9/04/2012

Long time has passed since I have been here :)

The third year has ended. Now I have some free time to describe what was the most interesting or the most anyoing in it.

First, what comes to my mind is Immunology. Subject that really can be interesting if only the style of teaching us was not so.... boring and not-useful. For over half a year we were taught about some genetics mutations that cause some diseases. You know, just like that:
*mutation xgfyshs-disease nr1
*mutation hbfddn hs- disease nr2 etc..

No pictures, only plain text with some symptomes. No wonder now I don't remember a thing.
BUT the last lesson was a bit more intersting. Brainstorm like in House MD :)

Introduction to Internal Medicine and Introduction to Pediatrics were better. Finally some real work with the patients. First auscultations, first palpations, first diagnoses. The first and the most important rule was: WE ARE NOT DOCTORS, so we cannot tell patients what is wrong with them.

Sometimes a silly situations comes out of from breaking that rule. One of our friend saw a lipoma that grows on one patient's arm. Lipoma is a concentration of fat tissue somewhere in the skin, but due to the type of growth it is classified as neoplasma.

So the patient asked our friend what is it. And friend replied : "Sir, do not worry. It is just a simple neoplasma!"


The patient turned pale and almost fainted.

On the pediatrics we were doing almost the same thing but on children. The most disturbing moment was when you are doing physical examination on a toddler and you saw the face of trust of the mother and all in your head is :"I have no idea what I'm doing..." :)

But THAT moment when you diagnose for the first time sucessfully...cannot be described, something beautiful :)

That is all for now. Perhaps I will write something more later!

See you soon.

11/08/2011

III year

At last.

We've been waiting for this moment for 2 years.. the mythical and mysterious third year of studying medicine.
In my country, by what you are called, depends on the year you are currently on:
a) first year -> Shit
b) second year -> Mr/Mrs Shit
c) third year -> Student
d) fourth year -> Mr/Mrs Student
d) fifth year -> Doctor
e) sixth year -> Mr/Mrs Doctor

So I am a Student now :) Honestly, it can be felt..for example during the first lesson of Introduction to Pediatrics when professor wanted to ask us about something, she called us by "DOCTOR X will you tell me...?"

I am taking following courses during this semester :
*patomorphology
*patophysiology
*Introduction to Internal Medicine
*Introduction to Pediatrics
*immunology
*Introduction to Onkology

The most interesting subject is, of course, the Introduction to Internal Medicine. For the first time during our 'studying of medicine' we have a contact with a patient AS HER/HIS DOCTOR!
But for now we are obliged only to check patient's blood pressure. Why not physical exam? It depends on the course, but as far as I am concerned, this thursday my group will percuss and auscultate the thorax of our patients for the first time :) Can't wait.
This course also helps us in realising it's not just fun anymore...it's our future life.

I'm sorry that this note is that short... I'm kind of tired :)

I hope something worth describing will happen soon!


9/26/2011

Short explanation

I am sorry for my absence that lasted for almost a month. You know - holidays :)

In about a week I am starting new year of learning medicine - the third year. I hope new ideas for posts will appear.

Thanks for reading and I still encourage you to comment.

8/29/2011

Life is a such fragile thing.

Today, at 7:00 am, I entered the ICU Department in the hospital I am currently working in.
After saying "Hello" to the today nurse staff I checked, whether there are new patients.

I was shocked, because a patient - let her name be X - has returned feverishly.

About 5 days ago X was delivered to our department after Caesarean Section from the operating theatre. During the surgery something (I do not know what - I didn't check the logs) happened to her head.
She stayed with us for a two days and later (in a good condition - consciously!! ) she was moved to Neurosurgery Department.

So X returned to us and today, I went with her for a CT scan of her head. The scan showed an ischemic stroke (and now I knew that was The Thing that happened on the operating theatre).

I checked her pupils - there was no miosis in the presence of the light...

I checked her BP - without infusion of extra fluids it balanced from 90/60 to 70/40...

Later today I saw a document with her husband approval that she can donor her organs...

I can only hope that she managed to see her new-born daughter..

Life is a such fragile thing.


7/26/2011

"CLEAR!! BZZZZZ! CLEAR!!!! BZZZZ! CLEAR!!!!!! BZZZZZ!!!!!....piiiiiiiiiiiii...."

