New Respiratory Illness

I'm a little late on this one because I was busy with exams, but here is an article talking about a possibly new respiratory illness that seems to be contagious.

So be careful if you live near Glengarry hospital and you are thinking about going in!

Pre-Clinical Years....Done

Most medical schools in North America are 4 year programs. The first two years focus on pre-clinical, lecture based theory. The final two years are practical, hospital based training where we actually learn how to practice medicine.

Being lecture based, the first two years are very similar to undergraduate years...just a lot more work, a LOT. As an undergrad, I usually had 6 or 7 final exams per term, which is more than most undergrads because I was in engineering. In medicine, I had 10 or 11 final exams per term. On top of that, each exam had considerably more material than I ever dealt with in undergrad. So, like I said, med school is a LOT of work.

Looking back, I have definitely learned a lot in the past two years. Not just about the science of medicine, but also interacting with patients. As physicians we have a limited amount of time (often only 10 minutes) to talk to patients when they are most vulnerable. Comforting and reassuring a patient with that kind of time restriction is definitely a skill that takes time to learn and experience to perfect.

I'm interested in seeing how things progress in the next two years, when we get to put theory into practice...

Why does massage or movement relieve pain?

Have you ever stubbed your toe and then grabbed or massaged your foot to relieve the pain? Or have you ever seen someone hit their own thumb while they were using a hammer and wondered why they would then shake their hand to make the pain go away?

If anything, these actions are counterintuitive methods of pain relief. If you just damaged a body part, wouldn't putting pressure on it or moving it around cause more damage?

Turns out that a lot our behaviour that appears counterintuitive at first glance makes sense once you finally understand the mechanics at work. In this case, when you hit your hand, foot, or any body part, your pain nerves from that body part send a signal through your spinal cord into your brain. This signal is what makes you think "ouch". There are other nerves that also originate in this same body part that send signals when the body part is being touched or moved. When these nerves are activated they temporarily attenuate or reduce the signal being sent from the pain nerves to the brain, giving you temporary pain relief.

Of course, this phenomenon doesn't work in every scenario... if you ever have your arm sawed off... it will hurt, a lot, no matter how hard you shake it...

Does Tiger Wood's platelet-rich plasma transfusion therapy work?

Tiger Woods, and apparently many other athletes, have tried platelet-rich plasma transfusion to accelerate their bodies' natural healing process to get themselves fit to play after injury sooner than normal. Platelet-rich plasma transfusion is used to heal tendon injuries, which are very common in both professional and amateur sports. The treatment involves collecting a patient's blood and removing his red and white blood cells so that only the plasma remains. This plasma, which is injected into the injury site, contains platelets, which release platelet derived growth factor (PDGF), which plays an important role in the natural healing process.

One of the reasons tendon injuries usually heal slowly is because they do not receive much blood; thus, very few platelets and PDGF ever reach the injured tendon. Injecting platelets into the injured tendon augments platelet delivery to the damaged tissue.

This article is a great introduction to platelet-rich plasma transfusion and also contains an interview with the physician who used it to treat Tiger Woods.

An important thing to note from the article is that we have not properly studied the effects of this therapy; thus, we cannot truly be sure that it actually works, nor can we be sure that it doesn't lead to some additional harm years after the injection is given. The article agrees that we need more research before we can state that platelet-rich plasma is a reasonable and effective treatment option for chronic tendon injuries.

Common sense battles bipartisan politics

Obama's monumental health insurance reform finally made it into US law this past week. Unfortunately, this victory for Obama (and the American people, in my opinion) will be tainted by political strategizing.

Before the bill was finalized, the senate was given the opportunity to put forth amendments to the bill. These amendments would then be voted on by the senate and if any amendments won a majority vote, they would be instated into the bill. However, if any amendments were instated into the bill, this would mean the bill was changed (obviously) and that the congress would have to vote on this changed bill once again. Thus, the Republicans, who have realized that they cannot stop this bill from becoming law, decided to make numerous amendments to stall the bill in bureaucracy. However, since the Democrats have a majority number of seats in the senate, they could form a united front and prevent any amendments from winning a majority vote.

One amendment put forth by Senator Coburn, who is a physician himself, was that the bill should bar insurance coverage of erectile dysfunction drugs for sex offenders. A majority of the Democrat senators voted against this amendment. I'm guessing that they voted against the amendment because they wanted to avoid Republican stall tactics and not because they believe sex offenders should have erectile dysfunction drugs covered. Thus, an amendment that should have been made to the bill was not. You can bet that this political strategizing by the Democrats will result in the Republicans using the votes against the amendment as a smear campaign during the next election, but more importantly...tax payers will be paying for erectile dysfunction drugs for sex offenders.

It is unfortunate when politics gets in the way.

Why do you get a black eye after you break your nose?

If you get punched in the arm hard enough, you will develop a hematoma (bruise) localized to the area of trauma. So why is it that you can get a black eye after breaking your nose?

When you break your nose, you damage adjacent blood vessels that release blood into the surrounding area. This is the same mechanism that results in a localized hematoma. However, the skin on your face has a looser layer of connective tissue underneath, which makes it softer than your skin elsewhere. The blood released from your broken nose can flow more easily through this loose connective tissue and often pools beneath the eyes. This blood then oxidizes, darkening and resulting in a black eye.

Why does yawning unplug your ears?

Your middle ear is an air tight cavity that is isolated from your outer ear (and the outside world) by your tympanic membrane. Your middle ear does connect to the outside world via your eustachian tube, which joins your middle ear to the back of your nose (actually to your nasopharynx). This tube is normally collapsed, allowing your middle ear to remain air tight, but it does open when you yawn or swallow.

The reason your ears get "plugged" when you are in an ascending or descending airplane is because a pressure differential forms between your middle ear and the outside world. When you yawn, your eustachian tube opens and this allows the pressure between the two to equalize.

And that is why yawning "pops" your ears when they are plugged.