Interdisciplinary: Who dat?

I met up with a couple friends from undergrad two nights ago.  One of them, BM, is in Physio school.  It was pretty cool to compare how our respective programs have been similar or different.  Mostly different so far.

She said that she was surprised how much writing is involved in PT school.  She had to write 3 papers so far.  I forget what the first paper was on, the second was on an experience with someone with a disability (this paper was done in partnership with a student from Osteopathic school), and a third paper on a topic of her choosing, which she wrote on Physio clinics under the public payment system.

It was really cool, how right off the bat her training is integrated into the training of other health professionals.  She recently finished a rotation in the neuro oncology ward, where she sat in on case reviews with med students.  She also completed some assignments where cases were reviewed by a team of students: a nursing student, a physiotherapy student, a medical student, and so on.  Each student reviewed the case and discussed their treatment plans from their discipline’s perspectives.  It must have been so interesting to see how each member approaches a patient, and to see how the treatment plans can compliment (or maybe even contradict) each other.

I told her how my mom recently hurt her shoulder when she fell on her elbow, and has a partial tear of rotator cuff muscles.  The orthopedic surgeon can’t do anything for her, so she was told to just let it heal on it’s own.  She had lost quite a bit of her arm’s range of motion (i.e. couldn’t put on her seat belt without help or a lot of pain) so she booked an appointment with a physiotherapist and has been really happy with the help she has had from there.  My friend BM was happy to hear this.  She said, “See?  We aren’t just support staff!” — I got the feeling this was more so directed at the world (Them!) than me.

One of the assignments BM had was for a group of the physiotherapy students to find out the different roles of various members of the health care team.  Her group did pretty well but in the end couldn’t figure out the difference in role between a licensed nurse practitioner and a registered nurse.  Her tutor asked them, “If you don’t know the difference between a licensed nurse practitioner and a registered nurse, how do you expect them to know the difference between a physiotherapist and an occupational therapist?”.   More than support staff for sure, but still trained to be a part of a team.  Definitely more than my training has been so far.  For sure these discussions haven’t come up in medical school, and yet I’m sure doctors will always be a part of the health professional team.  From my perspective, it’s too bad.

I thought back to when I learned about some kind of wrist-related pathology in first year Anatomy.  Was it carpal tunnel?  I don’t remember.  But I remember being told that the treatment for it was surgery.  Perhaps to cut open the flexor retinaculum, if it was carpal tunnel.  Frond was sitting beside me, and during break after lecture he told me he was so surprised that we were being told the treatment was surgery, rather than the much less invasive manual therapies he had learned and treated clients with in his previous life as a body worker.

Maybe it’s just my med school.  After all BM goes to a university that has made it’s name on “innovative” (unconventional) teaching styles.  It seems to work.  But regardless, more interdisciplinary training from the start of med school is something every med student (and patient!) will benefit from.

kinda cliche secretsss

Cool, I just accidentally discovered that if you zoom out of my blog’s homepage, you get a nice background surprise!

My first flu shot

I have such a great big brother.  He came by this morning to get his flu shot from my mom but he agreed to let me give it to him instead!  I don’t know whose idea it was.. maybe his.

I was a little nervous but just pretended it was no big deal.  I’ve always had a big discomfort around needles that sends creepers up my spine every time I see an uncapped syringe.  It helped that I told Andrew it might take a little a while and he didn’t mind.  I didn’t tell him it might hurt more than usual, but I’m sure he figured.  I watched my mom give a shot to Andrew’s girlfriend, and then it was my turn.  We took some practice shots with the cap on, just getting the motions down right.  Wipe with the alcohol swab.  Stretch the skin.  Pinky on the shoulder to steady the hand.  Pop in the needle – “Bok!  Bok!  “Bok!  Just like that”, my mom advised me, miming the wrist action in poking in the needle.  Pull out the plunger slightly to check for blood (don’t want to inject into a blood vessel, better into the muscle).  Then ease in the vaccine, and pull out the needle.  Easy peasy.

My mom was going to prepare the needle but Andrew insisted I do as much as possible.  There was a tiny bubble in the vial of the needle that I couldn’t get out and I was concerned about sending in an air embolis to my brother and killing him with a flu shot (i.e. your typical med student moment where one’s textbook knowledge reveals one’s lack of understanding the relative importance of things and one’s inexperience in clinical realities shines).  My mom took a look and said it was “insignificant” but she still flicked it out like a pro.

