Yesterday was pretty amazing and the only disappointment was getting to my first class 20 minutes late due to a freak winter snow fall that caused a few accidents on the route to school which delayed me a bit. Our Geriatrics/Neurology teacher, Dr. Bub was going over a post-stroke protocol which, if he was to ever get back into business is what he said he would want to focus on as a service. It sounded like a lucrative & fascinating type of endeavor with a lot of basic (and not so basic) neurology involved. I've found it interesting how some debilitating events or diseases affect the extensor muscles of the body or sometimes just the extensor surfaces. The elbow would be an example of an extensor surface.
With physical therapy, a stroke patient might undergo electrical stimulation of the triceps muscle in order to help straighten their arm but, if only e-stim is given to help achieve this objective then the patient will still have trouble performing this movement on their own without the electrical stimulation to their muscles because the first part of the neurologic pathway is missing. To pick up an object you must first have the desire and other associated thoughts which eventually lead to the motor cortex in the brain and then down the spinal cord then to the muscles. Thoughts of initial desire and ensuing neural pathways are very real and need to become ingrained in the brain. It's like, we can push a car from point A to B but, we shouldn't skip that initial step of putting the key in the ignition and turning the switch. With a stroke patient, they may be missing some wiring and have to undergo a process of finding and/or creating new neural pathways in the brain.
I got to talk with Dr. Bub a little after class (and which I would have recorded the entire conversation) but parts of what we talked about dealt with therapies that can actually alter the receptors on red blood cells, some other therapy can change sodium ions to potassium ions. We also discussed how back when the dinosaurs roamed the earth that there was more oxygen and a stronger magnetic field and how by manipulating those two factors we can alter physiology. Apparently, the Detroit Tigers baseball team is using a therapy for their pictures between innings to help avoid injury and keep their pictures strong. This is all stuff I have to look into and research more but, very exciting non-the-less.
After Geriatrics we had Activator class and a mistake I kept making in class ended up showing me just how very real the Activator protocol was. After laying a patient down on the table we can view the leg length and touch various parts of the body and via the mechanoreception and other neurological processes end up altering the leg lengths. Nothing is really changing as far as a patients actual leg length but different muscles can be stimulated to contract or relax in such a way as to give the appearance of one leg or the other getting longer or shorter in various positions. When I was checking leg length with reference to the 4th lumbar vertebra I found one of the short legs became shorter so, I was to adjust the L4 vertebrae in order to correct the situation. This is where I made my mistake. When you put your hands on a persons iliac crest, their L4 vertebrae should be aligned with those crest so, I was finding the L4 vertebrae, which I was to adjust, but messed up by thinking I was on the 5th lumbar vertebrae and kept moving up one vertebrae thinking I was moving to L4 but was *actually* moving to L3. I did this three times but the legs would never even out. Once I realized my mistake, I put the activator gun on the correct vertebrae, applied the adjustment and the legs evened right out. Utterly fascinating!
After Activator class I had to run to our lab at school to get some diagnostic ultrasound (US) done on my left elbow which had become swollen shortly after an intense workout last Friday. When I got to the US room one of the doctors there had just popped out into the hallway saying they needed a volunteer and I said look no further! There was a representative from GE in the Dx US room going over things on their US equipment so, I layed down and had them scan my neck, carotid artery, jugular, ICA and stuff like that. It was cool to hear my heart beat via my carotid artery and I spent a good 20 or 30 minutes being examined like that. Afterwards we got to my elbow and forearm and I was tickled to death that a couple of my differential diagnosis (ddx) ended up being things the other doctors in the room were considering. One ddx I came up with was an offshoot of another more normal diagnosis that's found in the lower leg, a process known as compartmental syndrome which happens when the calf and other muscles in the leg end up becoming inflammed and the fascia around those muscles can't expand to compensate for the enlarged muscles. This crossed my mind because when working out a person can get a significant "pump" in their muscles. A process where by a lot of extra blood perfuses the muscles being worked and causes them to become tighter and strain against the fascia. A cool part was that my ddx was initially dismissed then, at the end of the study I heard the chair of our radiology department mention that it could be a compartmental syndrome in the forearm! hehehe That was nice :)
Another initial thought I had was simply an inflammed bursa and I think I mentioned that in my last post. I did learn that the bursa for the elbow isn't something that's as clearly defined or deliniated as say, a bursa in the shoulder.
