medical guide

Silken Pupdate

I actually have a little extra time today, so I wanted to put out an update about my new service dog in training (SDIT) Fawkes and answer a few questions I’m sure I’ll probably get at some point! :D 

This lil pupper is Clayborn’s Africa aka “Fawkes.” My husband and I drove from Virginia to Colorado to pick him up because I love his breeder and appreciate the type of temperament she breeds for (she has bred SD prospects previously). 

I’m self-training him to mitigate the symptoms of PTSD and panic disorder with some professional guidance. He will be trained in several tasks, primarily deep pressure therapy, blocking, interrupting stereotypic/harmful behaviors, medication retrieval, and guiding me to a safe place during dissociative episodes.

Although his main job will be working as a service dog, we will also participate in conformation events and hopefully will do at least one sport (though we still haven’t figured out what sport yet!). Assuming he matures well and clears his health tests, I will breed him at some point in the future, which is a very exciting prospect as it will be my first foray into dog breeding. :D

Those who have been following my blog for a while might be wondering why I got a service dog prospect so suddenly instead of going back to school after I left my job. The short version is, I’d been considering getting a SD for the past 2 years but didn’t think I qualified as disabled until after I had a conversation with my boss about applying for disability benefits because my mental and physical health became so poor that I had to leave my job much sooner than I originally intended. I had wanted to go back to school, but ended up in a psychiatric day treatment program instead due to my anxiety and bipolar disorder being very poorly controlled. After talking with my doctors and therapist, we decided that even though it would be a bit hectic having 3 dogs and a toddler at the same time in our tiny house, I would truly benefit from having a SD and it would help me regain my independence (and sanity) better than just therapy and medication could.

I ended up choosing a Silken Windhound after spending a lot of time with my friend Katie’s Silken SDIT, Sega, who won over my entire family. The breed is the perfect size for the type of work I was looking for (big enough for DPT but not too big for our little house ha), has the sighthound on-off switch, and is very affectionate, biddable, handler-focused, and intelligent. A couple months in and I couldn’t be happier with my choice. :)

I have to give a shout-out to @silkenagentsofcsbeck@doberbutts, @why-animals-do-the-thing, and @noodle-dragon in particular for giving me great advice which has been invaluable thus far. Rachel (of @why-animals-do-the-thing) actually stayed at my house for a week to improve my training technique which was amazing, and I highly recommend her as a trainer; she’s pretty much the only reason Fawkes has good leash skills now haha! I’ll write a longer review of her training services later, but I just had to give a big thank-you to all these folks for making my dream of having a SD come true. :)

2

Today I taught myself about reading EKG’s and where they actually line up with things going on in the heart with regards to MIs. Basically you have 3 coronary arteries that get occluded in most MIs: Left Anterior Descending (LAD), Left CircumfleX (LCX), and Right Coronary Artery (RCA). LAD feeds the anterior heart and the septum. LCX feeds the lateral and some posterior heart. RCA feeds the right ventricle and some posterior heart, as wells as the SA node in 60% of people.

Now EKGs are confusing and complicated, but it gets easier if you remember where they measure relative to the anatomy. This little diagram helps me get started:

I’ve overlaid the heart over this in the diagram up top. Now remember, those arrows are vectors which is reflected in an EKG read by the upstrokes and downstrokes of the read. (I’m oversimplifying things, but physics makes my brain hurt, and this has worked for me so far.) Practically, what it means is that if the arrow is pointing towards the damage you get ST elevations. For example, in an inferior infarct, you get ST elevations in II, III and aVF, which point towards the inferior part of the heart.

You also have leads V1-V6 which are arranged like so:

(Image from wikipedia)

Notice their vectors point anteriorly. So an anterior infarct shows up at ST elevations in some or all of V1-V6. Meanwhile a posterior infarct will show up as ST depression in V1-V3 which point away from the posterior part of the heart.

To take it one step further you can figure out which artery is blocked. But that’s just a matter of knowing the blood supply, which is basically just what’s nearby. When I’m trying to figure it out on a test, sometimes I draw out this 5 second diagram (aka artistic masterpiece):

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disorder of the axial skeleton, peripheral joints, and extraarticular structures. Over 90% of pts have HLA-B27, a protein on the surface of WBCs in the presence of infection. It is 2-5 times more common in males, and onset is typically in the 2nd or 3rd generation. 