Andrew’s girlfriend took some pictures (again, Andrew’s suggestion) as my mom, Andrew and I hammed it up for the camera with shot poses.  I was kind of nervous still, but the two of them were breaking the tension.  Finally I was looking at Andrew’s freshly swabbed and shiny skin, the point of the needle pointing at the slope of his deltoid.  I had nothing left to do but Bok! in the needle.  I hesitated then unconsciously thought to pretend like this is no big deal and it’s easy, and suddenly it felt that way.  The needle went in and I felt a slight give and pop as the skin broke.  My mom suggested I push the needle in a bit further so I did and it slid in quite easily.  I adjusted my other hand so I could use the plunger, and the needle slid a milimeter or two out.  I was surprised how easily it was sliding in and out.

I had asked my mom ahead of time what it was that made taking needles painful.  She said it’s when the needle is pushed in and is slid horizontally, parallel to the surface of the skin, which leads to more broken nerve endings.

I pushed in the vaccine (which I know from experience is the most painful part) and then it was done.  I quickly slid the needle out and a red blob of blood quickly replaced it.  Some gauze on it and that was it!

Andrew was impressed, saying it was a pretty good job and didn’t hurt at all.  I was shaky afterwards but so happy — it was even kind of fun!  The pop of the skin is like popping bubble wrap.

In the pictures everyone looks relaxed and jokey, while I look a little gaunt and stiff.  My chin is pressed to my chest, my neck stretching back as if my body is trying to get closer to the needle and shoulder, but my brain is still trying to get away.

My second needle given, my first flu shot, and now a little less scared of needles!

A vaccination in action

Just finished.

Post vax dim sum - curry squid, leechee/goji berry jellies (shaped as fish), and yes a hello kitty mango pudding with condensed milk.

Medical verbal diarrhea

Since coming home I can’t help but bring things I’ve learned into every-day conversations.  I’m starting to realize that not everyone is necessarily always interested in being counseled.

Par example:

At a baby shower for my close friend.  It’s my first time getting to catch up with friends from home, and I go get the attention of M, who has a strange skin rash that hasn’t gone away in weeks.  Since we didn’t cover Skin in Pathology, I tell her what I heard from my brother (a doctor) about rashes: that generally speaking if it’s itchy it’s not life-threatening, that if it’s been hanging around for a long time it’s not life-threatening, and that often they don’t bother finding out exactly what it is, but they will prescribe first a steroid and then if that doesn’t work, an anti-fungal.  At least the last part is helpful for M, who thought the doctor was just humoring her by prescribing an anti-fungal when they still weren’t sure what it was exactly.

Later in the shower, Ktown, M and I are talking about high blood pressure.  M is worried because she has had a couple slightly high readings in the past few times.  Eager to ease her worries, Ktown suggests she shouldn’t have to worry because her eyes aren’t bloodshot.  M agrees; her eyes are not puffy like her father’s – he has high BP – and so she probably doesn’t need to worry so much. Later in the day I realize I never made it clear to them that hypertension is typically totally silent and doing it’s damage over the long term while the person is totally unaware until it’s well advanced.  I write a message to both M and Ktown clarifying this and saying that maybe it’s something she can talk to her doctor about.  Ktown responds thanking me for clearing it up and letting M know she probably doesn’t have much to worry about, but later cheerfully tells me that she was kind of perplexed why I sent the message that would likely just make M worry more.

Another conversation Ktown is telling me about, a silly one, about circumcised and uncircumcised penises.  She’s recounting this conversation, laughing at the awkwardness, where basically it comes up that a couple people we know are uncircumcised.  I can’t just laugh at this, but I have to bring up how circumcision isn’t just a matter of religion, there are also health benefits such as avoiding phimosis and paraphimoses, preventing HIV transmission, and decreasing the chances of smegma buildup which would lead to squamous cell carcinoma of the penis (the latter is something I didn’t quite understand until a fellow student kindly explained the whole concept of foreskin and the gunk that gets stuck under it – smegma – to me using his arm, his t-shirt sleeve, and the appropriate theatrics).

Noni for Lupus

I just caught up with Ktown over dinner, movie, and after-movie tea.  She’s studying grad school in Environmental Science and gave me some great insights into my possible year off from school; people to contact and ideas bounced (note to self: don’t assume first nations communities just need more research and surveying — perhaps they need something less academic, more tangible.  consider your own assumptions).

One cool thing was talking to her about her mom, who has lupus but has been in remission for years.  I was asking Ktown about what kinds of symptoms her mom has had (Ktown recalls hearing about pericarditis), what medication she would take (prednisone and methotrexate), etc.  I’ve met her mom and it’s amazing that she’s ever had a chronic condition; she seems perfectly healthy, even above-average active for her age.

