Internal Optimist

[InternalOptimist]

Recovery

Hi,


A brief post this week, mainly because I haven't been up to too much. This has been my week off for Easter, and I have spent most of it lying on the settee, watching day time TV and films. I was feeling pretty sorry for myself when I wrote the last blog, and up to about a week after the operation date. Now I am feeling better and better, great news! I can eat proper food and talk. I went to a friends birthday party yesterday, thinking I would be sitting in the corner unable to talk with people very much (not really like me at all) but hadn't really any problem. I did talk a bit too much, though, and have to go home a bit after twelve... Today I made a roast dinner with flat mates and ate properly!


It is only after you have had things taken away that you realise how important you are. Hopefully, (and now this sounds like I am writing a reflective piece of writing for my medical school) I can use this to appreciate how being ill can make some people pretty grumpy and relate to this. I was pretty grumpy last week, apart from when I was taking too much codine and was just a little loopy...


Anyway, summery - I am now well enough to do the essays and work that I have been putting off and excusing 'because I am too ill' which would make me sad, if I wasn't so glad about this new found health!


To wrap up, please find below a picture of my throat 5 days after the operation. The uvular was more swollen before this picture, but I couldn't really open my mouth enough to take a picture of it. The white bits are probably because of the cautery used to seal off the cut burning and killing the flesh at the back of the throat, which is then coming off. The uvular is still pretty big in this picture (compared to my or anyone else's normal size) which I suppose is because of inflammation from the surgery. It was very awkward, as it felt like there was something there that I wanted to swallow all the time, and it diverted any food or drink around it when I tried to swallow all over the painful parts!



The back of my throat, 5 days post op. Most notable is the inflamed uvula. Sorry about the pictures if you think they are nasty, but I always find this sort of thing interesting!

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Recovery ]

[InternalOptimist]

Misogyny

Hi,


I am feeling mostly better now, which is great! Wasn't as great towards the start of the week, so I didn't go into the hospital much, but I did go into a teaching session with a consultant and a couple of other medical students, where we practice ENT examinations on each other. I also hear from a friend about some shocking sexism she was exposed to, from a surgeon who is a well known misogynist... This is also my 100th post; thanks for following so far!


Most of our teaching comes from talking to patients, and trying out examinations or procedures on them. See the BBC 'Junior Doctors - Your Life in Their Hands' to see what I mean (though I don't really think that much of that that programme, many of them just seem so... unlike-able...). Hence why a few weeks ago I was practising ophthalmoscopy on patients under the directions of a consultant. The ENT consultants have decided that, rather than trying out all these ear, nose, throat examinations on patients - it would be a lot better for us to try them on each other, learning how not to hurt people by being hurt / hurting one another. A good idea, and its great to be taught examinations and so on as you do them, rather than read up on them and pretend you know what you are doing (as I have done before for an ABG).


The problem with being taught on one another is that if there is something... gross.. in the examination it is a lot more personal. When you are with patients it is all par for the course and expected, but with each other it is a little bit stranger. I was doing this with 2 medical students, and the male one (slightly low on tact) was examining the females ears, when he remarked 'wow I can hardly see anything, these are full of earwax'. Clearly something that is very normal, ears produce wax, and some ears produce more than others... Not something you usually want to hear about your class mate though, and the girl was clearly a bit hurt by this. When I was later examining his nose, it had this giant bogie sitting it it , wobbling around - again, normal for a patient, the nose makes these things, but strange to be peering at a class mates! (at least it wasn't as bad as this one!). With my messed up throat after the tonsil operation, we all had something on the examination to see, just strange to see it on a fellow medical students. Perhaps this is why doctors are not meant to treat their friends or family!

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Misogyny ]

[InternalOptimist]

Misogyny

Hi,


I am feeling mostly better now, which is great! Wasn't as great towards the start of the week, so I didn't go into the hospital much, but I did go into a teaching session with a consultant and a couple of other medical students, where we practice ENT examinations on each other. I also hear from a friend about some shocking sexism she was exposed to, from a surgeon who is a well known misogynist... This is also my 100th post; thanks for following so far!


