The LPA deadline has passed and therefore I no longer need to blog. It is early days, but I have no idea if it is of any benefit to continue! I didn't enjoy it at first, but I've got used to it now. Life feels different without having it to worry about....
If I blog again in the next 2 weeks it is a sure sign of procrastination. I should be revising for the next CCA. Why am I even here now?
Saturday, 21 May 2011
Thursday, 19 May 2011
Future plans...
It is with great trepidation that I face the next CCA. Although I know I have made a big leap from last year and I can't possibly have got worse over the course of this year, my CCA grades so far suggest the opposite to be true. From D high to D low is a damning verdict! Apart from clearly being on the rubbish side, at least there are some obvious reasons for this - my failure to initiate writing a doctors' letter the first time around and then in response to this, an over zealous instant referral the second time around. (However, I still maintain that the patient in question was an unreliable witness and had red flags that may not have been addressed elsewhere, but never mind). I would love to improve on my OSPE grades to boost my confidence (B low/C mid formative; B Low summative), but at this stage a pass will do! However, I will be concentrating on devising treatment routines for specific conditions, as we have been advised that this will be the format of the next exam. I also need to find out more about our first aid requirements - we did something earlier in the year, but it seemed quite basic - I'm just hoping I don't have to pay to do anything else!
In the longer term, it is all about technique for me. In my experience this (and trust/rapport) is the main factor which makes me return to a practitioner and this is where my focus will lie. Feedback suggests I'm good to go on the rapport front! I expect my palpation to improve in time and I generally hope to speed up the whole patient encounter straight away. I have managed to widen the variety of techniques I use in clinic this year, but it is a constant effort not to use the old favourites. I think it is really damaging to stick to a few trusted/most easily achieved techniques at this stage and I am always consciously trying to avoid doing this!
In terms of LPA criteria not quite satisfied, to be investigated more later (when time constraints and health allow) I would like to explore the evidence base for manual techniques further and have a few high quality papers at my fingertips to which I can refer people to. It is my experience in the last couple of years that often evidence is conflicting, as I have found recently regarding subjects such as stretching and using ice/heat etc. I aim to at least stay informed about the latest research both "for and against" ideas, so I can at least discuss it and direct people to it, in order that they can make informed decisions. I think I am coming to the conclusion that the "informed decision" is what it's all about and I will be satisfied that I am being professional enough if I can confidently say that there is no evidence that the treatment or advice causes any harm and if there is an absence of acceptable evidence of significantly good results, it is performed/advised on the basis of anecdotal or experiential success and it is then the patients' choice whether to proceed or not.
I also hoped to read up about harmonics, but this will have to wait. Sadly, an external course I did not take, but an approach I see taken by many students and enjoyed by patients. I am also loathe to admit the supine C/T thrust still evades me at this point, but I hope that I achieve it before I leave (whenever that is)! I also have not achieved the O/A thrust since we were told not to do the only version I ever found success with! I hope I can get over this. My other nightmare is the sidelying, posterior SI thrust - success comes and goes as it pleases!
I anticipate practising mainly structurally at first. I would feel like a fraud if I offered cranial treatment right now. Finances permitting, I will take the cranial course, maybe in January. I am definitely interested, but don't think I'll manage September sadly.
I want to learn all the osteopathic lymphatic (pumping) techniques / protocols! The closest I came to them was on the Classical one day course. The classical guys love them. Sadly, my dissertation left me none the wiser! The nature of the exercise and the papers included for review meant that although the results of various lymphatic protocols were discussed, the techniques and their implementation were mentioned only in the methods sections and were not instructive in their description (hence no enlightening tutorial from me on such techniques)! I also want to learn the specialist manual lymphatic drainage techniques for oedemas / lymphoedemas.
There were various areas I did not include in my learning contract that came up over and over again and will be part of my future quest to fill the gaps. Core muscle strengthening, rehab (especially re shoulder, knee and ankle) and strapping, to name just a few. I also need to brush up on my neurology, keep red flag information at the forefront of my mind and become really familiar with NICE guidelines. It is the information related to the less frequent presentations that is easiest to forget and I think it will require an ongoing reasonable effort to keep it familiar. I have little knowledge about sports injuries, but more about pregnancy which I definitely hope to take further.
There are other areas I would also like to explore in the future. I have always been interested in nutrition and I have recently developed an interest in Alexander Technique. I am quite interested in a few of the post graduate courses at the AECC such as diagnostic and treatment use of ultrasound and I would also like to be able to work with animals. I still find myself drawn to traditional Chinese Acupuncture, an original study consideration of mine. However, fee increases certainly rule out another degree for me!
Finally, I am hoping a couple of practice visits I am arranging locally and up North may lead to even a few hours a week employment and I have also made enquiries about room hire nearby.
Although I have had my ups and downs on the course, I still hope to find that this is a rewarding career and I already see it as an opportunity for lifelong learning!
In the longer term, it is all about technique for me. In my experience this (and trust/rapport) is the main factor which makes me return to a practitioner and this is where my focus will lie. Feedback suggests I'm good to go on the rapport front! I expect my palpation to improve in time and I generally hope to speed up the whole patient encounter straight away. I have managed to widen the variety of techniques I use in clinic this year, but it is a constant effort not to use the old favourites. I think it is really damaging to stick to a few trusted/most easily achieved techniques at this stage and I am always consciously trying to avoid doing this!
