Good times before the serious

One more week of psychiatry left! I am a little nervous about the interview/exam on Thursday but i keep telling myself it will be OK, min is at 12.40pm in Fremantle. On a separate note i handed in my Rural Clinical School (RCS) form the other day and was a little OCD about it after reopening and checking the questions and address mutliple times before i was able to put it in the post! I hope it gets there ok but i reeeaaaallllllly want to go to RCS next year! After  much thinking i have put done Busselton for my first preference followed by Esperance, Bunbury and Carnarvan. I have my fingers and toes and arms and legs crossed for Busselton, it is GP-base, has a nice group of 5 people, has sporting facilities and events and is close to my family and friends :)

I had a lovely time last Thursday night catching up with a friend who i hadn't seen for about 2 weeks! It's been so hard lately as we have both been so busy and have breaks when the other doesn't. But i was so glad to finally catch up! It made me realise even more that i don't want to be way up North next year away from my friends, and in Busselton we could still see each other :) We had a dinner date and cooked a seafood risotto which was the first time we had both cooked one and it turned out really well! Well i mostly did the chopping to complements to the chef of 'Lexi's Kitchen'! Her adorable kitchen hand Tilly was also there and it was so nice to have a little play with her. They are perfect for each other Lex and Tilly it was just meant to be and you can sense how much they love each other. I'm so glad Lex always has her by her side (literally :))

The Seafood Risotto

Dinner Date!

Tilly getting kisses with a full belly of food :)

Adorable

On Friday I finally got to see the Avengers! I had a trip with Emma and Erin to Fremantle, it was a really great movie i loved the characters and the humour in it! Definitely a good trip out, especially after i hadn't been to the movies for about 8 months! Before that i had training at the track, it was a good session with 300, 200, 100, 200, 300 x2 then a 500m which i did in 1min28sec which i was quite happy with except i really hurt my foot from wearing my spikes, it is slowly getting worse i have to be careful with it! But spent most of Saturday hobbling on it. I also spent some time with Kyle Saturday morning and we went to the Manning Markets, it was such a nice atmosphere with fresh fruit and vegetables, preserves, breads and flowers and i loved looking around with Kyle, we sat down and had a nice coffee, i don't get to see him much being in different hospitals so the time was so nice to have!

At the Manning Markets

Kyle and I :)

Drug and Alcohol placement

I had my Drug and Alcohol placement as part of the psychiatry rotation this morning and i wanted to remember some things i learnt. I found it very interesting and even had the chance to talk to a patient in 'detox' and rehabilitation who had been using cannabis, methamphetamine and alcohol since he was 13 years old. Now in his 30's he wants a life back. Next Step provides a range of services for people experiencing problems associated with their drug and alcohol use, as well as support for families. Services inpatient withdrawal unit, outpatient treatment services and pharmacy, youth services and community clinical programs. There are a number of centres around Perth such as in Warwick, Fremantle and Thornlie and smaller centres outside of Perth such as in Bunbury, Albany and Geraldton. 

Next Step Drug and Alcohol Rehabilitation Center near Royal Perth Hospital

Interestingly the biggest reason people come into these places is for opioid abuse. Currently those affected can reduce heroin use by using replacement drugs such as the opioid methadone which is supplied by pharmacies as a way to slowly introduce those dependent on opioids to alternatives which are safer to use and place them on the path to decreasing drug use altogether (ideally). But it is the withdrawal of alcohol abuse which is the most dangerous as it can induce seizures and Delirium Tremens. 

The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, nightmares, disorientation and agitation and other signs of severe autonomic instability (fever, tachycardia, hypertension). These symptoms may appear suddenly but can develop 2–3 days after cessation of drinking heavily with its highest peak/ intensity on the fourth or fifth day and may be worse at night. Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats. These may be hallucinations which are primarily visual, or illusions related to the environment, e.g., patterns on the wallpaper or in the peripheral vision that the patient falsely perceives as a resemblance to the morphology of an insect. They are also associated with tactile hallucinations such as sensations of something crawling on the subject — a phenomenon known as formication. Delirium Tremens usually includes extremely intense feelings of "impending doom". Severe anxiety and feelings of imminent death are symptomatic of DT.

