Endocrine, week 4

Let’s see – weight gain, mood changes from euphoria to irritability, decreasing libido and elevated blood pressure – either it’s exam time or we’re studying the adrenals … hey wait it’s both! Week 4 of Endocrine is still focused on the hypothalamic-pituitary axis, with this week’s material covering the adrenal glands and the many effects of the hormones produced there. The symptoms above describe Cushing’s syndrome, i.e. cortisol excess, which I’m convinced was first seen in a medical student. In fact I’m pretty sure that the mere thought of finals is enough to inducer higher levels of cortisol in the system, but then I have been speaking about finals for over a month now, so I can’t say that it’s a surprise…

There is only one week left before classes are officially over. In the next week we will have the course wrap up as well as several professors speak about the up and coming lab exams. Speaking of which – the gross anatomy lab has been a flurry of activity for a couple weeks now as people are desperately trying to cram all the muscles, nerves, arteries, veins, insertions and attachments into their little brains. We will have a week off after Endocrine week 5 and then the hell of finals will start. I am nervous and not quite ready yet, but honestly can’t wait to get them over and onto the Christmas break. Posting may become a little sporadic over the next couple of weeks as studying for finals will begin to dominate all the spare time I have …

Endocrine, week 3

It’s the “hump” week of the block and just that much closer to final exams. The stress levels that I had been predicting for weeks is in full effect. Study times in the common labs for anatomy and histology have become a bit of gong show, with frenzied students running about, trying to cram as much as they can into their little brains. The Endocrine material isn’t helping matters, this isn’t to say that it is hard, but rather that the material covered in this block is a lot to get as we approach finals. The study of endocrinology in general amazes me. It is fascinating how small chemical messages sent from the brain in the form of hormones exact such large effects overall in the body. It is hard to convey this sense of amazement or fascination through this blog, but let me just say that the inner nerd is enjoying himself.

This week we are covering the hypothalamus, pituitary and end organ axis (axes looked wrong but then what is the plural of axis?). Essentially, we are studying how a tiny area in the brain called the pituitary sends chemical messengers, known as hormones, to specific organs to cause a series of specific events. For example, the case this weeks covers a young man who has lost his sex drive. One of the differential diagnoses is that there is a problem with the pituitary which isn’t secreting enough Lueteinizing hormone (LH) or Follicle Stimulating hormone (FSH). The LH and FSH in term work on the testis to produce testosterone and spermatozoa. It’s been simplified but that is essentially the gist of one of the hypothalamic/pituitary/end organ axis.

The only downside to this week are the lectures on sex. The professor is passionate about her work, without a doubt, but learning about sex in medicine is about as dry as it comes. Somehow the fun is sucked right out of it and you’re left with this very mechanical process. This is, for some reason, very … uh … disappointing. Ah well, c’est la vie.

Boy! They can transplant anything these days …

… including (apparently) poop. In a recent article on the CBC.ca website, called “Don’t poo-poo technique: fecal transplant can cure superbug, doctors say” (follow the link at the end of the post to read the actual article) by ??, it was reported that doctors have performed several of these fecal transplants … I’m not sure how to react to this. It’s like part revulsion and part morbid curiosity and, like you, I proceeded to read on.

The treatment (the fecal transplantation) is used in cases of Clostridium difficile infection. C.difficile is a bacterium that infects the gut and causes diarrhea as well as other serious intestinal conditions including toxic megacolon which is a medical emergency. It is, unfortunately, the most common cause of acquired hospital infection in Canada (as well as the rest of the industrialized world). It is the type of bug that is opportunistic and when the normal flora of the intestine is disrupted by something like illness or antibiotics C. difficile can take advantage and colonize the gut leading to an acute illness.

“Clostridium difficile is a superbug that commonly spreads in hospital settings and has been linked to the deaths of at least 2,000 people in Quebec since 2003, as well as in other provinces.”

Problems begin to arise when you consider treatment. As far as I understand, the patient must discontinue using their current antibiotics and start an another (Metroidazole or Vancomycin) which is more specific to killing the bug. Even with treatment C. difficile infections can persist.

“The antibiotics sometimes wipe out the good bacteria but fail to completely kill the C. difficile – leaving enough of it that it later flourishes. “

Right – conventional treatments may not result in a complete cure and, up until now, I didn’t think there was an alternative type of treatment. How wrong I was! Some of the more scatologically inclined doctors in Scandinavia have been working on fecal transplants as a way to cure the infection. Not to be outdone the technique has found its way to the United States and now is even available in Canada.

“Calgary physician Dr. Tom Louie, head of infection control at Foothills Hospital, is one of the few physicians in Canada who treats patients with chronic C. difficile with fecal transplants, or fecal therapy. He has done 38 procedures to date. “

Call me crazy but before you volunteer you may want to look at the studies out there …

Studies that have been published show that more than 90 per cent of patients are cured through fecal transplants – most of them after just one treatment.

Interesting … there is nothing in pubmed, nor UpToDate and a Google search doesn’t turn up any scientific literature. There are passing comments made on the Clinical Infectious Diseases 1999;29:000 hotpage.

A recent discussion from the EIN Bulletin Board raised an option of “fecal transplants” that was claimed to have extremely good results, often with complete relief, within 24 hours, of diarrhea of months’ duration.

At a lecture at the German Anaerobe Society meeting held in Leipzig, Germany, Prof. Carl Eric Nord (Sweden) noted that they too have performed successful fecal implants to cure recurrent C. difficile diarrhea. They even maintain their own collection of total fecal flora and various components.