In terms of LPA criteria not quite satisfied, to be investigated more later (when time constraints and health allow) I would like to explore the evidence base for manual techniques further and have a few high quality papers at my fingertips to which I can refer people to. It is my experience in the last couple of years that often evidence is conflicting, as I have found recently regarding subjects such as stretching and using ice/heat etc. I aim to at least stay informed about the latest research both "for and against" ideas, so I can at least discuss it and direct people to it, in order that they can make informed decisions. I think I am coming to the conclusion that the "informed decision" is what it's all about and I will be satisfied that I am being professional enough if I can confidently say that there is no evidence that the treatment or advice causes any harm and if there is an absence of acceptable evidence of significantly good results, it is performed/advised on the basis of anecdotal or experiential success and it is then the patients' choice whether to proceed or not.
I also hoped to read up about harmonics, but this will have to wait. Sadly, an external course I did not take, but an approach I see taken by many students and enjoyed by patients. I am also loathe to admit the supine C/T thrust still evades me at this point, but I hope that I achieve it before I leave (whenever that is)! I also have not achieved the O/A thrust since we were told not to do the only version I ever found success with! I hope I can get over this. My other nightmare is the sidelying, posterior SI thrust - success comes and goes as it pleases!
I anticipate practising mainly structurally at first. I would feel like a fraud if I offered cranial treatment right now. Finances permitting, I will take the cranial course, maybe in January. I am definitely interested, but don't think I'll manage September sadly.
I want to learn all the osteopathic lymphatic (pumping) techniques / protocols! The closest I came to them was on the Classical one day course. The classical guys love them. Sadly, my dissertation left me none the wiser! The nature of the exercise and the papers included for review meant that although the results of various lymphatic protocols were discussed, the techniques and their implementation were mentioned only in the methods sections and were not instructive in their description (hence no enlightening tutorial from me on such techniques)! I also want to learn the specialist manual lymphatic drainage techniques for oedemas / lymphoedemas.
There were various areas I did not include in my learning contract that came up over and over again and will be part of my future quest to fill the gaps. Core muscle strengthening, rehab (especially re shoulder, knee and ankle) and strapping, to name just a few. I also need to brush up on my neurology, keep red flag information at the forefront of my mind and become really familiar with NICE guidelines. It is the information related to the less frequent presentations that is easiest to forget and I think it will require an ongoing reasonable effort to keep it familiar. I have little knowledge about sports injuries, but more about pregnancy which I definitely hope to take further.
There are other areas I would also like to explore in the future. I have always been interested in nutrition and I have recently developed an interest in Alexander Technique. I am quite interested in a few of the post graduate courses at the AECC such as diagnostic and treatment use of ultrasound and I would also like to be able to work with animals. I still find myself drawn to traditional Chinese Acupuncture, an original study consideration of mine. However, fee increases certainly rule out another degree for me!
Finally, I am hoping a couple of practice visits I am arranging locally and up North may lead to even a few hours a week employment and I have also made enquiries about room hire nearby.
Although I have had my ups and downs on the course, I still hope to find that this is a rewarding career and I already see it as an opportunity for lifelong learning!
Wednesday, 18 May 2011
Support Clinic
And out of the blue I found myself in support clinic! Having begged to be included last term and then being firmly rebuffed, I am suddenly included without even asking. My grade has dropped I suppose. Should I be even more worried than I already am? I've only managed two weeks out of the three as I was absent once. This is quite useful, but would have been so much better for me last term.
I have been told by one tutor that I am better than I think I am and that I just need to improve my confidence. My confidence was ok though before I started getting Ds! I really feel that there is nothing to feel confident about.
The best thing about this experience is that another tutor has taken me under her wing and seems willing to spend a bit of time with me each week. She has somehow uncovered some real concerns I have about the profession and wants to help me through it before I leave, as she has recognised that I'm just not sure that this is for me and I wonder if I will carry on doing it at all. I sometimes think I might last a year, I sometimes think I might never even start. There, I've said it. I'm glad I've got the chance to talk to her and I am extremely grateful.
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| Support clinic tutor summary |
Saturday, 14 May 2011
Round up
So, have I achieved my goals for the LPA unit?
Revisiting my contract, I anticipated focusing on technique this year and whilst I am happy to say I do think my confidence has improved and my HVT success rate has gone up, I still feel far from the practitioner I hope to become. I do feel that spending the time arranging information visually and trying to bring together in a clinically relevant way anatomy; surface anatomy; examination & special tests; treatment & theory of treatment; differentials (musculoskeletal & systemic) and pathophysiology has been incredibly useful for me, even though it was very time consuming. With hindsight, I see that I was trying to write my own osteopathy (BSO version) "manual" which could really go on forever! In terms of the many modifications we have seen this year (which I have not managed to keep track of well) and the hours I have spent annotating charts and diagrams, it is mildly amusing to me that many students are just learning techniques straight from Laurie Hartmans' manual now! I could have saved myself the effort! I do realise that I have taken the course very literally and approached technique as if there is a "right way", adopting the first year approach for the whole four years in essence. I can see how this has probably held me back now and increased my levels of frustration, but I do need a framework in which to learn and a foundation to spring from! However, this exercise has forced me to organise my information in a better way for me and create links between subjects I seem to have learned quite separately and I have undoubtedly benefited from this. I also know that learning by testing myself (Q&A cards) is the method which suits me best. I only wish I had taken this approach earlier and had also tried to make all my learning clinically relevant from the start (and stuck to one or two books).
The external courses, whilst draining my bank account, have really helped me fill in the gaps that I was so worried about. I hadn't attended any external courses in previous years, as I thought we would learn everything we should know within the degree course and that we were not meant to stray outside the syllabus. I really feel my soft tissue technique has now improved drastically along with my palpation as a result of these courses. Likewise, I found the IMS and ASM electives considerably helped my palpation. Somewhat unexpectedly, it is the obstetrics elective which I credit with improving my HVT success rate this year, particularly C spine, along with the fact that I did twelve weeks of extra hours in Chapman on Fridays and the tutor included technique in his excellent tutorials. There is nothing like one to one tuition and being told everyone has to try it and then getting individual feedback! Along with encouraging the belief that it is EASY! The power of persuasion.
