St George's Physio Blog - 2nd Year Watch

JackieS
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#41
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(Original post by iainmacn)
you can always do my essays if you're that keen!
trust me when I say the first time round was bad enough - and I don't miss it that much lol
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Cassius C
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Exam tomorrow :eek: Treatment/justification/viva... All good fun!

I've done a lot of work so I'm hopeful. I just hope I don't freeze or miss the obvious! That would be annoying let's say

Thanks for the offer of help.
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JackieS
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(Original post by Cassius C)
Exam tomorrow :eek: Treatment/justification/viva... All good fun!

I've done a lot of work so I'm hopeful. I just hope I don't freeze or miss the obvious! That would be annoying let's say

Thanks for the offer of help.
appears to have been major changes since my first year then - we were only just finsihing the IFP around now - no physio exams for us!
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iainmacn
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I don't think Casius is at George's, Jackie They have IFP next week.

Fun day today - we talked about stress. Oh the irony! We looked at stress scales, and they didn't include finishing off assignments! :woo:

The other side of today was neuro, and we did stuff on various pathologies, and then this afternoon we looked at speech, swallowing and language difficulties. We had an expert in from one of the main rehab centres and looked at alternative ways of communicating, such as a perspex sheet with groups of letters on in different colours, that the patient could select using eye movements. Fantastic idea, and I'm sure it would be a major plus for the patient, but £85 a pop for a piece of perspexx seemed to be rather over the odds for what it was, no matter how beneficial it was to the patient.

We also had fun trying out swallowing in different positions, such as lying down, or with the neck stuck forward, and it's surprisingly difficult. A really interesting session.

Other stuff included the group respiratory presentation, which we've been doign in the background, and I pieced together in powerpoint. All great fun with different versions, and for some reason the text won't preint out the same colour as on the screen on the slides from Office 2007. Weird!

Got my portfolio back from placement one - a bit disappointed with the mark - overall 2:2 - but I knew I didn't spend as much time on it as I could. I lost a fair few marks for not doing stuff consistently, so if I bother to be as thorough on all of it as I was on some bits then I should do fine. It's just all rather anal and personally I find some of it irritating! I don't mind thinkign about it and looking up relevant research, but recording it all on proformas is annoyingly bureaucratic. Still - I think it's the same at most unis, rather than being a George's thing.
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JackieS
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(Original post by iainmacn)
I don't think Casius is at George's, Jackie They have IFP next week.
Oh! That makes sense then! Coz you offered a hand I just assumed! lol
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iainmacn
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I thought he was at first then I vaguely remembered he'd applied but accepted somewhere else for some reason!
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Cassius C
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Iain's right - I'm not at George's. I guess each Uni approaches it differently. Personally I'm glad that our exams are over before Xmas. I gather other Unis do physio exams just after Xmas which would put the mockers on Santa time I reckon!
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iainmacn
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Hope the exam went well

Today was fun - just in for the morning and we had a respiratory thing about training the respiratory muscles. All you A level biology guys wil immediately be thinking of diaphragm and internal and external intercostals I hope!

So anyway - they're muscles obviously, and we know how to train muscles, but it's hard to attach them to gym machines! So - there are devices available that give resistance to breathing in (and also breathing out). Bretahing in's most important, as unless you're doing sporting activity (not likely with un-rehabbed COPD etc) then exhalation is a passive process. One caveat - it's useful to be able to use the exhalation muscles for coughing etc - which can be vital if you have a lot of secretions.

A common principle with training muscles is rest - new fibres develop on rest days. It's rather hard to stop breathing for a day though!

Anyway - an hour of theory done, and then a practical, trying all the devices, including one called a SNIP where you have to snort something that looks like a miniature dildo up one nostril. I bet I get in trouble for that if any of my lecturers read it (!!). Okay - it looks like a bullet. They even had different sizes for different size nostrils. One of my classmates proved very good at it - a history of snorting cocaine perhaps? (only joking). There were other fun games where you had to inhale hard and long, and the computer used that to direct a balloon over a mountain range. All rather fun - remember that a lot of exercises can be rather dull and repetitive and anything you can do to make it fun, particularly with children, will improve compliance.

We had a group presentation session inbetween - it's a good group and we really cut to the chase, so there wasn't too much faffinf - just getting down to what we wanted to change. There's a neuro presentation coming up next year, also done as a group - and that will need more time spent on it as it's marked and coutns towards the degree. Once again I'm in with a nice group, having said that pretty much everybody would be fine to work with! Inevitably you get on with some people a bit better than others, and this group looks like it'll be a productive one.

So - last day - and it's research methods. The essay is taking shape, although my stats is still abit flakey it's significantly improved after last week's lecture.
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iainmacn
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Sunday - and I spent a lot of today working on my essays. It may be the holidays, but I want to kill them off before I go back. Research methods is going fine, and I'm reassured by the advice that there isn't really one right answer - different people will home in on different things, but we have to say somethign about all the main bits.

