New Surgical rotation and conference presentation!

From vascular and gangrenous toes and feet we have now moved into breast lumps, breast cancer and hernias. Our general surgery team we are following over the next 4 weeks runs the breast clinics and carries out mastectomies and lumpectomies as well as general surgical abdominal management and hernias in outpatient clinics. Our first morning we sat in on a daily hand-over meeting introducing new patients to the various surgical teams. Then we met our team... well said hi and were whizzed off the the theatres right away!! So Illy and I found ourselves helping out with a bilateral mastectomy with lymph node biopsy and another unilateral mastectomy. The first lady unfortunately had recurrent breast cancer which was now very close to her pec major muscle under the breast and after having radio and chemo-therapy on the other breast  in the past few years had decided enough is enough and it was better not to have the breast particularly when the cancer is recurring. I admire her fight through the cancer and could understand her reasoning to have her breast removed!! After a quick lunch break we went to the breast clinic only to find we missed a few patients and the next ones did not turn up. Instead we had a thorough discussion about breast cancers, treatments and breast lumps. I found it all so interesting and i wanted to know more. To me breast cancer is an area i could go into in the future, alongside with obstetrics and gynaecology or paediatric specialist as a GP. We will see what the future brings!

Tuesday was a very short day, we had a morning tutorial and by the time we finished all the morning clinics and theatres ad started and it was too late to join in. We didn't really know our patient list so i took the rest of the morning to be productive at home and did an operation report, it was a good morning of study actually!! Then in the afternoon i had a lovely catch up coffee with Lex followed by a uni games meeting in the Octagon... wow it has come up so fast!!

Inflammatory breast cancer changes

Wednesday we had the morning hand over meeting and a ward round. On the way we met a lady who had extensive inflammatory breast cancer which is an uncommon but aggressive form which can occur at any age. The lady was in her late 80's and was otherwise healthy all her life, the only issue with this was it put her in such denial that she had breast cancer especially with no family history. As a result she did not present to her GP until she had severe pain, a large lump and the cancer had spread to her lymph nodes causing arm pain and even Horner's syndrome of the face invading her cervical lymph nodes and sympathetic chain. She had come to accept her diagnosis and was receiving a great amount of support from her family and friends which she initially denied at the start by not telling them about her diagnosis. While she wanted to stay strong and be the sturdy face of the family even in her 80's her family are there to support her through thick and thin and to give her the support she deserves particularly after all the support she had given them over her 8 decades of life! She was only too happy to speak to us as well and tell us about her story and we wished her all the best.

Types of hernia's

We then made our way to the general surgery outpatient clinic where i came across my first hernia patients. It is such a common condition i am surprised i have never really encountered them before! So i learnt all about the cough reflexes, diagnosing and treating hernias. Strangely enough one lady who i talked to in general med rotation back in March/April came in with a hernia and remembered me!! I was really surprised actually, she looked familiar and then when she said i had talked to her in hospital it all came back. Strange how it all works to see her again.

I felt quite stressed that day, thinking about Em and I giving our first conference presentation in Busselton on Friday at the annual WA Rural Health conference and preparing for it. Then uni games organising myself and mentally knowing i wasn't in the best running shape with my plantar fasciitis and telling myself i should not have high expectations of my running over there (lets just hope i don't become lapped more than once... especially in the 800m if that is possible :P). Then thinking about missing a week of surgery and catching up on work while trying to prepare for OSCE's in 5 weeks with which i have so much to do!! So it got the better of me and although i had a lovely chat to Kyle and some med friends i hate feeling anxious and not really being good company with my mind elsewhere. When i'm like that i just need some time to myself to relax and collect my thoughts and sit through the coming things one by one and day by day, write things down and not get overwhelmed. I was a little relieved after having edited our presentation for Friday and a trip to the gym at least.

Thursday i used the morning to go to the gym then made my way to the hospitals. We talked to a lovely lady who had abdominal pain in the ED department and another who had a post-lumpectomy seroma who was also lovely to chat too (a rarity in the hospitals really!!). Then i took the opportunity to have a much needed coffee date with Kyle at Santis! Went back and packed my bag and headed home to Bunbury. I was exhausted, i had a nice chat to everyone and an early dinner, then made my way to the forum and found some shoes for med dinner next Friday! They are probably the prettiest shoes I've brought with the rare occasion i buy shoes which are not used for running! I also got a needed haircut and felt ready to take on tomorrow :)

