Nineth Week - Respiratory

"At a rate of 70 beats per minute over an average lifetime of 75 years your heart will beat 2,759,400,000 times... you wouldn't think it would make that much difference if it missed just a few..." - Dr Pete Jones, University of Otago.

I'm back from mid-semester one break and feeling pumped, ready to go! 

Whether you believe in creationism, evolutionism or are sitting-on-the-fence-ism, you should agree that the human body is amazing. Sure, there may be a few personalities, political or sociocultural identities that grind your gears, but you must admit that at a body systems level the functioning body is extraordinary. We are all extra-ordinary! Have you ever considered the complexity and thus beauty of the working body? In a healthy body, there are multiple systems working in harmony: respiratory, cardiovascular, endocrine, musculoskeletal, immune and neural. Nearly everything, at the cellular and microscopic level is moving or being moved in a coordinated fashion. It is this movement that we recognise as life. Movement is what makes the world go around!! ... And we were all built to move, so lets move!!

Physical activity is fantastic. At moderate levels it has been shown to reduce the risk of depression, improve self-esteem, minimise the risk of cardiovascular disease, maintain functional activities of daily living, decrease the risk of some cancers, offset the effects of ageing and smoking tobacco. Smoking is an unhealthy habit, and unlike the other conditions listed above, it is a lifestyle decision people find themselves becoming dependent on. Smoking is so unhealthy, that even if you were to be physically active, you would still be at a substantially high risk for all the conditions mentioned above! As health professionals, we must pass a smoking cessation course - this was the highlight of Monday's 8am class. Helping smokers to live healthier lives is as much about lifestyle modification and smoking cessation as it is 'being physically active' alone. There is much to discuss about smoking (like, how it only takes ~6-9 seconds for nicotine to reach the brain, via the respiratory system!); but I would like to end this paragraph emphasising the benefits of a smoke-free lifestyle: reducing the risks of all cause morbidity, improved quality of life, financially better off, not harming those in your immediate surroundings with smoke and smelling better too.

Coincidently, we had our respiratory lab on Tuesday. This involved analysing O2 and CO2 under different conditions - I'll explain. We measured alveolar ventilation using a Haldane-Priestley tube. I searched Google for an image of this device, but found none that resembled what we used in our lab. Basically, it is a clear, plastic tube with a mouth piece and a valve near the mouth piece. A syringe is placed in the valve to suck out expired air. You can actually see part of it being held on the right hand side of the image. We tested the gases after both hypo- and hyperventilation... there were chocolates at stake for the highest measured CO2 in the breath-holding (hypoventilation) task and highest measured O2 in the forced hyperventilation tasks. This made quite a few of us light headed! The lab became even more amusing when we had 'breathing and gym' themed music (e.g. Take My Breath Away, performed by Berlin) playing whilst were were using the Douglas-bags. The Douglas-bag caught all of the air that I expired (breathed out). We compared the ratio of the bulk flow (of air) from rest and after exercise - this [respiratory exchange ratio] relates to the energy substrate (carbohydrate, fat or protein) that is primarily being used. But the main point of the lab was to look at the haemoglobin (Hb) dissociation curve: Hb saturation of a gas plotted against the partial pressure of a gas, namely O2 and CO2. ...All you need to know is that it was a good lab experience.

One PHTY254 lab this week included gait. For a second I thought we were back at primary school because we got to put ink on our feet and stride along a sheet of paper, leaving behind our foot prints!! ...The fun ended when we had to measure distances and angles of the foot, feet and stride patterns. On the subject of primary school... I find it ironic how many concepts use the acronym ABC. It is as if they wish to undermine the complexity of the process by stating it is as simple as learning your 'ABCs' - it's not that simplistic (if it were, we'd all be health professionals). On a positive note, it does have its merits - if you were to have a guess of an acronym that is used to explain something, a good bet would be the ABCs. First aid has its ABCs - Airway, Breathing, Circulation. Neuro has a activity-specific balance confidence scale. Cognitive behaviour therapy's ABCs are Antecedents, Beliefs, Consequences. Athletics trainers use Agility, Balance, Coordination. Smoking cessation practitioners Ask, Briefly explain benefits and offer Cessation support. ABCs for life!!

My subjects at a glance: Anatomy is now focusing on soft and hard tissues/structures associated with the vertebral column. Physiology has just finished covering the cardiovascular system (our cardio lab is in a fortnight). Rehabilitation science is focusing on clinical gait analysis. Clinical Practice was all about passing our smoking cessation 'quit card provider' course - we can now offer discounts on nicotine replacement therapy products, like gum, lozenges and patches.

The human body is amazing - so lets look after it!

Easter Break: Sport Medicing

There were two games to medic over the Easter Weekend (Saturday and Monday).

My role as a medic doesn't involve taking photos - but I did capture these when I had time.

