Ugh, there are so many!Rabies (To the tune of “Baby” by Justin Bieber) The Endocarditis Song Acute Asthma Management (To “Breakfast At Tiffany’s”) Coal Miners Pnumoconiosis (To “Monster Mash”)

Ugh, there are so many!

Rabies (To the tune of “Baby” by Justin Bieber)

The Endocarditis Song

Acute Asthma Management (To “Breakfast At Tiffany’s”)

Coal Miners Pnumoconiosis (To “Monster Mash”)

The Cardiac Arrhythmia Dance

A little treat for all you visual/kinesthetic learners out there. Why use words when you can just dance?

Cancer’s A Funny Thing …

I wish I had the voice of Homer

To sing of rectal carcinoma,

Which kills a lot more chaps, in fact,

Than were bumped off when Troy was sacked.

Yet, thanks to modern surgeon’s skills,

It can be killed before it kills

Upon a scientific basis

In nineteen out of twenty cases.

I noticed I was passing blood

(Only a few drops, not a flood).

So pausing on my homeward way

From Tallahassee to Bombay

I asked a doctor, now my friend,

To peer into my hinder end,

To prove or to disprove the rumour

That I had a malignant tumour.

They pumped in BaS04.

Till I could really stand no more,

And, when sufficient had been pressed in,

They photographed my large intestine,

In order to decide the issue

They next scraped out some bits of tissue.

(Before they did so, some good pal

Had knocked me out with pentothal,

Whose action is extremely quick,

And does not leave me feeling sick.)

The microscope returned the answer

That I had certainly got cancer,

So I was wheeled into the theatre

Where holes were made to make me better.

One set is in my perineurn

Where I can feel, but can’t yet see ‘em.

Another made me like a kipper

Or female prey of Jack the Ripper,

Through this incision, I don’t doubt,

The neoplasm was taken out,

Along with colon, and lymph nodes

Where cancer cells might find abodes.

A third much smaller hole is meant

To function as a ventral vent:

So now I am like two-faced Janus

The only* god who sees his anus.

*In India there are several more

With extra faces, up to four,

But both in Brahma and in Shiva

I own myself an unbeliever.

I’ll swear, without the risk of perjury,

It was a snappy bit of surgery.

My rectum is a serious loss to me,

But I’ve a very neat colostomy,

And hope, as soon as I am able,

To make it keep a fixed time-table.

So do not wait for aches and pains

To have a surgeon mend your drains;

If he says “cancer” you’re a dunce

Unless you have it out at once,

For if you wait it’s sure to swell,

And may have progeny as well.

My final word, before I’m done,

Is “Cancer can be rather fun”.

Thanks to the nurses and Nye Bevan

The NHS is quite like heaven

Provided one confronts the tumour

With a sufficient sense of humour.

I know that cancer often kills,

But so do cars and sleeping pills;

And it can hurt one till one sweats,

So can bad teeth and unpaid debts.

A spot of laughter, I am sure,

Often accelerates one’s cure;

So let us patients do our bit

To help the surgeons make us fit.

J. B. S. Haldane (1964)

Did you know …

The acid in your stomach is strong enough to dissolve razorblades?

While you certainly shouldn’t test the fortitude of your stomach by eating a razorblade or any other metal object for that matter, the acids that digest the food you eat aren’t to be taken lightly. Hydrochloric acid, the type found in your stomach, is not only good at dissolving the pizza you had for dinner but can also eat through many types of metal.

Doctor in the House - Physical Examination

Oh the good old days …

Epic Revision Marathon

Just finished an unusually productive revision session with a few friends and for about six hours of solid work we’ve covered the most ridiculous amount of material:

  • Whipple’s Disease
  • Zollinger-Ellison Syndrome
  • Lambert-Eaton Syndrome
  • Myasthenia Gravis
  • Turner’s Syndrome
  • Malaria
  • Hodgkins Lymphoma
  • Non-Hodgkins Lymphoma
  • Acromegaly
  • Sarcoidosis
  • Causes of Atrial Fibrilation
  • Interstitial Lung Disease
  • Beck’s Triad
  • Bronchiectasis
  • Indications for LTOT in COPD
  • COPD
  • Ramsay Hunt Syndrome
  • Fanconi Syndrome
  • Fanconi Anaemia
  • Tetralogy of Fallot
  • Peutz-Jeghers Syndrome
  • Osler-Weber-Rendu Syndrome
  • Meckel’s Diverticulum
  • Jervell-Lange-Nielsen Syndrome
  • Hennch-Schönlein Purpura
  • Froin’s Syndrome
  • Foster-Kennedy Syndrome
  • Felty’s Syndrome
  • Neurofibromatosis I + II
  • Wegener’s Granulomatosis
  • Dressler’s Syndrome
  • Alport Syndrome
  • Balkan Nephropathy
  • Glomerulonephritis
  • Infective Endocarditis
  • Chronic Interstitial Nephritis
  • Sjörgen’s Syndrome
  • Mononeuritis Multiplex
  • GCS scoring
  • Basal Skull Fractures
  • Cerebral Haemorhages
  • Cerebral Blood Supply
  • Stroke
  • Neuroanatomy and cortex function
  • Hypoalbuminaemia
  • Primary Biliary Cirrhosis
  • Protein Loosing Enteropathies
  • Polycystic Kidney Disease
  • Haematuria
  • Goodpasture’s Syndrome

Needless to say, my brain is pure mush now …

Using music as therapy for patients suffering from dementia.

This video is possibly one of the most moving things I have ever seen. It isn’t just that this man reacts and identifies with the music that he’s being played, but the after effects which last long beyond the music being taken away. He becomes articulate and expressive in a way you wouldn’t have thought possible at a first glance and seems to regain his identity, his memory and his past.

