The Medical Thread

@Madrugada - A while ago, whenever I posted any medical related question in Random Question Thread, you were the one to give the most detailed answer. Over the time I assumed that you are a medical professional.

@Hourai Rabbit - It is good that you get to make your choice. I cannot say anything because I don't know your circumstances but I hope that you made the right choice.

I wish I can take physiology this year. Human biology is pretty close to that, right?

edited 28th Aug '12 3:05:16 PM by dRoy

I'm a (socialist) professional writer serializing a WWII alternate history webnovel.

Hey, d Roy, sorry for taking so long to answer your question! I was studying for my exams, so I got a bit busy and forgot about it. From what I recall:

• Sternum fractures generally occur due to crush injuries, e.g. from car crashes.
• It takes about 4-6 weeks for the pain to subside.
• The sternum is well-supported internally, so there is seldom a need for doctors to stabilise it.
• The greatest danger is not to the sternum itself, but to the heart. If the trauma is great enough to severely fracture the sternum, it probably will damage the heart, or cause shards of bone to puncture it.
• Bonus anatomical fact! The sternum actually consists of three parts (hence why I asked which one before). From superior to inferior: manubrium, body of the sternum and xiphoid process.

"Doctor Who means never having to say you're kidding." - Bocaj

Xiphoid process is cartilage, isn't it, Yuan? And am I correct that one of the big dangers to the internal organs in a broken or crushed sternum is that the ribs will be broken or sprung loose by the same trauma?

...if you don’t love you’re dead, and if you do, they’ll kill you for it.

possibly a stupid question: do you think that the morality of some diseases is slowing down the finding of treatments for some of them?

^^The xiphoid process is cartilage, but it's usually ossified by adulthood. I also thought the fractured sternum's inability to support the ribs would be the main cause of internal organ injury, but my father says it's the crush injury itself which poses the greatest danger. If you think about it, that makes sense: any trauma severe enough to smash the sternum into bits will definitely injure the underlying heart, lungs and blood vessels. John Murtagh's general practice guide notes that cardiac tamponade and myocardial contusion (caused by blunt trauma) are complications to look for. Which is not to say that flail chest and severe rib fractures which will damage internal organs might not occur - they're very likely if the trauma is severe enough to damage the sternum.

^Any specific examples you had in mind? I think that the morality and ethical issues surrounding drug dependency are definitely slowing treatment of it, but that might not be what you have in mind.

edited 9th Sep '12 6:23:12 PM by Yuanchosaan

"Doctor Who means never having to say you're kidding." - Bocaj

Drug dependency is one thing, yes, but there are a lot of diseases that are thought to be brought upon onesself, like diabetes and heart disease and lung cancer.

It depends whether you mean attitudes from medical researchers and doctors, or from the government. I'm inclined to say "no" for both when it comes to heart disease and diabetes. If you look at it from a public health perspective, the disability-adjusted life years (a measure of burden of disease) for cardiovascular disease and diabetes are amongst the highest out of all diseases. As the western world becomes more developed, these problems will only get worse, so it's in everyone's interest to support better treatment for them.

Additionally, pharmaceutical companies make a great deal of money from treatments for CVD, its related diseases and risk factors, like statins to reduce cholesterol (the best-selling class of drugs), ACE inhibitors for heart failure, calcium channel blockers etc. I recently had lectures given by cardiovascular disease and pharmacology researchers; there are a lot of interesting treatments being looked at, ranging from coatings to put on stents to reduce stenosis, renin inhibitors (lecturer called it a "Holy Grail") for heart failure and hypertension, and HDL increasing agents (big target for industry here).

Lung cancer is tied up with the smoking issue, but I don't think obstruction of research is a significant problem. Public health workers are well aware that it has other causes: passive smoking, metastatic spread, pollution etc. The lattermost is a growing problem in many countries. My mother's godfather was a non-smoker and died of lung cancer because he lived in a polluted city.

I suppose public perception of these issues might result in difficulties obtaining funding, but that would have to be very strong and have government backing - like the stem cell research issue, drug dependency, some mental health issues etc. I can't see people objecting as strongly to cardiovascular disease, diabetes and lung cancer research. Most people will know at least one relative or friend who has one of those diseases (particularly CVD), and/or has died due to it. Even when people object to the behaviours that contribute to the disease, I don't think anyone who has had a relative die due to it objects to trying to find more effective treatments. In other words, attitudes towards primary and tertiary prevention differ.

edited 9th Sep '12 7:35:50 PM by Yuanchosaan

"Doctor Who means never having to say you're kidding." - Bocaj

Don't quote me on this, and I can't off-hand find where I read it, but I recall that the American Lung Association has expressed that it's getting more difficult to garner public support for lung cancer research because of the public perception that it's something that people bring on themselves by smoking; in combination with the more emotionally-effective appeals for support of other cancer research — breast cancer in particular.

It's not action against research on it, it's simply a siphoning of available time, energy, and money towards other, more "attractive" (I hate using that word in this context, but I really can't think of a better one.) cancers

edited 9th Sep '12 7:50:08 PM by Madrugada

...if you don’t love you’re dead, and if you do, they’ll kill you for it.

^That's a good point, and it probably does happen.

"Doctor Who means never having to say you're kidding." - Bocaj

I think lung cancers are worth researching, because there ARE other causes for them than second-hand smoke. For instance, smogs, cars, fires, etc. If people find a way to treat a fragile pair like lungs, it'll be a huge step forward to other areas.

