Podcast 030: Anaesthetics With Dr Marie Dreux

Anaesthetics! And the people who do it! They might have a title that’s hard to pronounce, but the ability to guide patients through operations safely remains rewarding.

In this episode, Dr Marie talks about life as an anaesthseticoshcsdokdtist, interesting cases and training advice.

Podcast

About the guest speaker

Dr Marie-Louise Dreux is an Anaesthetics Senior Staff Specialist at St George Hospital, Sydney. She trained at St Vincent’s Hospital and has worked in Alice Springs, Limerick (Ireland) and Basel (Switzerland), as well as St George.

Dr Marie is a keen violinist, playing in NSW Doctors’ Orchestra, Australian Doctors Orchestra and World Doctors Orchestra, as well as a passionate Sydney Swans supporter and member.

Music credits

Chill beats by Professor Phil Poronnik.

Settling The Contradiction In Urination Theory

Conventional medicine teaches that the parasympathetic system, through its powers on detrusor muscle contraction and internal sphincter relaxation, leads to micturition. Meanwhile, the sympathetic system does the opposite so the bladder does not push that sweet, gold urine out but holds it in.

Why, then, do people urinate more when they are nervous?

The pontine micturition centre is indeed an important area, one that struts around like a pompous turkey with its chest puffed out, wearing a mauve suit and a top hat. It certainly affects the desire to urinate. However, it is tempered by the all-powerful prefrontal cortex. That old dog!

The trusty prefrontal cortex: this fine specimen of modern decision-making prevents you from running yellow liquid down your leg, however surreptitiously you think it might be happening, while making small talk at a cocktail party or waiting in line at the post office. In short, it keeps socially inappropriate things from occurring at socially inappropriate times.

When the brain is racked by fear, the prefrontal cortex shuts down just a little, despite that possibly being the time you need it the most. No matter, because logic is replaced by emotion!

When the inhibition goes, so too does the bladder.

References

  1. Arnold, J., McLeod, N., Thani-Gasalam, R., & Rashid, P. (2012). Overactive bladder syndrome – management and treatment options. Retrieved from https://www.racgp.org.au/afp/2012/november/overactive-bladder-syndrome/
  2. Palmer, B. (2011). Can You Be Scared Enough To Pee Your Pants?. Retrieved from https://slate.com/news-and-politics/2011/10/peeing-your-pants-why-do-people-urinate-when-they-re-scared.html
  3. Innervation of the Lower Urinary Tract. (2018). Retrieved from http://vanat.cvm.umn.edu/lut/Innervation.html
  4. Know your brain: Prefrontal cortex. (2014). Retrieved from https://neuroscientificallychallenged.com/blog/2014/5/16/know-your-brain-prefrontal-cortex

Positive Psychology 101

Nothing is real unless it exists in the outside world.

Your thoughts are not real. You cannot control them. But you can control the environment that affects them.

You cannot control where a dog urinates during a friendly neighbourhood walk. Will it be on the stump of a tree today? Or will it very coincidentally be under the letterbox of the old man across the street you do not particularly like? You cannot precisely determine this, even knowing it would almost certainly occur at some point during the stroll, but you can create lessons and precedents to influence what is considered more acceptable and what is considered less so.

Your thoughts are a wild farm animal zipping around in a fenced paddock. In a particular instance, the beast runs where it wants. At any given moment, you cannot decide exactly where in that enclosed field the your thoughts are. This level of microscopic precision is out of your control.

However, by maintaining an environment conducive to the kind of thoughts that you would like, you can control the dimensions, the weather and the general disposition of that paddock.

It is okay to be human.

Humans cannot control their exact thoughts but, over time, they are very good at meddling with man-made objects and putting artificial restrictions on things.

This is positive psychology 101: you can influence the world around you in order to become less of a grump.

The Trajectory Of Adult Weight Gain

Behold! It is 500-1000g annually.

If you want to change your future for the better: sleep enough, eat healthy food and don’t be a sloth.

And maybe fidget to burn more energy, so you can eat more food.

Food is great.

References

  1. Hutfless S, Maruthur NM, Wilson RF, et al. Strategies to Prevent Weight Gain Among Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Comparative Effectiveness Reviews, No. 97.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK133218/
  2. Robards, T. (2016). Is it natural to get fatter with age?. Retrieved from https://www.news.com.au/lifestyle/fitness/weight-loss/is-it-normal-to-get-fatter-with-age-or-is-that-just-an-excuse/news-story/70471ba826cfbf8d125d24b31c77eb50
  3. Healthy Weight. Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/
  4. Publishing, H. (2015). Does Metabolism Matter in Weight Loss?. Retrieved from https://www.health.harvard.edu/diet-and-weight-loss/does-metabolism-matter-in-weight-loss

Podcast 029: Geriatrics With Dr Chris Middlemiss

Do you like cakes and constructing intricate delicacies in the comfort of your kitchen? No? Well, that’s too bad!

The recipe for geriatrics is diverse and beautiful. It’s 5 parts general medicine, 2 parts falls investigations, 1 part deathly despair, 3 parts woolly sweaters and 5 parts super cool.

In this episode, Dr Chris talks about the many reasons a senior citizen presents to hospital, the balanced geriatrician lifestyle and how to find your ultimate calling.