So it comes to Friday. Up early (I can't sleep past 6am these days even when i can!!) i made my way to Busselton (in severe weather warnings i might add!) and although took a wrong turn found the Bayview resort where the conference was being held. I didn't feel like a medical student, but i felt like a health professional! It was so good to mingle with rural doctors and medical coordinators, people would even ask 'so where do you work?' and we would have to say we are still students (though we probably looked like it they could have been just polite :P). But it made me so excited to be involved in the conference and to work in the rural workforce in the future! I had a wonderful opportunity to meet some of the rural clinical school doctors and coordinators i will be studying with in Busselton next year and even had the chance to chat to one of the students :) Our actual presentation wasn't until 3.30pm, i felt more relaxed as they day went on (although i was doing a lot of nervous eating!!) as the atmosphere was very pleasant and friendly. When we actually presented there were about 40 people. The conference had about 150 people and we all split up into 3 as there are 2-3 sessions on at the one time. Em and I were third out of the students and although we were nervous, everyone said we looked relaxed and gave a very good presentation! Thankfully they didn't ask hard questions afterwards and we finished on time, ti was a relief to have it done!! High five Em we just presented in our first medical conference!! :D One Aboriginal health worker there messaged our supervisor in Geraldton to say we did a great job and our supervisor passed on the message to us that night, it was a great compliment :) I look forward to going to the conference next year in Kalgoorlie if i can but more so to enjoy the talks and education as it is a wonderful conference. I drove home at 5.30pm in strong winds again and was flopped on the couch exhausted.... but relieved :)

Em and I after our conference presentation

Saturday i decided to stay home, although the conference was continuing in Busselton i wanted to do some work, exercise and sort myself out for Adelaide and Uni games!! So i went to the gym for a pump class (i look forward to joining there over summer :)) and finished some lectures i missed from Thursday, had a break and made some banana blueberry sugar free muffins i love, had a quick trip to the shops with mum and Sarah for some clothes and of course a trip to the health food shop! Did some more work and had a little walk along the Back beach with the puppies. Dad made a yummy salmon dish for dinner (Salmon AND as a home cooked meal!!).

So uni games you have come. I have tried so hard to be fit through my plantar fasciitis, i have worked hard to balance training with uni and life in general which is no easy thing and now i will fly half way across the country to see if what i have put in has made a difference, if the sweat and tears have given me any sort of edge. I haven't run for 4 weeks and i just can't wait to run no matter how slow i may be! But for my efforts sake i just hope i am not as slow as i think i am. So i have set myself a real goal, to try break 5 minutes in the 1500m (my PB is 4.47min) and to do at least 2 runs over the week depending on how my foot holds up. I will try look after it and not be silly. And i just hope to have fun and if all running fails, support the other competitors from UWA. It will be a great week none the less, i know my body and what has happened over the past few months, i almost gave in and called it quits so now instead i will make the most of this opportunity :) Go UWA!!! Uni games, Bring It On!!

Seafood Paella

Paella is a Valencian word which derives from the Old French word 'paelle' for pan which in turn comes from the Latin word 'patella' for pan. It is a Valencian rice dish that originated in its modern form in the mid-19th century near lake Albufera, a lagoon in Valencia, on the east coast of Spain. Many non-Spaniards view paella as Spain's national dish, but most Spaniards consider it to be a regional Valencian dish. Valencians, in turn, regard paella as one of their identifying symbols.

There are three widely known types of paella: Valencian paella (Spanish: paella valenciana), seafood paella (Spanish:paella de marisco) and mixed paella (Spanish: paella mixta), but there are many others as well. Valencian paella consists of white rice, green vegetables, meat (rabbit, chicken, duck), land snails, beans and seasoning. Seafood paella replaces meat and snails with seafood and omits beans and green vegetables. Mixed paella is a free-style combination of meat, seafood, vegetables, and sometimes beans. Most paella chefs use calasparra or bomba rices for this dish. Other key ingredients include saffron and olive oil.

I found this simpler recipe for seafood paella (don't know if i could eat the snails!!) which is on the list of meals to cook! :)

Paella 

Ingredients

• 2 tablespoons olive oil
• 1 red onion, chopped
• 2 garlic cloves, crushed
• 1 green capsicum, seeded, chopped
• 1 tablespoon smoked paprika
• pinch saffron
• 500g marinara mix
• 2 tomatoes, chopped
• ¼ cup dry sherry
• 4 cups cooked long-grain rice
• 1 cup frozen peas, thawed
• ¾ cup chopped parsley
• lemon wedges, to serve

Preparation method

1. Heat oil in a large frying pan on high. Saute onion and garlic for 2-3 minutes, until tender.
2. Stir through capsicum, paprika and saffron. Cook a further 1-2 minutes, until aromatic. Add marinara mix and cook, stirring occasionally, for 3-4 minutes, until seafood changes colour.
3. Add tomatoes and sherry. Bring to the boil on high. Stir in rice and peas. Cook, stirring, for 2-3 minutes, until heated through.
4. Sprinkle with parsley. Serve with lemon. Accompany with crusty bread, if liked.

TOP TIPs

• If preferred, make your own marinara mix using fish chunks of choice, calamari, prawns, mussels and scallops.