DT can sometimes be associated with severe, uncontrollable tremors of the extremities and secondary symptoms such as anxiety, panic attacks and paranoia. Confusion is often noticeable to onlookers as patients will have trouble constructing simple sentences or making basic logical calculations. 

General effects of alcohol relating to the neurotransmitters affected

We were given a little talk about the neurobiology of drug dependence which i have attempted to demonstrate below. Drug dependence is a compulsive behavior that is 50% due to genetics and triggered by a person's environment. Sort of like diabetes, some are us are predisposed to getting diabetes and when we do not look after our weight, diet and exercise we then trigger the diabetes and acquire the illness. 

Everybody has experienced something nice for example think of your favorite food. When you eat this food you increase levels of the neurotransmitter dopamine (1.) in an area called your nucleus abducens which tells you this is enjoyable. This information is relayed in a reward pathway to the area of the brain known as the frontal and prefrontal cortex. Here we have the ability to consciously control our reward, we can say 'no i have had enough of that food' or 'yes i would like another'. In those who take drugs, the levels of dopamine are significantly increased from the effects of the drug (2.) which tell them 'wow this is really good!' and they get a high. Over time whilst using the drug the amounts of dopamine reduce to normal levels hence people need more and more drugs to get the same effects (3.). What also occurs is those taking the drugs become accustomed to taking the drug to get this 'high' and it becomes a 'learned behavior' through signals to an area known as the hippocampus associated with memory. As the drug use continues, the pathway to the frontal cortex which allows us to consciously say 'no you don't need another one' dies away and the learned behavior pathway strengthens. This is what makes it even more difficult for those dependent on drugs to reduce and stop taking the drugs. It takes weeks to years for those affected to reduce this learned behavior and once again increase the reward pathway letting them make the conscious decision to say no.

The person we saw today was so determined to stop this time and get a life back, i wish him all the best! If he keeps up that determination he will be sure to pull through.

3 weeks until break!

Less than one week until the HBF fun run!! There are signs up around the city for road closures and i am getting excited! :) I am making sure i have a slower week this week so i can be ready to go, so i have finally forced myself to have a rest day today and take it easy. I don't think i can bring myself to miss training on Friday though :) Last Friday we did a session of 100m runs with 50m jog back recoveries. Really we did 2 laps but it made 15x 100m runs, then 5-10min recovery and did another lap of 100's (another 8). It was a good session and perfect running weather again! I had a good 10km run last night around Kings Park (minus a stitch) and still have the goal of getting lower than 1 hour 10min for the 14km on Sunday :)

I made it to visit Nanna A in the hospital after her heart attack nearly 3 weeks ago so it was really nice to chat to her and see her well again :) She is aiming to live until she is 101 so she can see the 100 year celebration of ANZAC day in Albany as her husband played a large part in those convoys, i will make it my goal to be there with her too.

Saturday night I went to the lovely twins from medicine 21st birthday - a black and white party which made a really nice night with their family and friends around. I think after 3 years i can finally tell them apart enough to call them by their names :P

Alana, Michelle, Jess and I at the twins 21st at the Vic Hotel Subiaco

Now with only 2 more weeks of psychiatry left we are getting into the more serious part. We need to have an observed interview this week and have our 1 hour case assessment next week which i am a little nervous about. Then it is a week of study and written exams and then.... a week off!!! It is only short but will be amazing, i am definitely ready for a little break. So although this week will be a little busy with drug and alcohol attachments and tutorials i need to try practice interviews to prepare for the 2 coming up. Wish me luck!

Signs and Fate?

I am only 4th year medicine and although some students have grown up with specific ambitions for their future practicing careers mine are still very much in the open. My thoughts lie with General practice specializing in pediatrics or obstetrics, but both in general medicine and psychiatry so far i have found myself in situations which could seem like a sign for what i want to or am encouraged to do in the future. 