Ktown and her mom both swear by Noni Juice as the reason she’s been so healthy.  At first I was skeptical, but then again…

Frond:  noni juice?

me:  http://www.nonijuice.us/

her mom called in to order more and the customer service person had the same story, lupus ‘cured’ by noni juice.

“Medical professionals studying Noni juice have discovered that it works on a cellular level to support healthy living” – Ktown says that to me: “it works on a CELLULAR level!”

but everything does, i think.

but food is food, and much isn’t known i suppose

it’d be easy for me to scoff, but i don’t think i should

Frond:  if it’s working it’s working. or at least she’s in remission

me:  it’s not that it cures everything for everyone, but if someone’s finding it’s working..

some people pray, some people drink noni, and some people just have more and more meds

Frond:  seems worth being understood if it’s having such a real effect and it sounds like it’s being studied

me:  the more i read the more i want to try it!

Swearing in the House of Commons is news

Environment Minister Peter Kent chides the other parties for not having been in Durban at the recent UN Climate Conference.

This is despite the fact that he is directly responsible for their absence, as he banned them from attending as part of the Canadian contingent (it is not unusual for opposition parties to be included, allowed to attend).

Justin Trudeau swears at Environment Minister Peter Kent then later apologizes.

“And I think the opposition has its back against the wall and doesn’t know what to do,” [University of Ottawa political science expert Michael Behiels] said. “Not a single opposition amendment has been accepted. Everything they try to do is basically laughed at, dismissed. So the opposition MPs have had it, and it’s just pouring out.”

Frustration all around.

Read more here.

Death panels, rationing, and a call to act

Quotable quotes from the outgoing admin of Centers for Medicare & Medicaid Services’ address to the annual conference of the Cambridge-based Institute for Healthcare Improvement:

On cynicism:

Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. . .

Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

On “death panels”

If you really want to talk about “death panels,” let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America. What happens in a nation willing to say a senior citizen of marginal income, “I am sorry you cannot afford your medicines, but you are on your own?” What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick. Enough of “death panels”! How about all of us – all of us in America – becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having.

On rationing

The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them.

When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen.

Our moral duty

And that brings me to the opportunity we now have and a duty. A moral duty: to rescue American health care the only way it can be rescued – by improving it. I have never seen, nor had I dared hope to see, an era in American health care when that is more possible than this very moment. . .We can do this, we who give care. And nobody else can. The buck has stopped. The federal framework is set by the Affordable Care Act and important prior laws, such as the HITECH Act, and, quite frankly, we can’t expect any bold statutory movement with a divided Congress within the next year or more. The buck has stopped; it has stopped with you.

Now comes the choice. To change, or not to change.

Bam.  Dr. Don Berwick = new hero.

Are the tar sands “ethical oil”?

Quotes from David Suzuki’s thoughts on the question: “Can oil be ethical?”

Two days after he was appointed federal environment minister, Peter Kent […] trumpe[d] Alberta’s tar sands as “ethical oil“. We rightly criticize oil-producing countries that support or indulge in violence, murder, oppression of minority groups and women, and so on. But because Canada does not overtly support or indulge in such practices, does that mean our oil is more ethical? Levant acknowledges that exploiting and using fossil fuels has environmental impacts. Does that mean there is a hierarchy of ethical practices or that one ethical practice cancels out other unethical activities?

The application of ethical standards in our purchase and use of products should be applied universally and not selectively. Canada signed the Kyoto Protocol, which became international law. When Jean Chrétien signed the document, he did so not as a Liberal but as the prime minister of Canada. This meant that, as a nation, we were committed to achieving the targets set by the agreement. On becoming leader of a minority government, Harper declared his intention to ignore Canada’s commitment. Is it ethical to ignore an internationally binding legal commitment? This is even more astonishing in light of Prime Minister Harper’s outspoken commitment to law and order.

Canada is one of the highest per capita emitters of greenhouse gases. Our rapidly melting permafrost releases massive amounts of the potent greenhouse gas methane, amplifying our contribution to the global crisis of climate change. Alberta’s tar sands require enormous amounts of energy and water to extract, further compounding Canada’s already excessive emissions. Is there not an ethical component to our demand for a greater share of the Earth’s atmosphere than most other nations? Rapid exploitation of Canada’s tar sands — by companies from countries including theU.S., Korea, and China — is not crucial for our nation’s survival or even well-being, yet we ignore the impact on the rest of the world. If that isn’t unethical, I don’t know what is.