Most of our teaching comes from talking to patients, and trying out examinations or procedures on them. See the BBC 'Junior Doctors - Your Life in Their Hands' to see what I mean (though I don't really think that much of that that programme, many of them just seem so... unlike-able...). Hence why a few weeks ago I was practising ophthalmoscopy on patients under the directions of a consultant. The ENT consultants have decided that, rather than trying out all these ear, nose, throat examinations on patients - it would be a lot better for us to try them on each other, learning how not to hurt people by being hurt / hurting one another. A good idea, and its great to be taught examinations and so on as you do them, rather than read up on them and pretend you know what you are doing (as I have done before for an ABG).


The problem with being taught on one another is that if there is something... gross.. in the examination it is a lot more personal. When you are with patients it is all par for the course and expected, but with each other it is a little bit stranger. I was doing this with 2 medical students, and the male one (slightly low on tact) was examining the females ears, when he remarked 'wow I can hardly see anything, these are full of earwax'. Clearly something that is very normal, ears produce wax, and some ears produce more than others... Not something you usually want to hear about your class mate though, and the girl was clearly a bit hurt by this. When I was later examining his nose, it had this giant bogie sitting it it , wobbling around - again, normal for a patient, the nose makes these things, but strange to be peering at a class mates! (at least it wasn't as bad as this one!). With my messed up throat after the tonsil operation, we all had something on the examination to see, just strange to see it on a fellow medical students. Perhaps this is why doctors are not meant to treat their friends or family!

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Misogyny ]

[InternalOptimist]

Alcoholic nurses?

Hi,


My last week on ENT this week, and another slightly late post. Sorry about this, but I keep getting distracted by other things in my life. Don't feel too taken aback, though, as these distractions are effecting the work I am meant to be doing as well - its nothing personal... This week I spent some time in ENT outpatients with a fantastic consultant, but spent a lot more time trying to help out a friend who has had some form of psychotic breakdown and has now fled the country.


The time in ENT outpatients was spent mainly with a fantastic friendly consultant. He showed a lot of concern for my ex-tonsils and was very jokey, while staying formal enough for (most) patients, and sharing a lot of knowledge. When I say formal enough for most patients, I mean things went swimmingly with all patients but one, where his joking fell embarrassingly flat. Here he was (for some reason) joking about the nurse who sits in the corner of the consultation room to help with the preparation of equipment, and saying that she needed to drink gin throughout the day in order to put up with him and the other doctors, and if the patient needed, they could borrow some of it. The patient took this a little too literally, and started an outraged monologue about how it was unacceptable for nurses to be drinking on the job, and the state of the NHS. Despite the consultant and nurses best efforts, the patient wouldn't believe that this was a joke (because it sounded far-fetched that they were back-tracking now...) and was grumpy with the doctor and 'drunkard nurse' for the remainder of the consultation. Perhaps there will be a law suit coming this way!



A scope used to look down patient's noses to their vocal chords - one of the things the 'drunk nurse' had to prepare for the ENT doctor.


Fortunately, the other consultations were conducted in fully professional ways, and no more problems were had. The most interesting of these 'normal' consultations was a man who had come for the results of a biopsy of a lump in his neck. He had come in with another male, who we assumed to be his partner because of how they were acting with one another, and I noticed the consultant carefully avoiding any labels for this other person in the room (it would be embarrassing to wrongly call a brother a partner, and visa versa!) The biopsy had unfortunately shown a lymphoma, and this news had to be broken in a skilful and optimistic way. The two people were evidently very upset by the news, both crying, though the consultant tried to reassure them that it was very treatable. At the end, as they left, the questions they were both asking the nurse were the same things that the doctor had tried to explain. Usually, when bad news is broken to a patient, they don't hear much afterwards due to shock, and the 'you have cancer' bouncing around in their head.


Despite these clinics, by far the most exciting thing that has happened to me this week is that one of my friends has had what seems like a severe psychotic breakdown. His mum called me to let me know that things were not right, she couldn't really get hold of him and asked me to go and check on him. I went over to his house, as I couldn't get him on the phone, where he then proceeded to tell me how everyone was persecuting him. The police had it in for him, had sensors in his rooms in his house to monitor his movement and the phone companies had hacked his mobile to use the camera to watch him (his was why he wouldn't call anyone). The university had hacked his laptop, so he bought a new one, which had then been hacked and they had uploaded documents detailing how to plagerise work efficiently (he assumes to get him in trouble) which had then mysteriously disappeared. There were people opposite his flat who were recording him all night in his room, which he could tell by the faint glow of what looked like a burglar alarm in their window. He knew there was people watching him as he could hear their voices mocking him, and talking about what he was doing. He hadn't left the house in a week, as he was afraid he would be kidnapped. And there was more.


