9 Conditions I’m Supposed to Learn on My Gen Surgery Elective

Well, the boss has given me some work to do, about these:

  • Colorectal Cancer
  • Small Bowel Obstruction
  • Perianal Sepsis/Fistulas
  • Haemorrhoids
  • Appendicitis
  • Ulcerative Colitis
  • Crohn’s Disease
  • Diverticulitis
  • Hernias

So I’ll write my basic notes up in here. Mostly going to deal with good definitions, epidemiology, aetiology and pathophysiology.

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2015

Due to illness and the general difficulties of 2014 the blog has been awfully quiet and I’m sorry for that! I look forward to filling it with ideas next year though- if you do stumble across this at any point I’m open to any requests. I’ll have plenty of time in Jan-Feb to populate this.

Anion Gap?!

So this is one of my quick notes on a medical topic.

By the end of your first year in medical school someone will have taught you about cell physiology, and perhaps mentioned the dreaded concepts of ACIDOSIS AND ALKALOSIS.

I will write about them another time, but when discussing these two issues the term “anion gap” often comes up, and the explanation usually goes through one ear and out the other. So here is a quick summary.

Look at serum H+ to establish acidosis/alkalosis, and then PaCO2 and HCO3- concentrations to figure out if it’s metabolic or respiratory, and if compensation is occurring (this is DEFINITELY worth a short write-up from me another time).

Remember the main ions present in the serum are:

  • Sodium (+ve)
  • Potassium (+ve)  [NB: this is low in the serum and is sometimes omitted from the calculation]
  • Bicarb (-ve)
  • Chlorine (-ve)

So the anion gap is the sum of the +ve ions subtract the sum of the -ve ions.

Anion Gap = (Na + K) – (HCO3 + Cl)

Typically the anion gap is expected to lie between 3 to 13 mEq/L depending on the type of measuring hardware used.

Now, it stands to reason that the ions in the body are charge neutral, therefore there are a number of unmeasured -ve ions that make up the gap.

The anion gap is relevant in situations where metabolic acidosis (Low pH, and low HCO3-) is occurring. 

The basic buffer equation looks like this:

H2O + CO2 -> H2CO3 ->H+ + HCO3-

But to understand anion gaps better- look at it with the spectator ions added:

H2O + CO2 -> H2CO3 + NaCl->HCl + NaHCO3

So now we have Cl- and HCO3- present in the buffer, equation which helps understand what is happening in metabolic acidosis.

If the gap is normal:

  • In terms of chemistry, you are getting an increase in HCl with a reduction in HCO3-, however as the equilibrium shifts to the left you retain the Cl-, which offset the loss of bicarb.
  • You can then look at a differential diagnosis in terms of disorders that cause excess HCL production or retention, or disorders what cause bicarb wasting. (Will put in a list later this week)

If the gap is increased:

  • There is an accumulation of an acid that does not have Cl as it’s ion. So this unmeasured ion increases as well, which increases the anion gap!
  • Similarly this will direct your differential diagnosis towards causes of exogenous acid accumulation.

So there you have it- my first foray into medical short notes.

I will place references and a pair of ddx lists later this week. This is a really complicated topic, so if you don’t have a good handle on the chemistry it can be quite hard to relate to.

Maybe next week I will do UMN/LMN lesion differentiation. There is a gap before engineering classes resume however send an email to unininjablog@gmail.com if you have a request.

Email Management Part 3: Towards Zero Inboxes

For part 3 of this series I want to briefly talk about the way you should aim to organise your emails. All of this is common sense, but often it gets overlooked or ignored because the status quo is reasonable enough to get by!

I often find myself dealing with students who use the excuse that they didn’t get/read an email when I’ve sent well in advance of seeing them. This is not strictly limited to my first-year students incidentally! Honestly speaking, the real consequences of this behaviour occur in later years and in the workforce, when time is money, and cannot casually tell your bosses you didn’t get around to reading a message they sent.

So learn the good habits and practices now, to avoid these issues later.

Concept of a Zero Inbox

Students ordinarily let their inboxes pile up over time without a second thought. Get into the habit of having an inbox with NO EMAILS IN IT at the end of every week. What this means is that you have:

  • deleted every email that is of no use to you
  • put the rest into folders by subject matter

If you have set up your email using the IMAP protocol I described in the previous email article then this all updates automatically if you do it at one computer, for all devices.

Obviously putting every email you have individually into different folder is a bit time consuming, so I will talk about automation as well.

Example of a n00b inbox (no folders, no organisation ,not empty):

Image

Choosing Folder Descriptions

  • Keep it simple!
  • One for every unit you are studying
  • One for any each uni society committee/extracurricular you correspond with
  • One for work correspondence
  • Ones for conversations with specific people, if needed

Another picture- see the added folders in the bottom right corner!