Disordered eating behaviors have nearly doubled among males and females over 16 years in the past decade. Nearly one in seven (15%) of Australian women will experience an eating disorder in their lifetime most commonly in their adolescent years. An eating disorder is associated with the highest death rate and greatest morbidity of all psychiatric disorders, however there is probably the least facilities available for those affected. This year in the hospitals I find myself crossing paths with people affected with eating disorders, from 17 to even 50 year olds which only shows how just tough and chronic the battle can be if no treatment and help is sought. When i see them i take the time to get to know them, i want to know how they feel, their thoughts, the challenges for them and what has or currently helps, i want to know about their life so far, their relationships with people around them and their plans for the future. Every one has a different story and a different approach. And i realise how much attention i bring to these people and how intently i want to help them. I hate the idea of there not being enough facilities around for eating disorders, how it can be a silent illness slowly progressing in those affected and not brought to attention until something terrible happens. And i want to stop that. Especially in areas outside of Perth in the country, it is vital to identify and act on eating disorders as early as possible to reduce its severity and chronicity. It hurts to see those affected not having help or the right help that is needed. So maybe my future also lies in helping to treat eating disorders? Maybe coming across those affected so frequently is a sign from someone above guiding me to a future where i can make the most positive difference? All i know is i will keep talking, keep asking and see in mind a future where i could help those affected. 

‘It’s not a game, its your life’ 

Mothers Day and ECT

Home cooked pancakes with berries :)

It was so nice to be able to have mothers day at home :) After a lovely morning run in the cool autumn weather Nicole came around and i made pancakes for breakfast which was complete with berries and organic maple syrup... yum! We gave mum our gifts and i was so happy the dress i picked for mum fit her, i love the colours and the style it suits mum well, i look forward to some pictures of it in Paris when mum, dad and pop go very soon! We had a nice trip down to the beach with dad and the puppies and enjoyed the misty sea with some yoga poses and leaps too :) Then it was about time for me to head back to Perth.

Pancakes cooking away :) 

                                                                                

Yoga on the rocks! 

Happy parents and puppies walking along the beach

Mum's looking lovely in her mothers day dress :)

 Back at Graylands today i felt like i was back to actually learning about psychiatry with our consultant and got to write in patients notes and be helpful :) Our registrar was on the list for supervising Electroconvulsive therapy this week so i got to see my first ECT on a patient! It is used to treat a range of mental illnesses such as severe depression, catatonia and some forms of mania and schizophrenia. The treatment induces controlled seizures in the patient by placing small electrodes at specific locations on the head. It has a lot of stigma attached to it mostly by the fact that seizures are regarded in society as an illness and damaging to the body. ECT is in fact a very effective treatment for mental illnesses which are particularly severe and/or unresponsive to medications. 
A series of brief, low frequency electrical pulses prompt a convulsion. The patient is under anaesthesia before and a muscle relaxant reduces the intensity of muscular spasms. There is in actual fact less harm having ECT medication than the psychiatric drugs. Common possible outcomes include short term memory loss, nausea and a headache which may last for a day or two. Whereas psychiatric medications can cause extra-pyramidal symptoms such as Parkinsonian tremor, muscle rigidity and a shuffled gait, increased prolactin and weight gain (particularly the olanzapine baby!) and of course sedation to name the more common side effects. There are risks associated with general anesthesia as in any operation but the benefits outweigh the risks by far. In some patients this is the only treatment option left. The process itself was so interesting yet so brief, the convulsions only lasted about 10 seconds if that and the machine monitors the patients brain activity levels... i need to look into how to read EEGs now! But that was one psychiatric experience i can tick from the list of my 'must see'!

