Y3S1W5: Walking Towards Health.

MSK continued with assessment and treatment strategies for the shoulder.  We were reminded about reactive and degenerative tendinopathy and introduced to GIRD (glenohumeral internal rotation deficit) often seen in throwers. In the grand-scheme of shoulder assessment we needed to assess the whole picture whereby "injuries start  with the big toe". In labs we applied Maitland and Mulligan manual techniques, strapping techniques and used exercise prescription to treat the shoulder. During the second lab, we all were given the task of presenting five exercises in small groups for specific muscles that were allocated to us. I presented exercises for the lower trap!

Thankfully, nobody's rolling any joints around here!!

There is a saying "If persons' with Parkinson's Disease saw a fire, they would be the first people out of the room", as they respond well to visual (and auditory cues) to initiate movement. In our neuro lecture we discussed rehabilitation strategies for persons with Parkinson's Disease. There were a few interesting ways in which we can teach them to manage gait, such as placing strips of tape on the ground for them to step over, displaying signs in their home suggesting when they should begin regulating their steps with verbal cues or to use mental imagery to pretend they're trying to squish spiders with their feet!! The second half of the lecture focused on strategies to improve upper limb function, especially in those who have little to no movement due to stroke or traumatic brain injury. There are many interventions, some of which are very clever such as using mirrors to trick the brain into activating the hand, and others are very innovative tools including using computers and motion technology to train the brain.

I had my first placement of 2015 on Monday morning at the School of Physiotherapy's Umove clinic. I got to work with a person with what seemed like a mild dyspraxia as well as what was possibly a homonymous hemianopia following a CVA. I had a bit of homework revising what each of these were, how they were diagnosed and how I could treat these conditions in following Umove clinics. I had three Umove clinics this week. During my other sessions I was able to work with a patient who had a brain tumour, multiple sclerosis and another stroke patient. Have you ever gone to the beach as a part of a school field trip and you were given a check-list for things to look for? e.g. a starfish, 2 different sea birds, a mollusk, etc.. Well, we have a checklist for neuro rehabilitation... basically, there are a list of conditions, assessments and interventions that we are aiming to check off as undergraduate students. Obviously, assessments and interventions won't be thrown randomly at clients just so we can tick them off, but where possible I will do my best to get a full house/bingo! With regards to interventions, the Umove clinic has a few interesting tools (see photo below). Did I mention that we get homework from placement too...?? I've got to give a presentation on apraxia on Monday. I've got two more weeks of neurological rehabilitation at the Umove clinic.

Umove's magic box that makes our hands appear on a screen!!

Students in my pathology lab group have picked up a trend, in our case studies, of patients dying. For most of the case studies, there is a reasonable amount of patient background given including the events pertaining to the pathology and other medical aspects. However, in almost all cases so far, the last sentence usually reads "despite treatment, he/she usually died from [an organ] failure". We get pretty excited when a person from a case study doesn't die... such as the girl who ate peanuts (despite knowing she was allergic to peanuts) and had an anaphylatic reaction.  Apparently, our case studies are of real, but historic, cases from Dunedin Public Hospital.

Our stethoscopes have arrived!! Woohoo!! Here is an unboxing of the stethoscope!

Tip for surviving physio: make good use of 'course reserve'! Books are usually quite expensive, so thankfully you can borrow them from the library! Course reserve is a small section where paper coordinators reserve books specifically for the course/paper. Obviously to borrow the book for a set period is free, which relieves your bank account and spears your bookshelf from creating your own home library of soon-to-be outdated books! (Books are usually updated every other year). Two books of interest for MSK are:

 However, this pocketbook for physio is super handy (& could be used to squish spiders!)... 

...you should consider buying this one for your back pocket!

In social events this week, second and third years had the one-off 'Physiotherapy City Tour' on Saturday starting at 3pm. "It's a historical tour [read pub-crawl] showcasing some of the finest bars, pubs, taverns and grills in Dunedin" ... that sums up the event very well. Students will start in North Dunedin and make their way over the afternoon toward South Dunedin. Now that's a lot of walking (and drinking)Transport will be provided to take students from the last pub to the stadium to watch the Highlanders versus Stormers rugby game!