I find this particularly poignant as music for me is probably my biggest passion next to medicine, and to see the two crossing over is fascinating. I’ve always held the belief that there’s more to music that just sound and words and I think in some way this video goes to demonstrate that.

Oh boy . . .

  • Me: So sir do you have any other medical conditions or anything you see your GP for on a regular basis?
  • Patient: No son, nothing except my COPD.
  • Me: Okay that's good, so just to check, have you ever been told you have high blood pressure?
  • Patient: No never
  • Me: High cholesterol?
  • Patient: No not at all
  • Me: And have you ever suffered from a DVT or something we call a pulmonary embolism?
  • Patient: No never.
  • Me: *Goes to patient notes to check drugs list* - patient is on an ACE inhibitor, a bucket load of statins and warfarin (presumably also going once a week to a clinic to have their INR checked.)
  • -FACEPALM-

Rest In Peace The NHS

So congratulations Mr Cameron and Mr Lansley, you’ve finally succeeded in dismantling one of the few achievements this country could genuinely take pride in.

I give it five years before the words above the gate of the historical London hospital I currently work in are erased to be replaced with a tacky, plastic, neon red sign reading “Virgin Health Care” or something similar, doomed to be another leach like tendril of an international corporation that couldn’t give a damn about your health or mine any more than the fucking bubonic plague.

If you and your party get even a whiff of government again in any election in the next fifty years it’ll be damned well to soon.

Enough said, surely?

Enough said, surely?

Things I don’t understand: No 6125

rambling-medic:

If trimethoprim and sulphonamides are anti-folate antibiotics, why then is methotrexate an anti-folate not an antibiotic but an immune system modulator? 

I think I can explain this, but I wouldn’t quote it as gospel.

Okay so! Folic acid as I’m sure you know is a vital component in, amongst other things, DNA synthesis and repair. It’s especially important in situations of rapid cell division and growth, for example pregnancy or the growth of a bacterial colony.

Bacteria, like our own cells, require folic acid also but aren’t able to obtain it from the environment and have to synthesise their own. Trimethoprim and Sulphonamides inhibit certain enzymes in the bacterial folic acid synthesis pathway. Therefore they impair bacterial ability to synthesise DNA, grow and multiply, ultimately starving the cells of folate and causing them to die.

Methotrexate at cytotoxic doses has exactly the same effect on cancer cells, affecting the human version of the very enzyme trimethoprim inhibits (dihydrofolate reductase) and causing death by the same manner. As for it’s use as an immunomodulator in things like RA or Inflammatory Bowel Disease, the jury is out on whether the effect is really to do with the immune system or actually an anti-imflammatory effect. Further to that, whether it’s mechanism of action in these conditions has anything to do with it’s anti-folate effects is uncertain. The important thing to note when it comes to it’s application is that the dose required for it’s “immunomodulatory” effects are much much lower than it’s anti-folate/cytotoxic effects, hence it’s safe use in non-oncological conditions.

In actual fact, methotrexate has been shown in studies to demonstrate a strong antimicrobial effect against Staph Aureus in particular (http://www.ncbi.nlm.nih.gov/pubmed/11293238) but with limited effectiveness against other bacterial strains. However because of the doses required to have an anti-folate effect, it wouldn’t be suitable as an antibiotic because it would exert it’s cytotoxic effects too!

Also, sulphonamides are a variation of sulphasalazines (both containing the sulphonamide chemical moiety), used in RA and IBD for the same reasons as methotrexate. Perhaps the reason for their differing uses lies in their remaining chemical structure.

So basically I think the answer to your question is that while they all have a similar theoretical effect, in reality their overall structure lends them to be more useful in certain situations. For example part of trimethoprim and methotrexate both have anti-folate effects. However overall methotrexate may have a greater affinity to human DHFR than bacterial, and vice versa for trimethoprim. This difference may be what gives methotrexate it’s immunomodulatory effects, which it’s why trimethoprim would likely be about as useful as a kick up the backside in rheumatoid arthritis.

I feel like I’m talking in circles here but I hope that was even slightly useful!

rambling-medic

Did you know …

One human brain cell can hold 5 times as much information as the Encyclopedia Britannica?

Or any other encyclopedia for that matter. Scientists have yet to settle on a definitive amount, but the storage capacity of the brain in electronic terms is thought to be between 3 or even 1,000 terabytes. The National Archives of Britain, containing over 900 years of history, only takes up 70 terabytes, making your brain’s memory power pretty darn impressive.

A disease is a condition of the body. An illness is the way a disease interferes with everyday living. Doctors are experts in disease, only our patients can experience the consequences of illness.
My housemate’s snowman Bob after the deluge that hit London last night. The inner child has been sufficiently appeased. Thank God it’s Sunday though, that way I can sit indoors in the warm with a mug of tea and listen to people moan about how shit public transport is instead of being stuck somewhere on the M25 for 5 hours doing the moaning myself. Yay for winter! :D

My housemate’s snowman Bob after the deluge that hit London last night. The inner child has been sufficiently appeased.

Thank God it’s Sunday though, that way I can sit indoors in the warm with a mug of tea and listen to people moan about how shit public transport is instead of being stuck somewhere on the M25 for 5 hours doing the moaning myself.

Yay for winter! :D

The Voices In Your Head

Researchers have recently demonstrated the ability to reconstruct words based on the electrical activity of the brains of subjects thinking them. The technique when refined offers hopes of communication with and for patients suffering from conditions such as locked in syndrome and potentially those who are comatose.