I decided to start my integrating clinical concepts essay. That way I can get feedback on my plan before George's packs up for Xmas - a lot of staff are in this week. I was going to do a literature search from home, but AOL went daft on me (and the rest of the country by the sounds) and I couldn't get on, so I headed into George's. Sadly the libe was shut as it's officially holidays (it's normally open 9-5 on SUndays) so I couldn't look at books, but I found some interesting stuff. I'm going to the the effects on outcome of psychological and social constructs after patients have had an above-knee-amputation (or something like that).

Interesting stuff - I'd figured some of it out, but for instance, it can have a different effect if it's amputation due to trauma (such as a car crash) or a planned amputation - such as when the patient has diabetes. I wasn't aware until recently that diabetes can lead to amputation - I think it's only when there's a vascularisation issue, but that can be quite common with diabetes, so patients need to be particularly aware otherwise it can lead to issues.

Early days anyway - just got about 20 interesting looking journal articles, plus some notes on common topics such as pain (it's not just pain, there's a hell of a lot more to it than that - a lot of it psychological and indeed cultural). In some ways this module seems a bit woolly but tbh I think on placement I'll see a hell of a lot of it with patients, so not so woolly after all
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jinglepupskye
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If you are interested in pain in amputations then this paper may be of interest.
Reflexology treatment for patients with lower limb amputations and phantom limb pain—An exploratory pilot study.
http://www.sciencedirect.com/science...7143314875bb74
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iainmacn
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thanks JP

Was that in the latest CSP amputee bulletin - seem to recall that had a piece on that.

tbh I don't think I can use it in my essay as that's about psychological factors, but I'll definitely take a look.
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jinglepupskye
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(Original post by iainmacn)
thanks JP

Was that in the latest CSP amputee bulletin - seem to recall that had a piece on that.

tbh I don't think I can use it in my essay as that's about psychological factors, but I'll definitely take a look.
I first came across the paper in March when the daily newsapers had articles on it. Since then I've looked at the paper itself. It seems weird that manipulating the hands can help to reduce the phantom pain from an amputated limb. Maybe some physiological factor is involved or maybe it is just that the person believes in the 'treatment'?
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iainmacn
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I've got a few papers downloaded on PLP - will see if they reveal anything. I know there's some weird stuff going on with it to do with nerves. If you haven't read it already, have a look at the stuff by DS Butler and Louis Gifford (general nerve stuff, not just PLP)

I might switch to the RA option on the essay - I've managed to find more literature on that, and it seems a bit more manageable in terms of nice clear cut papers rather than "Mixed results"
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iainmacn
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Can't believe it's been three weeks since I last blogged. Sinc then I've been busy in spite of it being the holidays.

Right - well I went for the RA essay, which proved fascinating. My plan to tackle the essays early worked pretty well - I got 95% of one done and 80% of the other, although since we got back we got some jolly helpful lectures on stuff that I researched for myself over the holidays. All interesting though. EVen so - I've started the term still feeling a bit swamped, so heaven knows how people who hadn't done a lot on the essays feel!

An interestign week for musculoskeletal - we started with the oversensitized nervous system (fascinating stuff) and then for practicals did various neurodynamic tests. These basically attempt to really hammer the nerves and get them to react if they're going to. I'd seen them doen on placement so it's great to be able to do the tests. Neuro was particularly fabulous this week - all the vlasses are interesting but this week's with Aimee, a band 8 from the wards, was double excellent. She brought in videos of patients, we had to spot the weaknesses, and then devise treatment programmes while she gave us feedback. An absolutely crackign session.

Respiratory this week was the group presentations. It's spread over two weeks, and my group went this week, which although it was an added stress also meant it was out of the way. Being an ex-teacher, I'm used to standing up in front of a group, but then I know more than they do, whereas this time there's a lecturer with a PhD sitting there who knows more than I do! Even so - it went well - it was only formative so didn't score, so we didn't go wild on it, but it was well received and got good feedback, albeit with some useful suggestions. There's a much longer neuro one to do after Easter, which is 50 minutes. I've got plans for that - we need group interaction, and I may even use some old teaching skills in it to throw in some activities!

This weekend I think I'm coming down with the flu bug that's doing the rounds. I've just done a bit of a redraft on the research methods essay, and need to tackle the final 20% of the other one. Maybe some study on neuro then.