Should I mention the cricket? Yes, of course (briefly)!! The Blackcaps (New Zealand's national cricket team) are facing off on against Australia for the Cricket World Cup on Sunday! We had an exciting match earlier in the week where we fended off South Africa for their place in the final. This was a big achievement in NZ sporting history. Fingers are crossed for the final!!!

On Thursday I popped over to the School of Physical Education, Sport and Exercise Sciences to participate in a research project undertaken by a School of Physiotherapy PhD student. The study had participants complete a few questionnaires, body measurements which included, blood pressure, lung capacity (electronic spirometry), and their fat and fat free mass calculated using a bioelectrical impedance machine (my data is below). The 'real' data however came from a 15min treadmill walking task. Participants had to wear a gas analysis machine during this task, which was linked up to the computer (photos below). A you would expect, it was a great experience and we received a $10 petrol voucher! The research, provided the hypothesis is supported by evidence, may change how exercise volume and intensity is prescribed! I won't give any more away than that - have a browse of the poster for more details!

 

Y3S1W4: Luck of the Irish

This week is the social sport edition of my physio blog. I'm going to attend as many physio organised social sport games as possible!! Social sports are organised by our student exec. We've got indoor soccer on Monday, netball on Tuesday, volleyball on Wednesday and touch rugby on Friday!

Indoor social soccer, Monday at 8:15pm. Physio students attended their first social 6-a-side soccer match at Logan Park High School's gymnasium. The number of students that attended were almost enough for two teams - great turnout! Our sports rep summed up the match very well. There were a couple of 2nd year 'pros' in our physio squad. For those, like myself, who haven't kicked a ball around in a few years, you'll be pleased to know that we have rolling subs! We beat the opposing team 7-nil, but football was the winner on the day. Social netball was held the Tuesday night at the College of Education Gymnasium. There wasn't a very good turnout - probably given that it was St Patrick's Day. We pulled in a few players from the teams that played before us and put in a solid performance to draw 15 all by the final whistle. It was a sharp learning experience for me - I've never played netball before, so learning the rules quickly was a must! Volleyball was on Wednesday evening at the School of Physical Education, Sport & Exercise Science's Smithells Gym. There wasn't many physio kids that attended this either... my peers didn't even have St Patrick's day as an excuse. I wasn't very good at Volleyball, I think I'll stick to social soccer when I can. Touch Rugby was on Friday. The physio team had two games. I'm not sure about turn out to this as I was at work, but I suspect it would have been good.

St Patrick's Day was on Tuesday, although you may be forgiven for being unaware, especially if you were studying (or adding to a physio blog) in the medical library after the 8am MSK lecture. There was not a single shade of green clothing in sight. The first costume I saw was a guy dressed in a kilt & green top around midday (I'm not sure if kilts are a part of the Irish culture?!) Thereafter, there was quite a few costumes around Dunedin.Whilst most of the students were still celebrating St  Patrick's Day, I zipped out to Hooper's Inlet to photograph the active storm of Aurora Australis. Funnily enough, the night lights matched the theme of the day! I've included two of my photos (I've edited the bottom image).

MSK assignment on whiplash was due on Friday! I finished that off earlier in the week after casually piecing sentences and articles together over the last few weeks. In lectures we checked out sick scapulae and differential diagnosis for disorders of the shoulder. "Sick" is actually an acronym describing signs and symptoms of rotator cuff dysfunction:

• Scapulae malposition on the rib cage.
• Inferior medial boarder winging.
• Coracoid pain & malposition.
• scapula disKinesis 

Another acronym mentioned was TUBS. Tubs is used to evaluate instability and dislocation of the shoulder joint.

• Traumatic
• Unidirectional
• Bankart
• Surgery

In MSK labs, students were putting movement tests to use that they would likely observe later that day (St Patrick's Day). The empty-can test is a upper limb position that is similar to that of emptying a beverage can... funny that. It may be a useful test to see if there is any alcohol left in the can before discarding it to the rubbish. Other tests included the 'speed test' and 'lift off' test - these may sound like useful post-drinking tests too, but really they serve little benefit away from the clinical setting. We later completed many orthopaedic assessments for the shoulder complex!

