Wednesday, December 30, 2009

I personally think that making resolutions for the upcoming new year is ambitious as there is a fair chance that I might not be able to live up to them. With the end of the year 2009 and the arrival of the brand new year, I take this as an opportunity to reflect upon myself and think about ways to further improve myself.

Whether you are a college student, a high school student or a working adult, there are plenty of resolutions that you could make to further enhance your study/working experience and to put yourself right on track for a successful future.

Anyway, in light of the potential for a change, I have come up with my own list of things that I want to do or continue doing.

1)Put on a significant amount of weight. Being underweight prevents me from donating a full pine of blood. Besides, I need to start impressing the girls.

2)Step up to be a better human. As a son and a brother particularly. They have been awfully neglected. I shall try my best, despite the heavy schedule that I am expecting to have.

3)Strengthen Relationships

4)To mold the character of a helping doctor to those who are really in need. To treat every patient with utmost respect as if they are my loved ones. But prior to doing that, I shall equip myself with as much knowledge as possible so that I know, I know so clearly that, the patient will not be in anyway being disadvantaged by my incompetency, and this patient is safe under my care.

5)To be the best student I can be, an active learner, a team player as well as a leader.

This is the last post for the year and I look forward to the new one.

A Doctor's Delights Discoveries from the Richard Travers Collection

Wednesday, December 9, 2009

Work in the lab ended early today. Majority of the people in Prince Henry's Institute are already in Christmas mood, conversation topics often revolve around the celebration of this upcoming festive season.

Since I have half of the afternoon free, I attended an exhibition on medical history, " A Doctor's Delights: Discoveries from the Richard Travers Collection" held in Sir Louis Matheson Library.

Have you ever pondered how the word "medicine" came about? The word medicine is actually derived from the Latin "Medicina", meaning the art of healing(Wikipedia). Early records on medicine have been discovered from early Ayurvedic medicine in the Indian continents not forgetting to mention about ancient Egyptian medicine, traditional Chinese medicine and Greek medicine that uses animals,plants and even bodily fluid as therapeutic agents.

Since then, medicine has improved by leaps and bounds as what we can observe today owing mainly to the invaluable field of modern scientific biomedical research. Some of the medical books and artifacts displayed there were from the 16th centuries, indeed intriguingly arousing. 20 mins of my life was spent walking down the memory lane of medicine.

Looking at the history of medicine shows how ideas have developed over the centuries. Medical barbers were the fore-runners of today's skilled surgeons; Leonardo Da Vinci was amongst the first to dissect the human body, trying to figure out the anatomy of the mysterious human body as well as to learn how it works. Till today, medical students still learn about anatomy in the same way.

Below are some pictures that I've managed to capture with my mobile, not the best of quality. I apologize for that. Will be paying a second visit within these few days for more pictures of the collection, stay tuned.

The Anatomy of the Brain with a Description of the Nerves and their Function (1664) by the British physician Thomas Willis (1621-1675) is one of the older items in the collection. A book from the founder of the circle of Willis! How fascinating!

Bernard, Claude, 1813-1878, Illustrated manual of operative surgery and surgical anatomy. This book basically talks about surgical techniques involved in different procedures. Picture depicts surgical amputation of the upper limb(fingers).
Insulin: Its use in diabetes/ Commonwealth Serum Laboratories, Department of Health, 1925. The therapeutic potential of insulin in maintaining glycemia in diabetic patients has been recognised since 1925!

Cole's atlas of anatomy and physiology of the human body.(Melbourne : E.W. Cole Book Arcade, [191-?]). Early atas of human anatomy!

Early prescription record in a local drug store.

The anatomy of gravid uterus by William Hunter(Not the one who discovered the adductor canal)! Quite a renown anatomist 1718-1783.
Intracranial Tunours: Notes upon a series of two thousand verified cases with surgical mortality percentages pertaining thereto/ by Harvey Cushing. A book by the same neurosurgeon who discovered Cushing's Disease!

Double Medal Honours

Saturday, December 5, 2009

Two scientists from PHI in Victoria are to receive medal honours from the UK Society for Endocrinology. The awards recognise their major personal contributions to international hormone research.

Professor Peter Fuller, Associate Director and Head of the Steroid Receptor Biology Laboratory at PHI, is to be awarded the 2011 Hoffenberg International Medal. The award, which is made to an endocrinologist judged to have made outstanding contributions to hormone research, also promotes international collaboration between researchers.

