101 Things You Wish You Knew Before Starting Medical School

Simple enough, here are 101 things you wish you knew before starting medical school.

  1. If I had known what was going to be like , i would never have done it.
  2. You’ll study more than you ever have in your life.
  3. Only half of your class will be in the top 50%. You have a 50% chance of being in the top half of your class. Get used to it now.
  4. You don’t need to know anatomy before school starts. Or pathology. Or physiology.
  5. Third year rotations will suck the life out you.
  6. Several people from your class will have sex with each other. You might be one of the lucky participants.
  7. You may discover early on that medicine isn’t for you.
  8. You don’t have to be AOA or have impeccable board scores to match somewhere ”“ only if you’re matching into radiology.
  9. Your social life may suffer some.
  10. Pelvic exams are teh suck.
  11. You won’t be a medical student on the surgery service. You’ll be the retractor bitch.
  12. Residents will probably ask you to retrieve some type of nourishment for them.
  13. Most of your time on rotations will be wasted. Thrown away. Down the drain.
  14. You’ll work with at least one attending physician who you’ll want to beat the shit out of.
  15. You’ll work with at least three residents who you’ll want to beat the shit out of.
  16. You’ll ask a stranger about the quality of their stools.
  17. You’ll ask post-op patients if they’ve farted within the last 24 hours.
  18. At some point during your stay, a stranger’s bodily fluids will most likely come into contact with your exposed skin.
  19. Somebody in your class will flunk out of medical school.
  20. You’ll work 14 days straight without a single day off. Probably multiple times.
  21. A student in your class will have sex with an attending or resident.
  22. After the first two years are over, your summer breaks will no longer exist. Enjoy them as much as you can.
  23. You’ll be sleep deprived.
  24. There will be times on certain rotations where you won’t be allowed to eat.
  25. You will be pimped.
  26. You’ll wake up one day and ask yourself is this really what you want out of life.
  27. You’ll party a lot during the first two years, but then that pretty much ends at the beginning of your junior year.
  28. You’ll probably change your specialty of choice at least 4 times.
  29. You’ll spend a good deal of your time playing social worker.
  30. You’ll learn that medical insurance reimbursement is a huge problem, particularly for primary care physicians.
  31. Nurses will treat you badly, simply because you are a medical student.
  32. There will be times when you’ll be ignored by your attending or resident.
  33. You will develop a thick skin. If you fail to do this, you’ll cry often.
  34. Public humiliation is very commonplace in medical training.
  35. Surgeons are assholes. Take my word for it now.
  36. OB/GYN residents are treated like shit, and that shit runs downhill. Be ready to pick it up and sleep with it.
  37. It’s always the medical student’s fault.
  38. Gunner is a derogatory word. It’s almost as bad as racial slurs.
  39. You’ll look forward to the weekend, not so you can relax and have a good time but so you can catch up on studying for the week.
  40. Your house might go uncleaned for two weeks during an intensive exam block.
  41. As a medical student on rotations, you don’t matter. In fact, you get in the way and impede productivity.
  42. There’s a fair chance that you will be physically struck by a nurse, resident, or attending physician. This may include slapped on the hand or kicked on the shin in order to instruct you to “move” or “get out of the way.”
  43. Any really bad procedures will be done by you. The residents don’t want to do them, and you’re the low man on the totem pole. This includes rectal examinations and digital disimpactions.
  44. You’ll be competing against the best of the best, the cream of the crop. This isn’t college where half of your classmates are idiots. Everybody in medical school is smart.
  45. Don’t think that you own the world because you just got accepted into medical school. That kind of attitude will humble you faster than anything else.
  46. If you’re in it for the money, there are much better, more efficient ways to make a living. Medicine is not one of them.
  47. Anatomy sucks. All of the bone names sound the same.
  48. If there is anything at all that you would rather do in life , don’t go into medicine.
  49. The competition doesn’t end after getting accepted to medical school. You’ll have to compete for class rank, awards, and residency. If you want to do a fellowship, you’ll have to compete for that too.
  50. You’ll never look at weekends the same again.
  51. VA hospitals suck. Most of them are old, but the medical records system is good.
  52. Your fourth year in medical school will be like a vacation compared to the first three years. It’s a good thing too, because you’ll need one.
  53. Somebody in your class will be known as the “highlighter whore.” Most often a female, she’ll carry around a backpack full of every highlighter color known to man. She’ll actually use them, too.
  54. Rumors surrounding members of your class will spread faster than they did in high school.
  55. You’ll meet a lot of cool people, many new friends, and maybe your husband or wife.
  56. No matter how bad your medical school experience was at times, you’ll still be able to think about the good times. Kind of like how I am doing right now.
  57. Your first class get-together will be the most memorable. Cherish those times.