... Just to help you visualise what the sport medic scene is like. 

As sport medics, we report to the coach, manager and team physiotherapist. However, we are trusted to make autonomous decisions and play a crucial role in advising whether a player is fit for play. Sport medics generally arrive at the match venue when the manager arrives. This enables us to set up & attend to any player before the team warms up and completes their pre-game preperation. We leave once all players that want medical attention, after the game, are seen to. This can make for a long day. Sport medicing is primarily about sport first aid. However, the sport medic involved with a team also looks after the player's individual physical health. Therefore, we provide massage, strapping and stretching pre- and post-game too.

http://www.dunedintechnical.co.nz/

Dunedin Technical A.F.C

Medics are allowed in the team areas [with players (on the bench), the coach, coaching assistant and manager]. Other people in the area include; the ball-boys (they fetch and cycle the match ball when it leaves the field) and photographer (local news paper reporter).
We lost this match 3 - 2.

Team physiotherapist

Soccer Ball!!

Scenic Soccer Field! This is Monday's field... it's much nicer than the location of Saturday's game.

Just before the match commences!  Monday's match - we won 8 - 0.

This is the players changing room pre-game.

Sport medics get their own treatment area!

Although the School of Physiotherapy offers the Sport Medicing course, it is in no way associated with any individual in a sport medicing context. Because of this we, as medics, are not allowed to wear any clothing with the School of Physiotherapy's name or logo. Nor can we say that we are physiotherapy students. Rather, we are qualified Sport Medics!

Eighth Week - Flexibility

Warning, this is going to be a long blog entry! Get yourself comfortable now.

Abstract: The current blog entry captures the usual week highlights and further explores the physio student's health. As in previous entries a metaphor or theme is applied: the metaphor used this week was 'clinical flexibility' but this was poorly executed, as you will soon read (because everybody reads the article after reading an appealing abstract!!). Limitations of this entry include: absolutely no Vancouver style referencing (not even APA style), and it is a long blog entry - bear with me. Upon reflecting to find that there is no results section (and that this isn't even a research article) we may conclude that it's time for a week holiday!

As a sports medic we are relied upon by our team to be on the sideline, no matter where the game location is - within reason. Consequently, we went on a short field trip to Mosgiel. The sunshine wasn't putting on much of a show, but our team sure was. Our team crushed / slaughtered / were victorious by quite some margin! A significant perk of medicing is the opportunity to be sideline, watching some excellent athletic performances. But how well did we perform as medics on Saturday? Well... we arrived on time, set-up a working space in the changing room, strapped and massaged as requested - but then completely forgot to introduce ourselves to the officials and management of the other team... until the second half. Woops! Luckily the injury count was low, with one member from both teams needing treatment for an ankle injury in the second half. The officials showed their disapproval by delaying my entry onto the field (as they control who enters and leaves the playing area). Needless to say, I won't be forgetting this important aspect at the next game.

Academic Journals in the Med-Library

Flexibility is a term that describes the extensibility of tissue, and therefore a body segment's movement, about a joint. As an example; in the clinic a practitioner may conduct an Ober's (IT-band) and Thomas (quadriceps) test to determine whether a muscle contracture (shortening) has occurred. If hypomobility is found, the patient will be prescribed stretches. I'm not going to discuss static, dynamic, ballistic or PNF stretching, rather I shall go on a slight tangent and discuss a psychosocial demand that may leave a person feeling 'stretched'. Last week's exams 'stretched' many students, especially due to class commitments immediately before the tests were taken. It appears that students relish the time before an exam because it is an opportunity to mentally (and physically) prepare. Being flexible is then to be able to overcome adversity (i.e cope with the lack of time to prepare). It is important not to be too far stretched (stressed). Biologically, the idea of muscle deformation (due to elongation forces) is called 'creep', but I'm not about to suggest these stressed students are creeps! Rather that they need to better manage their flexibility programme, as it's getting the wrong results... Are you impressed that I pulled off that metaphor?! ...In other words: learn to be flexible but not become over stretched = be proactive with your learning, prepare and use strategies to manage adversity in order to maximise your performance. Phew, we got there!