What profit is it to a man, when he gains his money, but loses his internet? Anonymous 16:26 I believe...

@yuan - Ooh, I didn't know that. So basically, if you hurt your sternum, that means you sustained enough blunt force to hurt your heart, correct?

I'm a (socialist) professional writer serializing a WWII alternate history webnovel.

Not always*

, but it's likely. It depends on how badly you damage the sternum, how weak it is already (e.g., if a patient has osteoporosis), the angle from which the trauma came etc.

"Doctor Who means never having to say you're kidding." - Bocaj

Ah, so there are multiple factors. I am not surprised. Interesting.

Say, what are some common heart failure symptoms that are not usually shown in fiction? I am pretty sure that there are more than just grabbing your chest and go HHHNNNNNNGGGGG!!!!

I'm a (socialist) professional writer serializing a WWII alternate history webnovel.

A pain going down your left arm, I think.

Be not afraid...

I actually had a question on heart failure in my recent exam! But I don't think that's what you mean - heart failure (also known as congestive cardiac failure) is a chronic disease. Perhaps you mean:

• Myocardial infarction (often known as a heart attack)
• Cardiac arrest (not a heart attack)
• Cardiogenic shock
• Ventricular fibrillation (the one you can shock)
• Sudden cardiac death
• Ischaemic heart disease
• Cardiomyopathy

Common heart pathologies are confusing due to their similar names, overlapping definitions and their tendency to cause or exacerbate each other. For example, cardiac arrest and myocardial infarct can cause heart failure, which may lead to further myocardial infarcts or an arrhythmia, which may lead to... This is complicated by the fact that some of the diseases are descriptive (e.g. sudden cardiac death, angina pectoris) and some are based on the pathophysiology (e.g. myocardial infarct).

Here's◊ a flowchart showing how some of these conditions interrelate.

"Doctor Who means never having to say you're kidding." - Bocaj

What do you study, Yuanchosaan?

Be not afraid...

I'm currently enrolled in a Bachelor of Medicine/Bachelor of Surgery/Bachelor of Arts, though the Arts bit is nominal at this stage. In terms of the doctor cycle, I'm at the "just hatched out of an egg" phase, so I'm filled with lots of enthusiasm and only a bit of knowledge. My parents are both G Ps, so I'm running things past them most of the time as well as checking textbooks.

Are you studying something medicine-related as well? I was under that impression, but I can't recall whether you actually stated that.

"Doctor Who means never having to say you're kidding." - Bocaj

That arts bit is kind of unexpected

I'm studying veterinary science.

Be not afraid...

Well, you guys are majoring in something practical.

I'm a (socialist) professional writer serializing a WWII alternate history webnovel.

I want to major in Ethics and Linguistics (because I'm insane enough to think double majors on top of a double degree are a good idea), so practicality flies right out the window. Still haven't made up my mind about it, gah...

@Loni: For some reason I thought you were a nurse - oops! Veterinary medicine seems intimidating to me; you have to learn how to treat many different animals

@d Roy: Was myocardial infarction/heart attack the one you were curious about?

edited 10th Sep '12 11:18:54 PM by Yuanchosaan

"Doctor Who means never having to say you're kidding." - Bocaj

It is quite intimidating... and sometimes I feel like I forget everything within a term of learning it =P

Be not afraid...

^I think that's the way every student feels: like their heads are leaky bags of sand. I'd put a there, but I doubt I'll be laughing come exam time.

Do you have clinical sessions, or the veterinary equivalent? If so, are you also prone to those sudden mental blanks which leave you staring blankly at a patient trying desperately remembering what to do, while your supervisor patiently waits for you to proceed, but there's this stethoscope in my hand and what where do I poke it and what was the history again ah!

I note that this is completely on-topic, as the thread title doesn't specify human medicine.

"Doctor Who means never having to say you're kidding." - Bocaj

We're coming up to clinical stuff like that soon... Basically, the first two years of the degree is basic knowledge - anatomy, physiology, bacteriology, animal handling, that sort of thing. Third year is when you actually start looking at clinical disease... and for the most part, we're in a classroom or an anatomy lab most of the day still.

I have a massive exam at the end of the year that's designed to test this sort of thing; there won't be an actual animal, probably, but they'll simulate a case by giving us photos and test results and asking us to say what we would do. I'm not looking forward to it...

Next year is when we really get into the practical medicine side, I believe.

I do recall my prac exam last semester... the instructor told me to go get 'the chestnut horse' and bring it to him. There were two chestnut horses in the paddock. I sat there staring at these horses for what felt like five minutes trying to figure out which one he meant and thinking "Oh my God, I am going to fail this exam because I don't know what a chestnut horse looks like"

edited 11th Sep '12 6:47:10 PM by LoniJay

Be not afraid...

So we've talked a bit about anatomy and pathology. How about some of the other fields of study related to medicine? This is what I'm studying in my course:

• Anatomy
• Pathology
• Histology
• Physiology
• Pharmacology
• Biochemistry
• Microbiology
• Cell biology
• Embryology
• Genetics
• Ethics
• Clinical skills
• Public health
• Research methods and statistics (*shakes fist*)

Of course, these overlap, so you have things like histopathology and pathophysiology. It's one of the reasons I love studying medicine: every day we study something different.

"Doctor Who means never having to say you're kidding." - Bocaj

Looks like you're getting the full honors. We still havn't properly covered medication yet

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