Image

Rules and Automation

Example pic from Thunderbird, running on a Mac:

ImageImage

 

Voila! That rule automatically moves ALL of those WordPress emails into the WordPress Admin folder.

 

Try this out for yourself, and see how it streamlines your communication 🙂

When thinking about future directions, be it career or degree-related:

Ask yourself what you want to get out of your future study and profession. Think about what you want to do on a day-to-day basis, and try and match that up with a type of job.

It’s good to have some idea for example, of the type of engineering/law/medicine/whatever, that you want to work in after you graduate. The hard part is validating your choice- really, until you get some work experience you’ll never really know how suitable you are for a certain job.

You can bridge the gap though by talking to people in your “dream job”, and reading about people’s experiences. Way back when I was thinking about medicine I certainly read lots of books and spoke to a few doctors about what the job was all about.

Otherwise it seems like you are throwing darts, blindfolded. Having your perception change is perfectly reasonable, but if there is no specificity to your ambition initially, you might be missing out on some peace of mind at the very least.

Side note: Online forums grossly populated by students are not the best place to get good career advice- often it’s like the blind leading the blind. Tread carefully.

Email Management Part 2: Beyond Access

So at this point I would hope you have:

  • set-up multiple email accounts
  • configured your mobile devices to view emails

Now you are able to access your email wherever you go, provided you have an internet connection of some sort.

Sidebar: IMAP vs POP email access

Something I didn’t have time to mention in the last post is the the importance of setting up your remote access using the IMAP protocol. I just want to make a note of this quickly here. I will explain why later.

Email Clients

The next thing you need to start looking at is choosing a client for managing your email on a desktop computer or laptop.

Why do you need to do this? Well mostly because if you want to be able to format emails easily and manage your contacts between multiple accounts, you need a centralised program!

The two clients I recommend are:

  • Mozilla Thunderbird (free! way better to use on Mac than MacMail, or Outlook for Mac)
  • Microsoft Outlook (really hard to go past this if you use a Windows PC)

Setting up email accounts is much easier to do on Thunderbird, but generally you can just get on google to help sort the process out.

For example the details for adding a UWA email address to a client are found here:

http://www.is.uwa.edu.au/it-help/email/student/pop-imap-settings

Basically besides putting in your username and password you’ll be asked for incoming and outgoing server settings, which are what you need to look up on occasion.

So why use IMAP?

Now that broadband access is widespread, using IMAP is crucial when trying to stay on top of lots of emails from many different accounts and different people.

If you use IMAP settings for every account on every device you own, they all automatically update when you read or send email from one device. So you don’t run the risk of replying to emails twice or feeling swamped because some inboxes havent updated to show you’ve read all of your emails.

So using IMAP = universal sync

Tomorrow night I will write in about the other nifty trick you need to learn- using folders and rules to organise your mail automatically.

Email Management for First-Years Part 1

Having spoken to a student about this last week, I was reminded that first-year uni students are not always checking their emails daily/twice-daily etc.

This is not a good thing. I don’t advocate being glued to your mobile phone or computer, but it is important to be able to keep track of your correspondences.

In terms of email, I suggest you create/manage a few different accounts:

  • keep your student email for uni related stuff
  • make another one like “firstname.lastname@gmail.com” – use this for professional/employment-related contact outside of university matters
  • and one more for personal email from family and friends

Things you need to learn how to do:

  • sync your email accounts to your smartphone and/or tablet
  • manage your email using a client (ThunderBird/Outlook etc)

For smartphones and tablets:

Basically there are two operating systems dominating the market:

  • iOS (Apple, obvs. Think iPhone/iPad)
  • Android (more or less everyone else)

Let’s start this series with  some decent guides to getting email access smoothly on your mobile devices:

http://www.apple.com/au/support/ipad/assistant/mail/

http://www.apple.com/au/support/iphone/assistant/mail/

https://kb.mediatemple.net/questions/1831/How+do+I+set+up+email+on+an+Android+phone%3F#gs

Follow these guides and see how you go. I suspect it will be quite simple for most of you, and/or you’ve done this already. But if you haven’t now is a good time to understand how it works.

I will post up another part tomorrow (hopefully!) talking about the difference between POP3 and IMAP email systems, and also explaining the concept of ‘push’ emailing.

Please leave a comment if there are things you’d like to know in particular.

Social Media: Why It Matters For Medical Students (or any others, for that matter!)

NB: I originally wrote this article for my university surgical society in 2012. I have amended and updated a few things in this version to make it more generally useful for all students. Whether you are a science, engineering, medical student or otherwise all of this stuff is pretty handy to know- just apply it to your own context!

As you read this article, ask yourself a question: How do you learn about medicine? If you are a preclinical student, lectures and labs will be your staple. On the other hand if you’ve moved onto the wards, the learning becomes vocational, and you’ll be engaging with doctors, patients and allied health staff to prepare for internship and beyond.