  58. Long after medical school is over, you’ll still keep in contact with the friends you made. I do nearly every day.
  59. Gunners always sit in the front row. This rule never fails. However, not everyone who sits in the front row is a gunner.
  60. There will be one person in your class who’s the coolest, most laid back person you’ve ever met. This guy will sit in the back row and throw paper airplanes during class, and then blow up with 260+ Step I’s after second year. True story.
  61. At the beginning of first year, everyone will talk about how cool it’s going to be to help patients. At the end of third year, everybody will talk about how cool it’s going to be to make a lot of money.
  62. Students who start medical school wanting to do primary care end up in dermatology. Those students who start medical school wanting to do dermatology end up in family medicine.
  63. Telling local girls at the bar that you’re a medical student doesn’t mean shit. They’ve been hearing that for years. Be more unique.
  64. The money isn’t really that good in medicine. Not if you look at it in terms of hours worked.
  65. Don’t wear your white coat into the gas station, or any other business that has nothing to do with you wearing a white coat. You look like an ass, and people do make fun of you.
  66. Don’t round on patients that aren’t yours. If you round on another student’s patients, that will spread around your class like fire after a 10 year drought. Your team will think you’re an idiot too.
  67. If you are on a rotation with other students, don’t bring in journal articles to share with the team “on the fly” without letting the other students know. This makes you look like a gunner, and nobody likes a gunner. Do it once, and you might as well bring in a new topic daily. Rest assured that your fellow students will just to show you up.
  68. If you piss off your intern, he or she can make your life hell.
  69. If your intern pisses you off, you can make his or her life hell.
  70. Don’t try to work during medical school. Live life and enjoy the first two years.
  71. Not participating in tons of ECs doesn’t hurt your chances for residency. Forget the weekend free clinic and play some Frisbee golf instead.
  72. Don’t rent an apartment. If you can afford to, buy a small home instead. I saved $200 per month and had roughly $30,000 in equity by choosing to buy versus rent.
  73. Your family members will ask you for medical advice, even after your first week of first year.
  74. Many of your friends will go onto great jobs and fantastic lifestyles. You’ll be faced with 4 more years of debt and then at least 3 years of residency before you’ll see any real earning potential.
  75. Pick a specialty based around what you like to do.
  76. At least once during your 4 year stay, you’ll wonder if you should quit.
  77. It’s amazing how fast time flies on your days off. It’s equally amazing at how slow the days are on a rotation you hate.
  78. You’ll learn to be scared of asking for time off.
  79. No matter what specialty you want to do, somebody on an unrelated rotation will hold it against you.
  80. A great way to piss of attendings and residents are to tell them that you don’t plan to complete a residency.
  81. Many of your rotations will require you to be the “vitals bitch.” On surgery, you’ll be the “retractor bitch.”
  82. Sitting around in a group and talking about ethical issues involving patients is not fun.
  83. If an attending or resident treats you badly, call them out on it. You can get away with far more than you think.
  84. Going to class is generally a waste of time. Make your own schedule and enjoy the added free time.
  85. Find new ways to study. The methods you used in college may or may not work. If something doesn’t work, adapt.
  86. Hospitals smell bad.
  87. Subjective evaluations are just that ”“ subjective. They aren’t your end all, be all so don’t dwell on a poor evaluation. The person giving it was probably an asshole, anyway.
  88. Some physicians will tell you it’s better than it really is. Take what you hear (both positive and negative) with a grain of salt.
  89. 90% of surgeons are assholes, and 63% of statistics are made up. The former falls in the lucky 37%.
  90. The best time of your entire medical school career is between the times when you first get your acceptance letter and when you start school.
  91. During the summer before medical school starts, do not attempt to study or read anything remotely related to medicine. Take this time to travel and do things for you.
  92. The residents and faculty in OB/GYN will be some of the most malignant personalities you’ve ever come into contact with.
  93. Vaginal deliveries are messy. So are c-sections. It’s just an all-around blood fest if you like that sort of thing.
  94. Despite what the faculty tell you, you don’t need all of the fancy equipment that they suggest for you to buy. All you need is a stethoscope. The other equipment they say you “need” is standard in all clinic and hospital exam rooms. If it’s not standard, your training hospital and clinics suck.
  95. If your school has a note taking service, it’s a good idea to pony up the cash for it. It saves time and gives you the option of not attending lecture.
  96. Medicine is better than being a janitor, but there were times when I envied the people cleaning the hospital trash cans.
  97. Avoid surgery like the plague.
  98. See above and then apply it to OB/GYN as well.
  99. The money is good in medicine, but it’s not all that great especially cnsidering the amount of time that you’ll have to work.