Including examinations again in my technique practice and increasing my knowledge of orthopaedic tests has made a big difference this year. Especially thinking about them from a differentials point of view and ruling conditions in or out. Likewise, practicing dcp more and moving from the somewhat rote fashion of last year to thinking more about justification and the actual meaning of any findings, has proved useful.
I have enjoyed going through case histories in study groups more this year as I have had more to say with regard to differentials as the weeks have gone by! I also think my new approach to pathophysiology is helping - ie: less is more - 3 sentences maximum about as many disorders as possible, rather than lots of detail about certain conditions and none about others! I have brushed up my pharmacology thanks to Darwin Court tutorials (the same tutor as Chapman clinic, forcing me to learn again!) and I am hoping I know enough to get through the CCA. Out in the real world I am happy I will be able to look things up, as the subject is vast and forever developing!
The surprise of the year was how much I learned about HIV patients. Friday tutorials were a wealth of new information and I enjoyed the clinic so much I am doing another eight weeks of extra hours this term! I was not expecting how much the external clinic tutorials would help me in general. EMC on Tuesdays, Darwin Court (Wednesdays) and Chapman (Fridays) really gave me a lot to think about. There were always tutorials in the external clinics and lots of information to be gleaned from them!
I did not spend the time I would have liked going over visceral and head and neck anatomy before the elective classes and I think I was lucky to get through the other revision I managed. The dissertation did take over towards the end of Autumn term and much of the Spring term and If I'm honest, I deeply resented its' intrusion into my precious time! Especially as my CCA results have been awful. My time could have been used much more wisely.
I have not managed to scan in anonymised case histories to back up my written descriptions of the integration of new techniques into clinic and I have to admit that this is because of how difficult it is to get anything photocopied in clinic - eventually I just chose to avoid any hostility by giving up! I felt as if I had used up all my credit asking for photocopies of new patient histories for study groups, the returning CCA patients and the case report patient. I have volunteered to photocopy items myself, but apparently this is not allowed. Ultimately, trying to get things photocopied is an ordeal I never want to go through unless absolutely necessary!
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| Logs of techniques and dcp routines |
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| Record of attendance of electives |
Saturday, 7 May 2011
The final countdown / Return of my patient
Summer term begins and I don't feel like someone who is close to being qualified! In many ways I'm not, with all the hoop jumping that is still left to be done. Seriously, I just don't feel good enough to be unleashed on an unsuspecting clientele. Having said that, it's not just me - I wouldn't want to employ the services of many of my colleagues either! I think I am suffering from a lifetime of seeing experienced practitioners at the top of their game. I suppose it is unrealistic to compare our abilities with what I am used to, but I am disappointed by this really.
Putting this blog together and being able to look back at it, has shown me how much work I have actually done. Bad CCA grades and a general feeling of doom, leave me feeling quite useless and as if I know nothing. At lease I can see that I tried hard! The dissertation was a real distraction though and although I had hoped to enjoy it and learn some techniques from doing it, I found this was simply not the case.
We have had some advice for our next OSPE, some of which was about avoiding the use of old favourite techniques. This is exactly the opposite of the advice I received after the mock OSPE. I am addressing this anyway and hope to widen the variety of techniques I use regularly.
My longest standing patient returned this week, following an operation to remove a cancerous tumour on his kidney. His scar was healing nicely but it seemed huge considering they had only taken part of the kidney away. The cancer was caught so early that there is no need for him to have radiotherapy or chemotherapy. He has been relaxing in the sun and looked incredibly well. The scar shocked me in some way. It was the only sign of the physical and mental trauma he had been through. I came away selfishly feeling my own mortality and thinking about how we are not safe in our own bodies. I am deeply interested it nutritional and other alternative approaches to preventing and treating cancer and I was also reminded that I want to find out more about working in palliative care. I felt really out of sorts for the rest of the day...
Putting this blog together and being able to look back at it, has shown me how much work I have actually done. Bad CCA grades and a general feeling of doom, leave me feeling quite useless and as if I know nothing. At lease I can see that I tried hard! The dissertation was a real distraction though and although I had hoped to enjoy it and learn some techniques from doing it, I found this was simply not the case.
We have had some advice for our next OSPE, some of which was about avoiding the use of old favourite techniques. This is exactly the opposite of the advice I received after the mock OSPE. I am addressing this anyway and hope to widen the variety of techniques I use regularly.
My longest standing patient returned this week, following an operation to remove a cancerous tumour on his kidney. His scar was healing nicely but it seemed huge considering they had only taken part of the kidney away. The cancer was caught so early that there is no need for him to have radiotherapy or chemotherapy. He has been relaxing in the sun and looked incredibly well. The scar shocked me in some way. It was the only sign of the physical and mental trauma he had been through. I came away selfishly feeling my own mortality and thinking about how we are not safe in our own bodies. I am deeply interested it nutritional and other alternative approaches to preventing and treating cancer and I was also reminded that I want to find out more about working in palliative care. I felt really out of sorts for the rest of the day...
Saturday, 30 April 2011
Pathophysiology revisited
I finally finished a task that I started early in the Autumn term which ended up shelved because of the dissertation - At a glance notes for my clinic file, copied from this succinct book of lists! Better late than never. Revision on the go...
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| A book of lists - Perfect! |
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| Patho summary sheets I made for my clinic file (1) |
Patho summary sheets I made for my clinic file (2)
Friday, 22 April 2011
Clinic week / Elective reflection
Well, clinic for 4 days really and only two new patients between them. Clinic is quiet and I am not very focused. I wake up and realise I can spend the time practising technique and suddenly everything is ok again. I really used the empty slots well and practised like mad! Feedback from friends is positive, my soft tissue is much better and my HVTs are more specific, but I still need to be quicker with the impulse!
