Wednesday, July 30, 2008

London Day 04

Perfectly magnificent day in London. DAY 04.

Unbelievably, I am here for the fourth day and it could be the 2nd day on my own. When I first reached, the feeling was great except for the slightly hot weather but for today as the temperature, I began to like this place called LONDON.

Let's talk about today!

CLimbed over 500 stairs up to the top of St.Paul's cathedral with a superb breath-taking view of the London city. Moreover, it was the first time for me to see a crypt in a cathedral! The craving, the flooring... everything was of such precision. Loved it.

Next, I moved on to Royal Albert Hall! Went on the tour with my Great Heritage pass and it was more informative than I ever thought! Even got to watch the rehersal going on around the circus area! :D

Went to my favourite place in LONDON --- PARK!
All the way to HYDE and Ken park! Ponds, lakes, fountains, grasslands, squirrels, canes, ducks, people, polices on horses, couples kissing.... ... I just enjoyed myself in there...Regent park I went yesterday was sth that was beyond the description of words, millions of duckling, vast rose garden, hectars of tress, flowers.... ...

On my way to Queen Gallery to watch Les Miserable, I met this London civil servant who decided to take a walk everyday in town. Great guy he was...

Shall recite more later later la... Gotta bath now!!!

Off to BATH AND STONEHENGE TML!

Take care Mum and Dad! I am well and fine!!!!

Tuesday, July 22, 2008

LAst day at PWH

Prince of Wales Hospital Inpatient CE-1 2008
CE and us! Real sad that CE Patrick was on sick leave today.

The place to hydrotherapy room where our lockers are located.

Just outside the hospital.
Sth I would see as I rush diagonally across the road junction everyday.


Everything ended so quick and I'm beginning to miss this place. No one would ever forget their first placement in their lifetime, isn't? It has ended with a good note. CE had given me positive feedback and a grade that would boost me to strive on.

Some photos for 20th Birthday!!!









More photos @ http://www.facebook.com/album.php?aid=46676&l=ab9b6&id=648946959

Sunday, July 13, 2008

SPECIAL OLYMPICS


I volunteered for the physical screening examination for the athletes of the special olympics 2008. I broke my record for the no. of times I used the goniometer today. I am now an expert in taking the measurement of a 90*-90* measurement for the hamstring, passive dorsiflexion for the calf and the hip flexion of the Thomas's test. It was also my first time dealing with so many different types of kids with special mental status. A totally different experience!

@ the beginning The almighty Polyu PT students
The whole crew
@ the end!!! Totally exhausted.

Doing a 90*-90* test on a little girl!

Saturday, July 12, 2008

Happy Friday

Morning.

0830am - 1030am
PWH adult Orthopaedic Ward D

The old Popo we dealed with on Thurs was still in hospital and we were more than happy. (Our previous patients always get discharges after our one day of rehabilitation) After our routine subjective and objective examination, we taught our PoPo to work on her quads and to walk with quadripod for the first time. She was indeed co-operative and nice. We chatted along the way and she told me her whole life-story. (her huby was once in airforce and how their friends were killed by the commnist's bomb etc etc) CE Patrick was as funny and educative as ever! We learn to test the lady's walking and turning skills without her knowing and at the mean time, enjoy the chat. As a therapist, I fully understand the need to "get things done" instead of just "accompany the patient". I am beginning to be more skillful each day under the guidances of our dear CEs. I am too starting to get use to reading the bed notes and writing them. It's not an easy job to stifle out 5cm thick and over of notes -- for now, I can do it in 10 minutes (gotta be faster the next time) :).

I seriously like CE Patrick, he makes my day more fulfilling and fun. :D I learnt and not just "study" a lot recently. The way to stretch, the concerns for strengthening, the differentiation between stiffness of different kind.... ... It was a totally hands on. This is reality.

1100am-1230pm
PWH Paediatric Ward
I was given a new case-study today. A 9 years old girl clinically admitted to the hospital for bilateral supramalleolar osteotomy for tibial internal rotation. She suffered from a in-toeing gait -- often tripping over herself. A right and left derotation of both of her tibia and fibua was done and she was put in a sarmiento cast. In 1998 she suffered from spiina bifida with myelomening. ocele (脊髓脊膜膨出) and had a operation then.

