). The job involves physical activities and the lifestyle is usually balanced - after all, physiotherapy is based around treating imbalances (we know a lot about balance).
2. Sustainability: there is a foreseeable job market in physiotherapy. Physiotherapy encompasses a  lot of speciality areas and corresponding work settings. The pay is generally pretty good too!
3. Scope of practice: as said in the above point, there are a lot of speciality areas: community, neurological, musculoskeletal and cardiorespiratory. The student gets a well rounded overview of the body systems.
4. Professionalism: therapists are a credible, accountable, independent and legitimised healthcare professionals. We use evidence based practice and best practice methods to achieve real results. This is a profession where we help others to improve performance, reduce disability and overall increase their perceived quality of life... And the therapist usually observes a substantial period of their progress to recovery.
5. Spirituality: For me, spirituality is about adhering to and developing your philosophy in life. As a physio you will be able to help and inspire people to lead active, balanced, healthy, fulfilling lives. Physiotherapy influences emotional, cognitive, social aspects as well as physical - each of which is pivotal to developing your spirituality.

While I'm doing lists, here are my top three TV medical dramas!! Although they are not based on physiotherapy, they are still entertaining, relevant to health professionals and a good way to pass time. (It also relates to the theme, vision - enjoy watching these!). As you may have guessed, it has been a quiet week at university...! When watching House, check out how he walks with his walking-stick - he doesn't use it 'properly' (it's in the wrong hand)!!

The highlight of the week was being challenged to press-ups and sit-ups in a Phty254 lab covering active and passive insufficiency. This was completely off task, but good fun (and we got all of our work done). I won. Admittedly, my body composition was advantageous, but she gave me a run for my money. The lab demonstrator made sure we knew what muscles were working and by what action (wasn't he good, haha).

Above I mentioned that we are known as phlegm specialists. This week, I was specialising in phlegm of my own. Yes, I have a cold. It is inevitable that germs will spread at university, and my immune system finally shifted into overdrive to combat some nasty bug I had not previously acquired. Bring on the weekend to recover!!

Fourth Week - Balance

We're just over one third of a way through the semester; there are 13 academic weeks in semester one. At the end of week eight we get a one week break - this will be much appreciated because the lecturers have just turned the workload up a notch or two. The week started with concepts like balance or equilibrium which were discussed in terms of posture, righting reflexes/responses and clinical tests; but there are other interpretations of balance, and so this became the theme for the week.

We wear gloves in the lab (standard practice)
 so there's nothing really special about the image,
other than it's a peace symbol.
Peace!!

There needs to be a balance in the student lifestyle. This week the balance scales were tipping between exercise and alcohol. The big social event was a 2nd and 3rd year physio student pub crawl on Saturday. Students took a bus to South Dunedin and worked their way through the pubs to finish in North Dunedin. Good exercise. Bad for the liver. But this can be balanced with more exercise... Social sports are coming under way with touch rugby and netball being held during the week. ...but, the week begun with drinking too. It's a balancing act.

St Patrick's day was on Monday (March 17th) and many students dismissed afternoon class to pursue a pint of Guinness, to do the Irish Jig and to generally partake in a giant piss-up. Otago University has a reputation for student culture where any excuse to drink usually goes. I, however, just dressed up in green and went to all of my classes.

Making sure it fits before tomorrow!
...Yes I'm still in my socks

Talking about dressing up... We received our clinical uniforms on Wednesday. These will be worn in 'big group' and 'small group' for Phty255: clinical practice 1. 'Big group' will function similar to labs. 'Small group' is our clinical placements where we will experience primary (e.g. first contact in a private practice), secondary (outpatient in a hospital setting) and tertiary (community) health settings. Small group will be a highlight of many blog entries once that begins.

Our second physiology lab was on Tuesday. It involved assessing the effects of anaesthesia on the sciatic nerve, from a mouse, over time. Not much to say about the lab other than it was very straight forward and we finished half an hour early (labs are usually 3h).

The word of the week is "otomise". The suffix '-otomy' is to disconnect. Thus the term, to 'otomise' something, has taken a life of its own. "The pre-frontal cortex has been otomised" or "I just otomised the cauliflower head".




Mnemonics are also in fashion this year. The two that stand-out for me were taught in neuro-anatomy for remembering whether cranial nerves have a sensory, motor or mixed role. SSMMBMBSBBMM = Some Say Money Matters, But My Big Brother Says Big Brains Matter Most. However, 'brains' could be substituted with another word beginning with the letter 'B' - and it gets worse! The cranial nerves themselves OOOTTAFVGVAH (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory and hypoglossal) could be remembered by this mnemonic: Oh, Oh, Oh, To Touch A Females Vagina, Gives Vinny A Hard-on. I'll try to keep the blog above board from here on in!

The highlight of the week was learning how to fit ambulation apparatuses (walking frames, walking sticks and crutches). Other manual mobilising techniques include using wheel chairs, piviot tables and a 'Slippery Sam' (a slippery fabric used to slide patients up the bed or out of tight spaces where a hoist will not fit).

I have a sports team to medic! I will be working with two other medics for a premier Dunedin soccer club. The team physiotherapist is going to teach us more and alternative strapping techniques! Woohoo! Our role involves pre-game strapping, 'rub downs' (massages) and first aid management. A substantial portion of Saturdays and Thursday evenings will be devoted. Although it is voluntary, the practical experience will be of most value.