Pathology informed us on the pathological process of autoimmune diseases such as type 1 diabetes, Hashimoto thyroiditis, graves disease, coeliac disease, Crohn's disease, pernicious anaemia, vitiligo, haemolytic anaemia, multile sclerosis, myasthenia gravis, systemic lupus erythematosus, Sjogren's syndrome, scleroderma & rheumatoid arthritis!! Autoimmune disease can occur in a range of local and systemic tissues creating a lot of autoimmune diseases, but luckily the pathological process have similarities! In labs we've been comparing photos of healthy and compromised hearts, brains & livers to that of steak, chewing gum and canned chicken soup. We were able to do some forensic work identifying the time lapsed from the insulted tissue (ignoring the fact that the patient had obviously died)... we're thankful medical professionals don't cut out the body organ and dissect it just to confirm an event happened 'x' time ago (days, weeks, months or years). Some other activities during the tutorial included looking at the blood works of different case studies and describing what was happening.

Tip for surviving physio: if you feel you've over committed yourself to work, university and community events, after noticing that you are already missing most lunch breaks throughout the week and deciding that you actually do value eating, you may decide to reduce your workload. This was my predicament of the week. I had a clash of work and sport medicing commitment for Dunedin Tech football. I know the team has plenty of fresh sport medic faces, so ultimately the decision wasn't too hard. I will pop over to help out when needed though. Being a back-up sport medic is often a good way to reduce workload whilst maintaining those social networking ties. I'll still be volunteering at the sport injury clinic on Sundays (and fortnightly on Monday evenings) though - often multiple avenues arise and you just want to be a part of them all!

It's Hyde Street Keg Party this Saturday. Sports Injury Clinic is on this Saturday too - probably won't save the hospital from student's with drunken mishaps though.

Y3S1W3: Physioterrorist

Physioterrorists existed in the good old days of patient management, especially in acute care settings. Physios were deemed physioterrorists when they put too much stretch through a muscle (static stretching) that caused pain. Yikes! That's got to hurt! It's now understood that static stretching should be pain-free. Phew!!

I've got a bone to pick with you! ...especially if you have osteomylitis involving sequestrum (i.e. dying bone), whereby to curette your bone (i.e. to scrape/pick off the necroses tissue) will help your bone heal! Pathology on Monday recapped bone healing by comparing it to healing of the skin, as well as describing the pathology of bone diseases. Each week we have a tutorial and 1% pre-tutorial test. "Pathology isn't all gore & grime... well actually, it is." - our tutorial supervisor.... we enjoy our overly enthusiastic tutor. She even has Harry Potter-like-spells, for example "Functio Laesa" which will generally inflict a loss of function (a sign of inflammation) on to the targeted physio student. We also likened our immune response to war! For example; our neutrophils are the mature gunmen, once they're all in battle or dead we send out younger, less mature neutrophils (metamyelocytes; likened to teenagers sent to battle), if they then become deployed, in battle & dying then our bodies send out the most young pre-curser neutrophil cells (myelocytes; likened to 5-10 year olds being sent to war...). Then there are the battle scenes themselves... the blood stream becomes a highway of policing cells (monocytes & neutrophils) which respond to messengers (cytokines e.g. IL-8) who flag down the police ensuring they make the correct turn into the affected tissue. Once they're at the scene, it's chemical warfare (inflammasomes) and things can get messy!

You've got some [ulna] nerve! In MSK we learnt about neurological testing versus neurodynamics of nerves of the upper limbs. The premise of neurodynamics is to slide and glide nerves. All of the nervous network, in healthy individuals, will have certain properties e.g. extensibility & compressibility - neurodynamic assessment and treatment plays on these ideas. Neurodynamics is often known as 'nerve flossing' because through these techniques you're effectively moving your nerves between bodily structures like you would a string of dental floss through teeth! Physiotherapists are able to move/position the body to slide nerves into positions that stress particular neuro structures over other branches of neuro structures, for example we can position the upper limb to have a bias stretching of the median, ulna or radial nerves! This is very useful when diagnosing the source of symptoms!