Our job: Improve her mobility. :D

0130pm-0330pm
Outpatient hand-class
Here, I saw loads of cases and got a feel of the HK physio department "high peak season" or "50+ patients in a day". The followings present to you the cases that were of absurd interest to me. :D Looking at X-ray is real intriguing too actually. :P

CASE 01 - TRIGGER HAND
O/E: Conditions improved. Pain+ on Flx. Swelling+.

http://www.handsurgeon.com/trigger.html
http://www.eorthopod.com/public/patient_education/6552/trigger_finger_and_trigger_thumb.html

CASE 02 - # Distal of Radius (1.5 mths post-op)
ORIF. Plating done.
O/E: Extensors atrophy. Stiffness at R/C joint.
Rx: Passive stretch extensor, R/C Mobolisation ex, ES extensor, Strengtheing flexors,scar mobolisation (radial side approach)

http://www.davidlnelson.md/Wrist_Fracture.htm

CASE 03 - # 1st metacarpal (3moths post-op)
Bone graft from the left iliac crest due to the complte destruction of the bones by a flour blending machine. It was actually written as "flower" in the case note. :P There was also poor coverage of periosteum and adjacent sof tissue.
O/E: Decrease in thumb abd/add (webspace)

http://www.learningradiology.com/notes/bonenotes/wristfxs.htm
http://www.uptodate.com/patients/content/topic.do?topicKey=ad_orth/12503

CASE 04 - Ulnar nerve palsy
O/E:
Typical claw hand.
Hypothenar/interossei atrophy
Inability to oppose the last 2 fingers
Inability to pinch a paper
Decrease in abd/add strength of hand

http://www.doctorslounge.com/neurology/diseases/ulnar_palsy.htm


CASE 05- Erb's Palsy

14 years old boy
O/E: Inability to raise arm above SH level

http://www.wheelessonline.com/ortho/erbs_palsy
http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe00216.htm

CASE 06 - Thenar degeneration/ Insatbility at CMCJ
The surgeon did a very innovative surgery. He used the tendon of the FCR to curl around the CMCJ joint in order to stabilise it.
http://www.wrongdiagnosis.com/sym/muscle_symptoms.htm

It was mid-term feedback in the afternoon. Mine was considered good. :) The CE said that I have had a high expectation for myself. oh well. Much more room for improvement thought.

Evening.
Met up with Shi qi from SG and we had grest fun shopping and watching the laser show at Avenue of stars.
The beautiful nightsky.


Performance in the streets of Mongkok @ 0000

Thursday, July 10, 2008

My First Cases :D

Date: 8/6/08 (Tue)

First time Hand-ons cases ever in my life
Case 01
60+ oldlady


HPI (history of present history):
"C" admission R TKR on 27/6
OT on 30/6 (Day 08 post-op)

PMHX: HT, minor stroke, L TKR 2006

Pre-morbid status: walking stick
E.T. (exercise tolerance): 10 mins up and down stairs

Case 02
30+ young man


HPI:
A & E: 4/7/08
Curshed by elevator at work
Laceration over L R/F DP
Bleeding+
Numbness+ over ulnar side 2DP> 10mm
DP shaft # seen with bone graft seen
Bruised tip of R/F operation 5/7/08

Intervention: OR + K-wire fixation, splinting by O.T.

