Cerebral Shunts and a Growing Cello Obsession

What I would give to be playing that cello in this current heatwave!

Stardate: 92179.63

This week is a mixed department week for me, due to the second years still being on their assessment. I've been in both general and screening. I'm actually welcoming the radiology department's low temperature! It's well-known I don't do well with heat or sunshine. I want Summer to hurry up and give way to Autumn; or at least for the sun and heat to give it a rest. Also, for those of you who can hear it, I've added an audio-player to my blog, not because it's important, but the song is that beautiful, I want everyone to hear it! If I could afford one, I'd buy a white cello right this minute... but alas, without including money for rent, travel and food, I have about £20 to my name. Such is the life of an NHS student!

Recently, I was witness to a type of examination I rarely get to see. It was an x-ray examination regarding a cerebral shunt. Cerebral shunts are commonly used to treat hydrocephalus, swelling of the brain due excess cerebrospinal fluid (CSF), but they can be used in cases of brain tumours, meningitis, head injury etc. These shunts are thin tubes placed into the brain's ventricle and tunnelled beneath the skin to the peritoneum (abdominal cavity membrane). The shunt reduces the intracranial pressure caused by the CSF by draining it into the peritonial cavity.

In Radiology departments 'shunt series' are simple sets of x-rays (skull, chest and abdomen) that may reveal any breaks in the shunting. In comparison, a 'shuntogram' uses CT and involves a radioisotope being placed into the shunt reservoir in the patient's head and measuring the speed it travels to the abdomen. Any delay implies a problem with the shunt. It was interesting to see, and also to help, as when you feel for the shunt locations, they feel like large lumps beneath the skin. I was worried I'd press a little too hard, but apparently they don't hurt! 

Aside from that, all I've been focusing on is just getting my case study done, but it's so laborious after a long day on placement! So far, I've managed to write 1,000 words, read it through, delete about 900 of them, and stare at the now rather blank Word document, hoping for either inspiration, or for the words to magically write themselves. So alongside making plans and drafts for my case study until the wee hours of the morning, I've been downloading sheet music for my violin, listening to The Piano Guys (the people who perform the song being played), scoured the internet drooling over cellos, and playing Pokémon while watching Star Wars. Because I'm ever so organised and practical, you see.

Next week, I'll be in general x-ray, so I'm sure there'll be plenty to do... including the dreaded 2,000 word case study! Maybe after the next two weeks, for the first time in nearly five years (possibly longer), I might sleep before one in the morning!

LLAP guys!

Cardiac, Cages and Conferences

An example of an Ilizarov apparatus on the tibia and fibula.

Stardate: 92138.26

So, this week I'm in Cardiac, Mobiles and Theatre. For a Monday, the cardiology department on the x-ray front was pretty slow. I helped out on some portable x-ray examinations in (surgical) recovery and also on the ICU. As the focus (funnily enough) in Cardiac is of course, the heart, you see chest x-rays in abundance here. 

But for the majority of the week, I have been placed on mobiles and theatre, and one thing I finally got to see, was a surgical procedure involving the fixing of an Ilizarov apparatus to a patient's lower leg, due to bone bowing caused by osteogenesis. After seeing so many in A&E clinics, it was interesting to see how they areactually done. 

Ilizarov cages (as I call them), are used to lengthen or reshape limb bones, to treat complex fractures, or non-unions of bone. They are named after the orthopaedic surgeon, Gavriil Abramovich Ilizarov.

The top rings are fixed to healthy bone by tensioned wire (Kirschner wires), allowing weight-bearing force to be transferred through the external frame, to bypass the fracture/injured site. The force is then transferred back to the healthy bone through the bottom ring. The structure therefore acts as a 'bridge', where the middle rings hold the bone fragments in place.

For bone lengthening/reshaping, the affected bone is surgically fractured, and the cage is attached. During recovery, the fractured bone will begin to heal. This process is slow, and the rings is adjusted using the network of nuts, increasing the spaces between rings. The adjustment is done four times a day, moving the fracture apart 1mm per day. This allows significant lengthening. 