One ddx I did not consider was cellulitis which, as the name implies is an infection of the subcutaneous tissue (fat layer) just under the skin. We did notice hyperemia throughout the subcutaneous layer to a degree which was out of the norm. However, regarding cellulitis, there we would normally see a red mark and have some kind of puncture wound to the skin and I didn't have that nor did I have a fever or any other symptoms. However ...I have had some sore kidneys in hte last couple weeks which was unusual. My thoughts there included thoughts of this new Propel Zero nutrient enhanced water beverage I've been drinking. That drink includes sucralose which, I believe is one of those artificial sweeteners which is derived by replacing a hydrogen atom from a glucose molecule with chlorine. Chlorine, like you might use in your pool, has a way of killing bacteria which isn't a good thing if it's killing bacteria that your body gets along with. Althought it's not as widely found in the literature, the kidneys have a bacterial flora just like the intestines so I was wondering if the sucralose from the new water I started drinking maybe killed off some of the good flora in my kidneys which, would then leave my kidneys susceptible to other bacteria and pathogens that aren't as well received by the kidneys.
Probably the best part of being in that US room was the amazing amount of brain power present. We had four DACBRs (board certified radiologist) including the head of our department. Dr. Hahn did the US on my elbow and forearm since he's a bit of a vascular specialist. The first lady to work on my neck was a DACBR involved in a fellowship with the head of radiology and then there was the GE rep who knew a thing or two about anatomy as well. What an amazing crowd and what an education! I was on cloud 9!
I spent about 4 hours in the clinic after that and managed to get two more CMRs knoced out, scanned one patients feet for foot levelers and even got an impromptu adjustment in. At the beginning of week 11 I had only 21 adjustments in but, by the end of the week it looks like I'm sitting at 28, that's quite an improvement.
I have to get to work on my Endocrinology paper that's due this Monday morning. Not being able to use the means I'm accustomed to in that class has proved to be quite detrimental and by that I mean not being able to use my laptop to take notes and look things up. For GIUG, I noticed I have 48 pages worth of notes but for Endo, I don't really have any and my grades in that class reflect that fact. So, I really need to hit a homerun with this upcoming paper in order to pass the class. I'm not sure if the teachers realize how very far ahead of us they are and how many words they use that we have to look up. I know people play games on their cell phones but, I don't see that happening on the laptops. One of our teachers made a comment Thursday to be sure to pay attention and stop playing games on the laptops but, as I looked down my row at all the people who had their laptops out, every single one of them had word documents up and were taking notes as I was.
Well, if my newer patients can keep coming through I should be able to at least get pretty close to the 50 adjustments I need. I'll do my 4th CMR next Saturday, take care of some other obligations at my St Peters clinic this coming Thursday, should be good on my hours since I almost have the minimum needed already. All that will help take care of my HCP/clinic class.
I think, on the 4th and 5th of April we have our next Endo and GIUG exams and I'll need a strong grade in Endo.
My Gonstead class is the only other one I need to get to work on. I still need to see the teacher to see how I faired in his class, that may be the only one left that can hold me back, assuming I get my Endo grade up. I need to work on everything but, finally have a good chunk of this weekend to myself.
One more reception tonight for my brother and his new wife ...that starts at 5 which is a bit early but, we'll see how it goes. I was thinking of spending an hour or two there, then leaving and maybe coming back for the end of it so I can get some more study time in. There just isn't all that much time to take care of everything and I really need to stay focused on school.
I have one browser open with things I looked up from classes but don't remember if I ever mentioned them or not.
Astrocytoma and Ependymoma are two cancers of the spinal cord. The ependymoma is the nicer of the two because it can more easily be removed. The Astrocytoma infiltrates the spinal cord, fusing with it and is virtually impossible to remove because you'd have to remove the spinal cord with it. Astrocytoma is more normally found in pediatric patients.
We've also re-visited syringomyelia which, can be caused by an ependymoma or even with patients with neurofibromatosis Type II. A syringomyelia is a fluid filled cyst one might find on the spinal cord.
Today's picture is of a low-grade astrocytoma.
Posts
No comments:
Post a Comment