Diagnosis L R/F D/P open #

PMHX:
Smoker (220/day)
Hx of ochitis/ eididymitis
IWD/increased BP/DM/COPD/asthma nil
Symptometic bradycardia

Case 03
10+ teenager


Diagnosis: Radial nere palsy after bone lengthening

O/E:
Tinal's test of radial nerve: 10cm above the wrist crease
2PD: diminished light touch and protective sense over the dorsal surface of hand and forearm
MMT:
Wrist extensor: Grade 0
Brachioradialis: Grade 1
Triceps: Grade 4

Case 04
18yrs old young boy


HPI:
"C" admission on 12/6
Antero-lat R ankle p+ when walk upstairs
Hind foot significant valgus
SLS on R ankle - collapse of foot into valgus/ unstable
Clinically supple subtalar joint, forefoot pronation/supination supple
Ankle DF 20/ PF 40

O.T:
Corrective osteotomy level II tibia
Divsion of fibula
External fixator tibia

PMHx:
Allergic rhinitis
Conjunctivitis (pink eye)
Neurofribomatosis Type I



Yesterday
Watched the treatment for Torticollis where babies screamed. + 1 new case & 1 old case.

http://www.hss.edu/conditions_15765.asp

Today
Pm off.

I really like my CE (clinical educator) in the morning. He is funny and teaches well. :)
Afternoon seems to be a drag without him.

Monday, July 07, 2008

理 大 實 驗 室 涉 殘 忍 虐 兔

It's my professor!

理 大 實 驗 室 涉 殘 忍 虐 兔
傷 口 潰 爛 痛 苦   三 兔 自 行 咬 斷 腳

【 本 報 訊 】 理 工 大 學 康 復 治 療 科 學 系 涉 嫌 虐 畜 , 理 大 動 物 道 德 委 員 會 早 前 突 擊 巡 查 期 間 , 赫 然 發 現 該 系 有 研 究 人 員 涉 嫌 不 善 處 理 用 作 實 驗 的 三 隻 白 兔 , 令 牠 們 極 度 痛 楚 至 自 行 用 牙 齒 咬 斷 雙 腳 ; 有 目 睹 事 件 人 士 企 圖 報 警 投 訴 理 大 虐 畜 及 涉 嫌 違 法 , 惟 遭 理 大 道 德 委 員 會 委 員 勸 阻 。 理 大 已 就 事 件 成 立 調 查 小 組 , 若 確 實 是 研 究 人 員 違 規 , 不 排 除 紀 律 處 分 。
記 者 : 梁 美 寶

據 了 解 , 被 指 涉 嫌 虐 畜 的 研 究 名 為 「 骨 骼 分 解 與 神 經 成 長 研 究 」 , 由 理 大 康 復 治 療 科 學 系 助 理 授 郭 霞 負 責 , 中 大 副 校 長 、 骨 科 醫 生 鄭 振 耀 授 及 另 有 兩 名 研 究 員 參 與 。 郭 霞 及 鄭 振 耀 均 屬 著 名 學 者 , 前 者 曾 在 四 川 地 震 後 為 災 民 安 裝 骨 骼 固 定 器 。 該 研 究 由 05 至 今 年 6 月 30 日 止 , 獲 研 究 資 助 局 撥 款 67 萬 元 資 助 , 主 要 研 究 骨 骼 重 生 功 能 。



理 大 作 內 部 調 查

郭 霞 曾 在 四 川 地 震 後 前 往 當 地 , 為 災 民 安 裝 骨 折 固 定 裝 置 , 但 其 研 究 被 指 涉 嫌 虐 畜 。
資 料 圖 片


該 研 究 需 以 40 隻 活 兔 作 測 試 , 需 將 白 兔 腳 的 骨 骼 弄 斷 , 再 以 不 同 方 法 試 驗 骨 骼 重 生 。 雖 然 進 行 實 驗 前 , 郭 霞 已 將 實 驗 所 需 的 動 物 數 量 、 動 物 受 傷 過 程 及 痛 苦 評 估 等 上 呈 校 內 動 物 道 德 委 員 會 等 多 個 部 門 , 也 獲 衞 生 署 批 准 , 但 當 理 大 的 動 物 道 德 委 員 會 於 3 月 份 突 擊 巡 查 時 , 卻 發 現 實 驗 涉 嫌 虐 畜 。
知 情 者 指 , 委 員 發 現 其 中 三 隻 用 作 實 驗 的 白 兔 , 腿 部 傷 口 嚴 重 潰 爛 , 令 牠 們 極 度 痛 苦 , 忍 不 住 以 牙 齒 咬 斷 自 己 雙 腿 , 「 見 到 人 覺 得 唔 可 以 接 受 , 有 人 想 報 警 ( 控 ) 告 校 方 虐 畜 , 但 係 理 大 就 話 內 部 調 查 呢 件 事 , 所 以 先 無 報 警 。 」 學 系 隨 即 把 該 三 隻 白 兔 人 道 毀 滅 , 以 減 輕 牠 們 的 痛 楚 。