I have also come across a great websit called 'Vegie num num' which i can't wait to cook from!! Have a look at some of the great recipes :) 

http://www.veggienumnum.com/2010/07/pea-avocado-penne/

Cocochocbanana Muffins

Cocochocbanana Muffins

Ok so these aren't sugar free but i made them for my friends and room mate and they are a hit so i had to post them to remember the recipe! :) 

Makes 12
Prep time: 10 minutes
Cooking time: 25 minutes

Ingredients
125g butter, softened
½ cup (100g) brown sugar
3 ripe bananas, mashed
¼ cup milk
1 teaspoon vanilla extract
2 eggs, beaten
1 ½ cups self raising flour
1 teaspoon cinnamon
½ cup shredded coconut
1 cup (200g) milk choc chips
1 cup chopped walnuts (optional)
Pinch of salt

Method

Preheat oven to 180°C.  Line 2 6-cup muffin pans with paper cases. Cream brown sugar and butter in a bowl.  Add bananas, milk, vanilla and eggs.  Stir to combine. Add sifted flour, cinnamon, coconut, choc chips, walnuts and salt.  Fold through very gently until just combined.  Add walnuts and stir gently. Divide the mixture between the paper cases and bake for 25 minutes or until starting to brown and a bamboo skewer inserted into the middle comes out clean.

Last Vascular Week

I couldn't sleep Sunday night, too much was on my mind for everything i needed to do and what was to happen throughout the week, some exciting, some sad, some needing more organisation and some i was uncertain how it would work out. Thankfully as each day went by i was a little more relieved so each night meant a little more peaceful sleep.

Monday was another morning of ward rounds and i took the chance to follow one of our surgeons to theatre to see radio-frequency ablation of the Long Saphenous vein with a diabetic foot ulcer debridement and another toe amputation. They sounded more complicated than they were but i was happy to have seen them done to tick them off the list :) the radio-frequency ablation involved basically destroying a vein which is mostly used for therapeutic treatment for varicose veins. With a quick visit to the cath lab to see a patient having a tricky stent put into their descending aorta we had a lunch break and caught up on some patient notes. After waiting around for our clinic we found out it was cancelled after no one told us!! I was a bit annoyed as i could have joined Lex for her birthday celebration with her family :( but the registrar only found out then too so he gave us a tutorial in the cafeteria and we finished up with our patient notes for the day. It was a special day for Lex and mum's birthdays i just wish i could have seen them, it was a little harder when mum was in Darwin but she can't complain about that ;)

Tuesday - another round of ward rounds and we took a history from a man bleeding somewhere in his GIT and we had to try find its source. He is a lovely man and only too happy to talk to us and let us do an abdominal examination. Seeing our doctors again they called us to hurry along with them and we thought we must be going to the ICU or somewhere important only to end up at the coffee place without our wallets! I guess that is an important place though :P i presented the man we just talked to off hand in probably my worst case presentation but we all had a good discussion on GIT investigations at least. We also saw an amputee patient then i went to the ENT clinic to follow up a patient and was happy to find i could see her get a surgery done tomorrow after seeing her in the clinic last week with loss of voice. I had some lunch and a nice coffee break with Kyle and Marcus at Santis but used the afternoon to run into the city and... got my med dinner dress from Forever New yay!! I even made it back for a good RPM class and got ready to head out for a lovely birthday celebration with Lex in Subi!! I love outings with lex and Subi is becoming a favourite place of mine :) I ran to San churro's to get Dim a birthday voucher then met Lex at the cinema's to see 'Hope Springs'. It was a laugh i really enjoyed it! I love Meryl Streep too i think she is fast becoming a favourtie actress of mine.

Blueberry waffles :)

There were some moments i almost couldn't watch with the scenes being a "Mr Bean" style of awkwardness haha. Afterwards we treated ourselves to half price waffles at Gelare's. I can't believe i have not had them before!!! I loved hearing lex's stories about when she was at school and her and her mum and brother would get the half price waffles every Tuesday, it is such a nice memory to have and spend time with your family like that :) We had them with blueberry cheesecake yoghurt and maple syrup and i had some blueberries too............ all i can say is YUM :) I want to go back every Tuesday! It was so nice to have that time with lex especially when she had been busy finishing a big assignment she really deserved a good break and birthday celebrations! :)

Gelare's Waffles!