We have had some time to discuss and demo techniques we learned in electives. Everyone seems to agree it is a real shame we can't try them all. Functional was the only one I didn't want to push for this year and unexpectedly we were taught some in the obstetrics elective. It was only this exposure that made me consider exploring it in future, as I definitely wasn't interested based on the two hours we got in second year. I also attended one S-CS class last term, but then I was off sick and didn't go back. Again, I would consider exploring this in future.
We have had some time to discuss and demo techniques we learned in electives. Everyone seems to agree it is a real shame we can't try them all. Functional was the only one I didn't want to push for this year and unexpectedly we were taught some in the obstetrics elective. It was only this exposure that made me consider exploring it in future, as I definitely wasn't interested based on the two hours we got in second year. I also attended one S-CS class last term, but then I was off sick and didn't go back. Again, I would consider exploring this in future.
Sunday, 17 April 2011
Technique LH Course & OSPE Feedback
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| Certificate of attendance LH Technique Course |
16th & 17th April
Oh the excitement - two days with the legend that is Laurie Hartman! Yes it was good, but I felt so tired and I found it all quite difficult. Clinic starts on Monday and I have spent the last 2 weeks "Easter holiday" running around trying to de-stress, but failing! I felt I couldn't give it my all, but still found it inspirational. Good job I brought the painkillers though - having had no manipulations for two weeks, my poor skeleton was lulled into a false sense of security. I was in agony by the afternoon of day one! I can't believe we are fourth years and will soon be hoping to earn a living out of this. I would pay NOT to be meddled with by one of us! Seriously, how can we be so bad at this?
I can't copy my OSPE feedback into this post and I don't know why. B Low is good enough for me right now, but in a way I am strangely disappointed, as I know I could have actually done better for once! It would have been really nice to do very well at something, it's been a while! The feedback is fair and I am glad I passed as I really wasn't sure how I had fared. I am so glad I didn't do badly. I really needed a bit of a pick me up after the CCAs and this has actually made me feel a bit better.
Sunday, 10 April 2011
Visceral & IMS Electives
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| IMS slides and list (hurrah!) of techniques completed with positive feedback |
a) I did the course so I never have to work for anyone again (depressingly, this appears to be most unlikely).
b) I just didn't get it in second year and couldn't imagine how we could pick it up again in fourth year having had no further experience of it for a whole year.
Thankfully I was wrong on the second count anyway. Suddenly I found I could feel it - my palpation had improved - JOY! We were in a small group, which always makes a huge difference to me and putting anatomy, theory of the techniques and practical application together in the class also really worked for me. Absolutely nothing beats one to one tuition! We are not allowed to use it in clinic though, so the learning ends here for now.
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| Visceral Elective Slides - Including list of techniques - Hurrah! One less list for me to make! |
Sadly I missed quite a few visceral classes due to illness (and ASM), but it appears that if I can just get my hands on the right Jean-Pierre Barral video / DVDs I can most likely catch up and learn at my leisure. That suits me just fine, being a visual type and all. Whilst I am a great admirer of the tutor leading this elective, the class was so large that I got no real benefit from going most of the time. Sadly, this elective was the one I found the least useful because of this, although I will definitely be trying to teach myself the techniques in due course (hopefully from JPB DVDs). The techniques were well worth finding out about. I just really need the attention when it comes to mastering technique though!
Friday, 8 April 2011
Clinic reflection
A patient presented this week with a proper lymphoedematous leg. Hurrah! She had inguinal lymph nodes removed following skin cancer in the leg five years ago. This has confirmed that I really want to learn the specialist manual lymphatic drainage techniques for oedematous conditions (as well as the osteopathic lymphatic pumping techniques which are focused more on immunity). The LEX was heavy and becoming debilitating - she could barely bend it at the knee. There were several other problems, but I was most frustrated by the limb and knowing that there is so much more I want to be able to do for her. I did manage to apply two of the soft tissue techniques I learned in the weekend course in November (VF) though.
I also heard from a colleague who saw a new patient of mine from a couple of weeks ago. Both he and his tutor felt that a completely different diagnosis was more appropriate than the one I came up with (which was actually decided mainly by my tutor, as I genuinely wasn't sure what was going on). They thought that early degeneration of the hip at 51yo in a personal trainer was most unlikely. My tutor had discussed with me that this was the most probable cause of the symptoms at the time. I find situations such as this extremely frustrating and this is exactly what makes me have my doubts about the whole thing!
I dread the 4.40 or 11.40 new patient slot, as I feel there is even less time than usual to discuss ideas and the diagnosis with tutor afterwards. This wouldn't happen at AECC! I did really like the way they booked time with their senior tutors to discuss new patient management plans and get questioned about their diagnoses etc before the patient returned to commence the plan. I had a complex acute patient this week and was not happy at all with the diagnosis I ended up getting signed off at 6.05, but I had no choice and amended it accordingly.
I was also blasted during a returning patient presentation recently, for no real reason other than the sound of my voice I think. It suppose it is just about getting used to tutors again, now we have swapped days, but I felt like a mouse being tossed in the air by a menacing cat. This is something I can laugh off now, but sadly, I realise with hindsight, that actively trying to avoid this sort of encounter in the past has possibly meant I missed out on learning opportunities - even if they did come with this sort of price!
I also heard from a colleague who saw a new patient of mine from a couple of weeks ago. Both he and his tutor felt that a completely different diagnosis was more appropriate than the one I came up with (which was actually decided mainly by my tutor, as I genuinely wasn't sure what was going on). They thought that early degeneration of the hip at 51yo in a personal trainer was most unlikely. My tutor had discussed with me that this was the most probable cause of the symptoms at the time. I find situations such as this extremely frustrating and this is exactly what makes me have my doubts about the whole thing!