The procedure I was present for was quite short (2 and a half hours in all), and the only thing that bothered me was probably seeing the wires about to come through, due to the wires pushing the skin outwards. The rest was fine. The sound of drills doesn't bother me, nor does blood or the sound of a mallet breaking a bone... on purpose (with good reason)!

Aside from that, mobiles has been quite quiet, so while surfing the internet, I came across an event that caught my eye: the International Association of Forensic Radiographers Annual Conference that's being held at Teeside University. Luckily for me, this event was open to students (with a student discount!), and after a long look at my funds, I decided I was definitely going. I've been told by friends on other courses who attend conferences that they're good for networking and experience, so how could I say no?! The topics that are going to be included on the day are:

• Update to the new Coroner & Justice act
• Post Mortem CT Angiography 
• The radiographer as researcher
• Pitfalls in NAI and follow-up imaging
• Radiological detection and interpretation of internally concealed illicit drugs
• and Ballistics

So on September 13th, watch this space! It might actually be interesting!

Next week is my guided study week, so unless something incredibly life-changing happens, I'll post again when I'm back on placement in screening. Due to me only having my case study to be getting on with now most of my portfolio is complete, I'm off to London for a few days to see my grandfather, and hopefully sit in on some cases at The Old Bailey. Murder trial anyone?

LLAP!

References

1. Ilizarov Apparatus, n.d. photograph, viewed 17 July 2014 <http://upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Ilizarov2.jpg/640px-Ilizarov2.jpg>.

Post-Exams Placement... And Prescriptions?!

This is definitely how I'm feeling thus far into my placement due to lack of sleep....

Stardate: 92102.82

It's been a long while since I last wrote a post, but in all fairness, I've had a lot going on to actually really think about my blog! I've completed all my first year exams (and passed them all, and gained an overall high 2:1 grade; one shall work harder next year), moved into my new house for second year, undertaken and passed 4 out of my 5 clinical assessments (1 more to go), and have also been going back and forth to placement sites.

I'm six weeks into my 11-week long Summer placement, and I'm getting to that stage where my brain is on the verge of going on auto-pilot from early starts, input overload and circuit overuse. I've done lots of general x-ray, some in my base hospital site, and some in the 'satellite' hospitals. I've been on Mobiles & Theatre, next week I'm in A&E, and the week after that I'll be placed in Cardiac for the first time. I think Cardiac is like mobiles, but I'm actually not sure. I'll find out soon enough!

Although the exams are over, I've still got work for the portfolio to finish, which includes a 2,000 word case study and various forms. The case I've chosen is about atelectasis. But more about that to follow, as I am still researching into the condition... well, enough to sound coherent and knowledgeable on the subject, anyway. 

You'd think with all that's going on, my body would at least try to function on at a normal human standard. But no, mine has other ideas. Upon visiting a GP with some worsening thoracic (upper back) pain, I found out I am now possibly suffering with Myofascial Pain Syndrome. In other words, my back muscles have knotted up in a specific point to the right of my left scapula and are making life much less fun than before. I'm managing, but I've now been prescribed a tube of Ibuprofen gel, and the strong painkiller Codeine. Yesterday, I was fine, but today, the codeine made me feel completely drowsy and a little more mellow than usual. I didn't fall asleep at lunch... honest.

One other thing you have to get used to, and has finally made an impact, while being a student radiographer, is being almost completely poor for the majority of your degree course. With all the travelling to placement, secondary accommodation, paying for food, rent and bills, and then waiting for the NHS to pay the claim money back into your account, it's no wonder I hide in my room cuddled up with a book! Holiday to Middle-Earth anyone?

I've only one more assessment to go, which is my spine assessment. I'm prepared and ready to get it over and done with. It's just a shame there are never many spines to x-ray on a general x-ray department. There's always the odd one or two, but it figures that when they do come through, there's always at least 5 other examinations to do, and the assessors are too busy to actually assess you!

But once that's done, I will be able to have 5 glorious weeks of doing as little as possible to enjoy. Shall I re-watch all of Sherlock, or catch up on all the video games I haven't finished playing? Oh, choices, choices! What's that you say? Go outside and enjoy the sun? I don't even know what that is anymore...

LLAP!