As physiotherapists, not only do we treat the physical aspects, but also we manage some psychological aspects of our clients. It is thus quite appropriate to blog about mental health from the student healthcare professionals' perspective. After all, the practitioner needs to be in a good 'head space' to achieve the best client outcomes. All muscle flexibility metaphors aside - stress is a pressing issue in healthcare. As alluded to in the previous paragraph, student's are bombarded with a lot of information. Student healthcare professionals are expected to retain and apply this information. Furthermore, we must be life long learners. This places a great psychological demand on students; this is known as 'stress'. Stress is not always a bad thing (it is a motivator that gets assignments done at the last minute); the keys is 'how to appraise the stressor'. Some student's may not care (this surely isn't us), whilst other's attribute the task to be highly important. High task demands coupled with a perception of not being able to meet these demands is a recipe for anxiety. Anxiety is characterised by a shift in attention-concentration and may lead to a performance catastrophe. Sitting in an exam (under time constraints), knowing that five minutes ago you could recall the structures and functions of the central nervous system, but now you can only remember where the thalamus is. "What's that structure inferior to it? Fornix? Septum Pellucidum? Pineal? Something starting with G? Oh No, I can't think! Time is running out, everybody else is writing fluently and I'm frozen steering at the question!" This is an example of a catastrophe. Moreover, our receptiveness to stress as a psychological trait can have a large impact on our day to day health. Healthcare professionals, like everybody else, are subject to low mood states, anxiety, depression, low self-esteem, sleep deprivation, low task and self efficacies. It is important to identify and address these asap. Psychology is a discipline of its own; rather than discussing each condition individually I challenge you to have a think about psychological factors affecting your life and share your thoughts with a trusted somebody and seek professional counselling (counsellor or psychologist) if you believe it would help. There is a stigma about seeking psychological help, however I advocate that seeking help is a sign of strength. People seek physiotherapists for help with physical problems, so seeking psychological professionals for psychological problems is most appropriate. In recent lectures we have discussed Cognitive Behaviour Therapy, Narrative Therapy, and the Social Problem Solving model of behaviour. It is important for physiotherapists to have a somewhat-in-depth knowledge of frameworks to manage psychological problems. After all, what use are physiotherapists if the client with a rotator cuff injury is too afraid to lift their arm! In conclusion, physiotherapist students: have some psychological strategies to help clients and should confide in a friend or lecturer about psychological issues of their own.

We were given another assignment this week and the semester one exam timetable is out! Let us prepare for our five exams graciously. There is plenty of time to learn the content, practice stress-management strategies, and be flexible enough to enjoy some social life. I found some UK physio student's blogs! These blogs seem to capture the demands of a physio student. Some blogs go beyond the first year of study (as I hope to do with my blog) - so there is hope! I don't feel these blogs are as good as mine... one of their blogs even discussed their recommended text books. So, as ridiculous as it sounds, here are our recommended text books for the first semester:

Social events this week included a BYO (bring your own - alcohol) with dinner for combined lab groups a, b, c & d of second and third year! But the highlight of the week was voluntarily participating in research (as a participant) at the University of Otago, School of Physiotherapy. The research involved recording EMG of muscles surrounding the glenohumeral (shoulder) joint under certain constraints and for multiple simple tasks. The main interest was on muscle stabilisation roles and mobilisation techniques. Although I don't wish to pursue academia, it is interesting to experience the research process as a means to appreciate the how we know (the mechanisms underpinning) clinical methods are effective.

It is a short week this week with Friday being 'Good Friday' for the Easter weekend. Next week is the Mid-semester break, so there won't be a blog entry about that (hence this weeks entry is super long).

Time to get back to nature, explore the outdoors, breathe the fresh air!

Seventh Week: Rat Race!

We began week seven with an afternoon lecture on washing hands. This is something that we generally take 'knowing how to do' for granted. Hospital-based health professionals wash their hands so much during a shift, it is a wonder they don't wash their skin off completely! If you hear multiple renditions (i.e. two) of Happy Birthday in the bathroom, you can safely assume that I'm washing my hands! That is how long you should spend washing (including drying) your hands (apparently).

We are rats on a race... not really. But there is a rat race, and we are the 'rats'. There were two exams this week: a Physiology Mastery Test (Wednesday) and the Neuroanatomy Rat Race (Thursday). The Rat Race was the most exciting. There were 50 stations, each with a neuro-anatomy exhibit or model. We had a minute per station and moved to the next station on the bell. Each station had two questions. For example: "What is the structure of label A? And what is its function?" or "What would happen if a lesion occurred to this structure?" Good fun, right?!

I was getting desperate for a picture this week, so here are the basics needed for sitting a written exam!

Because I had to revise content, you too will get a taste of some interesting bits!

• Did you know you can only taste five things? Bitterness, Umari, Saltiness, Sourness, Sweetness. You can also sense temperature, texture and pain, such is the case with with spicy foods! Flavour is really an olfactory sense.
• When you acutely hurt yourself, for example you stand on a pin, not only is there a withdraw reflex, but you are likely to hold the injury site to relieve pain. This will help relieve the pain due to a neural gating mechanism where pain receptor input to the central nervous system is overridden by your touch receptors!
• There are five stereotypical stages of sleep.  They cycle in a particular order (unless you are awoken). The first four are not associated with vivid dreaming, the fifth is and is called REM (Rapid Eye Movement). During this stage, if it weren't for the inhibition of volitional movement you might find the dreamer enacting their dreams, going for sleep-walks or in rare cases, murdering somebody.