I dread the 4.40 or 11.40 new patient slot, as I feel there is even less time than usual to discuss ideas and the diagnosis with tutor afterwards. This wouldn't happen at AECC! I did really like the way they booked time with their senior tutors to discuss new patient management plans and get questioned about their diagnoses etc before the patient returned to commence the plan. I had a complex acute patient this week and was not happy at all with the diagnosis I ended up getting signed off at 6.05, but I had no choice and amended it accordingly.
I was also blasted during a returning patient presentation recently, for no real reason other than the sound of my voice I think. It suppose it is just about getting used to tutors again, now we have swapped days, but I felt like a mouse being tossed in the air by a menacing cat. This is something I can laugh off now, but sadly, I realise with hindsight, that actively trying to avoid this sort of encounter in the past has possibly meant I missed out on learning opportunities - even if they did come with this sort of price!
Wednesday, 6 April 2011
Visit to AECC
This was a real eye opener and a great day out! I wanted to study chiropractic originally, but there wasn't a course in London. I think if I had actually gone to an open day there in the first place, I might have just moved to Bournemouth! The facilities were amazing and they are at a huge advantage being able to learn about and treat children as undergraduates, as well as having a high tech rehabilitation centre run by a physiotherapist, with some seriously state of the art equipment. Students took x rays and wrote their own reports which were marked and corrected by a specialist. This was also enviable. I have little experience of reading imaging. They are even taught how to use ultrasound for diagnostic and treatment purposes. They must save a fortune, given the amount of postgraduate courses they don't need to do!
I thought the way they had 2 hour slots for new patients and performed all dcp exams on everyone was of great benefit, although I did not agree with the lack of treatment at the first visit. All patients were provided with gowns and shorts which I thought was an excellent idea and I would like to do this in future. Their case files were extremely detailed with several standard forms in use and they were organised with dividers, which I felt made them much easier to follow. One of the forms covered consent and all patients had to sign this. I definitely plan on doing this in the future. The students do not mention consent again during the course of treatment, once this form has been signed!
I felt that the time they got to spend with senior tutors (by making appointments with them) discussing cases, diagnoses, clinical reasoning and management plans, was invaluable and something I have missed out on and could really have benefited from if we had such a system here. They had laboratories in their teaching building and I was told that their anatomy lecturer was one of the editors of Gray's Anatomy! They did not go into clinic until fourth year, but I felt this disadvantage was probably outweighed by how advantageous it was to get their dissertations out of the way in third year.
At the moment I really wish I had gone there - but I am aware that the grass is often always greener and I am just exhausted and miserable right now! I am thinking about looking into studying there though, but I imagine fee increases will put a stop to that. It not a realistic idea anyway. They really made us feel welcome and were happy to show us around. Sadly I heard that they were treated badly when they came to BSO and clinic reception were not expecting them!
Interestingly, the students I spoke to did not have any preconceptions about osteopathy and were curious to discuss similarities and differences. My own chiropractor also has this attitude and thinks of the professions as similar. I wonder why osteopaths have such negative views about chiropractors. It is all I hear in clinic from tutors and students alike. I don't understand it!
I am going to investigate Gonstead technique - some of the moves they had were great.
Sunday, 3 April 2011
Balanced ligamentous tension course / TMJ
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| BLT Course attendance certificate |
We were given a manual about TMJ in technique and I can't describe how much this pleases me, so here it is; a prime example of what I have spent all of this time trying to create for every area of the body. This is going to save me lots of time and I might even become quite adept at treating the TMJ as a result, as I've got something to work from straight away when practising! For the second time this year, I pleaded with a tutor to be given any written information at all for technique, but there is nothing available yet. I keep hearing how I am meant to be able to work it out for myself at this level. Fair enough, but what level I wonder - I'm certainly not on it yet! Below it is an example of my hastily scribbled notes from fourth year technique class, that I struggle to decipher afterwards and this year am finding particularly difficult to split into the individual techniques / modifications (as I try to work it all out for myself)!
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A manual - just what I need! Notes from technique class |
Saturday, 2 April 2011
Clinic report & CCA feedback
Clinic reports:
Monday - C High
Thursday - C Med
Again, positive feedback about patient care.
Need to work on differentials, improving knowledge base, direction of treatment & longer term management.
I think I am already tackling these problems the best I can, although I really do need to improve my management plans and somehow teach myself more about stretches and rehab exercises.
CCA - D low
Of course I am grateful to pass, but in addition to my D in the mock, this has destroyed my confidence! I am dreading next time. Usually, I think feedback is fair, but there are a few things I disagree with this time round. I can appreciate that maybe as a reaction to my feedback last time, I was over enthusiastic about referring this patient early on in the encounter. I was obsessed with safety issues and not leaving anything to chance!
However, the external examiner seemed to query my assessment that my patient was an unreliable witness and I firmly stand by this belief. She also mentioned in the notes that I "struggled a bit with the patients' accent" - what an understatement, we could barely understand each other!! Given that my marks have suffered, as I did, "not want to take responsibility for the patient" and the examiner was concerned whether I would have "continued with the process without so much guidance and prompting," I am somewhat uncomfortable that I do still stand by what I did and there is no way I would consider taking this patient on in real life!
It appears in the notes that I was trying to refer because of the fact she had Parkinsons' disease, whereas I was quite clear that it was because of her confusion, night sweats, unexplained weight loss and the lack of mechanical aggravating and relieving factors. The notes state that there is no need to refer as she sees a neurologist every three months - I feel this goes against everything we have been taught about "never to assume." I couldn't have justified not suggesting a referral, on the basis that I assumed the neurologist would know about the above symptoms and would have investigated them independently of treating her Parkinsons.'