100. One time an HIV+ patient ripped out his IV and then “slung” his blood at the staff in the room. Go, go infectious disease.
101. Read Med School Hell now, throughout medical school, and then after you’re done. Then come back and tell me how right I am.

Photo Credit: Background vector created by Macrovector – Freepik.com

The Best Movies For Doctors And Medical Students

The list contains more than 100 films , each medical student and doctor should see

Enjoy !

1- Patch Adams

2- Wit

3- Philadelphia

4- Terms of Endearment

5- Leaving Las Vegas

6- The Doctor

7- Awakenings

8- The Fisher King

9- Something the Lord Made

10- And the Band Played On

11- One Flew Over the Cuckoo’s Nest

12- The Painted Veil

13- The Race for the Double Helix

14- Article 99

15- People Will Talk

16- Malice

17- Sicko

18- John Q

19- The Men

20- My Left Foot: The Story of Christy Brown

21- Red Beard

22- My Own Country

23- The Hospital

24- Britannia Hospital

25- Bringing Out the Dead

26- The gifted hands of Ben Carson

27- Pathology

28- Syndromes and a Century

29- Doctor Dolittle

30- Doctor Zhivago

31- Dr. No

32- Persona

33- House Calls

34- The Barbarian Invasions

35- The Death of Mr. Lazarescu

36- High Anxiety

37- No Way Out

38- Whirlpool

39- Spellbound

40- The Abominable Dr. Phibes

41- Dr. Phibes Rises Again

42- Doctor Detroit

43- Red Angel

44- Tales from the Gimli Hospital

45- Nurse Betty

46- Night Nurse

47- Doctor in the House

48- Doctor at Sea

49- Doctor at Large

50 – Carry On Nurse

51- The Kingdom

52- Stitches

53- Medicine Man

54- The Great Moment

55- Oh Doctor

56- The Island of Dr. Moreau

57- Tombstone

58- Dead Ringers

59- MASH

60- Extraordinary Measures

61- Obsessed

62- dragonfly

63- City Of Angels

64- Dr. Jekyll and Mr. Hyde

65- Malice

66- Alien

67- The Last King of Scotland

68- The Andromeda Strain

69- Coma

70- Anatomy

71- Anatomy 2

72- Flatliners

73- Dr. Giggles

74- The Dentist

75- Cold Prey 2

76- Sick Nurses

77- Dark Floor

78- Visiting Hours

79- Rabid

80- Infection

81- Blessed

82- Death Knows Your Name

83- Body Parts

84- Re-Animator

85- Extreme Measures

86- Dead Ringers

87- The Clinic

88- Return of the Living Dead: Rave to the Grave

89- Shutter Island

90- Jacob’s Ladder

91- Outbreak

92- Repo! The Genetic Opera

93- Frankenstein

94- The Grudge

95- Boo

96- John Q

97- No Strings Attached

98- Bad Medicine

99- Doc Hollywood

100- Hysteria

101- Lorenzo’ s oil

102- My sister’s keeper

103- The Lake House

104- Living proof

105- The Impossible

106- The Elephant Man

107- The English Patient

108- Just Like Heaven

109- Django Unchained

110- Errors of the Human Body

111- The World War Z

112- Las Confesiones Del Doctor Sachs

113- American Mary

114- Side Effects

115- The Diving Bell and the Butterfly

116- Restoration

117- Gabrielle

118- The Good Doctor

119- Contagion

120 – The Physician

121 – St. Giuseppe Moscati: Doctor to the Poor

122- Elysium

123- Gattaca

124- Blade Runner

125- Brazil

126- Cloud Atlas

127- A.I. Artificial Intelligence

128- Eternal Sunshine of the Spotless Mind

129- Beautiful Mind

130- Forbidden Planet

131- Inception

132- Prometheus

133- Robot & Frank

134- The Fifth Element

135- City Of Joy

136- Blindness

137- The Sixth Sense

138- Master & Commander (Paul Bettany amputation scene!)

139- Nine Months

140- Arachnophobia

141- Outbreak

142- Molly (a personal fave)

143- Nell

144- Cider House Rules

145- The Fugitive

146- Young Frankenstein.

Did i miss some?

10 Tips To Be A Successful Doctor

New Law Allows Med School Grads to Work as 'Assistant Physicians'

1- Read more : Every day there are new medical studies , new diseases , new drugs … etc , if you want to be a successful doctor you should read more everyday.

2- Details : Pay attention to details , you may diagnose a case with only one hidden word or sign.

3- Money is not everything : You are a physician , It is not an ordinary job you are treating with humans.

4- Ambitious : Ambition has no limit and you should renew your ambition to renew your success.

5- Humility : Respect others , even if you are excellent people hate conceited physicians , also even if you are excellent young doctors may know what you dont know.

