Thursday, November 28, 2013

Call me Mrs. Shepherd Day 4 HAPPY THANKSGIVING!


I really wish I was home today. All my siblings drove home from all over the place to spend the day with my parents. Unfortunately, I can't make it.

I love fall and Thanksgiving in America. I love pre-christmas season in Germany. But today, I am missing the Carmel apples, hot apple cider, apple pie, stuffing, mom's cookies and so much more. I would love to be sitting at the table with my family. Hear how college is going for my brother in Steven's Point and how med school is coming along for my sister in Erie and I want to know what's happening in High School as a pretty awesome senior from my little sister. I want to cuddle my puppy (he is 11 years old). I want to sit by the fireplace and chat for hours with my parents. All these things I want. But Thanksgiving is not about wanting, its about being thankful for what you have. And I have a whole lot to be thankful for!

I am SO very thankful for the support my parents give me through medschool (and through life). It's not always easy....okay, it's never really easy. But you learn to grow with your challenges.

My dad gives me the opportunity to focus on my studies and not have to work to pay off my student loans as well. He is always there when I have a question and loves to show me around work when I visit. He also reminds me that I need to let go every once in a while and go party. Believe me, if he were closer, I'm positive there would be more than one occasion that we would be partying together.

My mother is always there for me. We skype so much we could go 6 months without physically seeing each other but never having the feeling as though we lived so far away. She takes the time to listen to me and give me her point of view. Random letters and packages from the states brighten up my day. She makes sure that I stay balanced, reminds me not to over work myself and that I can do it all! She has helped me through some of the toughest times.

It is never easy being so far away from them but I am so thankful I have them (and skype!).

I've had quite my ups and downs the last year, emotionally and physically. I've laid in bed not wanting to move because of my stomach aches, I've gone days with eating the absolute minimum possible because everything I would eat would cause the pain to come back, I've woken up on days where the pain was there and wouldn't leave. I lost the excitement for cooking and eating good food. But I am thankful that that is really the biggest medical issue I have!

Working in the medical field grounds you (or so it should). I see patients on a daily basis dealing with illnesses that change their whole lives and the lives of the people around them. The have to spend their days in the hospital, I can leave at night (unless of course I've got the night shift like right now).

Dealing with these patients and listening to them, has made me not care about so many other insignificant things. I don't get involved in petty fights or get upset about little things. Not to say that I don't ever get upset, of course I do. But I can calm myself down fairly quickly. I don't appreciate it though when others try to make issues out of issues that don't actually exist. It just makes life stressful to do so. So today and every other day, I am thankful for my relatively good health.

Since Thanksgiving isn't a holiday in Germany, I had a normal college day.

We had a patient to see, take history on and examine. This morning we had a friendly old man who had a stroke. He was very chatty and I think enjoyed the break up of the daily routine and being interviewed by three female med students. We spent a fairly long time examining him as well because the others came to join us. Afterwards, we discussed various neurological topics and then had lunch. After lunch, we got to go to the video EEG department and see some footage. On this particular ward, patients are hooked up to EEG machines and video taped in their rooms. This way, when they have an epileptic seizure, it is on tap and we can see what is going on in the brain. We looked at various patients and it was interesting to see how what happens in the brain correlates with what the patient is doing. Sometimes their brain is freaking out but they are just sitting in bed saying they feel weird.

We discussed a few more points before we were done for the day.

I went and got my bank card back, did a quick grocery store stop and was off to bed to get some rest for my night shift :)

Enjoy the food and company of your family and friends!



Wednesday, November 27, 2013

Call me Mrs. Shepard Day 3

Today was a half day....Neurology-wise.

Since it was only a half day in the hospital, we only had time to examine one patient to allow enough time to discuss the findings.

We had a nice young Neurologist show us one patient before we went to our own.

Neurology, as mentioned before, has never been my favorite specialty. German medical college requires you to complete a 3 month internship within the first 2 years of med school as a "nurse's assistant" lets call it. We work the same shifts as the nurses and get to do all the dirty work: clean, wash patients, answer bells, run around like a chicken with its head cut off. I did half of this time on the Neurology ward.