Feeling Alive

I feel more alive and i feel more like 'me,' i feel like i have gotten back a part of me that has been missing for over a year and i'm excited :)

I made it to the Boxing session at the Fremantle Warehouse gym, i almost thought i wouldn't make it in the busy traffic! The gym itself is the biggest i have been to and was soooo busy but it had an awesome atmosphere to work out to! I found Bernie and the others in the circuit room which was also packed and we got into it. It was an hour of boxing, burpees, situps, lunges, bikes, squats, runs, skipping.... you name it and we basically did it and it was so much fun!! I was a little sore the next day but not as sore as i thought i would be, i think the next session i can put more into it by knowing what to do, it was funny not being able to coordinate the little boxing bag i think i spent a lot of time laughing at one point :P The group that train with Jason (the coach) are really nice and friendly but dedicated at the same time which makes a great combination. Being in the atmosphere of the gym i stayed back a little after and went on the bike for 15min too :)

A picture i just found on the WA athletics website -
spot me running in this 1500m :)

Then Friday i was even more excited to FINALLY get back and reunited with the athletics running track!!! I car pooled with Bernie and we got there at 5, did a warm up and drills and we were set. The others did hurdles training but we had a session of 8x200's keeping up a constant pace throughout with 2min break between them. So we aimed for 40-45seconds each but got into the running mode and managed some good times for our first session back! We started off with joggers but couldn't resist and got our trusty spikes out (we have both had the same since we were 15!) and felt the extra speed of the spikes!

8x200m - 35, 33, 35, 33.5, 35, 33.5, 34, 33, 32.5, 32 seconds
I couldn't resist and did an extra 200m - 33 seconds
Then we did a 300m flat out run and although i haven't really done a pull pace 300m for years i was so surprised with my time - 46 seconds!!! Maybe breaking the 60 second 400m mark in the not too distant future is more of a possibility than i thought?? I think i was just so surprised because i have been concentrating on longer runs up to 10-14km, but i guess my hills and stairs have silently developed me some speed too!

What i also loved was the small but great atmosphere at the track. People we have never seen before encourage each other as we and others run by, they talk to us and are generally so nice and friendly - how has the atmosphere been so different last time i was training with another group? THIS is the track atmosphere i love :) And having Bernie as a training partner is more awesome than i can describe, i really hope she stays with the training.

I have more goals now, i have the University games in Adelaide in my sights in September, i am meeting with the dean of medicine next Tuesday to see if it is possible to get some time off medicine and my surgery rotation to go... fingers crossed!!

So after a high of my first session back at the track i then made the drive back home to spend mothers day with mum and the family. We had a nice trip to Busselton today and visited Nan and Pop with a lovely afternoon tea. Mum and i made some muffins and lemon cakes to take, it was almost like a mini feast! It was so nice to see them again though :)

I have also enjoyed mums green smoothies since being home and finally got to try a purple carrot! It looks and tastes like a carrot but i look at the color and expect it to be a beetroot... but i really like them i need to try some purple carrot recipes mum collected :)

Three sisters in the car to Busselton (and Sonic) 

        

Sonic and Bella Enjoying the ride!

 

Afternoon tea at nan and pops :)

              

A yummy healthy home dinner
complete with purple carrots!

The Serious, the Fun, the Chance and the Challenge

It's not very often we (my flatmate Emma and I) make it to college for lunch, so i am happily resting and digesting a nice tuna sandwich i was fortunate enough to have today! (its the simple things in life that count ;)) We are half way through our psychiatry rotation now with another 4 weeks to go and had some feedback/midterm lectures at Charlies hospital this morning. It was interesting to hear how the other placements are going, i discovered Graylands was the place where you have to be the most aware! We had a little discussion about procedures at Graylands and how we are put in situations which are not regarded as the safest particularly since we have no debriefing as to what to do in situations where patients may become aggressive. But so long as we keep our eyes open and instincts switched on we can follow our own logic. I am looking forward to going back to Graylands and finishing this week up at Osborne park, i might actually be able to talk to patients!! I went out a community visit with a Nurse Specialist from Osborne Park on Friday to catch up with patients who have previously been admitted to the hospital. We saw a lady with chronic schizophrenia who is doing well and dropped in on a man in a nice looking nursing home. It was good to see the patients in the comforts of their own home where you can often get a better idea of how the patient is functioning also. This next half of psych is the one of assessments, i am a little worried about them, they are observed interviews where we take the history and formulate a diagnosis and present the patient to an examiner... i would feel alot better if i had had the chance to talk to more patients but the plan is to be more proactive and pressuring to find patients well enough to talk to. If not i may have to ask family and friends to role play for me :)

