S2 Mid-Semester Break

Top of Sandfly Mount

Sea Lion!

Cargill's Castle at night

Me through a window at Cargill's Castle... Aurora Australis going on behind me!!

Tunnel Beach with Aurora Australis (southern lights)

Aurora Australis - active storm!

Basically, my mid-semester break had me chasing night lights, wonderful views and wildlife around Dunedin... Yes, all this is from Dunedin, New Zealand!!

Also, I continued to medic! Dunedin Tech are now fighting for second place! Only one more game to go next week!

 

 

 

 

I'm still working on my photography skills.

S2W7: Life on the Pharm

Quote of the week: "There is no surgery that we cannot make worse" - orthopaedic surgeon taking us for a lecture on fractures. That quote would certainly make many patients feel uneasy going into surgery.  Also from the same lecturer, "orthopaedic surgeons have a 'rule of three', reduce, hold and rehab... any more would be too complicated". This was probably the most humorous lecture all week as he also shared/bragged (jokingly) about how fast he could perform surgeries "my personal best time for a hip replacement was 15 minutes, all before the bleeding starts - but then I have to reopen them...".

The week began on Sunday with an early morning isolation to study at the university computer lab suites... we're talking 7am here! The computer suites have 24/7 access via a scanner that reads a chip in your Student ID card (then you enter your access code). I had to catch up on a few lectures of pharmacology for there was a mid-semester test on Tuesday morning!! I closely associate pharm with big/long chemistry words like 'phenylethanolamine N-methyl transferase' and gibberish drug names like 'suxamethonium'... often we would rather suck meth on a mmmmm... just kidding!! Methamphetamine is really dangerous! Meth can act indirectly to release noradrenaline from neural vesicles, which then increases heart rate, BP, dilates pupils, inhibits gastric activity etc. Methamphetamine addicts can be identified by shining a bright light into their eyes (when their pupils don't constrict you may think 'Meth!?!'), also they are likely to be constipated (don't go monitoring your flatmates toileting habbits though! There are plenty of other, more observable-friendly, signs)

Our pharm mid-term exam covered aspects of pharmacokinetics, pharmacodyamics, antiplatelet & anticoagulants, cholinergic and adrenergics, anti-inflammatory drugs, analgesics & anesthetics, some drug interactions etc! Pharm is interesting and challenging - there are many pathways, receptors, sites of action and classifications to know. Lucky it was a multiple choice test!! When it comes to clinically treating patients, this course will be super helpful, but often I will be looking drugs up and suggesting patients to see their doctor or pharmacist.

There was a class photo on Tuesday too. This was organized by the physio student executive for the second and third year students. The class photo is to be purchased, so I don't think I will get a copy up on this blog.

I'm still medicing for Dunedin Tech, but the season is drawing to a close in a few weeks. We've had a good mix of wins and loses and are currently running for second place in the Otago premier league. Hopefully the team running to win will lose a few games so we can catch up on points (if we draw equal our team will win the league based on goals scored over the season). I'm medicing again this weekend and as the team is playing two games a week to finish the season on time, there are a lot of strapping and massages given to battered bodies before the games - one player broke his fibular (but unfortunately I wasn't medicing on that day!)

 

And so I had a birthday... I arrived in on Monday to the 8am lecture to be greeted with a birthday card! This was prepared last Thursday (I discover this having thought that I missed a class, because surely I would see this being done!) and I was completely oblivious! Well done to my peers for organising such a great surprise!

This was the last week of new material on the lower limb in anatomy. We learned about Tom, Dick and very naughty Harry... a.k.a Tibialis posterior, flexor digitorium longus, artery, vein, tibia nerve and hallucus longus! Did you know that some people do not have the muscle 'peroneus tertius' in their leg? Well, now you do! The next half of the semester will focus on the upper limbs.

We had another clinical placement debrief and heard stories from peers about patients with schizophrenia seeking treatment in a physiotherapy setting. This tied very well in with a lecture on ethics focusing on patient's rights. In New Zealand health practitioners must comply with the legal legislation "Code of health and disability consumers' rights" which is basically the 10 commandments of patients rights.

The semester finished with a pharmacology lecture on muscle relaxants covering spasmolytic and paralytic (neuromuscular) agents. We were informed about the toxin used on arrow heads by native American tribes and how we could load arrow heads and shoot patients with muscle spasm in our clinical practices. I'm joking, of course! Curare is however the plant substance that spasmolytic (spasm stopping) agents are derived from. Curare itself has been useful for hunting animals as it is an antagonist to ACh receptors at the neuromuscular junction (stops the muscle from firing). Hunters can eat the animal meat and not be affected because Curare is not bioavailable orally. Surgeons most commonly use paralytic agents to immobilise their 'pray-tents'... but make sure they administer an analgesic as well before operating! Oh, and the medical application of botox was covered too - it's not only used to make people's faces more "beautiful".

In more personal news, I have a flat sorted for 2015 and have been employed for 10 hours per week (on top of being a full time student). We are now on a one week mid-semester break. When we get back it will be spring (September)!

S2W6: Build Me Up Buttercup!

Last week I mentioned that I was going to take a warm-up for the diabetes classes with some class mates this week. Our clients were put through their paces with a little dance routine to the song 'Build me up buttercup" by The Foundations. Admittedly, the routine was a little bit difficult in terms of tempo and short regular changes to the next movements! I found it to be a bit difficult remembering the steps myself, even with two others calling out the moves as we went! It was a good laugh, and I hope the males in the group enjoyed this feminine warm-up... social norms shouldn't be left uncritically challenged - even if you do feel a bit embarrassed waving your arms around to a cheesy song! I led the cool down - that's something you can do with two left feet! The supervisor said it was the [quote] "best warm-up by a second year group that I have seen".