不 排 除 紀 律 處 分

另 有 知 情 者 指 , 該 研 究 規 定 每 周 需 巡 查 有 關 白 兔 兩 次 , 疑 有 人 涉 疏 忽 照 顧 , 未 有 妥 善 處 理 白 兔 的 傷 口 和 讓 牠 們 服 食 抗 生 素 。 據 知 , 郭 已 向 校 方 解 釋 , 包 括 指 該 類 實 驗 早 於 1913 年 已 在 外 國 進 行 , 外 國 是 以 100 隻 狗 作 測 試 , 當 中 50 隻 均 不 能 忍 受 ; 又 說 文 獻 指 白 兔 在 實 驗 中 有 自 殘 行 為 屬 常 見 。 理 大 已 成 立 調 查 委 員 會 跟 進 事 件 , 預 料 月 內 有 結 果 ; 若 證 實 不 當 , 不 排 除 向 有 關 人 士 作 紀 律 處 分 。
動 物 地 球 總 幹 事 黃 繼 仁 批 評 , 「 呢 個 個 案 好 殘 忍 , 動 物 唔 識 出 聲 就 任 人 宰 割 ! 」 對 事 件 作 出 譴 責 , 指 學 者 作 動 物 實 驗 時 常 虐 畜 , 希 望 各 界 關 注 及 避 免 以 動 物 作 實 驗 。 愛 護 動 物 協 會 認 為 現 時 科 技 進 步 , 應 避 免 以 活 體 動 物 作 實 驗 。
根 據 《 動 物 ( 實 驗 管 制 ) 條 例 》 , 在 實 驗 過 程 中 , 必 須 有 麻 醉 劑 效 力 足 以 使 該 動 物 免 受 痛 楚 , 又 規 定 在 麻 醉 劑 消 失 前 需 把 動 物 殺 死 , 違 例 者 最 高 可 被 罰 款 1,000 元 及 監 禁 六 個 月 。



特 稿 : 常 用 實 驗 動 物 有 10 多 種

本 港 多 間 大 學 均 設 有 動 物 實 驗 室 用 作 醫 學 、 生 化 實 驗 , 包 括 港 大 、 中 大 、 科 大 及 理 大 。 據 一 名 管 理 動 物 實 驗 室 的 授 表 示 , 大 學 常 用 的 動 物 有 10 多 種 , 包 括 大 、 小 老 鼠 、 白 兔 及 荷 蘭 豬 等 ; 而 不 同 實 驗 會 用 不 同 動 物 , 如 無 毛 老 鼠 用 作 癌 症 實 驗 、 白 兔 作 基 因 實 驗 等 。 但 本 港 不 批 准 以 猴 子 作 實 驗 , 又 因 港 人 愛 貓 狗 , 怕 惹 起 愛 護 動 物 人 士 激 烈 行 動 , 故 大 學 甚 少 以 有 關 動 物 作 實 驗 。