I had a wonderful time at Radiolollipop last night. I have not been in a month as it is getting hard to find enough time to fit it in but everytime i make it i really enjoy it. I don't think i have mentioned it before but it is a volunteer-run organisation where everyday people (after a selection process) are able to go to childrens hospitals such as Princess Margaret Hospital and provide children with the best medicine - laughter. I have been going to Sunday Funday teams for on and off for over 2 years now. Last night i had a great time making a little girl laugh with an emu puppet chasing her around the ward. It is so nice to hear their laughter particularly when the mum says to you, 'thank you that is the first laugh she has had all day!' We smothered another little girl in bubbles much to her delight an had a great game of Uno with another who even sang a song for us :)

At the Radiolollipop station PMH level 7 dressed ready for some fun!
(I have the pink Umbrella)

An update on the HBF fun run training.... I can run 10km quite comfortably in around 50 minutes (12km/hr pace) with a drink stop so i am pretty sure i can make the 14km its just a matter of how fast i can go. I will aim to run 13km/hr so i can break 1 hour and 10 minutes! I have been focusing a little more on my upper body weights too and am slowly increasing weights both in Pump classes and doing isolated weights in the gym myself. I think i can see a difference in my arms now which is exciting! It will be even more exciting when it gets to the point where another person might see a change and make a comment :) So i will keep slowly and steadily working on my upper body strength, i could get some more motivation when it is needed from this site my sister really likes http://www.bodyrock.tv/

Another reason for some excitement, I have met a lovely girl in 6th year medicine at Osborne park who has a lot in common with me! She use to do track athletics and has told me about a great group she use to train with. After contacting them again it looks like we are going to be joining them for some sessions - Yay!! I have missed training with other people and needed another group since my last one i joined, the coach was good but i didn't like the dynamics in the group which made running not as enjoyable as it should be. But i have really missed training with people and running training in general. I had a good session at Kings park by myself on Sunday running up and down the Synergy hill but it is just not the same. Who knows maybe this winter training will help me reach the goal i have always wanted to do and make it to an Australian competition next year. I have qualified before but only by gaining a bronze medal but not getting the actual qualifying time in the state 1500m. I want to qualify and gain the experience no matter what the outcome, it has been a goal i have wanted for years and i feel that i just have to reach it and only then i will feel complete with my track running :) I'm 22 and getting into deeper medicine so i wont waste these chances! Maybe it is a sign, getting the chance to be at OP with this particular 6th year and coming across this other chance to train with her in another group, it is an opportunity i can't miss! The training is with a really good sprinter and hurdler Shannon McCann who is close to the speed of Sally Pearson! If that doesn't give extra motivation i don't know what does. There training schedule is

Somerville on monday at 4.45pm

len shearer tuesday at 4.45pm

boxing class in freo on wednesday at 5.30

Somerville on thursday at 4.45pm

At the track on friday at 5pm

Saturday is recovery day and sunday is either a beach or track session at 9am

So i am looking at starting with the boxing session in Freo with the other girl (Bernie) to meet the group and will look at joining them for Friday and Sunday sessions. It would be hard to do the training with hospital rotations on week days but we'll see how it goes. But i MUST be careful of my foot!! It gets quite sore running these days which is why i alternate running with cycling/weights so i am learning to play it safe :)