6- Responsibility : Be responsible in every action you make as we said before it is not an ordinary job.

7- Communication skills : If you have time you can take a communication skills course , you should deliver good and bad news or advises for patients in a right manner.

8- Time management : You should manage your time between your work and your family and yourself , you are not a machine , Enjoy your life.

9- Be Patient : Dont hurry up , If you are good doctor you will be famous and you will be successful.

10- Marketing : You should search about new ways of medical marketing so people can find you.

Ten Ways To Be A Good Medical Student

1. Be An Excellent Manager of Your Own Time
Medical school will overwhelm you. In the four years it will take you to get your MD, you will be presented with more information that you must master than you might have thought possible, even if you did attend a rigorous pre-med program. Accordingly, the first tip to being a good medical student is to develop time-management skills.

2. Be Friends With More Experienced Medical Students
Making connections early in your med school career with students who have been around longer than you can be invaluable. You can learn from their mistakes instead of making them on your own.

3. Be Respectful of Your Own Health
During this overwhelming time, you will be taxing your physical and mental resources to stay on top of your studies. While it’s important that you do well, of course, you must balance your quest for excellence with a commitment to maintaining your health.

4. Be Respectful of The Undertaking
Becoming a doctor is one of the most important things a person can do. Respect this undertaking, and understand that the other aspects of your life (anything non-med-school related) are going to have to take a back seat for a while. A long while.

5. Hit The Books Hard and Often
Get to love studying if you don’t already. There’s only one way to master the amount of information you need to when people’s lives are in your hands, and that’s to immerse yourself in it.

6.Play To Your Strengths, But Don’t Be Limited To Them
Medical school is like any other kind of school in some ways — it’s a learning experience. Do engage in learning opportunities that will showcase your strengths, but also look for ways to grow, to build on areas where you might not be as strong.

7. Choose Your Specialization ASAP
The earlier you can decide about which area of medicine you’d like to practice, the earlier you can become an expert in this area.
8. Find Mentors In Your Field Of Choice
Before you decide on a specialization, talk to the experienced students you know about what they think. Talk to doctors currently practicing in the field that appeals to you. Talk to your instructors. Make professional connections with people who are already doing the kinds of things you want to be doing after you’re out of school.

9. Write As Much As You Can
Med school may be too early to think about publishing your work, but if you are looking for prestige in your field, plan on publishing in the future. The best way to get publication worthy is to write what you can, perhaps by helping already publishing doctors prepare articles.

10. Take The Occasional Break
Good luck with this one!

Ten Ways To Be A Good Medical Student

1. Be An Excellent Manager of Your Own Time
Medical school will overwhelm you. In the four years it will take you to get your MD, you will be presented with more information that you must master than you might have thought possible, even if you did attend a rigorous pre-med program. Accordingly, the first tip to being a good medical student is to develop time-management skills.

2. Be Friends With More Experienced Medical Students
Making connections early in your med school career with students who have been around longer than you can be invaluable. You can learn from their mistakes instead of making them on your own.

3. Be Respectful of Your Own Health
During this overwhelming time, you will be taxing your physical and mental resources to stay on top of your studies. While it’s important that you do well, of course, you must balance your quest for excellence with a commitment to maintaining your health.

4. Be Respectful of The Undertaking
Becoming a doctor is one of the most important things a person can do. Respect this undertaking, and understand that the other aspects of your life (anything non-med-school related) are going to have to take a back seat for a while. A long while.

5. Hit The Books Hard and Often
Get to love studying if you don’t already. There’s only one way to master the amount of information you need to when people’s lives are in your hands, and that’s to immerse yourself in it.

6.Play To Your Strengths, But Don’t Be Limited To Them
Medical school is like any other kind of school in some ways — it’s a learning experience. Do engage in learning opportunities that will showcase your strengths, but also look for ways to grow, to build on areas where you might not be as strong.

7. Choose Your Specialization ASAP
The earlier you can decide about which area of medicine you’d like to practice, the earlier you can become an expert in this area.

8. Find Mentors In Your Field Of Choice
Before you decide on a specialization, talk to the experienced students you know about what they think. Talk to doctors currently practicing in the field that appeals to you. Talk to your instructors. Make professional connections with people who are already doing the kinds of things you want to be doing after you’re out of school.

9. Write As Much As You Can
Med school may be too early to think about publishing your work, but if you are looking for prestige in your field, plan on publishing in the future. The best way to get publication worthy is to write what you can, perhaps by helping already publishing doctors prepare articles.

10. Take The Occasional Break
Good luck with this one!

Love Syndrome

Aetiology : Unkown

Age of Onset : Teenage. Recent studies
have shown that it may affect people upto 25 years of age.

