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!