He was clearly not feeling well, and being a good medical student, I took a full history. Key to note was the fact that he had been taking a lot of Ritilin, which he claimed was for his ADHD, but I think it was to help him do his essays and increasingly heavy work load. He had been taking more and more as his deadlines approached, and was now feeling like this. I thought this was probably related, but he was adamant that he had never had any problems before and needed it to be normal. He wanted to get away from this 'persecution' so I offered to let him stay at mine for a few days to get away from it and think about what he wanted to do. He was going to finish Uni in a month or two, so I didn't want him to do anything rash.

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Alcoholic nurses? ]

[InternalOptimist]

Sexual health

Hi,


Again, I am sorry for the late post. A stubborn essay and other things in life keep delaying me from posting on the weekend Sunday as previous, and have even delayed me past a bank holiday Monday this time!


This week I start my sexual health rotation, and get the chance to get 'stuck in' right away... (sorry)... The best part of this week was spending some time at a sexual health clinic, where I tok histories from patients on my own (after seeing one done) but didn't carry out any examinations. I was very happy with this turn of events, as talking with people was very easy once I had explained that I wouldn't be carrying out the examination afterwards.


I really enjoyed my week, not because of the subject matter, but I think it was because it is so accessible for a medical student. If someone has a sexually transmitted infection, if can only be one of a handful of causes. The most common can be counted on one hand, and even an extended list is very simple compared with, say, a list of possible cardiac problems. As well as a small list of possible causes, a sexual history is very structured, comes written on a proforma that you need to fill in, and is all in all quite simple. You need to ask around their symptoms, their general health and their history of sexual contact (i.e. who did you last have sex with, what type of sex, did you use protection, who was the person before that, etc). The hard part here is asking these questions without embarrassing them, yourself, or seeming as though you are being judgemental. Obviously the medical profession do not judge people at all, but it can be hard to ask about the sex that a patient is having with his girlfriend 20 years younger than him, while cheating on his wife, without the patient thinking you sound judgemental (especially if they feel guilty about it themselves).


I saw some very interesting cases this week. I met actors from the adult film industry attending to have certificates proving they were clean from sexually transmitted infection (and let them continue to act), though these people did not need much of a history as they were attending more for a screen than with symptoms. There was a woman younger than me, who had come in with recurrent genital warts, and seemed very relieved that it wouldn't be me doing the examination (I suppose it is bad enough exposing yourself to someone for an examination, and when you don't feel you 'look right' down there it would be even harder). The most interesting was a middle aged man, who looked a little like Clooney. He insisted that he had been with his wife for 10 years, and she was the only person that he had had sex with in this time, but he just wanted to come in for a sexual health check up. There was clearly something fishy about this, but however tactfully I asked it (the usual way is something like "when was the last time you had sex with someone other than your wife") I couldn't get him to disclose whether he had had sex with someone else. I was sure that he had, but what can you do? He just got the tests, and I hope he is clean, or he will have a problem explaining to his wife how they both have an STI despite the fact he has been faithful. I suppose its possible he feels his wife has been cheating on him, but it isn't really the sort of question that you can ask a stranger (not than many of these questions are things you can ask strangers!)



For examinations, there is ALWAYS a chaperone present - to protect the doctor as much as the patient!


All in all, the interest here comes from the history, learning about people and trying to read between the lines, rather than the complexities of disease and pathology like other disease specialities. As I said before, I really enjoyed this as a medical student, but I am not sure how much I would enjoy it as a qualified doctor, as I may feel it gets a little same-y. None the less, I did get to try the genital-warts-freeze-spray on my hand (the nurse offered for me to try it, and I didn't want to look like a wuss in front of her [after all, patients get it sprayed on their genitals]) which I didn't think was too bad... Until I was at a social playing laser-tag afterwards - it really burns! Not enjoyable, and I can only imagine what it would be like 'down there'... At least now I can tell patients that it will hurt, and I am sorry, but I have 'tried it out' myself...


As well as histories and examinations, the sexual health clinic also looks at samples right then and there under a microscope, which can spot diseases such as candida by spotting yeasts. I have a look at some of the slides with one of the nurses who is working on this (everyone here seems very friendly) and its amazing how many bacteria you get in an average vagina. There are hundreds and hundreds of Lactobacillus on each slide that was made up from a swab from a vagina. The 'friendly' bacteria that live down there, stopping nasty infections from getting hold... gross...