Risk Factors : The age itself is the major risk factor. Others include
(a) Co-education
(b) Cell Phones
(c) Movies
(d) Internet Of these the part played by the cell phones is note worthy.

Pathology
Multi Organ System Failure

Clinical Features

Symptoms
A) The most common presenting feature is
throbbing pain in the heart often described by the patient as sweet pain.
B) Loss of appetite.
C) Sleeplessness.
D) Day dreaming
E) Disinterest in any type of work. There is a danger of patient being transformed into a
poet.

Signs
A) Very much dilated pupil (In search of his sweet
heart).
B) Blushing of cheeks (mainly seen in girls).
C) On Auscultation:
The First Heart Sound is heard as LOVE instead of LUB.
D) Smiling to self.

Pathogenesis and Clinical Course
The Disease is Gradual in onset. The patient presents with vague symptoms like loss of appetite,
sleeplessness, etc., As time progress mutli organ system involvement occurs with
varied symptoms. The symptoms are aggravated at the sight of patients sweet
heart. The sight of patients love causes the contraction of the radial fibres of
the iris muscle leading to the dilation of the pupil. The eyes remain wide open
and cease to blink. The Zygomaticus major muscle automatically contarcts and the
patient smiles (Smile at Sight Phenomenon). As the patient approaches his sweet
heart, action potentials are generated at an irregular rate in the heart and the
normal rhythm of the heart is lost. Microscopic examination of the cardiac
muscle reveals the presence of abnormal pacemaker tissue at certain areas called
the ROMANTIC SPOTS that are responsible for the lost rhythm of the Heart. The
patient feels agitated, and a throbbing pain develops in the heart. The
characteristc feature of the pain that patient wants to feel it more and more.
In advanced stages, the brain is affected. If not treated properly, the patient
may go bad.

Treatment
Marriage Therapy holds promise of 100% cure rates. If is effective only after 22 years of age. If performed early,
it may lead to adverse reactions.

Preventive Measures
Several attempts have been made to prevent the disease. The WLO (World Love
Organization) expert committee has finally declared that the disease is
inevitable during the age group and its prevention is literally impossible. Any
attempts to interrupt the normal course of the disease may lead to more severe
from of disease. So interventional measures are highly contraindicated for this
disease.

How Much Do Doctors Really Make?

Taking into consideration the explosive growth of human population globally, having reached a staggering 7.5 billion last year, one profession we can’t ever get enough of are medical doctors. With third world countries contributing to a major chunk of the populations, doctors are needed more than ever to counter and eradicate prevalent diseases that underdeveloped or even well developed countries find themselves up against. Did you know that doctors are among the highest paid professionals in the United States of America? Software engineers, lawyers along with other professions considered prestigious have a pay scale below that of medical doctors.
Ailments and illnesses are and have always been a part of the human condition which is why doctors can never run out of job openings. This high demand is represented by the sky high salaries that doctors receive. Doctor’s salaries vary drastically according to their specialization and area of practice. A doctor can earn about $156,000 a year as a pediatrician to about $315,000 as a radiologist or orthopedic surgeon. Interestingly so, despite these numbers, only about 11% of doctors consider themselves rich. Surveys have revealed that about 51% of all physicians and 46% of primary care physicians think that they were compensated fairly.

The “Doctors are overpaid” argument
Many would argue that doctors are overpaid. This claim is widely contested. In England, the basic salary for a newly qualified doctor is £20,295. Additional pay over this is accounted for the overtime hours. The average nurse works for 37.5 hours per week and junior doctors work around 56 hours per week but this number can increase depending on the patient influx and overtime hours. If a nurse chooses to put in extra hours, they are rewarded accordingly. It’s also important not to forget the responsibility a doctor carries with him. When things go well, the healthcare team including staff and nurses are appreciated, but when things go wrong, doctors are to be blamed. Additionally, being a doctor isn’t all about attending to patients and working long hours. It means continual studying, research and staying updated on medical advances happening internationally.

Let’s take a look at the highest paid salaries amongst doctors
Orthopedics seems to be the most financially rewarding specialization with an average salary of $421,000 for patient care in 2014. Orthopedists seem to earn a lot more than other physicians when it comes to non-patient care activities too. These may include product sales and speaking engagements which can add another $29,000 a year. Cardiologists are the runner-ups with an average compensation of $376,000 for patient care only. Whereas, non patient care activities can earn them another $19,000 on average. Developed countries have a high incidence of cardiovascular diseases and obesity is another associated culprit responsible for the rising mortality rate of developed nations. The first world lifestyle of fast food coupled with a sedentary way of life seems to keep cardiology amongst the most needed heath care. Moreover, gastroenterologists are third on the list with an average compensation of $370,000 for patient care and another $14,000 in non-healthcare activities.