I also went to the Global Poverty Project talk last Thursday and heard about the Global Poverty Project and their work towards the millennium development goals to end poverty in 2015. They had a medical student speak who did an elective in Tanzania, i would love to do that one day! The founder of the End of Polio Campaign talked about the experience he had and how they are getting other countries to make a stand and get their governments to put funds to eradicate Polio like Australia did - India is now Polio free so we only have 3 more countries which are endemic left!! I had a talk to him afterwards and he said they will be running an Anti-malaria campaign throughout the year to participate in so i look forward to supporting that :)

Live Below the Line has started today where people live off $2 a day of food for a week to see what it is like to eat like those in poverty - except we have the benefit of choosing between a range of foods and cooking it to utilize every cent! I didn't do it this year due to hospitals and training but i did it last year as part of the C&E events at Trinity. We had a small bowel of cereal for breakfast, a toastie for lunch and lentils for dinner. I wasn't too hungry (not exercising too!) but i was really craving fresh fruits and vegetables!! I worked with the kitchen staff and made this menu...

Proposed Menu

Living below the line = $2 worth of food per day for 5 days

*not recommended is you are currently taking medication frequently with food or require a special diet

Breakfast, choose between:

1.     2x pieces of toast 36c with a serve of butter 8c OR

2.     35g (3/4 dining hall coffee cup) just right 40c with 100ml (3/4 dining hall coffee cup) of milk 15c

*Tea bag (no milk unless reserved from cereal) 5c

2 piece toast	44c
Just right and milk	55c

Lunch, choose between:

1.     Ham, cheese and tomato sandwich/toasty; 2 slices bread 36c, 2 slices ham (50g) 6c, 40g grated cheese 4c, 3 slices of tomato (50g) 4c  OR

2.     Normal serve of vegetarian noodles/stir-fry available on that day 70c

Ham, cheese, tomato sandwich	50c
Vegetarian stir-fry/noodles	70c

           

Dinner, choose between:

1.     1 cup rice 15c with 1 cup lentil dish 30c (or similar especially made by Chris), plus a cereal bowl size of mixed salad 30c (lettuce, carrot, tomato, capsicum etc) OR

2.     1 cup rice 15c with 1 cup lentils 30c (or similar especially made by Chris) as above, plus ½ cup (30g) of the ‘wet meat’ dish 35c available on the night e.g. chicken curry, beef stroganoff etc This option is only if the ham, cheese and tomato sandwich was chosen for lunch.

Rice, lentils and salad	75c
Rice, lentils and meat dish	80c

Adding it altogether

	Minimum	Maximum
Breakfast	2 piece toast + butter and tea	¾ coffee cup Just right and milk
	50c	55c
Lunch	Ham, cheese, tomato sandwich	Vegetarian stir-fry/noodles*
	50c	70c
Dinner	Rice, lentils and salad	Rice, lentils and ½ cup meat dish*
	75c	80c
Total	$1.75	$2.05

*cannot have both on same day

NOTE: snacks are not permitted unless they meet the $2 a day budget i.e. if taking the minimum option and eating one extra slice of bread (13c) between meals

Fruit is too expensive; an average apple of 150g costs 85c by itself; even 150g of grapes costs $1.05!

We even made shirts to wear as a group and had a night eating on the floor with no furniture, it was a good experience and a challenge for most! I have donated to a friend doing it this year and wish everyone luck for the week :) 

Anyway that is enough from me for now i better get back to study! 

Ronald McDonald House PMH

As the community and environment resident advisor at Trinity last year i had a wonderful (and busy!) opportunity to organise many community events at college. As this year goes on it brings back memories from each event, so as they happen i want to write about them so i don't forget....

Tuesday a few residents had a trip to the Princess Margaret Hospital Ronald McDonald house where families of sick children stay who are away from home while their child is being treated in the hospital. I organised 2 trips last year and each of them was a great success (even though i worry too much about how they turn out!) The first time we made pasta bakes and cupcakes (i had to fit them in ;)), the second time we were quite ambitious and made lasagna with fondue and fairy bread... yum! The fondue machine was a big hit with the kids :)

                                                                       



 















We were able to sit and eat with the families, all were very appreciative of our cooking and everyone had a wonderful time :)