Wednesday was a different day which i enjoyed. I followed up a patient from the ENT clinic who was coming for surgery on her voice box. Basically she had a thyroid cancer and had to have it removed but in the process her recurrent laryngeal nerves were damaged which are close by and her vocal cords were mostly paralysed. This made talking and breathing difficult! SO the surgery was to open up the airways while preserving most of the vocal cords for her little voice left by taking away some of the surrounding muscle and cartilage. The poor lady was so nervous but she was in good hands! The ENT consultant/surgeon is probably the best doctor i have ever seen, he is so calm and composed, knowledgeable and very considerate of his patients, their family, other staff and even of us medical students!! One the operation was done his priority was to call the family and let them know it was a success, the first time i have seen a doctor even mention it! I also stayed and watched a septoplasty and learnt a lot about the anatomy of the nose and sinuses through the endoscopic camera :) I hurried away to get to the 12pm tutorial with the scary consultant then made my way through the wards to check up on a few patients.

Vocal cords 

I made it to an afternoon pump class but missed Trinity's Rocky Horror formal dinner to do some much needed work on the research presentation Em and I are giving on Friday... not so fun :( sorry trinity i have neglected you this year and cease to exist in college life! But i also made some quick banana choc chip muffins for our vascular team to say thanks tomorrow :)

We had our 8.30am Thursday tutorial  on trauma this time, then ran up to G73 conference room to join in with the chest x-ray/patient discussion session with our team. They brought us coffee!! it was perfect actually because then we got out our baked good (Illy also made a yummy blueberry slice!) and shared them around much to everyone's delight! We followed the consultants around for their ward rounds then i went back to trinity for some lunch. I made my way to Freo for Nanna A's funeral, it was a beautiful sunny afternoon for a beautiful service. I felt a little awkward not really knowing or recognising her family but slotted in with the walk to the crematorium. There i met Uncle Steven who i have not seen for a few years! It was really good to see him and we sat together in the service. I loved hearing about Nanna A's life, she is one inspiring lady! I didn't know she was president of the CWA... no wonder her cooking was amazing!! She did so much volunteer work from in a school in Albany to making pyjama's for the poor when she had no pyjama's herself. I loved how her grandkids would fight to stay with  her and visit in Collie over the summer break and she would take them to collect eggs and bake goodies together, the type of nanna i would love to be :) she was a determined and willful lady from sawing a hole in the wall for a window to learning to use the computer in her 90's and i admire her enthusiasm for all things in life! I would love to have a copy of her life story which she wrote before she passed away, and i aspire to be able to perfect the pumpkin scone recipe she gave me before i am 98, (hopefully i can get it within 76 years!!) and put lots of love in the food i make for others as food brings people together. So in true Nanna A style she insisted on afternoon tea after her service and we all gathered in another room together with tea, coffee, sandwiches and sausage rolls. And just as Nanna A showed, food brought Uncle Steven and I to have a lovely catch up! It was so nice to hear how he and the boys (Brendan, Liam and Jarrad) are doing and i hope to join them one weekend on one of their outings sometime soon :) Rest in Peace Nanna A, you are one inspiring lady who touched the heart of so many people, mine included.

Friday was presentation day... after our ward rounds i pretty much went straight back to Trinity to do some work and prepare some more, Em and i had a few practice run through, had lunch and headed off to present. There were 8 research groups presenting in total and we were the lucky last. I always get nervous talking in front of people but it went well and i was thankful for the good remarks we received from those who listened as we are giving the presentation in Busselton next week so this was a good rehearsal for that!! I was exhausted after the busy week and treated myself to a much needed walk along Matilda May, something i haven't done in a while! And found myself stretching and lying on the grass listening to the birds... bliss. 

The weekend was quite study packed which i needed. I had my Saturday gym session then got into work. I hadn't seen Kyle much that week and looked forward to seeing him Saturday night! We had dinner at a place up Hampden which is becoming a favourite of mine for the teriyaki salmon and miso soup! Kyle likes the Salmon Don with sushi and with free Jasmine tea it makes a good meal! Then we had a coffee at Ti amo's and i would have loved to spend more time with him but Em had invited the girls over for a movie night watching Hysteria. I always miss those catch ups so joined in with them and had a nice time and a few laughs at the movie :) Sunday was a good pump class session, washing and an afternoon full of chest x-rays to get my head around them, fingers crossed it worked!! I mainly want to remember 1. Pleural effusion (fluid line) and 2. Pneumothorax! (pleural line)

Pleural effusion in right lower lobe

Pneumothorax of right lung (collapse) 

I had another lovely walk through Kings Park to finish the weekend and admired all the spring flowers coming out... i love spring! 