I am amused that I am praised for being "honest" about my lack of knowledge about Parkinsons' when all I did was ask to look up the drug (Madopor), which we had been encouraged to do if medications were unfamiliar! I admit though, that my knowledge is limited.
The RP went ok, and it appears that I just really didn't shine in my second NP which was straightforward.
Anyway, better luck next time is what I need and a good helping of hard work in the meantime. I just hope I do not get another situation where I have to decide whether or not to refer after my last two experiences!
CCA Feedback
Monday - C High
Thursday - C Med
Again, positive feedback about patient care.
Need to work on differentials, improving knowledge base, direction of treatment & longer term management.
I think I am already tackling these problems the best I can, although I really do need to improve my management plans and somehow teach myself more about stretches and rehab exercises.
CCA - D low
Of course I am grateful to pass, but in addition to my D in the mock, this has destroyed my confidence! I am dreading next time. Usually, I think feedback is fair, but there are a few things I disagree with this time round. I can appreciate that maybe as a reaction to my feedback last time, I was over enthusiastic about referring this patient early on in the encounter. I was obsessed with safety issues and not leaving anything to chance!
However, the external examiner seemed to query my assessment that my patient was an unreliable witness and I firmly stand by this belief. She also mentioned in the notes that I "struggled a bit with the patients' accent" - what an understatement, we could barely understand each other!! Given that my marks have suffered, as I did, "not want to take responsibility for the patient" and the examiner was concerned whether I would have "continued with the process without so much guidance and prompting," I am somewhat uncomfortable that I do still stand by what I did and there is no way I would consider taking this patient on in real life!
It appears in the notes that I was trying to refer because of the fact she had Parkinsons' disease, whereas I was quite clear that it was because of her confusion, night sweats, unexplained weight loss and the lack of mechanical aggravating and relieving factors. The notes state that there is no need to refer as she sees a neurologist every three months - I feel this goes against everything we have been taught about "never to assume." I couldn't have justified not suggesting a referral, on the basis that I assumed the neurologist would know about the above symptoms and would have investigated them independently of treating her Parkinsons.'
I am amused that I am praised for being "honest" about my lack of knowledge about Parkinsons' when all I did was ask to look up the drug (Madopor), which we had been encouraged to do if medications were unfamiliar! I admit though, that my knowledge is limited.
The RP went ok, and it appears that I just really didn't shine in my second NP which was straightforward.
Anyway, better luck next time is what I need and a good helping of hard work in the meantime. I just hope I do not get another situation where I have to decide whether or not to refer after my last two experiences!
CCA Feedback
Wednesday, 23 March 2011
CCA and Dissertation
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| My lifes' work, my legacy - ensuring I will be remembered forever |
With my extension, the dissertation finally went in this morning. Joy turned to anguish though, as my CCA in the afternoon presented me with a patient of the variety I can only describe as "my worst nightmare." We shall see. I am not going to speculate on this one.
Friday, 18 March 2011
Hand and Wrist
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| Annotated Diagrams; Technique and Clinical anatomy revision cards - Wrist |
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| Annotated differentials textbook - Hand & finger |
Friday, 11 March 2011
ASM Elective
I have arranged to attend this elective as an extra and I am so grateful for this. It is absolutely brilliant! The group isn't too big and the techniques are taught with very specific instructions. Perfect for me. The theory at the beginning of the class is extremely useful when considering any thrusts. I have also noticed that really concentrating on minimal lever techniques is helping my palpation enormously. I'm so glad I didn't miss this! Sadly, we can't get our hands on DHs amazing slides - they are not going on bone! I am struggling to write it all down quickly enough.
Friday, 4 March 2011
Chapman clinic - Extra hours
This term I am doing 12 weeks of extra hours in Chapman clinic, as I want to get more hands on experience and I had some hours to make up. This is a very happy accident indeed (I could have ended up anywhere doing the hours). The tutorials are every week and they are very informative. The patients are usually known to the tutors and there is more time spent treating and less time spent presenting. There are also plenty of opportunities to HVT under the expert eye of a patient tutor! I have also found that this extra time allows me to ask for more patient feedback which is proving really useful.
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| Tutorial notes - HIV (Chapman clinic) |
Friday, 25 February 2011
Practice visit - as a patient
I went to see a very nice osteopath in Fulham who came recommended for his naturopathy skills and I thought I might be making a useful contact. However, I was double booked, the sink in the treatment room was dirty, the treatment and preamble were quite odd and he looked scruffy. He did use applied kinesiology though, which I have come across before and found rather interesting, even though it is subject to controversy. I didn't go back. Enough said. Important lesson though. First impressions count!
I have also done this previously with an osteopath in Ealing, who an ex colleague used to visit. He didn't manage to successfully HVT my neck, when I went in desperation with a facet lock, a relatively common problem for me. Admittedly, I only went because my chiropractor wasn't around that day. After a few attempts he announced that it didn't want to go and moved on to some soft tissue. This was so frustrating and a total waste of money. I vowed to really work on my C spine HVTs as a result!
Continuing to reflect on what I have learned from other practitioners, I had some reflexology lately with someone new. My regular therapist (in the days when I was working) was on maternity leave. It was terrible and I was so disappointed, as it was meant to be a well deserved treat. Her hands felt tense and inexperienced and her routine was not smooth and was quite uncomfortable. I would never go back to her. It reminded me of a massage I had in a similar situation a couple of years ago. I must make as much effort as I can to avoid ending up like this myself! This terrifies me more than anything - people not coming back because I wasn't any good. I can't even bear to think about it. How did I end up feeling like this?
