Anterior Shoulder Dislocation

Having played a lot of Rugby since a young age, it has become a central part of my life outside of, as well as within school. Having played a couple of times for the 1^st XV while in year 11 I was excited about the next season when I would be a part of the sixth form. However, towards the latter half of my U16 season I badly dislocated my right shoulder while making a tackle. The injury was one of the most frustrating things I have had to deal with, keeping me off of the pitch for the rest of the season! After much physiotherapy and recuperation I was very much looking forward to what the forthcoming season held. However, after a promising start to the season for the team unfortunately the injury reoccurred in a similar fashion but to an even worse extent. Although on the first incident the shoulder had to be put in place by the A&E team, it had only been displaced for an hour or so. This time perhaps due to the reoccurring stress on the shoulder, the A&E team were not quite so successful taking along the lines of 8 hours before I finally felt the pop I had been dreading.  Because of my personal involvement with this injury, it has become something that I have endeavoured to find out more about and so in this article I will try to briefly explain the injury as well as the rehabilitation process I am currently undergoing.

A shoulder dislocation occurs when the shoulder is wrenched upward and backward for example, while under great pressure from an external force. The force can be such as a fall or collision (as I experienced) with enough strength to displace the shoulder. The anatomy of the shoulder means that approximately 95% of shoulder dislocations occur at the lower front of the joint. There are two main parts to the shoulder; the socket of the scapula (the shoulder blade) and the humerus (the ball attached to the arm). Because of the shallowness of the socket, it makes the shoulder particularly vulnerable. For this reason the scapula is “extended” by an area of cartilage and is supported by ligaments called the joint capsule. Furthermore a group of four tendons collectively called the rotator cuff, reinforcing the shoulder joint from above in front and behind.  When the arm is moved away from the body and rotated in a certain position, the joint gives way and the humeral head is ripped away from the scapula socket. The stress on other features of the shoulder, such as ligaments in the rotator cuff, the ring of supportive cartilage and the joint capsule are torn.

Upon getting to A&E I was given medication to reduce the pain such as codeine. I was also greatly thankful for the Nitrus Oxide which was the only thing that seemed to moderately reduce the pain before morphine was administered! The dislocation is then confirmed on X-Ray in order to make sure the diagnosis is correct, while also checking for any other breaks in the neighbouring bones. The shoulder is then moved into a number of different positions, while being put under different pressures in order to relocate it. This is not a pleasant experience!

The shoulder is then usually placed in a sling which immobilizes the joint and greatly reduces the amount of movement experienced by the entire shoulder. This helps to reduce the risk of recurrent dislocations. After a number of weeks, the range of motion is then gradually increased, with strength exercises added in order to return the joint to normal function. Recurrent dislocations are common due to the damage done to the tendons and ligaments after the initial dislocation. Having suffered from two dislocations in recent past I am now awaiting shoulder surgery which will help to repair damage to the scapula joint and restore normal function.

It’s not all bad however. The injury has left me with a desire to perhaps pursue a career in orthopaedics somewhere in the future!

Sam

Work Experience; Day two- Respiratory

On day two, I met Dr. Jarad who is a consultant respiratory physician. We spent the morning in the respiratory department and I had a chance to see how Dr. Jarad supervised some of the younger doctors who were also on the ward. It was nice to see how he was able to support them with their decision making and act as a tutor to those less experienced than himself.

 After this, we went across the road where we spent the afternoon in his hot clinic. In this service it was very interesting to see how Dr. Jarad tailored his skills amongst his patients depending on for example their age. He was able to discharge his patients with a management plan that he had drawn up for them after examination.

It was interesting to gain another day of experience in a completely different field of medicine, and I was very much looking forward to my final day at the BRI where I would be shadowing an F1 doctor which I shall write about soon!

Cheers!

Sam

Work experience; Day One - Vascular surgery

Several months ago I secured my first exciting piece of work experience. After emailing Jane Stiddard, head of work experience at the BRI, I sat an interview with her and a colleague the following week. Soon after I found that I had been accepted for a 3 day placement during half term which I realised was a great opportunity. My placement was split into three departments and so I have chosen to break each day down into a separate post!

On the first day I shadowed Dr. Marcus Brooks a vascular consultant in theatre where I was able to observe several operations. Both patients treated had been diagnosed with having an AAA, or aortic abdominal aneurysm. This is where the large blood vessel that supplies blood to the abdomen, pelvis, and legs balloons outwards and becomes abnormally large. If it is left untreated it may rupture and this could lead to death in the worst case scenario! However, despite both patients having the same diagnosis, Dr. Brooks decided to use different forms of treatment on the patients. This was due to their medical histories being rather different. The first operation performed was what he called a traditional repair. A large cut was made across the abdomen and after the aneurysm had been located, it was replaced by a man made graft that would perform the function of a healthy aorta. Conversely, the second operation performed was called an “endovascular stent treatment”. This form of surgery offered a quicker recovery time and was probably chosen by Dr. Brooks because of the other medical complications this man had. In this surgery, a stent was fed through the arteries in the man’s groin, up through his aorta, until it acted as a replacement for the damaged area. The team of surgeons did all of this while watching via X-Ray imaging to guide the stent.

I found the day particularly engaging and it made me even more aware of just how amazing the technology used today is. I found the way in which the surgeons took the prognosis and history of each patient into account before surgery, in order to determine which of the several procedures they would use very interesting, although I hadn’t really thought about it before! So this was day one... I shall write another post about my second and third day of work experience soon!

Thanks,

Sam

Progress in stem cell research!

Last week while watching the news I saw a very interesting story detailing recent advances in stem cell research. The story in particular was about the breakthrough that a group of scientists working in The US Firm of Advanced Cell Technology had made while working with stem cells in order to try and treat diseases of the eye. They relayed that four months ago two patients had received retinal implants, and were currently doing well with no signs of unwanted side effects, or damage.