This image is of the Gowland lecture theatre. It is situated in the anatomy and physiology building, opposite the Dunedin Public Hospital, adjacent to the Faculty of Medicine and a one minute walk from the School of Physiotherapy. We live in this lecture theatre (for lectures).

In contrast, this image is of the College of Education Auditorium where we share our physiology lectures with students studying pharmacy, nutrition, dentistry and medical laboratory science. This building is across campus in the Faculty of Education (for students who want to be primary or secondary school teachers). It is much nicer than Gowland. There is a stampede of physio students twice a week across campus because physiology follows immediately on from our Monday and Wednesday 8am Phty254 rehabilitation science lectures.

 "Dare to be Wise"

Third Week: Internal & External Moments

Do you increase your 'external moments' at the gym by adding more weight to the barbell? Good on you if you do! But I'm not talking about tickets to the gun show - not those sort of externally gratifying moments!  For the physiotherapist, external moments refer to rotational forces about joints. Increasing the dumbbell load on your biceps curls is a prime example of increasing your moment arm! (Pun intended).

Advice: when instructing patients from Portugal, be aware that the Portuguese word "puxe" sounds like the English word "push" but actually translates to "pull". Confusion is likely to occur when opening a door that says 'push to open' (they will likely be frustratingly trying to pull the door off its hinges).

Zombie Rehabilitation (post-zombie apocalypse): Zombies usually have a staggering gait with a wide base of support. The current theory suggests their brain has undergone degradation with oxygen exposure to neurotransmitters, such as dopamine, especially to that of the substantia nigra (of the basal ganglia). Treatment strategies include electrical stimulating implants or drug therapy - similar to Parkonson's Disease. An alternative diagnosis is the disruption to normal cerebellum function. The discriminating factor between patients with Parkonson's/cerebellar damage and Zombies lie in their appetite for human brains: as a precaution have your receptionist(s) check them in before treatment.

Vaccinations for various diseases continued this week with a vaccine for Hepatitis B. This will be followed up by another blood test to see if antibodies specific to Hepatitis B increase. In class we used our goniometer and drew with markers all over the bodies of our patients (class peers) as we measured joint range of motion and assessed each others posture and kinematics (movement). To finish the week off we had our sport medic exam!

Tip for surviving undergrad physio: create and participate in lab and year groups on social media! Also, I'm still learning names - even those of people I associate with most in class, such inconvenient lapses in memory! It will improve - give the neurons time to reorganise.

What good is a physio blog without pictures. I thought it was best to start taking pictures from the outside to begin with. The three images are from the same building - different perspectives. In this building we practice most of our hands-on physiotherapy skills. 

Enjoy the sunshine :)

Second Week - Proliferation Phase

The proliferation phase of soft tissue repair peaks around this time and is characterised by fibroblast activity and angiogenesis: collagen is placed for initial strength and vascular networks develop around the site to enhance oxygen supply (amongst other repair mechanisms). The second week of undergraduate physiotherapy is, in some ways, similar.

Pre-lab preparation (gathering of resources, writing down of answers) helps the continuity of laboratories and social networks enhance the learning experience. This week consisted of  two neuro-anatomy laboratories, two massage labs, one strapping lab and a physiology lab (amongst other lectures)! I'll talk you through the labs this week.

Red blood cells (RBC). You can expand, shrink and make them explode. Boom! In the physiology lab we observed the effect of hyper-, hypo-, and iso-osmotic substrates on red blood cells. The intracellular and extracellular fluid shifts in or out of the RBC changing its size. In some cases (substrate dependent) the cell collapses (haemolysis).

Underwear is the uniform of choice in our 'Rehabilitation Science 1' labs... when else would we get to show off our gorgeous and well defined bodies?! Jokes aside, it seems that stripping down is an essential part of the paper to allow for the application of massage. Today was the last day of massage - next week we begin posture assessment. During today's class I made a joke to an older lecturer that I immediately regretted: she was informing us that the posture assessment session would require us in our underwear and in the past she had photographed students - I asked whether she would let us assess her posture! Wooops! I hope she saw the humour in that! I'm sure I will be the class model for the next lab as punishment.

Throw down an anchor, throw down some supports and lock them in! Thankfully we don't drown students (and their friends) here at Otago (other than with a high workload). Rather, this is the process for strapping joints! The only painful aspect is removing the tape, which closely resembles waxing body hairs off. During the lab intermission a few students, myself included, started a massage train... physio students have a good touch!

Anatomy labs are funny. We have all these toys (tools?) to play with! A highlight of the last neuro-anat lab was watching a classmate place a 'half brain' model into a skull and have the other half of the brain in the mouth. You'll have to remember that the models look realistic! For the future orthopaedic surgeon reading this article, the reconstruction of the TMJ with blue-tack is not sufficient in the long term (nor the short term).

We get cool abbreviations and acronyms to learn such as 'PRoM'. "I'm going to take you through your PRoM" does not mean going to a school dance, rather its a 'passive range of movement'.

The flat is now full - all the rooms are occupied with students studying in the health science arena. Sharing a flat with four others is great. They are so friendly and well organised!

Tomorrow (Saturday) I have a sport medic class, which will allow me to sign up to be a sport medic for a sports team! Woohoo! Also, there are some social sports being organised between the professional health science departments (medicine, dentistry, pharmacy, physiotherapy etc) which I look to participate in.