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Learning by Doing

I bake biscuits.  It started off as a bit of down time and then I realised it could actually be a revision tool.

 

The biscuits might look like a simple picture of a spine but as I iced that I revised all the facts I needed to know about the vertebrae.  It is a bit like haptovisual drawing, it’s impossible to tell by looking at the end product what learning process has taken place.

My institute has an innovative learning week, well it used to.  It was cancelled this year – I think it was something to do with the fact that all our teaching should be innovative, not just that one week.

 

 

Last year I had floated the idea of doing a biscuit workshop and not to be deterred by the fact the event no longer existed, we pressed ahead and did it anyway.

Teaming up with out training kitchen (part of accommodation services where they teach the students to fend for themselves) we ran an afternoon workshop aimed towards medical students.

Come along and learn to bake biscuits and we will decorate them with as close to anatomically correct icing as we can.

That afternoon I experienced one of the best educational experiences I have ever seen.

Two fourth year medics turned up.  They were on their orthopaedic rotation.  The simple cutters were not for them.  They went free style with a knife.  After much debate about the structure of the femur and pelvis they produced two dough shapes.  They had gone backwards and forwards in debate to ensure they captured as many features as they could and they named them all, only resorting to an app for help once.

After baking they decided to hold this femur in place by icing on the ligaments of the hip joint.  It’s not very precise but the discussion between the two of them as to where the ligaments should go and what they were called demonstrated that they were recalling information that they had been taught long ago.

The real cherry on the top of this learning experience was when the chef came over and asked them what on earth it was.  They explained.

He then asked them how a hip replacement operation was performed.

Using their biscuit as a prop, they explained the whole operation to him. the final piece in an exchange of knowledge that had started with him showing them how to use a rolling pin (yep 24 years old and no idea how to use a rolling pin).

I hadn’t expected that demonstration of revision and explanation to occur when we came up with the idea but if there was any doubt that these sort of ideas are worth it that experience has convinced me.

You can provide educational experiences anywhere.

First, Foucault, Fractals, Freedom Fighters, Foam Rolling, Fascia and Feminists

It’s the start of a new year and for me, the start of a PhD.

The first month (just managed to sneak this one under the wire) has been a fascinating start.

I’m going to be looking at different groups beliefs about aspects of the human body, particularly Fascia.  This is social research – a whole different ball game.

Anyone who has looked at social research will know you can’t really move without bumping into Foucault and his thoughts on why things are the way they are so there has been some significant reading in that area.

And then Fractals – this is the mathematical idea of repeating patterns that are found everywhere in nature.  That took some time to get my head around but once you are aware of it you begin to see it everywhere.

That experience is called the Baader Meinhof phenomenon.  The Baader Meinhof group was a militant organisation usually referred to as terrorists.  That doesn’t begin with an F and I think the quote that ‘one man’s terrorist is another man’s freedom fighter’ ties in quite nicely with the idea I am exploring that lots of different groups see the same thing in different way.

This tied in with the feminism strand where I had to read a really interesting book on Emily Davidson, the woman who stepped out onto the race course on Derby day back in 1913.  It’s one of the interesting things of moving towards the humanities; that there are many different ways of looking at the same thing.

Foam rolling? It’s the main connection that the public have with fascia.  Do you foam roll?  What do you think it is doing?

It’s going to be 6 years of wild exploration!

Christmas – the true story

Everybody knows that the true story of Christmas now days is over indulgence.

This could be in the form of presents and spending money you don’t have but it is also in the form of food.

There is a horrendous advert on the bus stop up from my house for one of the major supermarkets.  It shows a spread of food with the tag line ‘Christmas is a time for sharing…unfortunately.’  What a terrible message!

What does your body do when you overindulge?  We probably all know that we get drowsy and feel stuffed, but why?

Food enters our digestive system via the mouth where you chew it all up, mix it up with saliva and it is then pushed to the back of your mouth as a bolus; a nice round ball of food without any sharp edges that can be passed down your oesophagus and into your stomach.

The stomach is usually a small deflated hand sized organ that sits just under your rib cage.  It has a folded layer that allows it to expand as food enters it and it has three payers of muscles that lay in different directions to allow it to churn the food inside with the acid and continue digestion.

After the food has been broken up it passes from the stomach into the small intestine where it has bile added to it to aid with fat digestion.  The nutrients are removed from it as it passes along the 20ft of the small intestine.  Passing the appendix, it enters into the 6 foot of the large intestine where water is absorbed and the remaining waste passes out of the anus when you go to the toilet.

That’s the normal passage of events so what is the difference at Christmas?

It’s the volume of food that you eat and the speed at which you eat it.

The message that goes from the stomach to the brain to say that it is full is based on hormones.  These circulate in the blood to get the message to the brain and so the communication is not as quick as a nervous signal.

We have two hormones that control our appetite, ghrelin and leptin.  Basically ghrelin increases appetite and leptin suppresses it.  As the stomach expands it sends the message to the brain that it is full and leptin is released which should reduce our appetite.  This can take 20 minutes.

On the 25th keep an eye on the clock and see how much food you eat in 20 minutes!

Add to that the fact that there seems to be an increasing problem with leptin resistance.  People who are obese seem to require more leptin to be released before it has any effect.

Why do you feel sleepy?

The blood supply is diverted to the stomach to cope with the digestion of food.  Other systems slow down to accommodate the reduced blood supply.

Can I eat so much I burst?