We got details of our next placements this week - I got rehab medicine, which is apparently a lot of elderly patients. It's perhaps not the most exciting one, but it's one I need to get on my CV, and will provide me with a chance to practise some different skills. My personal tutor has given me some useful feedback on the portfolio from last time, so hopefully i'll ace this one, which is the first one that counts.
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ZakBrannigan
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(Original post by iainmacn)
Sunday - and I spent a lot of today working on my essays. It may be the holidays, but I want to kill them off before I go back. Research methods is going fine, and I'm reassured by the advice that there isn't really one right answer - different people will home in on different things, but we have to say somethign about all the main bits.

I decided to start my integrating clinical concepts essay. That way I can get feedback on my plan before George's packs up for Xmas - a lot of staff are in this week. I was going to do a literature search from home, but AOL went daft on me (and the rest of the country by the sounds) and I couldn't get on, so I headed into George's. Sadly the libe was shut as it's officially holidays (it's normally open 9-5 on SUndays) so I couldn't look at books, but I found some interesting stuff. I'm going to the the effects on outcome of psychological and social constructs after patients have had an above-knee-amputation (or something like that).

Interesting stuff - I'd figured some of it out, but for instance, it can have a different effect if it's amputation due to trauma (such as a car crash) or a planned amputation - such as when the patient has diabetes. I wasn't aware until recently that diabetes can lead to amputation - I think it's only when there's a vascularisation issue, but that can be quite common with diabetes, so patients need to be particularly aware otherwise it can lead to issues.

Early days anyway - just got about 20 interesting looking journal articles, plus some notes on common topics such as pain (it's not just pain, there's a hell of a lot more to it than that - a lot of it psychological and indeed cultural). In some ways this module seems a bit woolly but tbh I think on placement I'll see a hell of a lot of it with patients, so not so woolly after all

I really enjoy reading these blog physio entries iainmarch.It seems to me that you have really taken to physio like a duck to water,if i am allowed to say that. :yep:
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iainmacn
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Crikey - had to rescue this from page 3!

Well - I've been busy - had masses of work lately - two essays to hand in, and some neuro and musculoskeletal practicals to prepare for. Which is probably why I'm crasting on TSR when I should be writing them!

The workload has been mad - I think they could do with rethinking it a bit to spread the work out a bit. I'm loving it, it's really interesting and everything, but I seem to eat sleep and breathe physio these days, and I did want to keep the rest of my life going too!

We've had lots of fun stuff - visiting lecturers/practicals for neuro, lots of interesting musculoskeletal tests, and time spent practising everything. Everyone's into serious revision mode, and evry chance we get we pop up to the labs to practise upper limb tension tests or whatever. Plus we try and fit in helpign the first years, which was a really fun afternoon - a bit of relaxation as it was stuff we knew pretty well, but fun to get to tknow some of them better.

Anyway - better get back to study!

Second placement coming up - must ring them. Should be fun - I've heard it's lots of cancer patients and stuff so it should be interesting
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iainmacn
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Okay - another week passed, and it's been a big one. Very few lectures as we had the IPEs - interactive practical examinations to prepare for, and did we need it! My musculoskeletal wasn't bad after placement, although I had to work on the spine stuff, and had to brush up on a lot of bits and bobs. Loads to get stuck into with neuro too, but we were in most days (the snow on Monday slightly messed up plans) and all over the weekend, even hanging around drinking coffee until half past seven while working through some example questions. Stressful - you bet, but at the same time a really nice mutually supportive atmosphere, with some of the third years coming in to help out, people bringing in cakes for communal consumption, and generally everyone helping out everyone.

Then onto the practicals - never my favourite thing, and I was up first - modelling for my study buddy Lynn. We knew we were going to model for each other so had decided to work together a lot, quite apart from the fact we get on well anyway. I modelled for her, and was chuffed to see her pick exactly the three tests I'd have picked for the scenario (bar a minor foot eversion on the straight leg raise). I was confident she'd done well.

Then disaster struck - we all got swapped round, so she had a new model and I had a new person treating me. It wasn't that bad, but all our carefully laid plans went to pot. It meant I didn't work with her as my model afterwards, but it was okay. I had a nerve wracking time on the spine station - as although I thought I'd picked my tests carefully, I thought once I'd left the room that I might have misunderstood the question. Then onto the peripheral station, where I managed to have a complete brain mush and couldn't think of a third test so picked a functional one. Not a bad idea but I missed some really obvious stuff. Then I missed an incredibly obvious mobilisation that I knew backwards and did a far less obvious (albeit semi-appropriate) one. I really thought I'd stuffed the station up.