Cover picture by iofotoyayimages.com

The amazing anatomy of Dental Plexus

As you probably are already aware of, the trigeminal nerve is quite a vast one. It itself has three major branches which innervate a vast region of the head, including such internal parts as the sinuses and dura mater, and, of course, big part of the upper digestion earns credit to the trigeminal nerve – including the muscles involved in chewing and swallowing as well as the sense of your gums and teeth.

All of this is done via smaller branches which furthermore innervate their target structures. The dental plexus is one of those branches, which actually consist of two quite different parts (see the image below, precisely demonstrated by Anatomy Next).

Although they do innervate teeth, the superior branch comes from the maxillary nerve and the inferior branch originates from the mandibular nerve. The superior dental plexus arises from the infraorbital nerve in the infraorbital canal. This branch of nerves furthermore innervates superior molar, premolar, canine and incisor teeth together with gingiva surrounding them before the infraorbital nerve exits the canal via the infraorbital foramen and innervates the skin of the upper lip, cheek, nasal ala, lower eyelid and conjunctiva.

It is always worth remembering the close location of the maxillary sinus. Not only the nerves can be a common thing between the teeth and the maxillary sinus, but part of the dental infections can spread in the sinus as well.

The inferior dental plexus, however, arises from the mandibular branch of the trigeminal nerve as it travels through the mandibular canal on its way to become the mental nerve before giving a branch to the incisive teeth. It is worth noting though, that the gingiva is innerved via the inferior dental plexus just as it is with the upper dental plexus. The incisive branch, as the name suggests, innervates the incisors, and the inferior dental branches innervate the premolars and molars together with the canines.

Although the anatomy of teeth innervation might seem challenging to learn and remember, for me it is a piece of art. Such complex structures are amazing to explore and we really do hope that the illustrations and renders will make it easier for students out there as well. If you want to see the nerve in greater 3D detail, visit anatomynext.com!

 

Interesting facts about trigeminal nerve

Did you just feel that last warm gasp of summer air touch your face? Fair enough, whilst writing this it is still summer, but there is more to it than just motion of the air in the atmosphere. And this is where the fifth cranial nerve, or trigeminal nerve, comes in. It is a nerve responsible for such motor functions as chewing and biting and – you guessed it – the sensation in the face.

When talking about the trigeminal nerve, it is most important to remember both functional classification and anatomical division. For the sake of simplicity let’s start with the anatomy part. As the name “trigeminus” already suggests, the nerve itself is divided into three great branches – ophthalmic (or V1), maxillary (V2) and mandibular (V3), which leave the skull via different foramina – the superior orbital fissure, foramen rotundum and foramen ovale, respectively. Those branches converge on the trigeminal ganglion, from which a large sensory root and a smaller motor root travels to the brainstem, which it enters at the level of pons. This also quite precisely describes the proportion of function in the nerve, of which the most part is sensory that involves all three branches. When talking about interesting and unique things about the nerve, then the borders of the dermatomes of the branches are relatively sharp and have almost no overlap, comparing to other dermatomes of the body. This means that, when under local anesthesia or if a branch is infected, a very well-defined area will be affected. To explore the nerve in greater detail, we truly recommend you to visit anatomynext.com. The amazing detail really makes it stand out in the field and make anatomy learning and teaching a different experience.

When talking about the function, it is usually easier to learn the nerve step-by-step, starting from the very uppermost branch – the ophthalmic or V1. This branch transmits sensory information from the forehead, scalp, upper eyelids, parts of the eye such as conjunctiva and cornea, most of the nose (the exception are the nose wings, which are innerved by the maxillary branch), nose mucosa with the help of the maxillary branch and the frontal sinuses. Interestingly enough, the nerve innervates dura mater and meningeal vessels as well, although this is done in a teamwork of all three branches.

The maxillary nerve furthermore covers lower eyelids, nares and the upper lip, the cheek, upper teeth and gums, roof of the pharynx along with the palate and the sinuses that the ophthalmic branch did not cover – the maxillary, ethmoid and sphenoid ones.

The third branch, or the mandibular nerve transmits senses from the lower lip along with lower teeth and gums, the chin and the jaw and parts of the external ear. It is worth noting though that the angle of the jaw is not innerved by this branch, but by the C2-C3.

When summarizing the sensory part of trigeminal nerve, it is very useful to use sensory diagrams, which you can check out when learning anatomy with the help of Anatomy Next as well. As I already mentioned earlier, the borders are quite sharp and specific for each branch and this helps those of us who have a good visual memory, and all of the branches take part in meningeal innervation and divide the job of innervation of the sinuses between the ophthalmic nerve (for the frontal sinus) and the maxillary nerve (the ethmoid, maxillary and sphenoid).