Orange & Almond Oaties (Sugar free)

While having my cup of tea or hot cacao drink at night i realised i miss my dipping biscuits.... why haven't i tried to make some sugar free biscuits?? I opened the fridge and found a large orange needing eating or in its case cooking. I next rummaged through the cupboard of limited university student/college supplies and made my own recipe for some what i call my 'Orange and Almond Oaties!' :)

Ingredients

1 1/2 cups Oats
1 cup SR flour
1 tsp Baking powder
1 tsp Bicarb soda
2 tsp Cinnamon
1/2 cup chopped almonds
1 egg lightly beaten
1/2 cup vegetable oil (or light Olive oil)
1 Tbsp Honey
2 Tbsp grated orange rind
1/2 cup freshly squeezed orange juice

 Mix dry ingredients, orange rind and chopped almonds in a large bowel. Add together egg, oil, honey and orange juice and mix into dry ingredients. Roll into drops and lay onto an oven tray lined with baking paper and bake in moderate oven for 10-12 minutes or until lightly browned. Watch out these brown fast!!

They are quite crisp these biscuits, next time i will try adding another egg (I only had one left!) and to add some more moisture i would love to try these with some dates in a food processor to make a sort of paste, orange and date sounds delicious in my opinion!!

Enjoy with a tea :) (or better yet a hot cacao!)

Apple & Cacao Oat Slice (Sugar free)

For my next trial of my sugar free slices, i decided to branch away from banana... well almost :P I decided to add apples! This added some extra moisture as well as natural fruity goodness, top with some flaked almonds i found, and the result? ...Yum!! I think i have a new favorite :)  

Apple & Cacao Oat Slice



1 1/2 cup quick cooking oats
1 cup SR flour
1 teaspoon baking powder
1 teaspoon Bi carb soda 
1 teaspoon ground cinnamon
3/4 cup desiccated coconut 
1/2 cup flaked almonds
2 teaspoon vanilla extract
3/4 cup milk
1 large egg, lightly beaten
2 large mashed bananas
3 apples peeled and grated 
1/2 cup Cacao Nibs (optional)

Mix dry ingredients into a bowel, add mashed banana, egg, milk, vanilla and stir, add in cacao nibs if desired and pour onto lined or lightly greased lamington tray. Sprinkle with 1/4 cup flaked almonds and a little cinnamon and bake in moderate oven (180 degrees) for 35-40minutes until golden brown on top :) 

Ready for the oven

Yum!

A Lovely Weekend

I was very keen for a morning in on Friday to catch up on some research work. The morning is the best part in my little room where the sun shines through the little window around 8/8.30 but i never seem to be around to get it! I did this morning and it was a simple thing that made me happy :)

I had a call from mum that morning as a lovely lady who was 98 passed away after suffering a large stroke last week. Nanna A she insisted everyone called her whether you were related or not, a wonderful Nanna she was to everyone who passed her by, so giving, caring and 100% inspiring in all her 98 years of life. After hearing the sad news and seeing mum upset, i wished i could go home for the weekend. It is mum and dads birthday next week and i missed fathers day last weekend, but why couldn't i do home? So after a quick trip into Claremont quarter to get a few gifts, i drove home :) It was lovely just to sit under the patio with a cup of tea (and sponge cake from nan and pop who had just visited!) and chat about things and Nanna A too. Walking the dogs and catching up with dad and having home cooked meals - YUM!! i wished i wasn't full afterwards so i could eat more Beef Bourguignon!

Saturday i finally made pancakes for everyone which i love doing, and finished mine off with yoghurt, muesli, cinnamon and blueberries... why had i not done this before??

After a little study and rest and digest i made my way to the pool for a good swimming workout. It was a bonus to have a lane to myself to do some sprints and got a little lift when the man next to me commented that i seemed to be doing a good job working hard (even though my sprints felt like his cruisy pace!!) That afternoon we had a lovely family afternoon tea at the World Table restaurant/cafe along the inlet, it is one dad has wanted to try for a while, they are more of a restaurant but we still enjoyed their cakes and hot drinks soaking up the sun! I just loved the chance to have the whole family there together no matter what we chatted about. It was a lovely way to celebrate mum and dads coming birthdays :) 

Soaking up some sun!

Pecan Pie

Mum enjoys seeing us 3 girls in the car together even if it is a little squishy these days!!

Back at home mum and dad opened their birthday gifts, both of them wanted some dumb-bell weights and we had some fun posing as a 'power family'... i think we could make the next fitness magazine cover! :P

Sisterly 'Blue Steel' (for those who have watched Zoolander!)

As a side note i am very proud of my younger sister who has joined Nic and I and got a gym membership!! Can't wait to see her changes and go to the gym with her in summer when i am home :) if only i could have witnessed her first pump class... and aching butt!! :P it is well worth it though!
I was going to head home that night but ended up staying and doing some study. Mum and dad were rushing around getting ready to head to Darwin and had to leave home at 5am for a 7.30am flight. So when i woke in the morning they were already gone. After a little exercise i was also back to Perth. Sunday afternoon we had a rural clinical school BBQ at Swanbourne beach so i finally got to meet those who i will be living with in Busselton! I was a little nervous but excited all the same and when we finally met i relaxed, they are all lovely people from what i can tell! I was a little surprised as 2 of them had not been to Busselton before and it was not their first preference so i shared my excitement of how good Busselton is going to be and answered their questions about the town and the weather! I'm glad Kyle came to meet them too, but after the excitement of meeting them had my first thought of 'what if i get lonely and miss everyone in Perth??' I'm sure when i get to know them more i will feel a lot better :) I had a lovely trip to Bou Bar with Kyle afterwards for a coffee before getting to some much needed study to finish off a great weekend and prepare for quite a busy week ahead!