I have also done this previously with an osteopath in Ealing, who an ex colleague used to visit. He didn't manage to successfully HVT my neck, when I went in desperation with a facet lock, a relatively common problem for me. Admittedly, I only went because my chiropractor wasn't around that day. After a few attempts he announced that it didn't want to go and moved on to some soft tissue. This was so frustrating and a total waste of money. I vowed to really work on my C spine HVTs as a result!
Continuing to reflect on what I have learned from other practitioners, I had some reflexology lately with someone new. My regular therapist (in the days when I was working) was on maternity leave. It was terrible and I was so disappointed, as it was meant to be a well deserved treat. Her hands felt tense and inexperienced and her routine was not smooth and was quite uncomfortable. I would never go back to her. It reminded me of a massage I had in a similar situation a couple of years ago. I must make as much effort as I can to avoid ending up like this myself! This terrifies me more than anything - people not coming back because I wasn't any good. I can't even bear to think about it. How did I end up feeling like this?
Disappointment - what a waste of money
An integrated approach to the inter-connected tissues (LEX) (VF) 26th & 27th
I am devastated, I can't go to this course because I have to work on the dissertation. It can't be helped, I haven't been well lately. I am GUTTED. £90 and I can't sell the ticket. I've even tried to give it away, but everyone is in the same miserable boat!
I am devastated, I can't go to this course because I have to work on the dissertation. It can't be helped, I haven't been well lately. I am GUTTED. £90 and I can't sell the ticket. I've even tried to give it away, but everyone is in the same miserable boat!
Sunday, 20 February 2011
Chi Kung for osteopaths / EMC / Manus reflection / Pilates
It was getting far too close to the dissertation deadline to be doing anything enjoyable, but I had booked this ages ago. It was ok, but I think I expected something totally different. I wasn't in the mood to pant heavily in my chair, then get up and jump up and down, but it was definitely invigorating! Despite being my age, I had to stifle childish laughter half the time and I felt like a nasty old cynic. I was in fact very interested, but the timing was all wrong - I really should have stayed at home with my life's work... I owe it to devotees of lymphatic drainage techniques everywhere.
I am LOVING EMC. Our tutor is incredibly giving and her enthusiasm is inspirational. It is also a great opportunity to use the techniques from the obstetrics elective.
19/2 Manus reflection
I have managed to attend the Manus talks with Rupert Sheldrake and Averille Morgan this term. I appreciated what Averille was saying, but the presentation wasn't really my cup of tea. Rupert Sheldrake, however, blew me away with his morphic resonance theory. I will not be attempting to explain it here, but I am definitely going to buy his books. I am extremely susceptible to this sort of discussion, but I do find it fascinating and here was a scientist with what sounded like some hard evidence, which usually is what is lacking, Amazon, here I come.
Pilates
I have been attending a 6 weeks beginners course and I can really see what all the fuss is about. I definitely want to continue with this and would like to be able to teach some of it to patients one day.
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| Certificate of attendance - 1 day Chi kung course |
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| EMC tutorial notes - Fantastic! |
19/2 Manus reflection
I have managed to attend the Manus talks with Rupert Sheldrake and Averille Morgan this term. I appreciated what Averille was saying, but the presentation wasn't really my cup of tea. Rupert Sheldrake, however, blew me away with his morphic resonance theory. I will not be attempting to explain it here, but I am definitely going to buy his books. I am extremely susceptible to this sort of discussion, but I do find it fascinating and here was a scientist with what sounded like some hard evidence, which usually is what is lacking, Amazon, here I come.
Pilates
I have been attending a 6 weeks beginners course and I can really see what all the fuss is about. I definitely want to continue with this and would like to be able to teach some of it to patients one day.
Friday, 18 February 2011
Shoulder / Elbow
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| Annotated Diagrams; Technique and Clinical anatomy revision cards - Elbow |
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| Annotated differentials textbook - Shoulder |
Friday, 11 February 2011
Clinic reflection
I have had a few interesting situations in clinic since term began.
The most memorable being my worst patient encounter ever! I innocently approached a re-exam for a long term patient by starting with a completely new history. The lady was booked in for the assessment by my colleague who was unexpectedly unable to take her at the last minute. It transpired that she did not want this to be happening at all and did not want to answer any questions! She felt let down historically by the medical profession and undeniably had suffered some unfortunate side effects of medical treatment and it became obvious early on that there were yellow flag issues and she hadn't really been taken care of properly. She was extremely hostile and aggressive in her manner and I initially tried to call a halt after about ten minutes. We decided to carry on, but again, after another twenty minutes I stopped taking the history for good this time. I had been on the receiving end of this womans' rage and frustration for too long and she was crying now anyway. A failure of reflective listening! I calmed things down and brought in a tutor who decided we would treat conservatively and worry about the re exam later. I was glad when she left and I referred her back to my colleague, having fully debriefed him!
This is the only time I have really struggled with patient empathy. During the encounter I just found it unbelievable that someone would behave like that and not offer an apology. I felt like an emotional punchbag. I was very disturbed by this encounter and although I can be objective and have some sympathy for the state she has ended up in, I am left with a residual feeling of disgust. I need to work on being prepared for other situations like this so that they do not affect me personally. I should have no residual feeling about this encounter. I feel that I wasn't detached enough. However, it is of slight amusement to me that during a calmer dialogue when she genuinely opened up, I had asked her about her support network (she didn't have one) and suggested that maybe talking these issues through with a professional would be beneficial, only to be BELLOWED at again. The sound of her shouting at me that, "talking about it all was the problem," is still ringing in my ears. I am scarred for life!
