We Should Be More Pro-active Or Well See More Of Such Sad Fates Of Honest People.

We should be more pro-active or we’ll see more of such sad fates of honest people.

MEDICAL BOOKS

If you’re looking for some medical (non-textbook) books to read in your limited amount of spare time, check out some of my favorites below:

The House of God by Samuel Shem

A classic pre-medical school book. It details residency life in the 1970s. You can talk about this book with almost any medical student or attending. It is practically a medical school requirement. 

Intern: A Doctor’s Initiation by Sandeep Jauhar

A more modern look into medicine residency intern year from the perspective of Cardiologist Dr. Sandeep Jauhar. Comes with the highs and lows you can expect. After having been through 6 months of residency, I would say it is very accurate.

Gifted Hands: The Ben Carson Story by Ben Carson. Just because I find Ben Carson incompetent as a politician does not mean I do not respect him as a doctor. He is a phenomenal pediatric neurosurgeon and this book details his story.

On Doctoring: Stories, Poems, Essays by Richard Reynolds

A book of stories and poems from doctors throughout time and also from famous poets and authors depicting their views of medicine.

Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot by Christopher Crenner

An interesting look into a Boston medicine clinic from the early 1900′s. With excerpts from old patient notes which I found very interesting. 

And if you have an interest is something more dark:

Blind Eye by James B. Stewart

The real story of a doctor murderer from the 1990′s who killed multiple patients without getting caught for several years.

Devil in the White City by Erik Larson 

The story of the World’s Fair in Chicago in the late 1800′s. A great look into the history of Chicago and the murderous doctor who roamed its streets.

And lastly:

The Hitchhiker’s Guide to the Galaxy by Douglas Adams. Just a great book in general. My favorite.

Suggested by other users:

The Making of a Woman Surgeon by Dr. Elizabeth Morgan

Suggested by http://thetay-in-the-757.tumblr.com

This book is my all time favorite, as I am a female aspiring to work in the healthcare system myself. Dr. Morgan chronicles her own journey in the male-dominated arena of medicine in the 1970s and 1980s, as she struggles to maintain an appropriate balance between remaining empathetic towards her patients and yet must toe the line of not becoming too emotionally involved with her patients so that she burns out, as well as maintaining her own femininity in a man’s world.

When Breath Become Air by Dr. Paul Kalanithi

Suggested by http://nandemokandemo.tumblr.com

When Breath Becomes Air is an autobiography written by an esteemed neurosurgeon who discovers he has Stage IV lung cancer in his final stages of residency. It appeals to not only medical students, with his profound impressions of cadaver dissection and his first life and deaths, but also to current medical professionals by questioning philosophical domains of mortality and what a meaningful life is, as well as to non-medical professionals with moving thoughts on family, life, death and meaning. It is not a novel to be missed by any person.

JUSTICE HAS BEEN SERVED 

Molecule of the Day: Diazepam/Valium

Diazepam (C16H13ClN2O), also known as Valium, is a white solid that is of significant pharmaceutical importance. It is a member of the benzodiazepine family, which shares the similar bicyclic system comprising of a conjoined benzene and diazepine ring.

Diazepam is used to treat anxiety and panic disorders, and this is achieved by its binding to GABA receptors on neurons. This causes the active site of the receptors to become a better fit for GABA molecules, resulting in a higher binding of GABA to it. This triggers a greater influx of chloride ions into the neuron. 

Since the intracellular portion of the neuron is more negative than normal, the membrane is hyperpolarised to a greater extent. Consequently, a stronger stimulus is needed to trigger an action potential, which is created when a stimulus causes the membrane to reach the threshold potential.

Since the resting potential is now more negative, the action potential and thus firing of the neuron is less likely. This then produces the anxiolytic, sedative, amnesia-inducing, and anticonvulsant effects of diazepam. 

Diazepam can be produced by various synthetic pathways; one such one is shown below.

Requested by anonymous

The hardest battle you will ever have to fight is between who you are now and who you want to be.

Anonymous (via wnq-anonymous)

Anti-epileptics/Anti-convulsants Made Incredibly Easy

TREATMENT STRATEGIES:

Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.

Monotherapy until seizures are controlled.

If failed: titrate up to maximum tolerated dose –> shift to alternative drug –> use drug combination –> VNS, DBS.

Full drug therapy for 2 – 3 years after the last fit.

Gradual withdrawal over at least 6 months.

Rx Profile:

(Drawings are courtesy of @mynotes4usmle​)

Carbamazepine

Mainly for generalized tonic-clonic seizures

Trigeminal neuralgia

Bipolar disorders (with depressive predomince) - mood stabelizier

NEVER in abscence seizures

SE:

Lamotrigine

Safer profile, with minimal interactions.

Bipolar disorders (with depressive predominance) - mood stabilizer  

SE: maculopapular rash; SJS

Topiramate

Broad spectrum anti-seizure; used in migraine.

SE of TopIRamate: enzyme Inhibitor + Renal stones.

TREATMENT PROTOCOL:

Green: first line; Yellow: second line; Orange: third line; Red: contraindications. (Graph reproduced from Oxford Handbook of Clinical Medicine)

Epilepsy & Pregnancy:

Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.

Most of AEDs are teratogenic; Category D

Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.

Avoid phenytoin, valproate and barbiturates (use Lamotrigine)

Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)

Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.

Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.

Status Epilepticus:

WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.

Things to be done:

Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.

Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.

Pulse oximetry, cardiac monitor.

How to treat?

THE END