I attended a public lecture on concussion on Wednesday afternoon. The lecture is very relevant to physio and sport medic professionals. I found that it was not only a nice refresher, but was an eye opener to the management of concussion and brain injury. There were a few familiar faces presenting, including our own Dean of Undergraduate Studies (Physiotherapy), John Sullivan! John's (and colleagues) research has lead to recommendations and policies implemented by government agencies and [inter]national sports bodies. The presenter whom I found most interesting was the Highlanders Rugby team doctor, Greg Macleod. High performance sports teams are interesting due to the controlled environment and data that can be collected from athletes. The presenters described different assessment strategies specific to the context in which they are responsible for people with concussion, for example: in the neuro specialist consultation, elite sports environment and community levels. There was a discussion about the process from concussion episode to return to work and sport, with medical management being the key focus. In addition, a key point of interest was that the majority of people will know that seeing a medical professional is the best action for them if they are suspected to have a concussion, however those that implement these actions is very low. Furthermore, there is a cultural norm "she'll be right" in New Zealand needs to change with regards to health, in particular, concussion. Have a talk to your health professional or national sporting body representative if you would like to know more about concussion (or have a look at ACC Guidelines or visit ACC website but note that DrABC's of first aid apply first and foremost i.e. in the document linked it is recommended that the player is immediately removed from the field however, be certain that there is no additional contraindications such as a neck fracture).

Lab group C dinner (combined 2nd & 3rd years) at  Shahi Tandoor. The original plan was to have it at La Porchetta, which is also yum, but they were booked out for the evening! It was held on Friday from 7:30pm as some students work Friday afternoon. I'm not much of a foodie, other than I enjoy a good feed! Shahi Tandoor is an Indian style restaurant, and they make a great curry. All their food is reasonable to cheap & of high quality.... although it's not quite fine dining, there were great size food portions at a low cost! Perfect for students!

This weekend is the orientation for new sport medics at the Dunedin Sport Injury Clinic. The Edgar centre is the largest indoor multisport stadium in the southern hemisphere with 21 netball courts in only a relatively small section of the stadium! The sport injury clinic is almost an emergency room for acute sport injuries at the rear of the Edgar Centre. If there was an x-ray machine, you could almost call it a real emergency room (...... almost). It does have all the acute care gear that you need. In the event a player with a fracture come in, we call an ambulance over from the public hospital and they take charge of the player from there. The sport medics were orientated to the whereabouts of all the gear (as well as how to use the ambulance stretcher - with wheels) and shown how they want the paper work for each patient filled out.

Highlanders versus Waratahs! My Saturday evening was spent with family who came down to watch the rugby, needless to say I grabbed a seat with them too! Dunedin is fortunate to have an undercover stadium which replaced an aged (now demolished) stadium 'Carisbrook Stadium, then known as the house of pain'. For a small city, Dunedin has many facilities that are of an international standard. Anyway, back to the game! I enjoyed watching the university students in the zoo generating noise and cheer and the game play itself - the mighty Highlanders won! It was also great to watch the medical team bustling about on and off the field. Woohoo!! Best of all, I attended the game and got to catch up with family!

Left to Right: My parents, Aunt & Uncle, myself & Joyce.

The 'zoo' is by the other goal post.

Rewinding back to last weekend... I got involved in a 'cycle skills training' event organised by Dunedin City Council and cycle skills instructors (South Dunedin Police and other stakeholders, including primary school teachers were also involved). The event had us bike with a large group of primary school aged children across South Dunedin from their school to a recreational ground, practising the road/bike skills they had learned at school, for some bike skill games/challenges/fun. The kids and adults also got to sit in a 50 tonne truck to appreciate the lack of visibility these drivers have (there are numerous blind-spots, even with multiple mirrors on each side). There was a bike to be won for the best skills and road practice. As a physio student, it's always nice to branch out and give back to the community - I challenge you all to do this once in a while.

There will be social sports for physios to participate in over the year starting in a few weeks. Sports include: Netball, Touch, Volleyball, Basketball & Indoor Soccer... some of these sports start next week!! I'll participate and report on as many as possible next week!