There was also an article published online, 21 November 2006 titled “Emerging Therapies in the Treatment of C. difficile-associated disease from The Annals of Pharmacotherapy (Vol. 40, No. 12, pp. 2164-2169.), which mentions fecal transplantation as a nonstandard strategy.

Hmmm … so maybe I’m going to wait until more studies have been done before I volunteer. Regardless it’s an interesting idea of how to treat a serious infection in a rather non-conventional way.

Read the CBC article here for more information …

Here’s to statins!

Of course you can’t have a week on lipids without learning about the wonders of statins. The video below describes another new wonder drug, brought to you by the same people who provided the Anaesthetists Hymn … enjoy!

Endocrine, week 2

It’s the week of long names and rare diseases. Hyperlipidemia, hypercholestremia, hypertriglyceridemia, each congenital in nature but rare (at least for the most part). The fact is that the complex “hyper” fatty acid diseases really are part of the larger backdrop that has helped define how fatty acids affect vascular health and lead to atherosclerosis. The connection here, as it is with so many other diseases we’ve covered up to this point, is that the disease process involved in the pathogenesis of atherosclerosis is a combination of genetics, lifestyle and environmental triggers that lead to an eventual disease state.

Part of the week’s objectives involved an analysis of student lipid profiles. I have to admit that I was nervous. Given that I am one of the older students in the class, I somehow expected my lipid profile to be out of the norm (the glaring outlier in the analysis), especially when compared to all the younger punks students in the class. This fortunately wasn’t the case and my “bad” fat (my low density lipoprotein (LDL)) was low and my “good” fat (my high density lipoprotein (HDL)) was high. Furthermore, the ratio of Cholesterol to HDL was under the target range of 4.0. All good news, but what does it really mean? Given my age, total cholesterol, HDL, lifestyle factors and BP, I can use a model to estimate a 10 year risk of coronary artery disease in myself. The model is known as the Framingham CVD Risk Assessment (there is a calculator available here at the National Cholesterol Education Program if you’re curious about your own risk of developing coronary artery disease). My ten year risk of coronary artery disease is <1% … and I think I can live with that (at least for the moment).

Lacking sugar, lacking insulin

It’s Friday afternoon and the last thing that I want to do is focus on my homework. I usually take Friday nights off and relax, or, if I am lucky enough, go on a date with my girlfriend. Tonight though it’s hard to stay focused enough on the task at hand…I find my mind meandering about, thinking about beer or the latest movie. I feel somewhat guilty about this ’cause I know there are a number of my buddies in the OR tonight wishing they were somewhere else … suckers.

This week was intense in terms of class and concepts. The PBL case covered congenital hyperinsulinemia (which I couldn’t pronounce correctly at 8 am this morning much to the chagrin of my PBL group) and the majority of the lectures covered the opposite, i.e. Diabetes. I am too distracted to think of a decent story from the week and too tired to be funny. I did find a decent website dedicated to dealing with Diabetes that I thought might be helpful to those who suffer (and the numbers are increasing at a frightening rate). The site is called “Six until me” and does not contain medical advice but rather is a collection of posts from a woman who has diabetes. I like these types of blogs, I find them usually pretty useful at providing a more complete picture of a person’s experience. If you are someone who has been diagnosed with diabetes it may be useful to see how someone else deals with the disease on a day to day basis. Alternatively, if anyone who reads this blog (hi ma!) has any resources they’d care to share please leave a comment on this post.

As for me, right now, I’m going to go replenish my own stores of sugar with a burger and a frosty friend ’cause I’m feeling a little hypoglycemic…

5 weeks and counting …

…and for some reason I am dreaming of exam questions. I know finals are close and I know that I have been thinking a lot about the material but I am still surprised to find myself dreaming about actually taking an exam. It’s actually not that I dream about a specific test per se, but rather I dream of myself in a room with a desk answering questions about material we covered in class. The dreams are even disconnected from the material I may have been studying that night. For example – last night I studied endocrine but was having dreams about blood and lymphatics. It’s quiz style – “Describe primary vs. secondary haemeostasis”, and I tend to do ok, which I guess is reassuring. It is still a little disconcerting that not even is there that subtle break from school when my eyes are closed. The up side, I suppose, is that I have just doubled my study time (lol).

Endocrine, week 1

It’s the first week of the Endocrine and Metabolism block and I have a new PBL group to deal with as well as a new chunk of material to wrap my head around. The block runs 5 weeks and then ends a mere 5 days before the final exams start. The material covered is difficult but well taught as a class favorite (an excellent educator) is returning to head the block. My PBL group is a good one, for which I am thankful for – nothing worse that ending a hard block with a horrible tutor. Of the people in the group I am good friends with 4, which has never happened to me before, i.e. to have a group with such a large cluster of people that I like. the only downside is that we are way to familiar with one another which leads to some inappropriate, unprofessional comments being made. I don’t think our tutor will take issue but I’ll have to watch myself and make sure I don’t tell too many people to bugger off before the end of the semester.

Newts have nothing on me …

… except maybe limb regeneration, or so this is what I thought until recently.
While wasting time taking a break from studying I came across a “Medical Futurist” (I had no idea such a thing existed) by the name of Dr. Alan Russell who discusses, in the video provided here, how it may be possible to regrow limbs. In his short 18 minutes (well worth the watch if you have time) he discusses some advancements in disease and defect treatment which are truly revolutionary.

This seems like a good way to finish off the MSK posts, as I plan not to talk about anything related to MSK until I hit orthopedics next year – Enjoy!