A slide of Lactobacillus (the rod-like-things) - a bacteria found in vaginas... and yoghurt...

To finish things off, one of the nurses told me that women who wash out their vagina with washing products (shower gel etc) are much more prone to infections because of washing away all this Lactobacillus (you should use water)... Telling women this doesn't really get results, though, and people tend to do it. The tactic that is used, she tells me, is telling women that some men who attend the clinic ask why their new girlfriend smells 'so bad' down there, and if there is anything they can do. These men, the nurse tells the over-washing-woman, are suffering because their girlfriends use washing products 'down there' which end up making it 'smell worse'. As no-one wants to be smelly there, this leads to many more women washing themselves properly than just telling them they will get more yeast infections. A wonderful example of people being manipulated for their own good...

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Sexual health ]

[InternalOptimist]

And end to general practice this year

Hi,


Busy week this week finishing off my big project, which is now happily handed in. As long as I have passed it I am good and happy. Medical school sometimes seems like a series of hurdles you just need to jump over to get to the end and graduate. One more hurdle passed (hopefully)... Because of this project, I didn't get up to too much this week either, taking the opportunities to stay at home and try and work (but mostly procrastinate) when possible. I did spend a bit of time in the hospital though, and more importantly, spent my last day with the GP I had been placed with. I got to run my own consultation list, which was pretty scary at first. As I got into it, it became easier though stranger, as I think the GP put some of her craziest patients on the list for me to talk to!


It was very sad to leave the GP I have been working with, its very unlikely that I will be with her during my GP rotation next year as the medical school tries to balance out rotations in large and small practices. This means that, as this GP practice is practically a polyclinic, I will probably be in a single room that doubles as the GP's bedroom next year. This is one of the most exciting parts of general practice, it comes in all flavours!


The GP had decided that for this visit, she would give me my own 'list' of patients to see, meaning people who had called up for appointments had been given the option to see me. I wasn't going to be the only person seeing them, fortunately (unlike when I was in Tanzania), so this wasn't unsafe. It just helped the GP see more patients, and helped me practice running my own surgery, as it were. I was given log in details to the software used to display the appointments, patient notes, 'QOF alerts', and so on. Made me feel pretty important! I got used to the software, pulled up the notes for the first patient, and went out to the waiting room to call her name...


The first patient didn't go as well as I would have hoped, as she seemed convinced that I was a doctor, despite all my protesting against the idea. She opened with the phrase "Its a good thing that they assured me you were a doctor before I saw you walk through that door, as you do look very young"... I don't know who had been assuring the patient that the medical student was definitely a doctor, but it made her (probably) gout presentation a lot more complex than it needed to be!


This was followed by a couple of very straight forward cases where women wanted to delay their periods for a holiday and an anniversary. Not much I could do as a student here as much of these was prescribing, something that I definitely shouldn't be allowed to do yet! This was where the simple cases ended, though, and the rest of the day seemed to be filled with complex psychiatric patients. If I didn't know better, I would have said that the GP found it hard to deal with these patients who there is very little to do for in general practice, so gave them all to me to see instead... If I didn't know better...


I slogged through consultations with a number of people who had been diagnosed with borderline personality disorder (where I think I was demonised a little more than idealised), and as was beginning to give up hope with general practice, when a 10 year old girl came in who had been suffering from mouth ulcers in her cheeks. A nice simple case, or so I thought, but after a minute or two of talking I began to feel a bit uneasy. The girl had come in with her mum, and their relationship just felt a bit wrong. Not really sure what it was, but there seemed to be some tension and... well, I am not really too sure what it was. On talking with the GP afterwards (before deciding on a course of action, of course) she told me that this 10 year old had been manipulating her mum and dad for the last few years into getting what she wanted after she had been caught stealing sweets from a local shop. It seems that as a GP you get to be part of everyone's life story, and hear about all those things that go on 'behind closed doors'. A great job if you are a bit nosey like me, but as it seems that everyone is crazy beneath the surface I may not be won over by the GP quite yet!

