Three . . .

. . day weekend!

Our latest consultant has brought some assessments forward to tommorow and told us we can have Friday off. Yay!

See one, do one, teach one

There are lots of wise saying in medicine, another one to that given in the title is "If you dont put your finger in, you may put your foot in it." Yesterday I saw a grommet being inserted, last week a cataract operation (seeing one was pretty cool, the fourth wasn't such fun). Both times the surgeon turned to me and joked "See one, do one, teach one - so now its your turn." I asked if i could see them do it on the right ear-eye first before I tried

Tricky Question

"So are you interested in this field of medicine?" asks the doctor at the latest clinic that the Fuddled Medic attended. This is a tricky question, say that you are and the guy will look delighted and either pelt you with careers advice you grill you on the latest research. Saying "not particularly" may be the truth but not really diplomatic.

Instead yours truly chickened out and stated he didn't really know much about this speciality to make an informed decision.

In other news medicine continues to take over my life, it seems an evening in the library may be called for to lift the fog of ignorance that penetrates my brain.

Take care readers

For the Heart

Today a consultant told me he drank "enough red wine" and that it "was for the heart." Taking inspiration from this I entered Lidle which is opposite the hospital I am based at. I purchased a decent bottle of Shiraz. I was ID. The lady at the checkout apologised, as I was blatantly a medical student but she had to do her job. I asked if many medical students brought a bottle on a friday. She said yes, also on Monday, Tuesday, Wednesday, Thursday to.

I am off to finish said bottle and play monopoly. Thank goodness its the weekend. Another case of tinnitus or weighing up the pro's or cons of performing a tonsillectomy would have driven me mad.

Lithium

Yesterday my Psychiatry consultant told me I needed to know about Lithium. This is a good idea. As a result of my ignorance on the use of Lithium being uncovered I will present what I have researched/copied from a book here.

Lithium

• Mode of action is unkown
• Usually given as lithium carbonate, it is most useful in preventing mania. Needs to be given for 18 months for the benefits to be clear.
• At therapeutic levels the side effects are fine tremor, metallic taste, dry mouth, thirst, mild polyura, nausea, weight gain and hypothyroidism in 20% of women who take it - this is rarer in men, Renal impairment can occur after prolonged use
• Above 2.5 mmol/L you get coarse tremor, agitation, twitching, thirst and polyura, At higher levels renal failure, seizure, coma and death. Toxic levels can arise from dehydration or with a low salt diet
• Before starting perfom an ECG, electrolyte balance, creatinine clearancem TFTs.
• Measure lithium levels weekly, then every 3 months when stable
• Test thyroid function and renal function every 6 months to avoid rebound mania
• Withdraw gradually so that you avoid rebound mania
• Avoid in patients where adherence will ne an issue and avoid in renal failure and pregnancy. Best not to combine with diuretics, ACE inhibitors etc.

If you would like to contribute to my education and feel I need to know more then please let me know

Clinic

What makes a good clinic?

Finishing on time and having consultants/registrars who are willing to chat/teach comes close. But the clincher is having a cup of tea or coffee made for you by one of the nurses.

Thank you!

Dermatoscopy

The art of examining some skin using a dermatoscope. All GP's in Fuddled Medic Land had one brought for them by the PCT. In constrast the hospital in Fuddled Medic Land had to raise money via the hospital league of friends so that the Dermatologists had some to use