糧 食 有 特 定 要 求

該 授 說 , 各 動 物 實 驗 室 均 需 無 菌 , 並 對 照 料 動 物 有 極 嚴 格 要 求 , 進 入 實 驗 室 人 員 須 要 穿 上 無 菌 裝 束 , 「 好 似 入 ICU ( 深 切 治 療 部 ) 咁 ! 」
糧 食 及 食 水 均 有 特 定 要 求 , 如 實 驗 室 內 動 物 所 飲 用 的 食 水 不 可 含 菌 , 就 連 白 老 鼠 也 只 可 飲 用 蒸 餾 水 ; 食 糧 也 需 特 別 訂 購 營 養 配 方 , 以 確 保 牠 們 的 體 格 壯 健 , 適 合 作 實 驗 。 同 時 , 殺 死 有 關 動 物 時 也 須 極 快 捷 , 在 牠 們 感 痛 楚 前 將 之 殺 掉 。
香 港 大 學 表 示 , 06/07 年 度 , 港 大 實 驗 動 物 中 心 的 動 物 寄 養 區 , 每 日 平 均 有 25,710 隻 動 物 , 大 部 份 為 老 鼠 , 其 餘 為 倉 鼠 、 沙 鼠 、 雞 、 山 羊 、 豬 等 , 動 物 實 驗 有 涉 及 幹 細 胞 實 驗 。 進 行 動 物 實 驗 有 既 定 程 序 , 動 物 運 送 至 動 物 寄 養 區 及 分 送 至 動 物 房 後 , 有 關 人 員 會 進 行 日 常 的 飼 養 工 作 、 動 物 健 康 檢 查 , 再 在 動 物 身 上 進 行 實 驗 程 序 , 完 成 後 即 將 有 關 動 物 人 道 毀 滅 , 屍 體 以 醫 療 廢 物 程 序 處 理 及 棄 置 。
本 報 記 者

http://appledaily.atnext.com/template/apple/art_main.cfm?iss_id=20080704&sec_id=4104&subsec_id=11867&art_id=11309507

Happy Lunar Birthday

Happy Lunar Birthday to me.

In the chinese calender, I am 20.

Most exhausted day @ PWH.

Adult and paediatric wards.

Bought cakes for myself.

Mum and Dad sang me birthday song.

Chatted with friends.

Did my HW.

Time for bed.

11.45pm.

Friday, July 04, 2008

Total knee Replacement - On the inside

I've a presentation on Total knee representation aka TKR this coming morning and since I only get to look at patients before and after surgery, I did some research and found this wonderful pictures to see what's on inside. It is really much more clearer than those shown in Trauma and Disease classes. :D

Almost half of the patients we would be dealing with are elderly that had went through TKR due to oesteoarithis in the knee. Immediate rehabilitation had to begin post-operation Day 1 by physiotherapists in order to ensure a good range of motion further on in life.

Surgical Procedure

Left knee incision during knee exposure and with knee extended (straight) shows wear behind patella (reflected backward on the right) and in trochlear femoral groove (in center of the photo).

Left knee: a cutting guide is prepared for removing damaged bone from the top of the tibia. The saw will be used through the slot near the top and front of the guide. The long guide with T-handle above goes down the length of the tibia to help establish satisfactory alignment for a precise cut.

Left knee in extension: the final prosthesis in place. The round white plastic disk is the back of the flipped patella, the silver component caps the lower end of the femur, and the white tray below the femur is the combined plastic-metal component on the upper end of the tibia. All components have been cemented with a very thin layer bone cement.
Left knee flexed: after complete resurfacing "total knee replacement". The wound is closed, and rehabilitation can begin.


With thanks to http://www.genufix.com/total_knee_replacement_photos.htm.



SPECIAL VIDEOES SELECTION
3D Medical Animation of a Knee Replacement

Whole surgical procedure.
Know the anatomy and watch this! Real interesting.


Other common ortho cases.

Total Hip replacement

Birmingham Hip Resurfacing (BHR)

Cross Pin Fixation System

Animated wrist fracture repair surgery

Bunionectomy

Day 3 @ placement

Experience is that marvelous thing that enables you recognize
a mistake when you make it again.

- F. P. Jones

This was one enlightening quote that I came across in my email today and I found this phrase exceptionally true after the 2.5 magnificent day at Prince of Wales Hospital. My two clinical educators (CE) were really out of my expectation. They are indeed experienced. They knew every single minor detail to be aware of in a clinical setting and they adapt to situations very well. Not only that they taught us important skills and gave us precious reminders, they taught us manners and the way to uphold our status in the hospital. In the midst of handling us, they need to take cases and it was definitely a tough time. Today was my Day 3 at Prince of Wales and it had indeed given me a very good start and most importantly, it gave me the definition of a good physiotherapist. Maybe, there are better and more impressive ones out there, but now, it is them that had sparkled my will to strive further in this career.