Pathogenesis

  • Occurs at entheses (attachment points between tendon, ligament, or capsule and bone) 
  • Inflammation
  • Bone erosion
  • Syndesmophyte (spur) formation

Clinical Manifestations

  • Vague low back pain radiating to buttocks
  • Bony tenderness
  • Enthesopathy
  • Constitutional symptoms - photophobia, blurred vision
  • Extraarticular symptoms 
  • Morning stiffness

Physical Examination

  • Spinal stiffness
  • Loss of lumbar lordosis
  • Increase of thoracic kyphosis
  • Stooped posture
  • Decreased chest wall expansion
  • Schober test: detects limitation of forward flexion and hyperextension of lumbar spine

Diagnosis/Lab

  • No direct serum marker
  • Elevated ESR, CRP, Alk. Phos
  • Radiographic: “bamboo spine”, sacroilitis, pseudowidening of SI joint, sclerosis/fusion
  • Diagnosis at early stage is important to limit irreversible deformity

Treatment

  • Physical therapy - exercise is the best treatment!
  • NSAIDs
  • Anti-TNF
  • DMARDs
  • Referral to rheumatologist

Complications

  • Spondylitic heart disease
    • Aortic/mitral regurgitation
XF Episode Blueprint
  • *enter basement of FBI's most unwanted*
  • Mulder: Look Scullers, an X-File!
  • Scully: *rolls eyes* Mulder, it's me.
  • *they roll up in some off-the-wayside town*
  • Mulder: Agent Fox Mulder, FBI. *touches unidentified goop from crime scene*
  • Scully: I'm Special Agent Dana Scully. I'm a MEDICAL doctor.
  • Mulder: She rewrote Einstein.
  • *autopsy scene with shameless flirting and science babble*
  • Scully: I'm not sure how this happened to the victim, but it can be explained by science. I'm sure of it.
  • Mulder: Aliens, Scullo. Trust No1. You can't handle the TRUTH.
  • Scully: Sure. Fine. Whatever.
  • *searching for the culprit in a dark, abandoned warehouse*
  • Mulder: Does my boyish ability to hold this enormous flashlight turn you on at all, Scully?
  • Scully: Oh, brother.
  • *they run into alien/monster/paranormal thing*
  • Mulder: Scuhlee! Look! It's literally right in front of you! BELIEVE!
  • Scully: There's a perfectly rational explanation. I believe in science.
  • *back in basement after not actually solving the case*
  • Mulder: The Skinman wants a report, stat. Aliens, man. I'm Spooky. Also, you make me a whole person.
  • Scully: You'll search for the truth with shovels and back-hos, and I wouldn't change a day.
  • Mulder & Scully: *heart eyes*
  • *fade out*
Personality disorders as memes

Because this is how I learn things

There are lots of mnemonics for remembering the clusters (which have fallen out of use anyway) but I prefer one that make sense to me because it uses the A, B and C for awkward, bratty, and cowardly

Cluster A Personality Disorders (”awkward”):

Paranoid:

Schizoid:

Schizotypal:


Cluster B Personality Disorders (”Bratty”):

Antisocial:

Borderline:

Histrionic:

Narcissistic:


Cluster C Personality Disorders (”Cowardly”):

Avoidant:

Dependent:

OCPD:

Consider: Kori learning human anatomy and medicine just to patch up her boys. They find her poring over a basic medical guide one day, and practicing stitches on a small practice doll. Neither Roy nor Jason will admit it, but (even if it’s mostly practical) it’s one of the most thoughtful things anyone has ever done for them. In return, they look up anything they can about Tamaran physiology so they can return the favor if their favorite princess ever needs it.

