Monday, 31 May 2010

A catch up..

Well its been some time since I've posted so will try to feel in the gaps a bit...
Since I last posted I have finished vascular, had a week of urology experience and started + now finished paediatrics.



Vascular wasn't really my cup of tea - it was very gory with lots of leg ulcers and ischaemic legs with gangrenous toes. There is (fortunately) no smell quite like an infected leg ulcer. If you are a smoker perhaps paying a visit to a vascular ward might help you to quit - during my time there it was fair to say most of the patients were smokers/ex heavy smokers and/or diabetic. I only saw one surgery during vascular and that was a leg amputation due to ischaemia which had caused irreversible tissue damage.

This was quite a strange and brutal operation to watch, and literally involves the bones being sawn through. I found it quite surreal watching someones leg being taken off - I suppose this was because in medicine obviously normally you are doing everything you can to avoid long term damage to the patient but this was a situation where irreversible damage has occurred and now the surgeons job is really "damage limitation". There is sadly no point leaving a patient with a leg full of dead tissue that they cannot use and that will get infected causing damage to the remainder of the leg - it is much better to save as much of the leg as you can as this will improve the patients ability to late on walk with a prosthetic leg. I did feel very sorry for the patient though and I think even if (as in this case) you are aware you are going into an operation where your leg will be amputated it still must be a horrible shock when you wake up with only one leg. Of course it must be even more of a shock if you are in an accident and end up having your leg amputated as an emergency.

My week on urology also wasn't really my cup of tea - whilst its fair to say I'm unlikely to ever want to go into surgery, I found this a particularly dull area of surgery. Urology surgeries often involve camera going up into the bladder which (compared to the kind of views you get from cameras in GI surgeries) really isn't a very exciting organ to look at. I'm not saying surgeons who specialise in urology don't do great work because obviously they do but personally I can't see the appeal...
It was also a kind of rubbish week in general we were meant to have several teaching sessions on urology but all of them ended up being cancelled... Therefore I know very little about urology - hope not too much comes up in the end of year exams!

Paeds on the other hand has very much been my cup of tea! I had been looking forward to this rotation all year because Ive always thought it might be an area I would want to specialise in. My first week was in outpatients and this week was particularly interesting. One of the clinics I watched was a very specialised endocrinology clinic which was being overseen by one of the top endocrinologists in the country, as a result all of the patients in this clinic were individuals with really interesting conditions that needed to be seen once a year by a more specialised doctor as opposed to the local general paediatrician who normally sees them. There was no diabetes to be seen here! I saw patients with turners syndrome (where girls are missing one of their x chromosome), patients with growth problems due to various complicated causes such as pituitary tumours and patients with problems with their sex organs eg cliteromegaly. It was a really interesting clinic!! And too top it all of we got a free drug company marks and Spencer lunch afterwards :D.

My second week was in inpatients which was also interesting although certainly much quieter in general than the adult inpatients. Apparently during the winter it is a lot busier though because then lots of kids get respiratory problems. My on take in paediatrics was ridiculously quiet as only one kid came in during the whole evening so whilst we got to take his history and exam him we didn't really get much hands on experience unfortunately. During the week we did have a teaching session where we got to try examining kids - the doctor overseeing us got us to try and check a toddlers reflexes...this is very difficult! Firstly you have to try and distract the child in order to get them to relax their leg (or arm if it those reflexes you are testing) and then even once you have managed that, the space you need to tap in order to get the reflex is ridiculously small in a child!

Now I am just about to starts OBs and Gynae and I had my first session on the delivery suite yesterday and got to see my first birth :D. The birth wasn't natural but a caesarrean as the baby was showing sign of distress. Nonetheless it was so amazing seeing the baby being pulled out and then start crying and watching the dad walk over and see his little girl for the first time, and then once the baby was cleaned down he got to carry her over to the head end of the operating table so that the mum (who was awake during this c-section with a spinal anaesthetic as this is the preferred way for most caesarreans to be done now) could see and kiss her baby. It was magical! Certainly one of the plus sides to being a medical student is getting to watch moments like this :).

7 comments:

  1. gr8 2 c u postin bak on NMM HafaDoc - i wanna see more blogz...

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  2. Why was the leg full of dead tissue?

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  3. Thanks Anon :).

    Hi Katey, like in angina (where the hearts arteries get furred up with fatty deposits) the arteries supplying the leg can also get furred up causing reduced blood supply to the leg. This in itself has problems - patient may for example get pain in their legs due to the leg muscles not being able to get sufficient oxygen supply at times but it also makes it easier for the vessel to be completely blocked (like in a heart attack). When this occurs if the clot is not removed quickly enough then again like a heart attack the tissue starts to die. Sometimes as a result it is too late to save the leg when the patient presents if for example a major vessel was blocked and there was not sufficient alternative blood flow and sometimes surgeons attempts to fix the problem by using a vessel graft to bypass the blocked area are not successful. In these cases amputation may be the patients best option.


    Hope that helps :)

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  4. What have you been up to recently halfadoc?

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  5. Please continue posting! i really enjoy reading your blog

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  6. what an interesting read ... just was looking up children that need amputation as my 2 year old has had an accident , this post made me feel better as her foot is like the leg shown and now i understand the need to take it off as distressing as it seems

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  7. I'm so sorry to hear that Anon and I wish all the absolute best to you and your daughter. The only advantage to your daughter being so young (and please don't misinterpret me here, I am so sorry this has happened to your daughter whilst she is only little) is that she will probably adapt better to a prosthetic than someone who is older as her movement is still developing and she will learn much faster. And again this is probably far too soon to say whilst you are undoubtedly in shock over everything, but please do watch some of the paralympics if you haven't already and see some of the incredible things amputees can go onto do.
    But I am so very sorry, and my thoughts are with you, I'm glad my post helped if even a little.
    Best wishes

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