The most memorable being my worst patient encounter ever! I innocently approached a re-exam for a long term patient by starting with a completely new history. The lady was booked in for the assessment by my colleague who was unexpectedly unable to take her at the last minute. It transpired that she did not want this to be happening at all and did not want to answer any questions! She felt let down historically by the medical profession and undeniably had suffered some unfortunate side effects of medical treatment and it became obvious early on that there were yellow flag issues and she hadn't really been taken care of properly. She was extremely hostile and aggressive in her manner and I initially tried to call a halt after about ten minutes. We decided to carry on, but again, after another twenty minutes I stopped taking the history for good this time. I had been on the receiving end of this womans' rage and frustration for too long and she was crying now anyway. A failure of reflective listening! I calmed things down and brought in a tutor who decided we would treat conservatively and worry about the re exam later. I was glad when she left and I referred her back to my colleague, having fully debriefed him!
This is the only time I have really struggled with patient empathy. During the encounter I just found it unbelievable that someone would behave like that and not offer an apology. I felt like an emotional punchbag. I was very disturbed by this encounter and although I can be objective and have some sympathy for the state she has ended up in, I am left with a residual feeling of disgust. I need to work on being prepared for other situations like this so that they do not affect me personally. I should have no residual feeling about this encounter. I feel that I wasn't detached enough. However, it is of slight amusement to me that during a calmer dialogue when she genuinely opened up, I had asked her about her support network (she didn't have one) and suggested that maybe talking these issues through with a professional would be beneficial, only to be BELLOWED at again. The sound of her shouting at me that, "talking about it all was the problem," is still ringing in my ears. I am scarred for life!
Friday, 4 February 2011
The tragic emasculation of british osteopathy (MW)
4/2 Mervyn Waldman course
A whole day of inspiration. I must get hold of the slides. Lymphatic pumping techniques demonstrated live! (Relevant to my dissertation). Amongst other things...
The presentation was based on Stills' two fundamental premises of disease:
1. There is often a somatic component to disease
2. Effective manual treatment of the somatic component, may play a significant role in enhancing immune response and recovery from disease
It was an incredibly interesting approach and right up my street. This couldn't have come at a better time - I am really flagging and feared my enthusiasm was lost forever!
3/2 Such an inspirational Manus talk by Mervyn Waldman that I immediately enrolled on his one day course tomorrow!
A whole day of inspiration. I must get hold of the slides. Lymphatic pumping techniques demonstrated live! (Relevant to my dissertation). Amongst other things...
The presentation was based on Stills' two fundamental premises of disease:
1. There is often a somatic component to disease
2. Effective manual treatment of the somatic component, may play a significant role in enhancing immune response and recovery from disease
It was an incredibly interesting approach and right up my street. This couldn't have come at a better time - I am really flagging and feared my enthusiasm was lost forever!
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| Paper recommended by Mervyn Waldman - very exciting! |
3/2 Such an inspirational Manus talk by Mervyn Waldman that I immediately enrolled on his one day course tomorrow!
Friday, 28 January 2011
Cervical Spine
I really want to be good at these techniques. General cervical spine is passable, although left handed techniques are weak; C/T is coming along, but the supine HVT is proving elusive and as for O/A, I found a way that worked for me, thanks to a patient tutor, but then we were told we weren't allowed to use it. DISASTER! I have had no success since. This is torture.
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| O/A - Annotated diagrams / notes |
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| C/T - Annotated diagrams / Notes / Technique summary |
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| Annotated diagrams; Technique and Clinical anatomy revision cards - Cervical spine |
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| Annotated differentials textbook - Cervical spine |
Friday, 21 January 2011
EMC Tutorial
Again, I find myself preparing for a tutorial, along with my colleagues in EMC this time. Public speaking even in a small group terrified the life out of me in first year. If there is one change in myself that I have really noticed, it is that this is getting easier. I still hated it at the end of third year though and just watch me at the end of this year! No doubt I will be eating my words. Something has changed though, I just can't put my finger on it. My contribution is below:
Pre-eclampsia – the most common of the dangerous pregnancy complications
Pre-eclampsia – the most common of the dangerous pregnancy complications
AN EMERGENCY
Can affect mother & child
Typically occurs after the 20th week, is considered early before the 32nd week & can occur up to 6 weeks post partum
3 main characteristics:
1. Sudden hypertension
2. Proteinuria - Large amounts of protein in the urine due to glomerular endothelial cell swelling
3. Generalised oedema
Other signs & symptoms can include:
Blurred vision
Headaches
Pre-eclampsia may be related to an autoimmune or allergic reaction. Substances from the placenta can cause endothelial dysfunction in the maternal blood vessels of susceptible women. While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium, kidneys and liver with the release of vasoconstrictive factors being secondary to the original damage.
Many studies have suggested the importance of a woman's immunological tolerance to her baby's father, whose genes are present in the young fetus and its placenta and which may pose a challenge to her immune system
Continued exposure to a partner's semen has a strong protective effect against pre-eclampsia, largely due to the absorption of several immune modulating factors present in seminal fluid.
Long periods of sexual cohabitation with the same partner fathering a woman's child significantly decreased her chances of suffering pre-eclampsia. As one early study described, "although preeclampsia is a disease of first pregnancies, the protective effect of multiparity is lost with change of partner.
The term Eclampsia is used when the condition is also associated with convulsions & coma
Friday, 14 January 2011
Acupuncture / Inspiration
Occasionally I see my acupuncturist - what used to be a monthly blow out, is now a very rare treat - or emergency! This is a lesson in how I would like to be as a practitioner and this time I am viewing it as a practice visit. I can't describe what this experience does for me. When I ask how I can learn, he just says it is all about intention! Oh, and lots of meditation and chi kung. I suspect there is more to it!
Interestingly, in seven years, I have never asked what he is doing or why and he never volunteers the information either! It is a very peaceful 45 minutes. Serenity. This is the effect I want to have on my patients.
Interestingly, in seven years, I have never asked what he is doing or why and he never volunteers the information either! It is a very peaceful 45 minutes. Serenity. This is the effect I want to have on my patients.
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