New class, new exam: how to organize your study schedule

Hi guys, i decided to write this post for all the students who want to organize a new study session and make a schedule for a new exam. Actually this is my personal method, and it works for me so I thought it could work for you as well :)

  • First of all: prepare all the material you’ll have to study. Books, notes etc… and make a list of all the requested arguments for the exam - professors usually make a list or a programm of the whole course. When in doubt, ask the professor.
  • Before organizing a new schedule, read everything. Literally, everything and try to cut and edit all the things you won’t need or usless stuff (it happens to me that when I have to study from a huge text book and I have also my notes I took during the lessons, I have a lot of stuff I actually don’t need)

Now that you have your own material prepared and you know what you’re talking about because you read it, you’re ready to make your schedule. 

Scheduling Tips

  • Always, ALWAYS, set a timetable. Use a planner, a journal, whatever you prefer, but don’t think that you’ll be able to do all the things without planning them first. As you complete tasks, mark them and go ahead, and if you can mark or make a list of all the things you find more difficult or complicated and spend more time later to analyze and understend them.
  • For your fist study session with a new subject, don’t even try to study/repeat all the programm in two or three days, unless it’s a very very small exam. Your first (actually, second) approach has to be: learn it in the most effective way, not in the shortest time. So, take your time and pay attention to this reading/learning part of your schedule. 
  • When you’re still learning and not repeating the subject, it may be useful to write down important things, drawing mind maps, starting orgazing your summaries and notes and post-it etc…and this is the perfect time to do it. If you try to create mind maps and summaries when you’re at two or three days from the exam, you won’t be able to use them and so it will be a waste of time! 

NEILSWESNINSKI’S AFTG FIC REC

hey guys! as a thing for reaching 1k followers on this site (what??) i put together a collection of some of my favourite fanfics for the foxhole court! hopefully you guys like it, and be sure to check out all the amazing authors!

Keep reading

What did you do today?  

  • Did you take a bath or shower?  If not, go relax for a few minutes.  You’ll feel better afterward.  
  • Did you remember to take any meds or vitamins?  If you didn’t, go get them and take them.  Your health is important.
  • Did you eat something and drink a glass of water?  If you’re hungry, please eat and make sure you stay hydrated.  
  • What about your phone, tablet, or computer- are they charged?  Hook them up to charge overnight if you haven’t.  

Set your alarm for tomorrow, practice deep breathing, set out your clothes so you have less to stress about in the morning, and find something that relaxes you- reading a book, sketching or journaling, or turning on some Netflix.  Or simply just go to bed so you are well rested in the morning.  If you need something to help you wind down like a guided mediation, YouTube has some great ones.  Find some way to take care of yourself tonight.

Everyone, I’d like to introduce Beamer!!! He is officially my service dog, partner in crime, my king. We still have 11 more days of training and bonding together at the Training Center before I get to take him home, but I love him so much already!! He’s a gorgeous golden, and will perform the following tasks for me:
- Block
- Cover
- Deep Pressure Therapy
- Anxiety Alerts
- Nightmare Arousal
- Medication Reminders
- Guiding during dissociative episodes

In addition, his presence and my need to pay attention to him will help keep my anxieties lessened, as I will have less energy to focus on myself and must instead focus on him.

I can’t believe we’re finally together and I love him with all my heart!!!!!

Urinary Tract Infections

Definition of UTI

  • Pathologic bacteria in urine
    • Asymptomatic patients: growth of > 10^5 (100,000) CFU/mL
    • Symptomatic patients: 10^2 (100) CFU/mL

Classification of UTI

  • Lower tract infections: urethritis, cystitis
  • Upper tract infections: pyelonephritis, prostatitis
  • Community-acquired
  • Nosocomial: catheter-related

Etiology

  • E. coli - most common
  • Gram negative rods
  • Adenovirus - children

Pathophysiology

  • Colonization of external genetalia
  • Bacteria can ascend into the urinary tract 
  • Upper tract infection most common complication of lower tract infection
  • Hematogenous spread - S. aureus

Who gets UTIs?