We've learned objective assessment strategies for joints below the lumbar vertebrae, finishing with the clinical biomechanics and assessment of the foot. Future MSK labs will involve case studies and applying our subjective and objective assessment skills to diagnose disorders and to clinically reason treatments for common musculoskeletal conditions.

The quirk of the week was a lighting problem in the Barnet lecture theatre for neuro. The lights would systematically turn off over a 30 second period. The lecturer had to continually increase the brightness or turn the lights on again between demonstrating physical assessments. The lab ended half an hour early due to the lighting inconvenience even though most of the class could have contributed to adequate lighting with their mobile phone flash-lights! If only we had brought candles!

"Hello Mrs Atrial Fibrillation, how is your husband Mr Diabetes-hypertension today?" Obviously this is not how we address patients. Unfortunately their condition often sticks more readily in our minds than their name. Here is this week's tip for surviving a community physio placement: how to remember patient names. Get to know them on a personal level. Trust me, it's not that easy but here is how it can be done:

1. Introduce yourself. "Hi I'm Phil. What is your name?" - they will usually reply telling you their name. DON'T write it down in front of the patient unless it's a formal conversation! If you didn't catch it you can ask again immediately after otherwise wait for the end. If you don't think you can pronounce it, either ask them now or wait until the end of your conversation!
2. Small talk. Start with the weather, if they're enjoying the clinic, where they're from and you can tell them where you're from too. Use their name in conversations and repeat it over and over in your mind.
3. Actively wait for a 'tell'. Just like in poker when a player unknowingly makes a gesture that suggests a poor hand of cards. Only, for the patient this is likely to be some detail that you didn't specifically ask for (or were expecting them to tell you). I liken it to a 'tell' because a few patients don't readily give away information about their personal lives (e.g. that they have a grandchild).
4. Find out as much as is appropriate from that 'tell' and look for another 'tell'. The more you find out, the easier you will remember them as a person and not a condition.
5. Thank them for the nice conversation and write their first name down (when you're out of their sight). Bear in mind not to write anything else as not to breach confidentiality if your piece of paper gets lost! If you cannot remember their name, ask them again at the end.

S2W5: Home Sweet Home

Knock.. knock.. knock... at the flat door... "Hi, we're here to see the flat!" Yep it's that time of year again. Landlords are re-listing rental accommodation for the next year and students are busy viewing the listed properties. You can often identify these people because they're roaming the streets in groups with a map leading the way (the map being the distinguishing factor between flat hunters and students heading into town to down some drinks). Unfortunately there are no early bird specials, but it sounds like a good idea to first year students regardless. My current landlord decided to renovate the bathroom without our consent or giving us any formal notice this week. I don't think any of us living here were surprised because they had painters working outside our bedroom windows for most of last week without any formal notice too. Anyway, apparently now is the time to start flat hunting! My tip for surviving physio is to choose the best possible accommodation that you can call "home" for the year. Here is a brief check-list:

• Warmth
• Sunshine (especially in winter)
• Insulation of walls, roof and underlay under carpet
• Double glazing & Low ceiling
• Well fitting doors and windows - no leaks/water stains on the ceiling
• Heat pump or fireplace 
• Ventilation: extractor fans & windows

• Location
• Proximity to university, work or supermarket
• Neighbourhood
• Hill vs Plateau
• Car parking (free!?)
• View from inside out and from outside in.
• Other obligations e.g. having to mow the lawns?

•  Costs & facilities
• Cheap Rent & Bond
• Cheap Power, Gas & Internet
• Furnished vs Unfurnished - check walls and curtains for mold!
• Quality of features e.g. energy efficient appliances, smoke alarm and clothesline
• Friendly Tenants
• Good Landlord

This is my second week at a community physiotherapy placement. The chronic diseases class is held at Unipol, which is the student's gym at the University of Otago (free entry with a current student or staff ID card). Unipol backs on to Forsyth Stadium, a covered sport stadium for mainly rugby and soccer matches. During the placement half of the student physios contributed to a great warm up and cool down. I will be contributing to this next week with the other half of the physio students.

In many ways, University of Otago is like Hogwarts. There are many old buildings (some that look like castles!), many stairways (luckily they don't change!) and secret passages between buildings. The secret (or not so secret) passage to Barnett lecture theatre is always exciting! Barnett lecture theatre is located in the Dunedin public hospital and I feel like this is becoming our second lecture home. I like it because there is an over-bridge between the hospital and the anatomy and physiology department where Gowland lecture theatre is. Let me take you on the over-bridge (secret passage) to Barnett! The lecture theatre itself looks like it was taken straight out of the Harry Potter movie too!!

Phty 254 MSK and anatomy were in sync this week with presentations and assessment of the knee complex! We are now expected to learn the assessment techniques at home before the lab to fully utilise the lab time (perfecting the technique). This means that we partner up as soon as we enter the lab and start mobilising joints. When other students arrive, we test their joints out too! I am always pleasantly surprised to find joints that I previously thought were very well stuck together, actually have a reasonable amount of accessory movement!

Home is not only a geographical place, such as the town you live in, a flat or parents house. Home is a place of personal significance, attachment and comfort. At home this week my flatmates and I are having a potluck lunch on Saturday. I hope they decide to flat together next year! After the potluck lunch I'm travelling to my other home to see my parents - so that's two delicious meals in one day! Lucky me! It snowed again on Friday, so our Pharmacology lecture was cancelled - it was a good idea to stay at home in the warmth.