The award highlights Professor Peter Fuller’s international reputation as both a clinician and a scientist. Peter’s research interests lie in understanding the molecular mechanisms of steroid hormone action. He has led studies that focus on the adrenal steroid hormone aldosterone and its role in hypertension and cardiovascular disease. His laboratory also studies the molecular pathogenesis of granulosa cell tumours of the ovary. Both Evan and Peter will travel to the UK in March 2011 where they will give their medal lectures at the Society for Endocrinology annual meeting

I reckon another cake day is on the way to celebrate Prof Fuller's achievements. A knowledgeable clinician with an absolutely humble character. Still cant believe I'm going on ward rounds with him tomorrow.

On another note, I just realised that I haven't been doing what I am supposed to do since I landed in Melbourne. - My virgin visit to the club! Who is up for it?

Of Medicine and Life long learning

Friday, December 4, 2009

It is Friday once again and today concluded my second week of studentship in Prince Henry's Institute. Life as a student here is never mundane as everyday is different. You learn different things/techniques, you make different mistakes, you meet different people, you hear different codes(code blue/code red) and you attend different seminars. Quite variable. There is an explosion of knowledge in Prince Henry's itself and It makes it hard for me to digest and catch up.

I reckon it is fundamentally crucial for doctors or even medical students to keep themselves(or at least try to) updated with what is happening in the medical field from time to time. One of the best resources that I think is absolutely useful is Medscape. Just subscribe to their newsletters in various fields and you could get heaps and heaps of updates/advancements and even clinical trials that are currently being carried out in different parts of the world. There are videos on panel discussion on every single topic you can find not forgetting the chance to earn some CME points at the same time.

At this stage, year 2 medical students from Monash should probably be quite familiar with the drug Thiazolidinedione(TZD) which is used as one of the agent to control glycemia in T2DM patients. When I learnt about it last year, I was quite fascinated as this drug actually acts as an agonist to the nuclear receptor PPAR gamma to initiate transcription of insulin sensitizing genes. Interestingly, this is the same receptor that Simon and I are looking at right now in terms of tumorigenesis of granulosa cell tumor of the ovaries. However from a recent conversation with Jun, an endocrine fellow in MMC who is currently pursuing her Phd in PHI, I was told that one of the TZD, rosiglitazone was found to cause heart failure in patients by inducing water retention while messing up sodium balance. I then searched for this particular drug in Medscape and found an article written in 2001 claiming that Rosiglitazone could reduce cardiovascular mortality and morbidity in T2DM. I was confused for a while, wanting to know the real story behind this wonder drug. I then googled "Rosiglitazone FDA Heart Failure" and then a second article written in the year 2007 from Medscape appeared. Guess what? Roziglitazone really has an adverse effect and could precipitate heart failure, warned by the FDA. Pioglitazone which is widely used is currently being reviewed as well. I doubled checked, and It was valid. In a short duration of time, a drug can be known to cause harm, treatment strategies could be modified, guidelines are then being reviewed as frequent as possible. Frustrating huh?

In medicine, things are constantly changing. Thus, this serves as a good reason for us to instill the habit of keeping ourselves updated even at this stage itself. Even in undergraduate, why not? Many still could not accept that fact that medicine is really a life long learning process. It is not a course, it is not a job, it is not a career either. It is a life.

On another note, I attended a talk 2 days ago and was amused by the debate between the endocrinologists, diabetologist and the researchers. They were arguing about the use of insulin secretagogues in the management of T2DM. The researchers claim that insulin secretagogues like Sulphonylureas causes pancreatic beta cells exhaustion and on other hand, the endocrinologists softened their comments by saying that choices of medication is indeed limited. Was reading through Nature's Endocrinology review and there was an article saying that the current stereotyping of DM is oversimplified owing to the fact that the prevalence of "Double Diabetes" or better known as "Type 1.5 diabetes" has dramatically increased in both developed and developing countries. They argue that there is a need to review the current dichotomous classification of DM. Interesting isn't it, its never ending. New things come up every single day.

Managed to catch up with Prof Fuller this afternoon when all the staffs of the steroid biology receptor lab celebrated over the acceptance of Amanda's thesis on the role of mineralocorticoid receptors in the context of cardiac fibrosis and heart failure. She is now officially a post-doc research fellow in PHI, nicely done!

I expressed my intention of doing a BMedSc to Prof Fuller and we had a good chat about it. That concludes the day and I shall look forward to the endocrine ward rounds and journal club with Prof Fuller on Monday. A teaching session with the Endocrine Director of Southern Health without the presence of other medical students, how lucky. Hopefully the presence of inspiring figures like him will keep my passion for medicine burning.