Y3S1W2: Pistols & Screws

It's uniform purchasing time again (especially for second year students). Here's a recap of our uniform requirements: Navy blue dress pants or cargo shorts with a white polo shirt (embroidered with a physiotherapy logo). It is suggested that we have either a woollen vest or a merino pullover jersey for the winter months. If we're in the hospital, we cannot wear sleeves i.e. a merino jersey. We must wear tidy, enclosed and dark coloured shoes that can easily be cleaned if vomit, urine or other fluids come in contact with it. Our 2015 Tshirts were handed out upon payment to join the physio students association (re: discounts on social events). And later this year we will be able to purchase other sport/casual gear embroidered with the physio logo. It's cool to rep physio gear in public.

A fourth year student is ordering in some stethoscopes! We'll pull off the 'Doctor look' now for sure... it'll just be our poloshirts with the words "physiotherapy" that will give our identity away! The medical profession seems to get excited about branded gear, just like elite athletes get excited about big brands like Nike or Adidas, medical staff may get excited about brands like "Littmann". We're ordering in some Littmann stethoscopes... so that'll make us look cool. What would make us even cooler is to use them to detect dysfunction of the heart and lungs in second semester, on placements and in our physio jobs after graduation/registration.

Wine & Cheese on Wednesday, 7:30pm to midnight. Picture this: young professional physiotherapy students dressed in immaculate, semi-formal attire spending an evening mingling between peers of each year group in a casual social setting, sipping on fine wine or beer, with platters holding a variety of cheese, crackers and savoury sides placed on tables around the room, tasteful music projecting from one side of the room managed by a DJ. Pretty high class wine & cheese event, right?! Almost! All of the above is true, but now think 'great big party with loud music, disco-like lights, night club-style dancing and lots of alcohol consumed'. It was a good time - I would recommend it to 'non-drinkers' too. I met a few second years and enjoyed a few drinks myself. The wine & cheese was held at LoneStar in North Dunedin, our tickets came with two free drinks and nibble. There was a bar tab for $4 drinks (great value), with a selection of wine, beer or fruit juice available.

Social Adventure (formally 'Flat Crawl') was on Friday night. I didn't attend this, but the idea was to progress around 3rd year physio student's flats like a 'pub crawl'. The theme was zoo animals (second year students) and zoo keepers (3rd year students). Naturally there were challenges at each flat and, again, lots of drinking. It was a good night for all that attended.

Last year our lectures were almost entirely held in Gowland Lecture Theatre in the Lindo Ferguson building (departments of anatomy and physiology). This year we've changed camp ground to Dunedin Public Hospital's Barnett & Colquhoun lecture theatres!

I arrived early to Pops/path on Wednesday 8am (Colquhoun lecture theatre) to find the lecture theatre technicians setting up the audiovisual streaming between Colquhoun and Barnett. They had an audience of about five early bird students to witnessed their humorous display of checking audio and visual connections. Technician1 conferring about sound levels "[indistinguishable mumble/vocal noise from the other end] Speak up! [some moments later...] Oh, have you just discovered time travel? Your reply was a bit delayed". Student observing from our end "I think he just needs a coffee". Technician2 conferring about video quality "You're looking a bit blurry this morning, don't think it's the video quality though..." I don't think I'll mind turning up early to 8am lectures if these comedy acts continue.

We had an eye opening ethics lecture and tutorial about privacy and confidentiality. Although now considered ethically poor, historically the professionalism and care in note taking involved medical practitioners (namely doctors, nurses, etc) writing down notes about patients like "lazy slob" or "smelly young kid". When patients were given rights to view documents these absurd comments were changed to abbreviations (e.g. SYK) so that patients less likely to understand them (like an inside medical joke). The public will be pleased to know that this is a violation of patient rights and has become a very rare practice. There is now a code about privacy for health practitioners made up of 12 principles of which they must adhere to (you may be interested to check them out!): https://www.privacy.org.nz/the-privacy-act-and-codes/privacy-principles/

