Archive | October, 2011

Nearing the end of exam week

30 Oct

[2:38:06 PM] Frond: i just had a thought

[2:38:15 PM] Frond: about how med students are often thought of as arrogant

[2:38:19 PM] Frond: and annoying

[2:38:35 PM] Frond: because they think they have all these solutions and ideas and know so much about medicine when they haven’t experienced it yet

[2:38:50 PM] Frond: and how it’s good to have beginner’s mind and approach people to learn from them

[2:39:00 PM] Stephanie: true say

[2:39:11 PM] Stephanie: i wonder why we are that way

[2:39:20 PM] Stephanie: i think it’s the approach we develop in science

[2:39:25 PM] Stephanie: undergrad style learning

[2:39:28 PM] Stephanie: exams with 1 best answer

[2:39:33 PM] Frond: yeah for sure

[2:39:50 PM] Frond: and i think it’s easy to be on the outside of practice and criticize the way things are

[2:39:56 PM] Frond: without being in it or a part of it

[2:40:04 PM] Stephanie: ya

[2:40:06 PM] Stephanie: you don’t know what you don’t know

Why would a child have rickets in the Caribbean?

30 Oct

Earlier last week Frond and I were studying at the library when we heard a nice ruckus stir up outside.  It was a full piece band with tuba, horns, drums, and crisp white uniforms!  It was Grenadian Thanksgiving and there was a small ceremony being held to commemorate the occasion, as well as remember the 19 US Marines who died when they came to Grenada to oust the group that had overthrown the previous government.

Frond and I, curious, went outside and sat a ways away to spot the Chancellor and other dignitaries.  When we got outside there were a few other people sitting close but not too close like us.  One of them was a woman and a toddler, they both looked Grenadian.  The baby was well dressed and looked healthy but I noticed her classic bow-legs right away.  Rickets!

Bow leg of Rickets. Photo by the Thatcher Family.

Rickets is a childhood bone deformity caused by a lack of Vitamin D.  Vitamin D can be absorbed in the diet but mostly the body creates it’s own vitamin D on exposure to sunlight.  So why would a child have rickets in the Caribbean?

This morning on the drive to school I saw another child with rickets.  He was walking down the side of the road with a grandmotherly figure and another child.  All three looked well dressed and otherwise healthy, at least in my 2 second glimpse.  Leah says it’s really common in developing countries despite being in the tropics.  I’m not sure how much this has been studied but it is a really interesting question, considering that even in a Caribbean medical school, we’re taught that vitamin D deficiencies and rickets is due to lack of sunlight.  There must be more to it than just sunlight.

Emma Morton for The Sun, Nov. 13/10

Maybe a lack of nutrition somehow affects the body’s ability to generate vitamin D?  Perhaps there’s another mineral deficiency going on, calcium or phosphorus. Maybe age-related; I haven’t seen many older kids with rickets, just the two toddler-aged children.  Hmm.

Increased in-hospital infections with increased temperatures

30 Oct

Knitted bacteria by loxosceles

An 8-year study of infection data from 132 hospitals finds that as outside temperatures rise, in-hospital infections with some of the most problematic pathogens rise also. –

What just happened? The researchers looked at blood-samples from 132 US  hospitals (they admit that New England was somewhat lacking in representation) for 8 years, tracking the number of infections diagnosed as due to different kinds of bacteria.  It’s never normal to find bacteria in your blood, even normal flora of our bodies like E.Coli.

What were they looking for? They wanted to see whether the number of bacterial infections changed depending on the temperature outside (i.e. the season).

What’d they find? Well…

Independent of season, monthly humidity, monthly precipitation, and long-term trends, each 5.6°C (10°F) rise in mean monthly temperature corresponded to increases in Gram-negative bacterial BSI frequencies ranging between 3.5% for E. coli (95% CI 2.1–4.9) to 10.8% for Acinetobacter (95% CI 6.9–14.7). The same rise in mean monthly temperature corresponded to an increase of 2.2% in S. aureus BSI frequency (95% CI 1.3–3.2) but no significant change in Enterococcus BSI frequency. – Eber et. al (2011)

For every 5.6°C rise in monthly temperature, they increases in some bacterial infections and not others.