Surgery Week 3

I had a wonderful relaxing night Sunday to prepare for the week ahead! Lex and i had a girls night and met in Subi for Wagamama's dinner, i had one of the nicest meals i have had out! It was ponzu stir-fry with chasoba noodles which was stir-fried chicken (or tofu) with red and green capsicums, carrot, spring onions and spinach, served with a spicy ponzu sauce on top of green tea noodles.... yum!!

Ponzu Stir-fry!

With our hunger satisfied we made our way to the ACE cinemas to see The Sapphires which we have both been wanting to see for a few weeks! It was a really good movie and although had some nice messages behind it also had some humour, i loved the voices of the Aboriginal girls they were amazing! But the night was not complete without a quick trip to San Churro's where we both tried a dark hot chocolate and an Aztec/chili truffle for me to sweeten off the end to an already lovely night out :)

And then the next week of surgery began. It was an interesting one that is for sure! On Monday after ward round i went to an amputation gym and met a young man who lost his foot due to a bone cancer and was learning to use a prosthetic joint after a below knee amputation. He will be running soon with no doubt :) it was a different story to some elderly patients who may never get to walk with a prosthesis after an amputation. Many may have a number of co morbidities which prevent them from obtaining a prosthetic joint to begin with, then the strength to use a prosthesis can be an extra 75% most elderly patients cannot achieve this. I was almost  ashamed to admit that i assumed almost anyone could get a prosthetic joint after an amputation but there are so many factors involved both physically, mentally, psychologically and socially which need to be taken into account before a prosthetic joint can be considered.

Monday afternoon we had outpatient clinic and met many patients who had had stents put in for aortic aneurysms and dissections and these appointments where to see how the stents were going and to assess for any 'endo leaks' causing the vessels to dilate up again around the stent. With a tutorial from the registrar at the end it was another valuable learning experience.

Aimee Mullin

On Tuesday i followed the gym up with an amputation clinic and met some patients at their follow up appointments to see how they were going, how their prosthesis was fitting their limbs and any complications they are having which again reinforced what i learnt with how much more complex a prosthetic joint can be and how difficult they are to use initially!! Although i did have respect for those with prosthetic limbs i have even more now and admiration to those athletes in the Paralympic games at the moment in London... they are the true Olympic hero's!!!

On Wednesday i went into the theatres to see a couple of toe amputations - they were quite quick compared to other operations and with no real need for me to scrub up and assist i found myself answering my registrars phone while he was undertaking the surgery... scary answering calls from other specialists as a medical student!!! Then we went up to the Cath lab to see a person have a stent put into her aorta and align over her renal arteries which according to our doctors didn't happen to often being more complicated!

Thursday was a long but awesomely productive day. In the morning 3 of us went to the outpatient Ear, nose and throat clinic and were exposed to what seemed like a whole new realm of medicine we have had so little information on!! I wish i knew most of the terms they were talking about but i learnt quite a bit in the 3 hours i was there. I hope to follow up one lady who had her thyroid removed due to an invasive cancer but now damage to her recurrent laryngeal nerve meant her vocal cords where affected and made breathing difficult so she is to have a surgery to open part of the cords next week. I also saw a disabled patient have a tracheotomy changed but felt ill hearing what sounded like the patient chocking in his own secretions. His carer said he was putting on a show for us but in all honesty the sound was horrible :(

Aorto-bifemoral bypass
(white tube)

After a lunch break that afternoon i went into an amazing surgery where a lady was having an aorto-bifemoral bypass (and a toe amputation). Basically they opened up her groin to clear up each femoral artery then they opened up her abdomen to get to her aorta which is behind all the intestines and GIT organs... it was the first time i had seen the insides of the abdomen on a living person and it was quite amazing even though i was 2m away and couldn't get a good view not being scrubbed up. Luckily one of our peers was right there which would have been amazing!! To attach the graft to the aorta then into her leg they passed the tube under all the ligaments in her groin by hand! I thought it was amazing how they were able to clamp the aorta for an hour or so with no adverse effects too. Such a good surgery to see. But i also had some success as i put my first catheter into this patient, i was a little nervous about putting them into females but it went really well! Another tick off my little green book :)

I left the surgery after 5 and headed to the wards to do some heparin injections on patients and learnt to leave the needle in for a few seconds afterwards as this prevents bruising and bleeding at the injection site and was proud to see when i took the needle out there were no spots of blood :) Leaving the hospital at 6.30pm it was a long day, but well worth it :)

Cacao Nibs & Banana-oat Slice

Sunday = washing day after a morning gym session, but i also had an inkling to do some baking! (no surprise there :P) Having spent most of the weekend out i needed to get lots of work done, so i bargained. I put my washing on and knew it had 25 minutes to be ready, if i could make something in that 25 minutes then i was allowed to bake... mission accepted!!