The smaller, but not lesser part of the nerve has a motor function which involves four muscles of mastication (masseter, temporal and lateral and medial pterygoids) as well as four other muscles – tensor veli palatini, tensor timpani, mylohyoid and the anterior belly of the digastric. They are all controlled by the motor part of the mandibular branch and involved into the process of eating – biting, chewing and swallowing. The exception is the tensor tympani, which has a sound dampening function, including the sound of chewing.

As always, your feedback is welcome. What are your thoughts? Please share a comment below or contact us via email!

What is Hemodialysis (Extracorporeal dialysis)?

Hemodialysis (haemodialysis), also called kidney dialysis or just dialysis, is a treatment for acute kidney failure. Patients need dialysis if their kidneys are not working properly, i.e. they are no longer removing enough waste (such as creatinine and urea) and fluid from the blood. This usually happens when around 85-90 percent of kidney function is lost.

In order to perform the hemodialytic treatment, the blood of the patient is put in an artificial kidney which, through the pumping machine, circulates the blood through a filter that cleans it, and returns it back to the patient. Therefore, the blood needs to be extracted from the patient.

In urgent cases this is implemented by putting a catheter inside a big blood vessel (central venous catheter). In case the treatment could be scheduled in advance, the substitutional treatment is performed by arteriovenous fistula, which is a junction created surgically (using local anesthetic) between a vein and an artery, most frequently at the level of the forearm.

At the beginning of the dialytic session, the patient is connected to the hemodialytic machine by central venous catheter or by the insertion of two needles at the level of the fistula.

Every treatment lasts approximately 4 hours, and is done 3 times per week. The duration of every treatment and the weekly frequency could vary, depending on physician’s discretion based on clinical necessity of the patient.

The main point of the treatment is “the dialytic filter”, an element with bio-compatible dual compartment. Blood extracted from the patient flows in the first compartment. In the second compartment flows aqueous solution, enriched with solutions essential for the blood. This solution is also low in (or deprived of) waste that needs to be extracted and it’s called “dialytic solution”. To allow an adequate depuration, the blood flow through the filter is maintained with the help of a pump, with a flow rate of around 250-300 ml/min.

The amount of fluid, that is extracted during a single treatment, depends on the quantity of liquid that the patient takes in the interval between two consecutive sessions. Fluid intake is measured by weighing the patient at the end of the dialytic treatment and at the beginning of the following one. The “ideal weight” of the patient, called “dry weight”, is defined according to the clinical and instrumental data of the nephrologist who practices the dialytic treatment.

4 Excellent Post Surgery Healing Foods

Healing is a pivotal factor when it comes to surgeries. Surgical operations are carried out only when they’re necessary or when there is no alternative or agreeable way out of a medical condition. Surgeries are meant to readjust and restore normal physiological functions of the body. It is an invasive and vulnerable process for the patient. A surgery isn’t successful until the postoperative care is followed through for speedy recovery.

Surgeries commonly cause inflammation, swelling and bruising. However, having the right diet and incorporating all the right foods in it can minimize these side effects and prepare your body for quick recovery. Here are 4 healing foods that will fuel your body to get back on your feet and equip you with the macro and micronutrients to strengthen your immunity.

Increase lean protein intake

Collagen is a structural protein in our body that contributes to the physical structural integrity of physiological components such as blood vessels, hair, skin, tendons, bones and many other parts of your body that demand structural support. Post-surgery protein demand for your body increases from 0.8 grams per kilogram of body weight to up to 2 grams per kilogram, and it must be met. Eggs, fish, beans, legumes, soy and turkey are rich sources of protein. You need this extra protein intake to repair the incisions in your body to heal and mend through the formation of collagen.

Fermented Dairy for ease of digestion

Nosocomial infections are a dangerous threat after surgery. These infections occur from the hospital environment after an open surgery, and can prove to be deadly for the vulnerable patient. This is why antibiotics are prescribed after surgery to prevent any such infections from taking over, but they also kill the normal flora of the body that are responsible for contributing to normal functions. E.Coli lined in your small intestine is amongst the good bacteria that aids digestion of food and may be affected by the prescribed antibiotics too. To prevent the antibiotics to take a toll on your digestion, you can repopulate your normal intestinal flora by eating fermented dairy foods that include yogurt and kefir. A small serving of kefir can introduce 8 to 12 normal flora species!

Fiber

Fiber is an important nutrient in our body that decreases the absorption of cholesterol across the microvilli in our small intestine but, most importantly, it provides something for the intestine’s peristalsis activity to push against and facilitate the excretion of waste. Post surgery pain medications, anesthetic agents, alterations to diet, dehydration, stress and reduced physical activity can all contribute to the digestive upset patients experience. Prunes are a rich source of soluble as well as insoluble fiber which facilitates the elimination of stool. Other fiber containing foods include beans, apples, pears, bran flakes, oatmeal, flaxseed meal and legumes.