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: And end to general practice this year ]

[InternalOptimist]

Celebrity STI

Hi,


Back into the normal run of medical school, and enjoying the fact that I am relatively free from work a the moment, while the weather is also lovely. Usually it seems that the amount of sunshine is directly proportional to the amount of work I have to do, and thus the amount of time I have to spend inside on a computer. Not any more! I can enjoy a cycle to and from the hospital to learn there, and enjoy my time away as my own time... At least until the exam and presentation in a little over a month. Still, they can wait!


This week I spent some time in infectious disease outpatient appointments, and infectious disease ward rounds, and some more time in the sexual health centre, where a somewhat familiar face made a visit.


Clearly, because of confidentiality, I am not going to say anything about the B-list celebrity who was coming in for a sexual health screen, but it is interesting to note that these poor people have to live their whole lives in the public eye, with all these people they have never met knowing about intimate details from their lives. I am sure some use these details for their own publicity, carefully cultivating certain images, but its sad to know that others just want to get on with things and not have rumours fly around about them. Anyway, celebrity or no - everyone should have regular sexual health check ups! Apart from this unexpected visit, the sexual health clinic was pretty similar to previous times I have been there. I would talk to the patient on my own, present them to a doctor or nurse, who would then come in and do an examination with me. There were a large number of teenage boys who had come in with lumps on their penises which had been there for some time. All of these were diagnosed as Fordyce's spots, a harmless feature which just occurs on some penises. Strange that so many came in in one day for these lumps. Perhaps it was sex-ed week at school... Doctors often comment that patients seem to come in clusters of disease, where you won't see something for some time, then a number of that particular condition will come in in one day. I suppose its like buses...



Sexual health clinics are slowly losing the stigma that people have attached to them... Come one come all, they have free sweets!


Other than the time in the sexual health clinic, which I am still really enjoying, I got to join some outpatient sessions and ward rounds with the infectious disease doctors. As I did an intercalated year based around infectious disease last year, I was hoping that my amazing knowledge of all things infectious and puss-filled would come in useful, but it has turned out that I actually know basically nothing about clinical infectious disease. Who could have guessed that having to learn each of the proteins that make up HIV and how they are put together would not have any real-world use. (I use real-world here to mean clinical doctor. I am sure most of the things I learn have little use outside of medicine...)


Despite my astounding lack of knowledge (as in, I know the same for infectious disease as I did for the other specialities) I really got into the infectious disease clinics. Most specialities have 'bread and butter' cases which make up most of their work load, e.g. endocrinologists see a LOT of patients with diabetes and thyroid disease. This has always put me off of specialities, as I can imagine that the lack of variety would lead to it getting boring (for me, at least). Not so with infectious disease, it seems. The clinic consisted of a huge range of diseases from serious cellulitis, to endocarditis, osteomyelitis and HIV. From just one clinic this was a good range of disease, and there was a lot of detective work to be done as well. Many patients are referred to the infectious disease team with problems like PUO - a long standing fever, or generalised lymphadenopathy. The diagnosis is often not easy to find, as many of the tests are nowhere near 100% accurate at picking up the disease (such as TB) so clinical judgement is important.


One of my favourite things about the infectious disease clinics was all of the patients who have caught weird and wonderful infections while abroad. Obviously the problem-solving and diagnostic side of things is very interesting for these people, as they can be rare diseases, but hearing about their travelling stories (one was distributing free text books through Sub-saharan African slums) is fascinating. Made me want to go back on my elective (until we looked at the lump under the next patients skin, caused by botfly larvae growing under there before becoming flys...)


All in all a great week, and perhaps I will become an infectious disease doctor... Despite the fact that I saw some pretty nasty infections in the sexual health clinic this week, the worst things in medicine (in my opinion) are still those chronic ulcers in the vascular wards, with that necrotic smell from the dying tissue that fills the ward...

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Celebrity STI ]

[InternalOptimist]

Gay doctors and HIV

Hi,


Sorry for the recurrently late posts. The Diamond Jubilee has meant lots of fun things to distract myself from and make the most of this 4 day weekend, though also meant that I haven't been with a computer to post until today... Despite my poor posting, I do have things to talk about. Last week was pretty interesting, mainly spending time in outpatients, in both an HIV clinic, and a general infectious disease clinic.