Cacao - a delicious super food!!

And i made another tasty and healthy favorite:
Cacao Nibs & Banana Oat Slice! :)

Here is what i put together...

1 1/2 cup quick cooking oats
1 cup SR flour
1 teaspoon baking powder
1 teaspoon Bi carb soda 
1 teaspoon ground cinnamon
2 teaspoon vanilla extract
1/2 cup milk
1 large egg, lightly beaten
1 large mashed banana
1/4 cup Honey
1/2 cup Cacao Nibs

Mix dry ingredients into a bowel, add mashed banana, egg, milk, vanilla and honey and stir, add in cacao nibs and poor onto lined or lightly greased lamington tray. 

Cook in moderate oven for 25minutes until light brown on top... perfect amount of time to collect your washing, hang it out and even wash up the few dishes! If that isn't time management i don't know what is. 

And now with a hot cup of tea and piece of cacao-banana slice with a dollop of peanut butter with my washing done i will be content to settle for some study :) 

My study pack :)

Taekwondo Cup

After a long day at an OSCE preparation session getting a head start for our end of year exams i was thankful to make it to Kyle's Taekwondo cup in the evening. I haven't seen him do Taekwondo before, after starting again this year he is really into it and loves it! Luckily when i got there a little late his round hadn't started yet and i got to see all his Sparing rounds. I was very impressed with how well he did since he had only gotten back into it about 8 months ago after last doing Taekwondo when he was about 11 years old! Some people you could tell had so many years of experience they were so fluent, quick and powerful with their moves and you couldn't tell Kyle had only started up again at the beginning of the year against them he has progressed so fast! Unfortunately he hurt an already sore toe and pulled a ligament but in true fighting spirit with a bit of ice he finished his other 2 rounds and still did really well. He was certainly admired by everyone there for his perseverance and determination so long as he didn't hurt his foot more which thankfully he didn't :) I hope he is still able to do the pattern session tomorrow which is less jumps and a little easier on his foot... damn foot injuries why do they cause so much problems, who needs feet :P It was really nice to meet some of his team mates who he trains with they are all so nice and very sportsman-like, a few came up to me and said how nice Kyle was, i agreed and said i was very lucky to be his girlfriend! I took a few pictures while i was there :)

Very Proud of you Kyle :)

Vascular week 2!

Not mine but an example :)

The second week of surg with the vascular team was no less exciting than the last! Well Monday we were excited and ready to hit the theatres again but the case was cancelled... minor flop but our ward rounds are still good and we had a nice tute with a registrar. In the afternoon we sutured Pig Trotter!! It was really cool learning how to suture and although i felt sorry for making cuts in a dead pigs foot i told myself that i was doing a fine job stitching him back up :P It was tricky even at the start to tie surgeon knots with rope but i eventually got it after a few practices, it is so satisfying when you get it! The intradermal stitch was hard to hide under the skin but also satisfying to get right.

Cannula's... for some reason i battle with these, i can't get into the veins although i am good when taking blood! After a few disheartening attempts, i finally did one on tuesday! :) AND i had to take blood at the same time which made it a little trickier, i am very thankful to the patients who let us do the procedures, so long as we have an air of confidence even when we don't feel it ourselves then they are happy. Some tips i want to remember though...

1. Align the vein by palpation with a marking on the skin i.e. a freckle, when the vein is not obvious

2. If you miss the vein on first entry, realign the vein and without taking the needle out and angle the needle to the vein and go in from the side

3. Once you get a flash back of blood showing you are in the vein you need to advance more at a lower angle/along the vein to ensure the cannula tube is inserted fully

4. Advance the cannula tip and hold the cannula in the vein when withdrawing the needle, this will also reduce blood exiting the cannula before the bung is placed on