  • Females > males
  • Increased incidence with sexual activity
  • Childhood: M > F

Female Patients

  • Vaginal introitus and distal urethra normally colonized by gram positive organisms
  • Female urethra more prone to gram negative infection 
    • Close to anus
    • Short length 
  • Risk factors
    • Hygiene issues
    • Sexual activity
      • Void after intercourse decreases this risk

Male Patients

  • Rare
  • > 50 years of age, BPH is main cause

Other Risk Factors

  • Pregnancy
  • Unsterile or prolonged catheterization
  • Obstruction
  • Vesicourethral reflux

Cystitis

  • Most common manifestation of UTI
  • Infection/inflammation of bladder
  • Most commonly E. coli, can be adenovirus
  • Clinical presentation
    • Irritative voiding 
    • Supraspubic discomfort
    • Other urinary complaints?
  • PE
    • Unremarkable
    • No CVA tenderness
  • Lab
    • Urinalysis
      • (+) LES
      • (+) Nitrites
    • Urine gram-staining
      • E. coli
      • Contamination possible
  • Acute urethral syndrome
    • “Painful voiding syndrome”
    • Dysuria with sterile culture
    • Irritants, trauma, etc.
  • Management
    • Antimicrobials
      • Short-term (< 7 days) for uncomplicated cases
      • Longer therapy (7-10 days) for DM, recurrent UTI, over 65, Men
    • Symptomatic treatment
  • Follow-up
    • Repeat urine C&S 3-5 days after antibiotics finished

Pyelonephritis

  • Infection/inflammation of renal parenchyma and pelvis
  • Most commonly E. coli or Proteus sp. 
  • Presentation
    • Flank pain
    • Fever
    • Chills
    • Toxic appearance
    • CVA tenderness
  • Lab
    • Urinalysis
      • (+) LES
      • (+) Nitrites
      • WBC casts
    • Urine gram stain
      • E. coli
      • Contamination possible
    • CBC
      • Leukocytosis with left shift
  • Imaging
    • Only done in complicated cases
  • Complications
    • Sepsis/shock
    • Scarring/fibrosis
      • Chronic pyelonephritis
  • Management
    • Usually treated as outpatient
    • Empiric therapy
      • Broad-spectrum antibiotics
        • IV 
        • PO quinolone
        • No nitrofurantoin
        • Watch resistance for Augmentin and Bactrim 
      • 14+ days
        • Inpatient: 24 hours after fever resolves
        • Outpatient: 14 days
  • Follow-up
    • Repeat urine C&S 1-2 weeks after treatment completed
    • Treatment failure
      • Imaging or referral

UTIs in Pregnancy

  • Asymptomatic bacteriuria very common - treat due to risk of complications to fetus
  • Cystitis
    • No fluoroquinolones
    • Recheck urine C&S
  • Pyelonephritis
    • Hospitalization
    • Empiric IV therapy, then PO
    • No fluoroquinolones
    • Recheck urine C&S

Nosocomial UTIs

  • Foley catheters 
  • Care for UTIs not reimbursed by Medicare/Medicaid 

Recurrent Infections: more than 2-3 per year

Vesicoureteral reflux (VUR)

  • Reflux of urine from bladder into ureters/renal pelvis
  • Common cause of UTI in children
  • Renal scarring due to volume and duration of reflux
  • Presentation
    • Weight loss
    • Nocturnal enuresis
    • Failure to thrive
  • Labs
    • Urinalysis
      • (+) LES
      • (+) Nitrites
    • Urine gram stain
      • E. coli
    • Cast formation
  • Imaging
    • Voiding cystourethrogram (VCUG)
    • Management of VUR
      • Mild
        • Spontaneous resolution usually
        • Antibiotics until puberty
      • Severe
        • Surgical intervention
        • Antibiotics into condition corrected

Everyone has something to contribute to the fight against global fascism. Songwriters, welders, mechanics, plumbers, teachers, librarians, museum guides, secretaries, medical receptionists, dentists, editors, call centre customer service agents, comic book writers, bus drivers, everyone, everyone except dictators and would-be dictators and the people who support them. We need everyone in every field, not just graduate students in the humanities, not to diss people in the academy or whatever but like… everyone.

the ultimate night-shift survival guide.

Congratulations! Someone out there trusts you enough to manage a hospital full of sick patients overnight! You will be the first port of call for cannulae that slip out of veins, for patients in post-operative retention that need catheterisation, and for urgent reviews of chest pain and shortness of breath.