I have noticed that a larger proportion of HIV doctors are (outwardly) gay compared to other medical specialities. Perhaps this is linked to the fact that when they were training this disease was ravaging some of those in the gay community, and they were determined they wanted to help stop it. Perhaps it is related to the fact that there are more gay patients in this speciality, which attracts gay doctors. Perhaps it is just a more accepting patient group, and doctors who are HIV specialists feel happier to be open about their sexuality... Whatever the reason, this is a trend I noticed, and when going into the clinic with the HIV consultant I was secretly trying to work out whether he was gay or not. By some coincidence (small world and all that) one of my friends who I knew outside of hospital life walked into the room, and after the exclamations of surprise at meeting each other here, he introduced me to his husband. I knew he was married, just not to who! It definitely solved the question over whether the consultant was gay though!


In the infectious disease clinic, the most interesting case that I saw was a man who had been travelling through Africa and had been bitten by a dog. He had come in with a walking stick, wrapped in a shawl, very 'new age' style, and talked about how he had been travelling by foot through the birthplace of man. This had been about a month ago, and he had been bitten by a dog, who was one of a pack belonging to a witch doctor. The witch doctor had assured him that there was no rabies in his dogs, because of his medicines, and so this man had travelled home without having any preventative treatment. Recently, with all the media coverage of rabies in the UK, this man's friends and family had urged him to get it checked by the doctors. Unable to diagnose rabies, the only thing that could be offered would be to treat him as though he had been infected, to reduce his risk of contracting rabies. He was not keen on this idea, talking about how he never had any vaccines as they harmed your body, and told us that he could probably get a natural cure in crystals. I am unsure as to why he came into the hospital in the first place, if he wasn't going to accept any treatment. To reassure his friends and family, I guess... After a lot of discussion, and calling the HPA, the man was still sure he didn't want the recommended treatment because it was not guaranteed to work. The recommended treatment consists of immunoglobulin and a vaccine as soon after exposure as possible. This lead to a long discussion about medicine, and how very little is guaranteed. He demanded proof that it would help him, which we then emailed to him to read. He decided he may come back in after reading it if he and his 'healer' decided it was 'appropriate'. Its very strange how someone who is so obsessed over proving things work practices types of medicine that many feel do not have any proof. Perhaps he is more used to the 'definites' that some alternative medicine practitioners work with. This homoeopathic diamond will definitely cure your breast cancer... Perhaps that helps the placebo effect...


I hope he does come back in for the treatment, but it seems that he won't. The odds are that he hasn't got rabies, he will chose crystal therapy, and feel that it has protected him. I hope that's the case, as the alternatives are pretty bad. it seems silly, but all these lectures about 'autonomy' are all about letting patients make decisions that we feel are misguided, and I just need to remember that it is his life, and my beliefs. He should be allowed to follow his own beliefs.

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Gay doctors and HIV ]

[InternalOptimist]

Follow up

Hi,


Relatively relaxed week this week. I spend some more time in HIV clinics, follow up the rabies-bitten patient who I spoke to last week, and present a case based around Fordyce's spots for my end of rotation assessment.


In the HIV clinic I am with a different consultant to the one I was placed with last week, and this one is also gay. Somewhat more flamboyant than the person I was with last week, his entire patient list seems to consist of middle aged HIV positive gay men who have a crush on him. When I say it seems to consist of, I mean that every single patient who we saw together was a middle aged, gay, HIV positive man. HIV positive people have several outpatients appointments each year, to make sure that they are still doing well with their disease and drugs (it is very important that they take the drugs every day to stop resistance occurring), which means that the patients get to know the specialists very well. Patients switch between consultants to find one that they like; for example all of the HIV+ afro-Caribbean people are managed by a large, jolly Jamaican woman. Obviously all of these middle aged HIV positive gay men like flirting with this flamboyant consultant, who is very informal with his patients. I can tell why they like him though, he is very complimentary towards them, almost towards being inappropriate, though they clearly love it, and love him for it. The patients range hugely (though always keep within the male, gay, middle-aged category). There are high powered bankers, through to homeless down and outs. All are treated with the same glamorous, dazzling fashion. It looked great fun to be a patient of his, and I know that if I had HIV I would want to come to him (though I don't quite fit into the necessary bracket...)


The rabies-man (hopefully a name that will prove to be incorrect) has refused any medical treatment for his bites. He has decided that chromotherapy is all he needs to balance his bodies energies and push the rabies virus out. I really hope that the dog didn't have rabies, as this is one person I don't want the medical profession to be saying 'told you so' to. Perhaps the worry should be if he doesn't get rabies, and spreads the word that colour-therapy can cure rabies, meaning many other people might be exposed...