Stop The Tar Sands

Not surprising but still ultimately sad. The guardian’s take here, which nicely sums up the (non)-repercussions of backing out of Kyoto at this point, and what it would have taken to meet Kyoto (it’s true that by now it was way too late).

From PostNoBills:

The Canadian government currently lead by Prime-Minister Stephen Harper is not gambling with our future, gambling implies that we are unsure of the result, Stephen Harper, his governement and the governemnt of Alberta lead by current premier Alison Redford as well as the various vested buisness interests are plainly and simply destroying our environment. Here are a couple of quick facts: About 90% of the water used to process the Tar Sands ends up in acutely toxic tailing ponds that line the Athabaska River and threaten the health of the whole river basin. For every barrel of oil extracted, six barrels of tailings are produced.  [Steph: For every 1 barrel of oil extracted, 3 barrels of water are used.] According to a recent Environmental Defense report, the ponds are already leaking over 11 million litres a day of contaminated water into the environment. Should proposed projects proceed on schedule, 2012 would see a five-fold increase, to over 25 billion litres a year.

For such a vast and beautiful country, full of boreal forrests and fresh water it is quite sickening that we are also responsible for one of the largest projects that is causing such catastrophic environmental damage to the entire planet. It comes as no surprise that Canada’s current political leaders would be withdrawing from the Kyoto Protocal. When you’re running one of the largest sources of greenhouse gas emisions it makes no business sense to have to pay for it, does it? The fight is not about Kyoto now, it is about stopping the tar sands. How much more of the future are we willing to forsake to run the present day. We should be talking about sustainability not profitabilty.

postnobillz

“It’s in the way we live our lives exactly like the double-edge of a cold familiar knife and supremacy weighs heavy on the day it’s never really what you own but what you threw away and how much did you pay?”
Greg Graffin

Today it was announced that Canada will be withdrawing from the Kyoto Protocol. It’s not too hard to see why, all one has to do is look towards Alberta and the Oil Sands. “The Alberta Oil Sands Operation are the largest single point source of greenhouse gas emissions in Canada” Source, desmogblog.com If current development plans proceed, by 2020 the Tar Sands will release twice as many greenhouse gases as are currently produced by all the cars and trucks in Canada.

The Canadian government currently lead by Prime-Minister Stephen Harper is not gambling with our future, gambling implies that we are unsure of the result, Stephen…

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Alcohol Is More Harmful Than Heroin, Crack: Lancet Study

I am home for the holidays!  Ah, what a feeling.  There are lots of festivities planned in the next few days, and so this article is pretty timely.  Thanks Frond for sending it to me.  Be safe with your merry-making, everyone!

In the present study, Dr. Nutt and colleagues undertook a review of drug harms using the multicriteria decision analysis approach, a special approach that has been shown to be useful to help decision makers who face particularly complex issues with many conflicting objectives.

The multicriteria decision analysis (MCDA) model assessed 20 drugs most commonly used in the United Kingdom for their potential to cause 16 harms, as listed below:

• Drug-specific mortality;
• Drug-related mortality;
• Drug-specific damage;
• Drug-related damage;
• Dependence;
• Drug-specific impairment of mental functioning;
• Drug-related impairment of mental functioning;
• Loss of tangibles (job, housing, income, etc);
• Loss of relationships;
• Injury;
• Crime;
• Environmental damage;
• Family adversities (eg, family breakdown, child neglect, etc);
• International damage;
• Economic cost; and
• Community.

Drugs were scored on a points scale of 100, with 100 being the most harmful drug and zero being something that caused no harm at all.

The study found that overall, according to the new MCDA model, alcohol was the most harmful drug, with an overall harm score of 72. Heroin came second, with a harm score of 55, and crack, with a harm score of 54, came third.

Heroin, crack, and crystal meth (harm score, 33) were the most harmful drugs to the individual, whereas alcohol, heroin, and crack were the most harmful to others.

[…]

They conclude, “It is intriguing to note that the two legal drugs assessed — alcohol and tobacco —score in the upper segment of the ranking scale, indicating that legal drugs cause at least as much harm as do illegal substances.”

[…]

In the MCDA model used in the study, alcohol did the most harm largely because of the harm it causes to others, he added. “If you just looked at the harm to users, alcohol would actually fall behind heroin, crack, methamphetamine, and cocaine, but because of the ubiquity of its use and because of a lot of things that can happen during intoxication, alcohol ends up doing a lot of damage to other people.”