The ones they saw increases for are the Gram-negatives:

– E.Coli, which can cause a range of infections, from meningitis in young people to moderate diarrhea and dehydration, to extreme bloody diarrhea and widespread internal bleeding around your body.

– “Acinetobacter” or Actinobacter, which can cause pneumonia, or pus-filled cavities (abscesses) around your body if it gets systemic (i.e. into your blood).

Both of these bacteria are normally found on or in healthy people.  The trouble starts when it gets to where it shouldn’t get, and/or change so that they are more disease-causing.  That’s called “acquiring increased virulence” and it happens a lot in hospitals where you have lots of sick people and people who are always around sick people, and lots of antibiotic use.  Since there’s so much antibiotic use, bacteria in hospitals can more quickly develop antibiotic resistance which is something they can pass on to other bacteria.  Along with sharing antibiotic resistance, bacteria can share other virulence factors.

One of the more well known potentially antibiotic resistant bacteria, S.aureus, was also found to have increased numbers of infections as outdoor temperatures went up.  S. aureus resistance is pretty common now in both hospitals and out in the communities.  There are still treatments for most, but there are also strains of antibiotic S. aureus that don’t currently have any antibiotic that will consistently work.

No increase was observed for Enterococcus, which are bacteria that can cause GI problems like diarrhea, but can also cause troubles elsewhere once they get into the blood.

The bottom line? Bacteria become more dangerous as temperatures outside go up.  We’ve already seen that as temperatures go up, there are more infections.  The last paragraph of the paper sums the whole thing up (as they always do!):

In conclusion, we reported substantial increases in the frequencies of bloodstream infections due to clinically important Gram-negative organisms in summer months. These increases, as well as variations in infection frequencies within seasons, appear to be associated with elevated monthly outdoor temperatures. The seasonal trends reported may be used to inform infection prevention and should be considered in the design and evaluation of longitudinal quasi-experimental studies of infection prevention interventions. Furthermore, if the underlying mechanisms of the temperature associations are identified, these findings could inform the global climate change debate.

Emphasis mine.  Interesting!

The Cup of Divas

29 Oct

Abby was just in my room, checking out my earrings hanging by my mirror, the little Buddha statue sitting on my dresser.  Then an odd cup, sitting inverted on the surface-top.  “Oh what’s this?”  “Oh my God don’t touch that!”  Abby found my Diva Cup. I really shouldn’t leave it out lying around.  But hey, it was a great way to introduce the idea to someone (how else, really, can it ever come up?) and I think she thought it was a great idea.  And on top of that, she and I reached a new level in our friendship.

Julia first told me about Diva Cup, which I wasn’t sure about because of swimming (flip turns, hey!) but I highly endorse it.  Think of how many tampons and menstrual pads you keep out of the trash!

How things change?

29 Oct

I skyped with my mom last night.  She was in the Starbucks under our apartment, working.  She told me “I’m still working on Tuesday’s notes!”

I haven’t been talking to her very regularly while I’m at school but when I do I always notice how similar the things we say are.  I’m working on notes, she’s working on notes.  I’m trying not to fall behind, she’s working on notes from Tuesday.  Just so many notes!

I’m writing notes on lecture materials and she’s making notes on patients who came in for appointments, but it makes me wonder how much things will change with time.  I’ve been looking forward to 3rd and 4th year because those will be my Clinical Years in the hospitals.  But really, even after I graduate and start working, it’s more notes.

True, that part of it is my mom’s fastidiousness with her note-taking.  And ya, there will be advances in electronic medical records (I hope).  But I look at my friends back home, who are enjoying each other’s company, going to concerts, cottages, climbing CN towers and generally living.  And I know it’s just Term 4 but even living in as beautiful, natural, and soul-enriching place like Grenada, I sometimes feel like I am living in a book and in terms.  What is going on in the world?  What are people like when they aren’t stressed?  What am I like when I’m not stressed?  Was I always this irritable?