These two phases form the bedrock of medical education, but I make the case that for the 4-6 years you spend in school, it’s hard to engage with the profession on your own terms. Rushing from class to class and cramming for exams do not lend themselves towards self-development, and it’s here where social media can open up new avenues for students.  Many medical students are using Facebook in 2013, though Twitter remains a niche service- possibly due to a lack of awareness about its value in this context. “I don’t care about what Kim Kardashian just had for lunch!” is a common protestation I hear when I talk about the medium.

The utility of the service though, is that major news organisations and professional bodies use the service to put their information out there. So it’s relevant, up-to-the-minute information coming straight to you.

Only the very committed are prepared to find and read journals, but social media is a gamechanger in the sense that it brings the content directly to the user- subscribe to an educational Facebook page for example, and you’ll see various articles, blogs and talking points delivered to your news feed. Live surgery on YouTube? Global health documentary being aired soon? Chances are it’ll be advertised through Facebook.

Twitter offers the added benefit of being able to directly speak with people you wouldn’t normally have access to. Through Twitter I’ve spoken to medical students, consultant surgeons and everyone in between – some as far away as the US and UK. Say you wanted to know about an overseas hospital for an elective term- these days you could just tweet the hospital or a doctor working there to start a dialogue. Closer to home I was able to link up with a PhD student who was able to help me with infectious disease during semester. The other useful angle is the use of live-tweeting sessions. Early in 2012 Houston Hospital broadcast a live neurosurgery via Twitter and managed a Q&A session concurrently.

It’s no different for students in other disciplines but I think that engineering is a special case though. I think engineering education is pretty dormant in the social media domain (good chance for a student to publish a research paper perhaps? :P) . I think the problem is that nobody is trying to externally engage students to bridge the gap between theory at university and practice in the workplace. This blog at least will try and bridge that gap, but I would advise that rather than following dry providers talking about topics that are hard to relate to, you should :

  • look to learn what the qualities of a good professional are
  • slowly (wait until 3rd/4th year) look towards compiling a set of useful skills that would be very useful in the work-place
  • be able to read engineering literature (journals and profession standards), and understand key points

There is a whole world of professional practice that exists beyond what we see in in our humble town, and there are many Facebook pages and Twitter accounts you can use like a noticeboard to highlight the memorable things for students while putting a more human face on industry.

I will write a follow-up piece about good clients for Twitter, and list some good accounts to follow for students. 

Opinion Piece: Some Thoughts About Starting Uni

I attended a workshop on leadership in medicine and medical education yesterday, so I got to thinking about what constitutes good leadership for undergraduate students still finding their way.

DISCLAIMER #1: There is no evidence base for my remarks besides my own personal experience. Obvs if you are a mature-age student this is all old hat to you. Go read my guides to EndNote instead. Or read this and chuckle.

DISCLAIMER #2: This is very disjointed, I will edit it later.

I think at the stage of early undergraduate study you can make the mistake of:

a) jumping at every opportunity available to you, or

b) just ignoring everything outside of your book study

c) forgetting that you have responsibilities outside of drinking at the Tav and clubbing all weekend

3/3 choices are poor ones- instead try to thread the needle of pursuing things you are interested in while still maintaining academic integrity and some semblance of a social life.

I think it’s important understand what issues motivate you the most, and try to marry that up with your academic studies. There is no point in randomly compiling a CV with experiences you did for no reason other than to, well, look good on paper.

What does this have to do with leadership? Well, I’m not sure coming out of high school that most uni students are strong in the following areas:

  • assertiveness- this includes knowing when to say ‘yes’ and when to say ‘no’
  • decision-making
  • keeping to deadlines
  • planning/ goal-setting
  • good old-fashioned communication

FYI- it’s okay to have deficits in these areas! At some point you have to start addressing them though, if you want to be accountable for yourself, especially so if you want to lead others.

To work on these you need to have broaden your experience by taking on tasks/positions you haven’t encountered before, you need to continually evaluate and refine your approach to study, and learn how to be a good team player.

You can also lead by taking a stand against inertia. What I mean by this, is that being prepared put your hand up and lead a discussion in a silent classroom, or even being brave enough to not sweep a problem under the rug, are far more enriching than pretending that doing nothing/avoiding things is okay.

Even if you are a first year student, every day at least one time, you’ll have that choice.

Try to remember that leadership DOES NOT EQUAL being shouty and obstinate. Really it’s about being able to inspire the people you work with to get behind what ever you + your organisation’s mission and vision are. It’s about getting the best out of others. Not berating them or making them feel insignificant in your presence. If you can get people on-side, then meeting deadlines and targets become much less fraught.

So to conclude those are my incomplete thoughts about how you can put yourself on a path towards being the kind of leader people are willing to get behind, and a leader that gets results.