Spent the later half of the day at ultrasound after a shleepy morning in MRI.
The last case of the day, in particular, reminded me that humans are still fragile beings afterall.
This middle-aged caucasian came in on wheelchair, and he was really Big, like he filled the entire ultrasound scan bed. He struggled to lie down on it, putting his walking stick aside because of his weak knees, probably due to the weight all these years. He was a cheerful and cheeky man, with blond hair and twinkling brown eyes.
We had a really good conversation while Alan (a hk sonographer) continued the scan. We found out that he was the guy who brought coca-cola into China, Hongkong, Japan, Seoul, Borneo, and a long long list of places. He should get a plaque from macdonalds, they owe him. Throughout the scan, he kept cracking jokes, making digs at Alan, winking at me, then he kept praising Alan, saying “he’s a good man, he’s one of the best sonographers around.” and “He told me 2 weeks ago, that i’ve only got 4 weeks to live. He’s the one who found that I had cancer all over.”
I didn’t believe him, and though it was just mindless crap.
Until Alan said, ” Yea, and your veins aren’t looking too good either.”
Coca-cola man replied, “What, like from the cannulation?”
Alan said, “Yea, most probably. The pain’s at where the cannula was, isn’t it?”
Coca-cola man hissed, “Those bloody bastards. Can’t they cannulate properly? It’s a bloody butchery here.”
And they continued making digs at the staff, how incompetent doctors are, etc etc.
When it was over, he turned to me and asked, “Are you a Christian, sweetheart?”
“Nop, but I belive there’s a higher being up there.”
“I believe in God, and He will take me wherever I’m supposed to go. So I’m not worried about that. But I have a lovely young wife who will be a widow in 2 weeks’ time. A beautiful 2-yr old son who will be fatherless soon. Hell, I won’t even be there during christmas.”
He paused, and looked at me straight in the eyes.
“But I believe in laughter. I believe in happiness.”
“That’s what you’ve got when you only have 2 weeks.”
He picked up his walking stick and wobbled back into his wheelchair.
His emergency doctor came over and asked about his results. He then told me that he thinks she’s the sweetest doctor in the whole world, the best he’s got. And told her that he refuse to stay overnight for more treatment for some stupid bloodclots in his veins, and he’s gg home to his wife and son. She smiled and told him she will make arrangements.
As I wheeled him round the bend to the waiting area to be sent back to the emergency department, his son, who was still in the stroller, screamed chirply, “DADDY!” and waved frantically. His wife stood up and went, “What took you so long? what is wrong?” I left him at the waiting area, wrote on the card for the porters to send him back by, and left the 3 of them in there.
Went back and was told that I could leave since I was already doing ot. Picked up my bag, and passed by the waiting area. Took a glance at them, and hesistated. Then, I turned and walked out the front door.
Something off the net again, the content below is all available from this webbie.
Apparently, there are different types of smiles. And they have been broadly classified into 3 categories.
The Commissure Smile
67% of the population exhibit the commissure smile, making it the most common smile pattern. In this smile, the corners of the mouth are first pulled up and outward, followed by the contraction of the levators (muscles that raise the upper lip) to show the upper teeth. Celebrities with recognizable commissure smiles include: Dennis Quaid, Kate Hudson, Jennifer Aniston, Jamie Lee Curtis and Mel Gibson.
The Cuspid Smile
31% of the population exhibit the cuspid smile. This smile pattern is commonly associated with the shape of the lips visualized as a diamond. The levator labbi superiorois is dominant. They contract first, exposing the cuspid teeth, then the corners of the mouth contract to pull the lips upward and outward. However, the corners of the mouth are often inferior to the height of the lip above the maxillary cuspids. Celebrities with recognizable cuspid smiles include: Elvis Presley, Tiger Woods, Drew Barrymore, Sharon Stone and Tom Cruise.
The Complex Smile
2% of the population have a complex smile. The shape of the lips are often illustrated as two parallel chevrons. The levators of the upper lip, the levators of the corners of the mouth, and the depressors of the lower lip contract at the same time, displaying all the upper and lower teeth simultaneously. A key characteristic of the complex smile is the strong muscular pull and retraction of the lower lip downward and back.
Celebrities with recognizable complex smiles include: Julia Roberts, Marilyn Monroe, Will Smith, Oprah Winfrey and Angelina Jolie.
As if it wasn’t complicated enough, someone came up with the real and the fake smile.
Try out the test, see if you can pick out a fake smile. I scored pretty well. hoho. only 1 wrong. wahah. so be warned, i know if you’re for real or not.
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Today, after spending a ridiculous 27 bucks at spotlight over pretty papers, i was walking happily alongside bao but was completely weirded out, having 2 complete strangers stared at me then giving me a smile.