Mushrooms

Did you know that an intake of about 4 oz of Shiitake mushrooms can rapidly boost your immune system by increasing the performance of gamma delta T-lymphocyte cells. T-lymphocytes are the warriors of your immune system. The mushrooms also reduce the quantity of proteins responsible for inflammation, thereby reducing inflammation itself. Who doesn’t like a good mushroom soup anyway?

Cover picture by yayimages.com

Informed Consent and autonomy

Informed consent requires that a patient agrees to a certain procedure while Autonomy provides that the patient has the sole responsibility to decide. These are very ideal and in theory their practicability is simple. But is it?

At the wake of limited resources, the patient may not completely have the final say as to what happens to them. They may not have as many options to choose from, as the resources may not be as plenty. Further in developing countries, consent and autonomy is further complicated by the paternalistic relations that exists between the provider and the patients. The patients are less informed on their care and their conditions and interpret illness in a society and cultural context thus resulting into lesser accurate information on their well-being.

Healthcare providers in developing countries therefore have to create a balance between respect for autonomy and informed consent with the need to adequately educate the patient on the preferred care they choose. With the limited resources, the doctor often will choose the diagnostic procedure and have a big say on the prognosis treatment and rehabilitation of the patient. Consent to this end is thus used with overall call on doctors since Hippocratic times to do no harm.

Non-Maleficence

The principle of “doing no harm” is the underlying ethical principle in the limited resources system and heavy patient load clinical atmospheres. The doctors who are often the more informed party have to constantly recall the Hippocratic oath section stating “…I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing”

The healthcare provider has to often balance between the available resources, the huge patient numbers with different needs and in this situations he/she has to do good at all times. Students in medicine in the whole of the healthcare profession seeking an elective in low resources settings must in similar way be prepared to do no harm. They must practice within their scope, they must appreciate their skills deficit and must at all times only perform a procedure that they are certain of their competence to and safeguard the safety of patient as a principle superior to hands on experience and clinical exposure.

Beneficence

This principle is rather a common phenomenon and often seen as a direct inferred principle to any practice of medicine. The premise from which it progresses is that all actions of the provider must be such that it benefits the patient.

While beneficence to the patient is relative and its interpretation different to various providers, in developing countries, this is seen as extending beyond the clinical care of the patient.  It involves a proper provision of information on the need to seek the professional health services as well as advice on the measures that are essential for prevention of further harm arising from the condition. Healthcare providers take an active role in preventive care and health promotion.

Students intending to undertake an elective in a developing must therefore be prepared to undertake deliberate efforts both in learning and for benefit of patients to educate the patients on care. Further they should be ready to participate in CMEs and other sessions so arranged within the hospital of placement.

While discussions revolving around ethics elucidate heated debates, understanding the centrality of the patients in them is a sure way to ensure the open view of ethics. Learning ethics and their application best happens in atmospheres where the ethical dilemmas often arise and where their application is not a direct sweep of the written standard.

A placement abroad and especially in a developing country is a unique exposure to learn through practice of the ethics in healthcare practice.  These are opportunities that healthcare students should keenly consider.

 

About the Author

Richard Kariuki, BSC Hons Health Services Management and the Lead Placement Advisor at Elective Africa, a healthcare placements organizer to Africa.

Sorrow Of The Dentist by Ayam Chhatkuli

And now, something slightly different than what you would expect from Meddy Bear. We are here to prove that doctors also have an artistic side to them.

We present to you a poem written by one of our fans, Ayam Chhatkuli from Nepal.

Enjoy!

 

 

 

 

Sorrow of the dentist

Before I joined the med school

the focus of my sight was different

I used to see a whole human

All I see now is the teeth with calculus and stain.

 

When I see an old man walking

all I remember is a complete denture

I’m fed up with my prostho work

help me God I surrender

 

The man has a class I fracture

46 got a root stump

A life with no joy and rupture

Is equal to a dump

 

I come to encounter mainly 2 sorts of patients

Few are philosophical

And many are hysterical

 

People actually are very unhygienic

They bath with Quatar soap and have a Jean Patou’s spray

But use a single brush for 6 months

and walk with a grossly decayed tooth till the next may

 

Inside the heat of this mask

My beard failed to grow

Nose felt difficult to breath

Salivation decreased its flow

 

These days I dream of teeth

Good dreams angels appear as a canine

Bad dreams impacted lateral at age nine

She insists to describe her beauty

All I can see is her anterior cross-bite

with peg laterals

Falling in love for a dentist

is almost like winning the battles.