"To be a great musculoskeletal physiotherapist, you don't need to be the best at [performing] manipulations"... a quote from a lecturer taking us for a lab on manipulative manual therapy for the thoracic spine. There are plenty of treatment modalities in MSK physio. Having a great understanding and technique for all is important; being the best manipulator may or may not translate to best patient outcomes, especially if better results can be achieved by mobilisations or other treatment modalities. I must admit that learning how to manipulate the spine has been something I have dreamed of (... I should probably dream bigger dreams), so to learn and practice PA manipulations of the thoracic spine was very exciting for me (and for a few others, I imagine). We were taught the pistol grip technique for patients positioned in supine lying (facing the ceiling) and the screw manip technique for patients positioned in prone lying (facing the floor). I've quickly realised that I find the screw technique much easier and more comfortable than the pistol grip alternative, mainly because, during the pistol grip attempt I managed to 'click' my fingers rather than my class mates back. I'm still going to practice this though - a full set of tools is better than a near empty tool box - also I know how I can change my technique so that my hands don't hurt. The lab was very entertaining. Many students got their first 'crack/pop'... and a select few got multiple 'crack/pops' in a single manipulation! Needless to say, there were a few "woohoo's" during the lab. Research suggests that manipulation has a large psychological effect on healing - it certainly sounds convincing from a practitioner point of view too. In the same lab we palpated and mobilised joints of the ribs. Rib joints of the anterior aspect of the body can be a bit tricky for males to palpate on females - but in an assessment it may need to be done thus informed consent and protection for both patient and practitioner via palpating through a towel may be needed.

Our second MSK lab this week covered SNAG & NAG. It may sound like a family fishing trip; kids nagging "are we there yet?" and snagging fish on hooks. In the physio context, this Mulligan concept is a manual technique effecting the apophyseal joints of the spine. [Sustained] Natural Apophyseal glides is a technique based on 'Mobilisation with Movement' that when used that should instantly reduce joint pain, especially of the neck. Also in the second lab we were asked to create an exercise programme using the online software 'PhysioTec'. This is a library of exercises with easy to follow instructions and pictures for clients to take home and complete. Clients can even log on online to view their saved personal programmes if they misplace their exercise sheet. It's very helpful and easy to use! www.physiotec.org

Pathology covered acute inflammation pathways, and necrosis e.g. different types of necrosis are coagulative (myocardial infarction)/gangrenous(gangrene), liquifactive (pimples) and caseous (from smoking). I'll leave the pathology update there for this week, more next week!

The Sport Medicing course has pretty much finished for the second year students. Well done to those that attended the 'Social Adventure' last night and still made it to the Saturday lecture. The Saturday course provided additional info and sign-up forms for sport medicing opportunities. I got to give a brief overview of my experiences as a sport medic with the soccer team. I look forward to helping these second years... hopefully a few choose to medic the team that I've been working with!

Y3S1W1: Pops!

Physio has hit the ground running, smashing almost all of our lectures this week for sixes! (The excitement of cricket world cup is still wearing off).

Here is our paper lineup for semester one!
PHTY353: Pathology - the scientific basis of disease!
PHTY354: Physiotherapy Rehabilitation Science 2 - there will be three modules covered in semester one. These modules are musculoskeletal, neurology and physical agents (electro-therapeutics).
PHTY355: Physiotherapy Clinical Practice - the more placements, the better!!

We have 8am starts again this year. Our timetable is even busier this year than it was last year. Here is a sneak peak at next weeks timetable. Thankfully, we're each in our own group (A, B, C & D). Each group will cycle through a three week period with three placements per week. My placement begins in a few weeks time. We will all have Umove at some point during the year too - this will be my  first placement. I'll fill you in on these details as they happen.

We have been informed that our grades in year three will directly influence who can apply for honors next year. There are six places up for grabs for the top academics of my year group (provided they achieve an average of A- or higher). I know of quite a few students in my cohort striving to gain physiotherapy honors. I wish them luck! On a slight change of topic... I was talking to a PhD candidate, who was doing their research at the School of Physio, about academic life and one point of our conversation in particular struck my attention. Their reality was that, of the three common career areas (teaching/lecturing, researching and practicing physiotherapy) they [realistically] were only able to pick two (research and clinical practice were his current two picks). It reminded me of the meme 'good grades, a social life, & a good nights sleep - pick any two' that was making its rounds on social media a few years ago. I'm definitely prioritising good grades - the other two will probably change on a week to week basis.