The first was a middle-aged, chubby caucasian, who stared at me as if i had a mushroom growing on my forehead, and then caught my eye, and gave me a broad grin. I guess he was trying to be friendly.
The second was another middle-aged, chubby indian man, with a huge moustache, who stared at me as if i had a dozen more mushrooms growing out from my forehead, and then caught my eye, proceeded to raise his eyebrows, looked at me with a sideward glance, and showed me his perfect set of teeth.
something like this, but minus the elaborate head-dress and armour.
and my facial muscles failed me, i think i gave him a terrified face. oops.
It was a week of unhappenings again at the hospital again. I can’t seem to shake off the suay streak. maybe things will be good next wk onwards~
first day was the Queen’s birthday, yeay~ God save the Queen! the only reason i’m happy is probably becos we get to miss one day of clinicals since its a public holiday.
second day was spent in General department as usual, since no roster was up yet. Happy news was that Jon was the liason this time, not Anthony. But still the first day in general was again, plagued with mistakes.
1. Miscentering of a stage B clavicle. Too medial with too little collimation.
2. Mispositioning of a stage B pelvis. Patient was oblique due to the pain, image came out slightly rotated with slight exclusion of the tip of right hip replacement. AP Pelvis revealed left pubic rami fractures. 2 hip replacements were seen, but request form stated there were NO medical devices. O_o attempted inlet and outlet views, but didnt manage to get a very nice outlet view cos the bucky and the tube were at their maximum range. Chopped the iliac crests a little. =\
3. Scanned a cassette with a radiographer’s initials when it was she who handed the form to us. But becos of some problems, the chest xray was slightly chopped at the costophrenic angles. She was not very happy about having her name on a substandard chest xray, seeing that she’s one who actually do a rib projection with a filter.
And she said “Why is my name on this xray when I didn’t even supervise it?”
I owned up saying, ” because you handed the form to us, I scanned it with your initials on it.”
Then, she started going on to me about how to position properly, the cassette was placed in the wrong orientation, and how resolution is better when it is done landscape compared to portrait on digital systems, to which i still don’t understand. Pixel size should be the same lengthwise or widthwise, with differing matrix sizes for different cassette sizes isn’t it? Does she mean that the pixels are not squares? Can someone correct me on this? I’m totally clueless.
The point was, I was assumed to be the one who made the exposure. Not the first time during clinicals, which was quite sian. Is this what work life is about?
Third day i was rostered to the Computed Tomography (CT) room. saw 2 rainbows on the way to work that day =]
1. first case of the day was a quite a damper. the patient had 1 accompanying doctor, 2 nurses and altogether 3 radiographers. During the slide, the foley catheter was pulled out accidentally when it got caught onto something and well, urine spilled all over. really all over. over the scanning couch, over the pat slide, over the bed. And cos the scanning couch’s mattress was slightly indentated in the middle, there was literally a river of urine in it. -_- everyone had fun cleaning after that.
2. Inpatient case of abdo/pelv scan. A radiologist questions why consent was not obtained for inpatient for use of contrast as a protocol, which sent him and the radiographer into a wild debate. Atmosphere wasn’t too good in the room.
3. An inpatient for a abdo/pelv again, this time radiographer went through the possible risks involved. Radiologist scheduled for cannulation was doing an interventional procedure somewhere else, and another registrar was called in to do the cannulation. She hooked the side port of the cannula to the power injector, which of course, led to the port exploding cos of the buildup of back pressure during injection. Nothing was wrong with the patient, apart from having sticky contrast media running all over her arms. But because the patient started raving around during the scan, it had to be paused and all of us rushed into the room to see what went wrong. And just a second before that happened, Radiographer Evan just pointed out that the pressure at which the contrast was going in was particularly high.
Radiographer Nicole sprayed contrast all over herself while reloading the power injector for the second scan, so naturally she was not very happy. Registrar who connected the cannula was no where to be found. Everyone was quite pissed.
CT Machine started showing signs of hanging, as it scanned for 2cm in the scout film and stopped completely. the scans have to be replanned. And it continued to appear for the following few cases.
4. Cardiac scan for calcium scoring. Seeing that it was an ECG-gated scan, plus becos of the high amount of contrast that was going into the patient, radiographer Nicole pointed the possibility of terminating the scan halfway to the scheduled radiologist. He was not very impressed by the new 64 slice CT machine, seeing that it was actually a few months old. They agreed to continue with the scan after much consideration. Scan went on smoothly.
5. Machine finally broke down for good during a sinuses scan. Patient had to be moved upstairs for the scan. Congestion in the waiting area was a major headache as no patients are allowed to be upstairs along the corridors. One of the radiographers had to become the porter for the day, moving up and down with every single patient.