This is a short video from an open-heart surgery:
video
The heart of this patient is "shaking" in a very strange way. This is called the Ventricular Fibrillation. It is a very dangerous state in which both ventricles of the heart are contracting independently. There is no blood flow throughout the vessels so the brain is exposed to hypoxemia (low level of oxygen in the erytrocytes) and hypoxia (low level of oxygen in the cells). 
After about 5 minutes of VF we can consider a patient is dead due to irreparable brain damage. Mostly.

When we learn basics of the CPR we are taught to use the defibrillator as soon as it is possible. What does the defibrillator do? It sends an electric shock which "resets" the heart (it changes the polarization of cardiomyocytes to the state of depolarization -> when there is no contraction activity). If the patient is lucky, the heart after a few seconds will resume its normal rhythm. 

In various of medical series (dr House, Gray's Anatomy) we often see an usage of defibrillator when the ECG shows a flat line - IT IS A LIE! This flat line is a state (asystole) in which the heart is not contracting at all so what does the defibrillator need to stop?! It will not start the heart again, please remember that!

Conclusion: the defibrillator does NOT START the heart -> it STOPS it in order to help in RESUMING normal rhythm.

In the right bottom of the film you can see an ECG trace and how does it change during VF, usage of defibrillator, resumption of contraction activity.

7/12/2011

The not-always-Immune System.

Our organism is remarkable. Everything is under control the Central Nervous System, the lungs give us an opportunity to breathe, which keeps us alive, oxygen is transported by the red cells troughout the whole body. The Gastrointestinal System provides all the cells with nutrients, thanks to the muscles we can walk, lift groceries... :D

Lots of things, indeed.

One of the systems in our body is the Immune System, which is our line of defence against microorganisms such as bacteries, viruses, fungus etc. Without it, we would be dead within few hours/days after our birth.
The Immune System is composed of two parts:
*non-specific - all the barieres that protects our ogranism : the skin, the mucouse layers, lysozyme, chloric acid in the gaster, etc. and also special type of cells called monocytes
*specific - 5 types of cells : neutrophils, eosinophils, basophils, limfocytes

(these are very basic information; in reality, the Immune System is much more complex)

In order to defeat the enemy, those two parts of the Immune System must cooperate without any mistakes. When something is broken (for example: there are not as many immune cells as it should be)  - the disease appears.

Sometimes, the Immune System is over-reactive. It triggers the response caused by not dangerous "thing" - this type of disease we call: the allergy, and the percentage of people all over the world, that suffers from this disease is approximatelly from 30 to 40.

I am one of them. I am allergic to mites and fur of cats :)

Today I was in the hospital, in the Allergies Department to get my next immunization against mites. I started on December last year and in the next week I will finish my journey with this immunization :)
Week by week, I have been stung with a needle, at one end of which there was my arm, and at the other and there was a syringe with my medicament - dead mites. Week by week - rising volume.

Some of you would be shocked - "What? He is treated with his own poison? How is that possible?"

The explanation is simple - my organism needs to get used to mites. More specific - to the rising volume of it.

Before my first immunization, my organism triggers a whole immune response to harmless mites: I have sneezed, coughed etc. while other members of my family don't. Especially on Saturdays, when we clean up a whole house and dust was floating everywhere.

Sometimes, when patient is really,really allergic to something, he/she can fall into an anaphylactic shock : the airways become blocked due to swollen mucouse layer and the patient falls into cardiac arrest. When this happens, physycians give patient an injection of epinephrine - it will start the heart and reduce edema of the airways. If patient is lucky.

That tragic response of the organism is a result of releasing 3 mediators of anaphylaxis, mostly from basophiles: histamine, serotonin, heparin. Those mediators are released when we suffer from average disease as well, but not in as high volume as it is during anaphylactic shock.

They have synergistic effect:
* relaxation of the smooth muscle cells in the medial wall of blood vessels which results in..
* ... increased blood flow
* ... increased filtration through the endothelial wall

It helps our organism defeat the disease and we see those effects as a erythema, swelling, temperature rising in the place of injection immunization vaccine.

These are very basic information, as I've already said. For more information I encourage you to look for it for yourself :)

Tomorrow I'm going to clinic to start my second day of holiday practise. I hope something worth writting will happen :)

See you later!

Going worldwide

I'd try to post my next "stories" only in english.

Why?

I want my blog to develop and I want it to be read by as many people as it is possible. I want it to be place, in which lots of medical students (not only, but also "lovers" of the medicine) can share their experiences, thoughts and stories from their life - of course in comments session, main part of this blog is still mine :)

So I encourage YOU to "read,share and check" -> if I make any language or meritorical mistakes :)

See you later!