Practicals in school never seems to be practical out in the hospital. Our seniors had always been warning about us about that too. No doubt, I had learnt much more given the same amount of time spent. Things taught in the hospital were DETAILED and CONCISE and required us to have REASONINGs. Maybe, our school does the same but we are just too naive to take note of the real importance behind it.

On simple example was the way to teach a patient to use a walking aid. It sounded simple. It looked simple. We always thought it was something easy but we performed horribly. Two words - NO EXPERIENCE. We did not even know we are performing the wrong stuffs (reflected by the quote above). Maybe, school exists only to give us an introduction class and to teach us the simplest and most ideal way. It does not mean that the stuffs are in anyway useful or accurate. Well, our CEs always ask, "Do you know your stuffs? " or " You have learnt that stuffs before?". Well, we would laugh our way through these "rhetorical questions". Actually, our brains are not rusty, they are just too new and unbrushed.


To new Physio birdies:
This is how we teach a patient to stand from a chair, walk and sit down with an elbow crutches. Please do not underestimate the task.


1) Ask the patient to shift their butt to the front of the chair.
2) Place the crutches in the H shape.
3) Put the crutches slightly to the affected side, almost towards the front so as to facilitate the taking of crutches during standing.
4) Ask the patient to put the good leg slightly bent backwards.
5) Rmb to tell the patient to put weight on the good leg while standing up and not support the whole body through the crutches while standing to prevent the C.G from falling into the front -- making one unstable
6) Ask patient to lean forward and stand up

7) Check the 3 important signs while standing -- Sh elevation/depression, Elbow Flex to 20-30* , crutches are placed slightly a foot length away from the feet with one facing forward

8) Teach the patient the correct way to walk. Take note of the followings:
- Eyes face forward
- Crutches are slightly turned out at the forearm
- Crutches are grabbed and close to the body at the upper arm ( use your hand to tuck under the axilla and ask the patient to "squeeze your hand" as you walk to facilitate the most efiicient way of walking"
- Small steps initially with progression - rmb that affected leg can be taught how to swing forward too
- Always turn to your good side in a small circle!


Plus plus plus..... sitting down, walking down the stairs etc.etc.

We were told to do a presentation his coming Monday. It's really time for me to get back to the hardworking Hiu Yan.

For once, I learnt how to read the bed notes, SMARTLY. It was real delighting.

Different teams in the orthopaedic wards in PWH.
1) TRAUMA
2) AJR - Adult joint replacement
3) Tumour
4) Medical

*** Time for revision. Physiology. Pathology. Electrophysical therapy. Anatomy. Rehabilitation protocols. Abbreviation. Case presentation. Clinical reasoning. :D
My timetable for the month!
With thanks to Billy. I think Daddy will like it... :)



Lovely photos of them are out!
Good memories that are worth recalling.
Gabriel and my dear senior, WingYan.
The former TMS SJAB -ians and the happily married couple.




They even set up a website on their own! How lovely. Wishing them long-lasting and see you in HK!
http://www.gabrielnwingyan.com

A simple girl's wish that came true.

A romantic that I loved followed by Muisc and lyrics.
27 Dresses.

Wednesday, July 02, 2008

1st day @ Prince of Wales Hospital.

It was sorta of an orientation around the hospital in the morning and there were really loads that i would see.

Candy fainted in her mask. It was indeed quite shocking.

Learnt infectous control and transfer later on.

I just realised that what we learnt in school is just something ideal and it doesn't really work in the real world.

Practicals in school aren't practical anymore.

Shall recite more this weekend.


In extreme exhausion right now.

P.S. I settled a supposedly to be settled business today.

Happy and tired day.



A nice written song.
Illusion.
歌名:沒有人
作曲:伍樂城, 編曲:伍樂城
監製:伍樂城, 填詞:黃偉文

*原來沒有 從來都沒有
纏綿邂逅 完全虛構
那一刻含情回眸
原來是我妄想裡的 那點綠洲