Nights are long. There is the cacophony of bleeps (why is everyone hypertensive at the same time?) punctuated by long stretches of silence where you find yourself afraid to fall asleep because the moment you do, your patient will crash and a code blue will be called.

But there are a few simple steps that will keep your night manageable and your sanity in check.

1.    Get a proper handover from the evening shift. Yes, it’s tempting to encourage your colleagues to get out of the hospital while they still can, but not getting a proper handover screws you over at three am. Does this patient need more fluids? Why is this patient fasting? This patient is hypotensive, is this there baseline? Asking your colleagues for a brief rundown of each patient’s plan and any expected issues overnight will let you anticipate any major (or minor) dramas.

2.    Caffeinate early. By all means, come prepared with a large coffee at the start of your shift. But more than one or two will leave you wide awake at the end of your shift and unable to sleep. Drink your coffee during handover, and then swap to herbal tea/fruit tea. Or better yet…

3.    Water. Drink lots and lots of water. I am for at least 1L per shift. Are you writing notes? Fill up your water bottle and drink as you do. Running between wards? Take your water bottle with you. Clerking patients? Drink while you write up their admission notes.

4.    Resist the urge to devour chocolate and candy. Yes, I know it’s hard when every ward has a selection of tasty treats at the nurses’ station. But too much sugar leads to the dreaded sugar crash and makes fatigue worse. Stick to low-GI, high protein snacks and you’ll feel much better. My personal favourites are sunflower seeds, pepitas, and nuts. Easy to munch on and don’t weigh you down.

5.    Try and eat a proper “lunch”. Having some sort of meal mid-shift tricks your brain into thinking you’re working normal hours. If you have a breakfast before your shift, a lunch during, and a dinner afterwards, it’s almost like working during daylight hours, except not really.

6.    Prioritise. Try and do bloods and cannulae in a round before patients go to sleep or when they wake up. Unless they have antibiotics due at 2am, there’s really no need to wake patients up unnecessarily. Also, if they need an IVC for 8am antibiotics, leave it until the morning. They will inevitably tear it out in their sleep otherwise.

7.    Ask for help. If you’re not sure, ask. Don’t worry what others will think – it’s better to ask and feel like a fool than not ask and not be able to sleep later.

8.    Keep a list. Write down what you’ve done for every patient you see overnight. It makes handover a lot easier, you won’t miss things, and it allows you to keep track of what you need to follow up on. Saw a patient with chest pain? Better write that down so I remember to repeat trops at 6am. Patient had pain? Better remember to ask the home team to review that.

Night shifts are a rite of passage for almost every junior doctor. Hopefully this list makes them a little more bearable and gets you through the night!

To my fellow medstudent bookworms:

I decided to compile a list of books that are great for future doctors, doctors, or anyone that is working in the health profession.
These books help give you an insight on what becoming a good doctor is really all about.
Enjoy!

1. Every Patient Tells A Story- Lisa Sanders M.D.
2. Informed Consent- Benjamin j. Brown M.D.
3. Medical School Admissions Guide- Suzanne Miller
4. Medical School Interview- Fleenor
5. The Mindful Medical Student- Jeremy Spiegel
6. Med School Confidential- Robert H. Miller
7. Becoming A Physician- Jennifer Danek
8. On Call- Emily R. Transue M.D.
9. Hot Lights, Cold Steel- Michael J. Collons
10. Blue Collar, Blue Scrubs- Michael J. Collins
11. The Night Shift- Brian Goldman
12. The House of God- Samuel Shem
13. Kill As Few Patients As Possible (And 56 other ways on how to be the world’s best doctor)- Oscar London
14. The Secret Language of Doctors- Brian Goldman
15. How Doctors Think- Jerome Groopman
16. First, Do No Harm- Lisa Belkin
17. Better- Atul Gawande
18. Complications- Atul Gawande
19. Being Mortal- Atul Gawande
20. The Checklist Manifesto- Atul Gawande

My personal recommendations are the books by Atul Gawande, Brian Goldman, Oscar London, and Samuel Shem! 📚