I know this will pass and it’s growth.  I appreciate it, even now, and am going through things that are giving me a chance to explore aspects of human behaviour that I haven’t seen before.  It’s life, in a different way.

Isn’t it true: grass is always greener, especially over facebook statuses.  Less internet, more study.

Made in Grenada: Carib

29 Oct

Tagline: “Drink What You Like”.  I think around Carnival time it was “Drink Who You Are”, which kind of inadvertently highlighted the whole beer/urine comparison.  Smart move Carib, smart move.

Carib: Made in Grenada. Just down the road in fact! Down the highway about 5 minutes drive from school.

Feel: Cool, smooth, bottle-y.  Nice on a hot day, which is every day.

Find it: Anywhere.  Tis ubiquitous.

Price: Not sure the individual price but 3 for 10 is the usual deal.  Do these even come individually?  Either way, it is typically your cheapest drink you’ll find.

A familiar sight: The famous 3 for 10EC Caribs. 15 if you are MJ's.

Taste: Coming from Canada, I don’t have high expectations for the national mass-produced beers.  But Carib is surprisingly good!  I’m not a regular beer drinker, but when I do… I choose Carib.

Insider Tip:Mispronouncing it may tend for you to be waiting longer for the drink as your server tries to get what you are saying to them. It is “Care-ib”, not “Cariiieeb” which sounds even more shrill when you’re yelling it across a bar. And by you I mean me. (Still fun to say though. Cariiiiiieb!)

Sexy veggies

28 Oct

With the end of Micro is the start of Medical Nutrition.  In honour of that, and also of upcoming Hallowe’en (with all those “sexy costumes”), here’s to the 10 Naughtiest Vegetables on Earth!

I showed Frond this and he was not as amused as I thought he’d be.  I still chuckled (sophistication has never been my most defining trait).  Tomato has a penis!

Just amblin’

28 Oct

Finished the micro exam today! Just 1 more to go on Monday, Clinical Skills and Physical Diagnosis.

Yesterday there was a “Grenadian traffic jam” when a car was walking down the middle of the road.  It ran off to the side, the cars passed, then it stuck to the sidewalk and passed by.  Then it started running (galloping?), crossed the street and jumped up onto the other sidewalk.  Moo Mad Cow!

I love when cows stop traffic.

October 25ths in review.

25 Oct

Blow your mind. At year’s end you should look back at your thoughts and opinions twelve months before and find them quaint. If not, you probably didn’t read or explore or work hard enough. (Come to think of it, this is not a bad rule for life.)- Chris Blattman

2007: Turning 22.  No pants party.

Sums it up. Start of a wacky wild year.

2008: Turning 23:

Family time. End of a wild year, start of a reflective one.

2009: Turning 24.  Biking in Thailand.

Post-MSc, biking along rice paddies in Thailand.

2010: Turning 25.  Boat cruise on the Tyne.

180 1st year med students on a boat.

2011: Turning 26. Studying for exams in Grenada.

Remnants of the S-cookie

Frond's reflection in the fridge, making breakfast.

Basophil Breakfast: eggs, peas, corn and carrots.

Amazing popcorn results. Frondly hand on CPD notes.

Studying for exams, view from the library. Thank you Grenadian Thanksgiving ceremony for reminding me of the sunset!

Hello nude fat sumo enthusiasts!

24 Oct

Top searches that led people to this blog: (In honour of the recently finished Path exam, here is a rank order list.  Not in honour of the course, you’re told ahead of time it’s in rank order.  That’s my bitterness of the day!)

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I’m happy to see sumo fat and fat wrestlers up there, but not sure why nude searches are pointing here.  Whatever; welcome all you fun-loving Rubenesquians!
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