Anyway - result were out today and I got 73% for the spinal one and 88% for the peripheral one - so very happy with that

I had intended to spend the rest of Monday studying neuro, but my brain was fried, and in spite of our best efforts to kick start ourselves we barely did anything! By three pm I was ready to head home, but fortunately another study buddy Houra turned up and got me goign again. We ended up going back to her flat and studying until about 11pm, and I went home completely pooped. I was in again early to do more practice - but felt absolutely wiped out. I think the constant pressure had really taken its toll, and I wondered how I'd get through the day. I still wasn't feelign good come lunchtime, so got some paracetemol, but still felt very tired. Then it was my turn, and I got into the room, for some reason felt suddenly calm and relaxed, and read the question. Parkinson's - sit to stand. Excellent I could do this in my sleep. You have five minutes to plan, so I wrote down the progression of exercises, and wrote a big bracket at the side with "CUEING" in large letters. Then it was time to put my plan into practice, which I did admirably, apart from the cueing, which I totally forgot until reminded by the examiner. Even so - I felt a right numpty. A bit disappointedd with the final mark of 60%, as I know I could do better, but then again without the cueing it really wasn't a good performance. Still -that leaves me with an average score of just over 70% for the practicals, which I know I don't do well on. I think everyone found it really stressful and there were plenty of tears and wibbly looking people.

Then it was time for the pub! I can't remember a lot about that tbh but I know I enjoyed it!

And so now it's time for the next placement. Elderly rehab for me, which I think is a real mix of stuff - some neuro, some geriatrics, some orthpaedics. I have a new set of books to read - no sleep until the end of the third year
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iainmacn
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Right - end of first week on placement. Boy has it been busy!

First things first - the induction - which basically means a powerpoint talking us through equal ops policies, fire policies, how to bleep people etc. All rather tedious but of course important.

Then off to my ward - which was in a hirtherto unexplored part of the hospital. I've always loved large building with loads of interconnecting corridors, not sure why but there it is! ANyway - went up, introduced myself, met my clinical educator (CE) who is absolutely fabulous, and after a quick tour and a bit of paperwork it was off to the wards.

It's been a amd week. I'm not going to detail everything, but my CE has gradually got me doing more and more stuff - building me up from following to leading, and askign me to make more and more decisions - all the time checkign them of course! Just the way I like to learn.

A word of warning! If you've decided on physio as a career - bear in mind that even if you end up working in out patients, while training you can expect to be on wards, and will more than likely see patients who are incontinent - which may well mean that they do it when you move them from lying to sitting. In other words, you as a physio are there when the s**t hits the fan - or at least when it hits the bedsheet. If this puts you off then it's not the career for you. I can't say I was looking forward to it, but it's part of the job.

Another thing to be aware of is that patients die. Especially patients in an acute care ward or elderly patients. So far this week I've twice gone in to find that a patient has died overnight, although apparently this is a bad week as it normally only happens once every three weeks or so. We've also had a patient with COPD who we were treating to clear secretions suddenly desaturate (lose oxygen) and have to be taken up to intensive care. Not anything to do with what we were doing, but again - it can be a shock. Oddly I think I'm already getting hardened to it.

In spite of all that - I'm actually really enjoying placement. A lot of the oldies are absolutely lovely, and so far only one has talked about the war. Mind you, he made up for all the others! There's also been some major victories - such as people walking for the first time in weeks, or suddenly going from seemingly couldn't care bed ridden people to wandering the wards like there was no tomorrow. Part of physio is getting people safe to go home or to a nursing home - so they not only need to be medically fit but also a low enough falls risk to be discharged to somewjere else. Falls is a major factor with the elderly, and many of our patients have come in after a fall - which often leads to a fracture, although we deal with patients who've come in for all sorts of reasons. The placement has not only given me a chance to do loads of manual handling, it's provided me with a chance to see conditions such as Parkinson's, dementia and COPD in real life (completely different from pretending in the labs) and also to work as part of a multi disciplinary team. It's vastly different from the last placement, and while I still think I probably would rather work in o/p than elderly care, I'm realising that it's an interesting area.

There's a drastic amount of study to be done, a portfolio to write, as well as several other assignments to kick off - but as they're generally interesting then I don't mind working hard.

Did I say my CE was fantastic?
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Cassius C
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Jeeze I'm feeling stressed reading the last 2 pieces you've written Iain. I'm thinking 1st year aint so bad...!

Glad someone else doesn't like practical exams. I can't ever get past the artificial aspect of it. I appreciate why we do it but it's not my finest hour!

Keep smiling
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iainmacn
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perhaps I was being a tad OTT in my last post - spoke to someone else yesterday who has a geri's placement but it's elective surgery so the patients are generally less dementia/incontinent - but do be prepared for it if you want to do the course. Having said that I've had some cracking chats with them - even if they're not really with it, when you do actually connect it makes it all the more significant

yesterday was rowing - and another race. For the first time though in a race we managed to put together our best form and ended up coming third. Not fantastic, but then again our best result as a crew, so very pleased with that. I really want to spend more time rowing, but I also need to study. Got to write up the portfolio - this is something you have to do as a record of your placement and what you learnt. You have to do similarly once you graduate, so it's good practice.
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