6. A couple of diabetic patients who had no case notes, and no accompanying nurses. Had to call up their clinics to make sure they had stopped their medication as they require intravenous contrast again. Didn’t help when patients themselves had no idea which medication they were on. but it all got through in the end.
Fourth day at CT again
1. Hope was on the machine getting repaired before lunchtime so that the hectic transporting of patients could stop. But it failed us again on the second case, reverting everything back to square 1.
2. Patient with allergies to contrast but doctor requested for the scan to go ahead. Gave antiemetics before contrast injection but patient still vomitted. poor guy, he was literally all jittery during the injection.
Fifth day at Angiography suite
1. first case was delayed for 1 hour, as the radiologist was unavailable.
2. trouble with paperwork, patient not registered.
3. Saw 2 rare cases that are rarely seen in Sillypore, well i haven’t seen it being done so far. then again, i haven’t seen much. heh.
Ablation of Varicose Veins (ultrasound-guided) No idea why it was don’t in the angio suite when no angio was needed. The staff from VNus was there to guide the procedure and use of the Closure.
Sclerotherapy of Cystic Hygroma in supraclavicular fossa. cool stuff. Didn’t know there was such stuff.
On the whole, the week looks like its getting better. hopefully next week will be good. Think its portables next week, need to wake up 5 plus again =_= and take walks up to the ICUs.
Its officially over. Last paper was as exciting as the last with repeated sample mcqs again, with a slightly surprising decision of choice of topic asked for the 30 and 20m essays.
enough of digress, and onto the Radiology 101.
Roomie and I were curious why penile implants are considered health hazards to patients having MRI scans, as it was stated in the notes, that ferromagnetic penile implants can induce heating, with spontaneous overinflation. so we giggled, googled, and tadaa~ even though this paper didn’t answer our questions, it was still an interesting read.
Ignacio Moncada Æ Jose´ Jara Æ Ramiro Cabello
Juan Ignacio Monzo Æ Carlos Herna´ ndez
World J Urol (2004) 22: 371–377
DOI 10.1007/s00345-004-0427-7
Abstract (excerpt)- Penile implants offer a dependable way of restoring erections in virtually all motivated patients. The satisfaction rate among both patients and partners using these devices is high. However, too often, urologists do not present this option with the same authority as other treatments. The reason is fear of complications and lack of expertise in managing them. Although they are not very frequent, complications may be catastrophic.
The most significant postoperative complication associated with the implant surgery is infection of the device, which is quite frequent, but some other important complications are distal and proximal perforation of the albuginea, SST deformity, ‘‘S-shaped’’ deformity of the penis, erosion of a component, and mechanical malfunction of the device.
Complications
Buckling of cylinders as seen in MRI was a strong predictor of persistent pain. Statistical analysis of the data using the odds ratio indicated that buckling was associated with a 300-fold increase in the probability of persistent penile pain compared to the absence of buckling (P<0.0001 Fisher’s exact test). The sagittal view provided the best image of the
buckled cylinders (Fig. 1) although the coronal view was also helpful.
Figure 1: Buckling of one cylinder of prosthesis (sagittal)
Figure 2: Buckling of one cylinder of prosthesis (coronal)
Buckling of cylinders is not the only pathological situation which can be assessed with the help of MRI. Infection (Fig. 3), fibrous sheath around the reservoir precluding the complete deflation of the prosthesis or around the Resipump in Mark II prosthesis (Fig. 4), SST deformity or hypermobile glans (Fig. 5) are among other pathological findings.
Figure 3: Penile edema and sepsis. Figure 5: Hypermobile glans.
Figure 4: Fibrous sheath around Resipump in a patient with a Mark II penile prosthesis.
For Radiographers,
T1 and T2-weighted images are obtained with a pelvic surface coil using the spin-echo technique for tissue contrast, with the prosthesis in the flaccid state and then in the inflated state after activating the pump mechanism. Sagittal, axial and coronal views are normally obtained in every case in each state. In addition, oblique views are occasionally obtained. Penile length from pubis to glans may also be measured with the help of
MRI in the flaccid state and after full inflation of the prosthesis.
MRI provides good definition of the tunica, cylinders and prosthesis reservoir in each projection during flaccidity and erection. The pump is less clearly defined, probably due to its metallic parts.
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Its been declared officially, we have a natural disaster on hand! the storm is bringing Ozzie is long-awaited supply of rainwater, even though inefficient damps and catchment areas are at fault. to date, we braved 2 storms to get to school for the papers, once to get to Vincent’s for dinner, have a combined record of 3 spoilt brollies from the wind, wet clothings and more wet clothings, and 10 numb toes on my feet.
couldn’t sleep last night because of the furious vibration and rattling of the windows and frame from the wind. only managed to catch 2.5 hrs before the paper. and now, i really swear, the wind is really really intent on ripping our bedroom windows off. quite scary actually. x_x