Rude jokes and general 'banter' should probably be kept for class mates, rather than your examiner...


At the end of the modules we have to present patient cases to the rest of the year. I was presenting someone who I saw in a sexual health clinic who came in and told me, and I quote "I've got lumps on me knob". It turned out that these lumps were just a normal physiological phenomenon known as Fordyce's spots, just large sebaceous glands on the shaft of the penis. The consultation was pretty simple, until he started squeezing these spots to show us what would come out of them... Pretty gross... Either way, I somehow accused the consultant I was presenting to of using prostitutes in front of my year - pretty embarrassing result of a 'witty' quip, but hopefully I won't get kicked out for it.

End of sexual health rotation, pretty uneventful week, and I will keep you up to date with how things go next week in my orthopaedics rotation! My final rotation, and the one with my end of year exams in it!

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Follow up ]

[InternalOptimist]

Vioxx and deductions

Hi,


I started my last rotation last week, meaning that in 6 weeks time I will have finished my forth year of medical school! This rotation is focused around rheumatology and orthopaedic surgery, meaning joints and bones. This is the last major speciality that I don't have any real clinical experience of, so in a way it is nice to be rounding off that basic medical knowledge of knowing a little bit about something from each speciality. Seeing as my final year is just repeats of rotations I have done already, but with more expected from me, it means I can no longer use the excuse that 'I haven't studied that yet' when my family or friends ask me difficult medical questions!


I spent some time in a physiotherapy clinic as part of this rotation, and I was very impressed! The person I was working with only looked a few years older than me, but she had an amazing well of knowledge on muscular conditions, their causes and good ways to treat them with exercise regiemes. A totally different ball game to the things we are taught in med-school (basically just the anatomy). They actually get to heal people with their hands, all her patients seemed so happy with her and by moving their limbs around she healed them - I have decided that physiotherapists are the medical equivalent of Jesus, and any patient I see with any joint or muscle problem for the rest of my career would definitely benefit from a referral to a physio!


As well as spending time with the physio this week, I spent in a nurse lead clinic for those on biological therapeutic agents for inflammatory joint conditions. This was much more medical, and much more related to those years of lectures I have been through. Very complex though; I think rheumatology is going to take some time to get my head around. The biologic agents these patients are on are basically antibodies which have been made in a lab, which are injected to reduce the levels of inflammation (and thus help their inflamed joints). They all have names ending in __mab such as infliximab. These are very expensive, costing about £20,000 a year per patient, but they really do seem to help. I bet the patients are happy that they don't have to try and foot their own bills! In this clinic I met a person who had suffered a number of heart attacks some years ago, as he had been put on the drug Vioxx. As can be seen by the link, this drug was pulled off the market after it was found that the drugs company who had tested it had withheld information showing that it increased the risk of problems such as heart attack. After all, if you have spent millions developing a new drug, no-one will take it if it might kill them, so that isn't the sort of information you want available to the general public! I remember it being mentioned in a lecture in my first (or second) year, how it was found by using the 'track back changes' function on word when looking at the research they had submitted; meaning that it was previously included but was purposefully removed. Ruthless... The first time that I had met someone affected by this, and he was remarkably un-bothered by it all. I would probably still be trying to sue them!


I also noticed that (of the admittedly rather small sample size) more than 50% of the patients with Rheumatoid Arthritis (RA) we saw were keen ornithologists, often going on field trips to see birds. RA is believed to have appeared as a disease in the last few hundred years, as while there is evidence of skeletons being affected by different arthritis-related-illnesses, there is no evidence of skeletons with RA before this time. People have guessed that this may be a new environmental substance, or viral infection, that is leading to this 'new' seeming (and certainly not uncommon) disease. Using my expert medical-student knowledge, and this huge sample size of 5 patients, perhaps birds may hold the answer, perhaps they somehow lead to us developing RA, through some kind of parasite or virus they can pass on. If this turns out to be the case, you know where you read it first!


[Pic]
If my brilliant scientific deduction is to be proved correct, we will have to be the ones to do something about it. Birds are inherently lazy...

[For the rest of the post, and the rest of my blog, please go to: A weekly blog from a clinical years UK medical student: Vioxx and deductions ]