Podcast

About the guest speaker

Dr Chris Middlemiss is a geriatrician and “nan whisperer”, who took his time working out what he wanted to do. He works at Sutherland Hospital, and also at the Garrawarra Centre, an aged care facility specialising in the care of behavioural and psychological symptoms of dementia.

Chris is married with two kids, and plays soccer adequately when he is wearing his contacts.

Music credits

Opening and closing themes by Professor Phil Poronnik.

The Flushing Of Cannulas

Goose. Geese. Moose. Meese. Cannulas. Cannulae. Whatever!

Blood Extraction

Why throw away the first 10mL of blood when collecting it from an existing cannula? It’s because that portion is theoretically contaminated, such as by previous infusions.

Saline Flush

The purpose is, also theoretically, to keep the cannula open and working. Patent, as they say. That’s why this is recommended after giving IV medications or just periodically. Basically, after each use.

Not Water

Normal saline is injected, not water. This is because a pure water injection would lead to the water rushing into red blood cells, due to that trusty process of osmosis. This sudden water influx would make them explode.

Which, as you can imagine, would run counter to the usual hospital purpose of trying to heal people, not atomically bomb their bloodstream.

References

  1. Blood collection from intravenous cannula. (2019). Retrieved from https://vitualis.wordpress.com/2006/05/15/blood-collection-from-intravenous-cannula/
  2. Keogh, S., Flynn, J., Marsh, N., Mihala, G., Davies, K., & Rickard, C. (2016). Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 17(1), 348. doi:10.1186/s13063-016-1470-6
  3. Labos, C. (2019). Why can I taste saline and medications when they’re inserted into my IV?. Retrieved from https://www.mcgill.ca/oss/article/you-asked/why-can-i-taste-saline-when-its-injected-my-iv

Differential Diagnosis Of Acute Abdominal Pain

Here’s a sordid acronym: BITCH.

Acute abdominal pain

  • Bleeding (haemorrhage)
  • Inflammation
  • Twisting (torsion, leading to ischaemia)
  • Congestion (obstruction)
  • Hole (perforation)

Bleeding

  • Ruptured AAA, ovarian cyst, ectopic pregnancy or abdominal organ
  • Leads to haemoperitoneum, meaning blood in the abdominal cavity

Inflammation

  • -itis of any organ in the abdominal area
  • Just think of the anatomy in the region to come up with possibilities
  • Appendicitis is the most likely surgical cause, while gastroenteritis is a common ailment of the masses

Twisting

  • Sigmoid volvulus
  • Torsion of gonadal structures (ovaries or testes)

Congestion

  • Things that involve blockage
  • Constipation
  • Intestinal obstruction, ureteric obstruction from renal calculus or urinary retention
  • Mesenteric ischaemia

Hole

  • Perforated gastrointestinal structure
  • Gastric or duodenal ulcers

So Money Guest Co-Host

I’ve been featured on So Money, a podcast by award-winning journalist Farnoosh Torabi.

http://podcast.farnoosh.tv/episode/ask-farnoosh-235/

She edited out the part where I explain that the triple application rejection was actually for KFC. But no worries! It wasn’t ever my ultimate dream to work in a chicken shop, so I wasn’t really cut. I guess she wasn’t impressed with that.

Here’s the summary.

Me: “It was such an important life tribulation! It was actually for KFC!”

Farnoosh: “I’m not familiar with KFC. Do you mean…Kentucky Fried Chicken?”

Me (too enthusiastically about this significant life setback): “Yes!”

Farnoosh (secretly editing that part out): “…”

She also edited the part where I accidentally said, “HELLO!” loudly and way too early because I thought she was done talking.

As well as the bits where we talked over each other awkwardly. There were a few of those. (She did leave in all the praise I had for her.)

How To Win Friends & Influenza doesn’t operate like that. It has more instances (two) of inserted laughter than removed content. The editing is focussed on audio quality and there are no advertisements or revenue aims.

But this was a fun So Money interview nonetheless, where we tell you how to manage your money. Except that you shouldn’t take any of this as financial advice, because it’s not.

Take your lawyers and slowly back away. No one needs to become hurt here.

Podcast 028: Adolescent Medicine With Dr Linette Gomes

Chronic diseases can strike people of all ages, from foetus to corpse (probably not inclusive). Adolescent medicine is what it sounds like: the branch of medicine that deals with adolescents, particularly when it comes to chronic diseases.

In this episode, Dr Linette talks about what adolescent medicine involves and the type of health practitioner it suits.

Podcast

About the guest speaker

Dr Linette Gomes is a paediatrician and adolescent medicine physician. She is currently appointed as a senior staff specialist in the Adolescent and Young Adult Medicine (AYAM) Unit of Westmead Hospital.

Dr Linette’s specialty is in the area of behavioural and developmental paediatrics. She has a PhD. in “Medical Expertise in the Management of Attention Deficit Disorder (ADHD) with Hyperactivity” from the Children’s Hospital Education Research Institute at Westmead Children’s Hospital.

Dr Linette was previously the Head of Paediatrics at Hawkesbury District Hospital. She continues to have a private clinical practice at Rouse Hill, where she sees younger patients with ADHD, Autistic Spectrum Disorders, learning difficulties and developmental delay. Her main interests and work are now in her staff specialist position at the AYAM unit, Westmead Hospital, where she hopes to make a valuable contribution in the years to come.

Outside her work, Dr Linette’s life revolves around her family and friends. She enjoys reading and travelling.

Music credits

Opening and closing themes by Lily Chen.