This year in our neuro rehab (PHTY354) we will study, in depth, the physiotherapists role from acute care to community rehab, and every step in between. On Monday we jumped straight in to management of acute care (intensive care, high dependency and acute stroke units) neuro rehabilitation. Content has picked straight up from where we finished off last year. Physiotherapists have a role to help patients who have been admitted to hospital with traumatic brain injury, stroke etc. Their lives are at risk, and our job is to help rehabilitate them (as a part of the multidisciplinary team) as soon as possible. We learned about intracranial pressure (ICP) and monitoring other vital signs, the contraindications and obviously the importance of physiotherapists in these early stages. Neuro labs will comprise of self-directed learning modules which form a portfolio to be assessed by the end of the year.

Pops is pathology for the professional health science programmes (medical laboratory science, pharmacy, dentistry and physiotherapy). It might be popular in that it is a shared third year paper of the above degrees but we'll have to wait and see as to whether it is popular with the students... with 8am lectures, I hope the content makes getting up early worthwhile. So far, we've discussed things like staining tissues to investigate micro-structures, cell regeneration/damage/homeostasis and cells/diseases of the blood.

Something else that goes "POP!" in the morning is toast! Wednesday was a drizzly day and I was running behind time for an 8am pathology lecture. I arrived to the lecture on time but had to sacrifice breakfast. Thankfully, the Otago University Student's Association (OUSA) provide FREE breakfasts between 9-10am during the semester and examination periods. I stopped by to satisfy my stomach before popping over the medical library to start combing through articles and physical exercises for our MSK assignment about a patient with whiplash.

MSK for PHTY354 is also a continuation of last years content. Lectures continue to develop our knowledge of disorders, clinical reasoning skills and rehabilitation protocols. We're finishing off our orthopaedic tests and treatment strategies in labs - at the end of semester one we will learn how to safely manipulate (POP! Crack!) the cervical spine. This technique must be learned under the supervision of a registered physio and may be daunting for the physio student and even more so for the recipient. I'm very much looking forward to this! In the meantime, we're differentiating structures and sources of symptoms - starting with palpation of key bony landmarks of the cervical spine and treatment such as PA and unilateral AP mobilisations. Palpation, accessory and passive movements of the cervical spine was challenging and will require some more practice - pressing on deep tissues and nerves hurt whilst compressing the carotid artery is simply concerning! Also, I'm still getting my head around which is the correct way to pronounce "cervical" - one way refers to a region of the spine whilst the other refers to part of the female reproduction system (both are spelt the same!!)

Clinical practice labs this week reminded us of SOTAP notes, how to prescribe walking aids and other useful skills we learned last year. Clinical placements begin next week for the students in the first rotation.

The student exec have been busy again organising social events. The social events are underway next week with 'Wine & Cheese' on Wednesday and 'Social Adventure' (which is replacing 'Flat Crawl') later in the week. I'm heading along to the Wine & Cheese next Wednesday - I look forward to telling you about this more in my next post.

I'm flatting a bit further away from Otago University, in North East Valley, which means I get to experience a pleasant 15-20min walk through the Dunedin Botanic Gardens on most days of the week. The Botanic Gardens offer more than a superb floral display and adventure through the themed gardens. The gardens are a place to feed the ducks (the info centre there gives you free packets of feed for this purpose), occasionally there are morning running courses signposted and over the summer period there are Sunday musical concerts.

If your landlord doesn't allow you to have animals or pets at your flat then you could consider germinating and planting seeds from fruits eaten over the summer period (or just purchase a seedling). The plants will generally need less attention than a gold-fish, cat or dog and can make your study environment a little less boring. I have had some success with a mango seed that I planted a few weeks ago... here it is! If your flat has a reputation for being cold, then I don't suggest you grow mango trees.