The treatment took healthy stem cells from one unborn embryo and manipulated these to grow into retinal cells which would line the back of the eye. These cells were then injected into the back of the eye where a healthy retina should be. The cells would then hopefully attach themselves to the eye’s membrane, and would help to restore healthy vision. If this were to work, people with currently incurable diseases such as Stargardt’s would have much improved or even normal vision. This is a disease that causes much blindness in young people.

The aim of this experiment was to trial this method for safety. And so far the results suggest that the treatment is completely safe, and has even improved the patient’s vision slightly. However, experts agree that despite these early signs of success, it is far too early to decide whether this treatment is safe and effective. To accurately provide evidence supporting this could take several years. Furthermore, the use of stem cells in ways such as these are still under scrutiny from certain people who argue that use of the unborn embryo’s stem cells is an unethical practise and should be banned.

I hope you found this as interesting as I did!

Sam

A visit from the dean!

Earlier in the week, I was fortunate enough to attend an informal meeting along with the other members of the medical society at my school, with the Dean of medicine at Bristol University. I found the talk very informative and it was good to hear the information from “the man in charge” too. The discussion included a brief summary of different aspects of studying medicine, followed by a number of questions from our society covering anything which we were unsure about as of yet.

One thing that I will be sure to remind myself throughout the year is the fact that A,A,A grades at A2 are now more of a necessity than achievement. Even to be considered for interview amongst the huge number of other candidates would require this much from me. Having said that, at the moment I feel that these grades are definitely within my grasp but it has definitely stressed the necessity for A LOT of hard work in order to get into medical school!

An interesting point I had not yet heard off was the possible introduction of “MMIs” which would replace the regular interview. Currently, most interviews are approximately 20 minutes in length and consisted of a number of previously decided questions. However, the Dean said that he felt these were not a fair representation of one’s true self. Some would have little access to practise interviews, others would be far more nervous than others, and so forth. In order to make the interview process a better reflection of an individual, Bristol University, as well as several others have decided upon replacing the normal interview with multiple mini interviews. These, as the name suggests would be a collection of maybe 7 or 8 interviews each consisting with perhaps one question. The idea is that these would be a better representation of the actual candidate. For example, their communication skills, in the short time they would have in these interviews. So if you are considering medicine it would be in good interests to read up a little on these interviews! Who knows which medical schools will be using them by the time we come to apply!

Thanks,

Sam

Medlink 2011!

During the Christmas holidays I attended Medlink 2011. This was a four day course which we would stay on the Nottingham university campus and attend lectures which would hopefully give us a better insight into what it would be truly like to study medicine at university! So on the 17^th of December I took a train with a friend down to Nottingham. I was slightly nervous but nevertheless excited at the same time!

Exhausting is one way that I would have to describe Medlink but I do not regret it one bit! The lectures I attended were incredibly interesting and covered a huge range of topics. I particularly enjoyed the talks from specialists themselves, who would talk us through one specific field of medicine! Because of this I have gained a good knowledge on several aspects of medicine, ranging from paediatrics to general practise. My favourite lecture however must be the Edge Session. It was a two hour talk from James Ridgeway, who I have to say, is one of the most motivational, yet at the same time hilarious professors I have had the luck to meet! The lecture covered a vast amount of information which would be vital in order to take advantage of every opportunity we could to get into medical school, and it has definitely made me realise that if I am going to succeed in reaching my aspiration as a doctor, I am going to have to put my all into it.

As well as the numerous inspirational lectures I had the pleasure of attending, there were also some practical sessions which I found very enjoyable. As well as learning the basics of using a stethoscope, we honed our skills with an ophthalmoscope!   My favourite practical session was one in which we were presented with a mock patient who would describe their symptoms and leave us as potential medics to come to an eventual diagnosis as to what it was.

Furthermore, Medlink gave me a chance to experience what life on a university campus would be like, and I thoroughly enjoyed my entire time there! This is an opportunity that cannot be missed and it has confirmed all the more that medicine is really what I would like to study in the future! :)

Cheers! 

Sam

Friday Fun!

Since 2009 I have been a volunteer for an event called Friday fun. It is hosted at a local youth club every other week and is for children up to the age of 25 who have any form of disability, from learning difficulties to Down’s syndrome. The club currently works with around 50 members and I have found it an incredible experience so far. We try to provide the children with different activities such as table tennis and ensure that they always look forward to the event! As well as their enjoyment, the club also develops member’s life skills which are of vital importance. I have found whilst attending the events that I have also improved some of my skills such as communication and listening which is a great bonus considering I have enjoyed my time there so much! One thing I have really learned to appreciate amongst the children is the numerous different skills and abilities they all have in completely different areas! I have learnt that they are all individuals, and obviously have a right to be treated the same way as anyone else. The first Friday Fun of 2012 was a great success and I am sure this will continue throughout the year! One of the highlights of my night was working with several of the children on covering a song using the instruments available to us, while getting everyone as involved as possible. This was something I had not previously done and found it very interesting. The youth club provides a number of opportunities that the children may not have at home, and the wide range of instruments and music production equipment they used can illustrate this point. Anyway this is my first post so cheers for reading!

A point to note from one article I have read in the student BMJ is that "people with disabilities have a higher prevalence of health problems than the general population, and are therefore more likely to spend time in hospital." So  I would definitely recommend seeking out any similar opportunities that you can find to any potential medical students! You will definitely not regret it and are sure to develop communication skills which will come into use later in your careers!
Thanks again!
Sam

Myself and Cian playing a
bit of footy!

Mike on guitar, and Cian enjoying
the music!

Playing table tennis with Michael!