Every morning I had about 5 patients to completely wash and get ready for the day. A lot of the patients couldn't even move so we were constantly rotating between rooms and moving them around. It was really, really hard work. The second half I did in OBGYN was heaven compared to that.

A lot of the patients are difficult to talk to because they straight up can't or don't understand what you are trying to tell them. It is frustrating.

Then there is the point of them not operating.

Anyways, the first patient the doctor showed us had a stroke and was not able to understand what we were saying or asking her to do. She would either just look at us with blank eyes, do something completely different than that what we asked or keep saying she doesn't understand.

We didn't get a lot of examinations done on her.

My friend and I had our patient assigned and we went to go see her. Our patient's situation isn't completely diagnosed yet. We took her history and followed that with a complete neurological examination. We didn't find a lot of things that were pathological. Our best guess was that she might have a peripheral polyneuropathy. The doctors are still running all kinds of tests though.

After all the groups had seen their patients, the doctor took us to see one more patient. The patient most likely has Creutzfeldt-Jakobs disease. It was impressive to see. The neurologist told us that the hospital was a sort of center for prion diseases so she has seen quite a few cases but most neurologists go their whole career without seeing a patient like this one.

After that visit, we looked at some CTs and MRIs and then went to a conference room to discuss our patients. I had baked cookies last night so I brought some for the others.

We spent a good 1.5 hours discussing our cases and were then done for the day.

I continued my day teaching english, attending a work meeting for my night shifts and then running errands in town.

Little life lesson, don't leave your bank card in the machine too long without operating the computer (by, for instance, looking for the right amount of money you want to deposit) because if you wait just long enough, the machine will eat your card. Fml. I got mad for about 3 minutes and then decided to let it go, have to deal with it tomorrow (although it doesn't fit my schedule what so ever) and move on since I couldn't do anything about it anymore. I met up with a good friend of mine for a quick Christmas market visit (opened today, yay!).

The next few days will be a little crazy. I have night shift tomorrow, Friday and Sunday and leave for a hospital Monday morning 1.5 hours after my night shift ends......oh my.

Thus, I won't be up long today. (hopefully)



Tuesday, November 26, 2013

Call me Mrs. Shepherd Day 2

Today was a very information loaded day.

We spend the whole morning reviewing and practicing a thorough neurological examination.

This included:
-the basic things non-neurologists have to at least complete if they see a patient (for instance in the emergency room)
-the cranial nerves and how each one is individually examined (see below for more information if you'd like to know more)
-examining muscle strength
-motor function
-muscle tone (muscle tension)
-muscle trophy (muscle mass)
-autonomic nerves system

I offered to be the genuine pig for the demonstration of the exams. This meant I was poked, hammered, touched, moved and asked to walk, stand, touch my nose with eyes closed and so much more for a good cause. :)

After many hours of all of that, we had a quick 20 minutes lunch break (just enough time to inhale a sandwich) and were off to the neurophysiology department to get an introduction into EMGs.

EMG= electro-myo-graphy
basically using electricity to record the muscle (myo) activity

For this examination, it is necessary to insert a needle probe into a muscle. As always, I was the guinea pig (I like being the guinea pig, it's like a free check up at the doctor).

Getting mentally prepared
Here comes the needle
The needle is in

Okay let's do this

Pressing against the docs hand
The electrical potentials in my muscle

It didn't really hurt having the needle inserted. It was a bit odd leaving it there for a bit.

We recorded the electrical potentials while relaxing and then while contracting the muscle. All is good with my deltoid muscles :)

After we discussed a few more possible pathological EMG findings, we were done for the day.

It was just around the time that some of my American friends tend to be in the hospital restaurant grabbing lunch so I stopped by to see if they were there. Indeed they were. I sat and chatted with them a bit. I try to use these opportunities to see people (these are the same friends that complained about seeing me too little).

After weeks of just opening letters and putting them to the side, I used my time at home to finally catch up on all of that, do laundry and clean my room.

Tomorrow is only a half day in the hospital and then I have to teach English.