In an earlier blog post, I mentioned that some lecturers have distinct personalities. Well, the lecturer taking us for respiratory physiology has a great sense of humour. Upon revising his lecture presentation the night before, he thought that some of us might find it a bit boring due to the many equations involved, furthermore he assumed that some of us would rather watch paint dry. Being the kind lecturer that he is, he allowed us the option to watch paint dry... literally. He used spray paint on a blank canvas, with a drying time of 30-40min... perfect.

Big group - neurology: the focus of this lab was an individual with an interesting neurological condition. The person had lost proprioception due to a multitude of events including tumours in his spine (and surgical operations gone wrong). The person allowed us to test our assessment skills as well as our concoction of experimental therapeutic techniques. We certainly valued the time this person volunteered!

 

Sixth Week - Gait

I have recovered from last week's cold. It would have been nice to have learnt some respiratory physiotherapy at this point to have cleared my own chest from phlegm. No doubt that will come later... I might have to get a cold later on to test it out, as my impromptu attempts on Monday (when I eventually thought to look into it) were flawed.

I have no real sport medic news to report. I had last Saturday off, and will have this Saturday off too. There are three sport medics assigned to the team and there only need to be two attending a game - my turn will come soon enough. We hope to learn some strapping principles of kinesio-tape application at some point too. 

Tuesday was April 1st. April Fools! Alas, no pranks were made by lecturers that morning. In the afternoon PHTY254 class the lecturer sprang what would have been a great joke on us. We had to provide swabs for MRSA testing. Testing sites were: a single swab to each nostril, and another to the perineum - that is, a distal region of skin between the legs, gonad and anus. Our lecturer pointed out that we must take care labelling them as in the past a sample of bacteria that should have belonged down below was found in a sample labelled 'nostrils' - lets hope it was poor labelling.

Physiology lab this week involved electrodes, an electrical stimulator and pumping waves of electricity through the ulna nerve and then through the soleus muscle. We mainly investigated the H-Reflex, recruitment of muscle fibres and tetany. Good fun. I was explaining the cellular mechanisms which trigger the actin/myosin cross-bridging to a student and the lab demonstrator happened to over hear me. To my credit, she said that I explained it very well. With a slip of my tongue, I joked that I should be the demonstrator... and now I potentially have a job for next year!! Demonstrating the Human Body Systems (HUBS191 & HUBS192) labs in semester one and two. Watch this space!

Gait is the theme of the week and relates to movement of body segments that allow us to walk... People have come to study physio from many walks of life. Entry into Physiotherapy at Otago University is competitive (best grades are selected first) and there are limited placings (~100). The main entry into physiotherapy at Otago this year is through Health Science First Year (HSFY). Other ways to enter the course include second year entry (for those that couldn't get in via HSFY in the first year) or through the graduate entry category. These are for people whom, like myself, already have degrees. In my year group there are a few Bachelor of Physical Education students like myself (one in particular has worked with the Crusaders rugby franchise and the Blackcaps NZ Cricket team), a few people have Bachelor of Science degrees, I know of one who has a Bachelor in Massage Therapy (she works with the Highlanders Rugby franchise and has owned her own clinics) and another student has a Bachelor of Engineering!

Here are most of the students in Lab Group A for PHTY254/255. There are four lab groups in the second year (we were the first to organise a group photo!) PHTY255 module this week was on musculoskeletal assessment. We covered subjective and objective assessment, which equates to having a chat with you [the patient] about your symptoms, creating an hypothesis on the problems you present with and then testing the hypothesis for an accurate diagnosis. We would make a treatment plan from there. We have more acronyms to remember: C-THREADS (cancer, thyroid, heart, respiratory, epilepsy, anticoagulants, diabetes, steroids), S.I.N Factors (Severity, Irritability, Nature), 5D's of Red Flag clearing (if you haven't 'got the D' you're cleared for 'manual handling'... of the spinal vertebrae), NPRS, PSFS, VAS, VBI, TOP, and many other short hand notations!!

Anatomy had a good dance and song to go along with myotomes and dermatomes of the upper and lower extremity... it's a bit long to explain in the blog though. We have a secret language where C7 is flipping the bird... and nobody wants an S4.

The Cancer Society Relay for Life was on Friday afternoon - Saturday morning. It was the first NZ University Relay event which is fitting as the University of Otago was New Zealand's first university. There were 46 teams from the many departments and social groups associated with the university. The idea of Relay for Life is to fund-raise and have your team members locomoting around the track for 15 hours where team members could pass the baton on to another team member when they got tired. By the end of the night, the event raised ~$46,500 for the Cancer Society. The School of Physiotherapy had a team 'Physio Kids' entered as well as a massage team for anybody with sore / stiff lower extremities (feet / legs). Here is most of the Physio Kids team! Needless to say, my gait was a bit stiff by the end of the event!!