5. If taking blood via syringe do this BEFORE any saline is inserted or bung is put on

6. Insert bung and saline solution

7. Clean up any blood on skin and tape/dress cannula to secure

That morning i also went in to theatre for an elderly patient who had a met call that morning from losing a lot of blood from a fasciotomy (fascia is cut to relieve pressure to treat loss of circulation such as in a swollen limb) resulting in a hypotensive crisis. Myself and another medical student followed the surgeons to theatre and prepared to watch them assess the fasciotomy wound and made an artery bypass. Only one of us was to scrub up initially so i was to stand on the side a little back but then got told i could scrub up also once the main surgeon came in. This is a 5 minute process to scrub up and be sterile, by the time i had scrubbed and walked in i was just a little surprised to see them have this man's leg fully open with everything cut except for the bone!! They said to me 'quick turn around Janelle this is the most fascinating part' and using what looked like a piece of string they cut the bone and were simply holding this mans leg from the thigh down in the air.... We were now doing an above knee amputation! Apparently in my 5 minutes scrubbing they had tested the muscles on the mans lower leg/calf and due to a lack of blood supply they were unresponsive and non-salvageable so they opted for an above knee amputation. This man was in his 80's with a number of co-morbidities and this was the best option to enable his survival, he was very unwell. What i didn't realise is how quick an amputation was! I always imagined it to be a tedious process of cutting layer by layer but i guess not! The longest part was probably the suturing at the end and the whole process only taking around 30 minutes if that, wow. 

I was so happy to have a break at the same time as Lex on Wednesday and had a lovely afternoon tea in the sun sharing our hot drinks and a citrus cake from Santis :) Having bought a few scratchies our luck increased a little more when Lex won $2!! :) Thursday was also a very interesting day! We had a lecture at 8.30am so the extra hour in the morning i squeezed in a gym session before heading to the hospital. After the lecture we sat in on a meeting and drug rep talk with all the vascular doctors before discussing patients and heading out to a late ward round with all vascular consultants present to get each others opinions.... wow a 15 person ward round was difficult to manage!! We weaved our way through ICU, 4th floor, 5th floor and 6th floor and at the bottom of the food chain us medical students were left huddling at the door trying to see the toe or leg of a patient but by the time we even worked out their name we were off to the next one! The main consultants are so tall and very imposing we felt a little small trotting along in their shadows! 

After a lunch break i made my way to surgery to watch a carotid endartectomy on a patient i had met the day before. He had classic symptoms and came in with left sided arm and leg numbing, tingling and weakness which lasted less than 24 hours, a classic case of a TIA (less severe than a stroke lasting less than 24 hours). He was a lovely man to talk to and i was happy to follow his case and scrub in on his surgery. I had seen one last week for my first surgery and had a little knowledge about the anatomy and felt quite humbled when i could answer the questions the surgeons gave me and remarked that i was answering correctly ones RMOs don't get and should become a vascular surgeon!! Apparently i even answered a question correctly that a medical student has not got for 2 years (i gave myself a silent YAY!!! :)) It was quite funny last time i learnt that when they put a stent into the carotid artery there is 2-3 seconds where the blood runs free through the cut artery which mean it escapes! Coming off the aortic arch from the heart the blood is under high pressure and i was directly in line with the artery... feeling a little unsafe i moved to the side just at the right time as a jet of bright red blood streamed 2-3m right where i was standing 2 seconds ago and hit the poor nurse behind me!! I thought 'yep this is surgery alright!'. There were a few minutes where i couldn't see too much of the process as my step was then covered in blood (yes i need one to see the patient on the table, i am just glad there is no BYO step haha) but i really enjoyed being thee and learnt alot!

Friday morning i went into another surgery and saw a lady have her femoral artery (in her leg/thigh) opened to remove a plaque... only this one we could not find an end to it, her poor arteries were so clogged and calcified its a wonder any blood was getting to her legs at all. So we opened up the artery next door and unclogged as much as we could of that one to give her leg some chance! The surgeon harvested a nearby vein to patch up the artery which was quite good to see, it was her longest deep profunda artery endartectomy the surgeon has done and took quite a while, 3.5 hours for this procedure. The patient was a smoker, and i just wished she could see what she was doing to herself, its a shame they can't see their own pathology its just like the Quit smoking adds seeing all the 'muck' clogging them up but would seeing it make a difference in their smoking habits?? Please do not smoke!!! It looked much worse than the image below, even the gangrenous/dead tissue on the foot looks mild these days after only 2 weeks in my surgical rotation!!

       

There was some bleeding complicating the closure but once it was fixed i was able to SUTURE!!! I only did about 6 but it was the first time i had sutured on a real patient! I think i did an alright job if i say so myself :P another tick off the surgical list :)

That afternoon i had an ultrasound of my foot which confirmed i have a thickened plantar facsia so the diagnosis of plantar fasciitis is confirmed and ruled out any other causes. It gets me down though i just wish it would get better :( I said no to the corticosteroid injection as i would rather monitor the pain to get it better for once and for all rather than masking the pain for a few months and not actually fixing the problem itself... what ever it is. Being so tired from the week and in a bit of a flop i didn't go to the gym but think i needed the break anyway to resettle myself and spent the night doing some study and preparation for an OSCE preparation day all day Saturday for our end of year exams (scary!). I think some sleep is in order for now... what an interesting week!