Below I described how to do a rough exam of the cranial nerves. It's really only for those interested. It is kind of funny to test them all on a friend though, who knows what you'll find. Hopefully nothing pathological :)

See y'all tomorrow!



The cranial nerves:
We have 12 cranial nerves

I olfactory nerve
II optic nerve
III oculomotor nerve
IV trochlear nerve
V trigeminal nerve
VI abducens nerve
VII facial nerve
VIII vestibulocochlear nerve
IX glossopharyngeal nerve
X vagus nerve
XI accessory nerve
XII hypoglossal nerve

So how do you roughly examine the function of each? Well here we go...

Olfactory Nerve: 
Function: smell
Test: Ask the patient if he still smells the same or if food still tastes good (a lot of our taste sensation comes from the smell)

Optic Nerve:
Function: sight
Test: A very basic test would be to use one of those boards with the letters or numbers that keep getting smaller and see how much the patient can read. Even more basic: "How many fingers am I holding up?"

Oculomotor, trochlear and abducens nerve:
Function: They all innervate the eye muscles.
Test: Have the patient look at your finger or pen and tell them not to move their head (or you can hold onto it). Now move the pen up, down, left, right, upper right, lower left, upper left, lower right (not necessarily in that order), make sure it is far enough that the whole scope of the eye movement is examined and see if the eyes move along nicely and symmetrically. It is okay for the eyes to show a nystagmus (a jerking back and forth) for about 2-4 times when on the far left or right if it stops after a few beats.

Trigeminal nerve:
Function: sensory innervation of the face and motor innervation of the chewing muscles. Also sensory innervation of the cornea of the eye
Test: The nerves exit the face at very specific points. You press those spots and ask if that hurts the patient (beyond the feeling of the pressure). Then you stroke the patient along the forehead, below the eyes and the chin and ask if they have the same sensation on both sides. The corneal reflex is performed by touching the cornea with a Q-tip and the patient should blink or shut his eyes (contact lens wearers usually can tolerate more since they overcome this reflex while putting their contacts in). The chewing muscles can be tested by asking the patient to clench his teeth and you touching the muscles to see if they contract.

Facial nerve:
Function: sensory innervation of the face and taste
Test: Ask the patient to show his teeth with a big smile and see if the mouth opens equally or if one side droops. Ask the patient to lift his forehead (again, looking for symmetry if they are healthy and asymmetry if something is wrong with the nerve). Ask the patient to scrunch his nose. Ask the patient to fill his cheeks with air like a hamster. Ask the patient to pretend to whistle (or really whistle I guess, unless you are my sister Fran who absolutely hates it when people whistle.) Again, this is a nerve to ask the patient about taste differences.

Vestibulocochlear nerve:
Function: innervate the balance center and the hearing center in the ear.
Test: Ask if the patient has experienced dizziness. Depending on the direction, the appearance and duration one can differentiate the origin. Rub your fingers together next to the patients ears and ask if they hear it at the same loudness on both sides. Hold the patients head in your hands, tell them to focus on your nose and quickly turn their head from side to side. They should be able to not lose focus of your nose the whole time you move their head.

Glossopharyngeal nerve:
Function: innervation of the uvula and muscles in the back of your throat.
Test: Look into the patients mouth and tell them to say "AHHHHH". The uvula should rise symmetrically. The other muscles in the back of the oral cavity as well.

Vagus nerve:
Function: This guy does a whole lot of things. For the purpose of a rough neurological examination, we will concentrate on his contribution to the vocal cord innervation.
Test: Ask the patient if he can still speak normally. Is he hoarse?

Accessory nerve:
Function: innervates the sternocleidomastoid and trapezius muscle.
Test: Place your hands on the patients shoulders and ask them to shrug their shoulders while you try to push down to see how strong they are (test for trapezius). Ask the patient to turn his head from side to side (test for sternocleidomastoid).

Hypoglossal nerve:
Function: motor innervation of the tongue.
Test: Ask the patient to stick his tongue out and then move it from left to right.

These are obviously not all the nerves' functions or all the tests available but if these are performed, you've done a good job for a rough neurological examination of the cranial nerves.

Have fun examining!