It’s unlikely but not impossible.  There are some rare clinical cases of people managing to rupture their stomachs through over indulgence.  It’s not going to look like the scene from Monty Python but it’s not going to be pleasant.

Why do I get heart burn? What is heart burn?

The stomach produces a very strong acid.  The lining of the stomach is immune to this acid and protects the organ from its effects.  The oesophagus connects the mouth to the stomach – it is not immune to the effects of this acid.  It is possible for the acid to pass up into the oesophagus through the sphincter (valve) that would normally separate the two.  This is acid reflux and you feel it as a burning sensation as the acid attacks the oesophagus (treat it and if it keeps happening see someone about it)

What should I do?

Cut yourself some slack.  It’s Christmas (or any other holiday).  Be aware that your dinner probably contains around 3 times the amount of calories you need in a day.  You might have had a drink, your will power might be lower and you might feel obliged to eat every dish that Aunt Bessie puts in front of you. Take your time, eat slowly, see if that leptin message is on its way.

 

    Happy Christmas and see you in 2020.

Christmas and eponyms

Christmas seems an appropriate time to be looking at eponyms (think about it)

Today is December 1st so I get to open the first window on my advent calendar.

It is a tablet calendar.  If you aren’t Scottish, or don’t know what tablet is then you are missing out but also far less likely to become diabetic.

As well as my actual advent calendar I am also running #Anatomyadvent where each day I am posting an eponym, a structure in the body that is named after the person who described it, and we are seeing what anatomists in twitterverse call it.

The academic move is against using eponyms.  They don’t encourage understanding and you can see that naming something after ‘some white dude’ doesn’t tell you a lot about what it does or where it is.

A common language in medicine is a great way to communicate.  Trips to the A and E with my son have  sped up since I have learned the language.  We can be precise, the medic knows exactly what we are talking about.

Opinions are split about eponyms and I think whether they are good or bad  depends who you are talking to.

If I am talking to the medical student then their learning the term  ‘pouch of Douglas’ tells them nothing about where it is, what it does.  You can see that the powers to be might think calling it ‘retro uterine pouch’ tells the student where it is.  It helps, it helps those people who understand latin.  Translating things out of Latin so that more people could understand them is a move we made back in the 1600’s.  Is this a backwards step?  putting things back into Latin.

If I am engaged in Science communication then ‘retro uterine’ means nothing more than ‘Douglas’ . It sounds like Latin, it sounds elitist, it puts people off.  Douglas, on the other hand, begs the question ‘Who was Douglas?’  It opens up stories from the history of medicine.  It allows conversations about why parts of the body are named after ‘some white dude’.  It promotes discussions about why no one else seems to appear in history -its all ‘random white dudes.’  Eponyms can be a springboard off into other directions.

Are they good or bad?  I think it depends where you are standing.  Let’s see what #Anatomyadvent shows us about their use.  Have they gone or are they still in use?

 

P.S.  It appears that the pouch of Douglas might actually be called the Rectouterine pouch now because it is between the rectum and the uterus, rather than the Retrouterine pouch because it is behind the uterus – both factually correct –  but only one will be the correct name.   Ironic that trying to clarify the name of it has actually created confusion.

Coughs and Sneezes

As everyone says now days, Winter is coming.

And with it the inevitable batch of coughs and colds.  Bacteria and viruses spread around the place by people acting as incubators and distribution centres for illnesses we could all do without.

But how does your body protect itself against the invasion of these nasties? What is the difference between a cough and a sneeze and why might you never look at an escalator in the same light again?

Everybody knows that coughs and colds can be airborne.  This is why we are all told to cover our mouths when we cough or sneeze, to help control the spread of the infection. So what lines of defence does our body put in place.

The chosen site of infection is the respiratory system – the way we get air into our bodies to supply us with oxygen.  This route starts at our nose, passes backwards to the rear of the throat where it joins up with the oral cavity.  From there is passes down through the pharynx and larynx and into the trachea, our air pipe.  This tube’s shape is maintained by semi circular ridges of cartilage.  There is no cartilage at the back so that the oesophagus (food pipe) can expand to allow food to pass down into our stomach.  The whole system is lined with special cells that produce mucus.

Whether this mucus is called snot or phlegm depends on whether it is produced in the nose or in the lower respiratory tract.  Where ever it is produced, its purpose is to engulf any particles that shouldn’t be in the air passages.

Once the invading particle has been engulfed, how does it get up out of the trachea?  The cells that line the trachea have cilia; little hairs that beat to waft particles away from the cells.  Within the trachea the beating of the hairs is coordinated so that mucus is passed from the lower cells up towards the larynx where it can be disposed of by swallowing.  This system of moving the mucus from the depth of the lungs to the throat is known as the mucociliary escalator.  It gives all the defeated bacteria and viruses a ride up to the waste disposal route.

So what makes us cough and sneeze?

The respiratory system also has sensitive hairs within it that detect things that should not be there.  If these hairs are triggered in the lower respiratory tract then a message is sent to the diaphragm causing it to contract rapidly and expel air from the lungs.  This is a cough.  If the nasal passages are irritated then it causes a rapid expulsion of air through the nose – a sneeze.

Why does the cough persist?

The presence of foreign particles in the airway, their attempt to invade cells, and coughing, can cause the lining in the airway to become inflamed. This inflammation can be a good thing as it is caused by an increased blood flow to the area which brings increased levels of immune system components, but it does tend to linger for a few days after the initial infection or irritation has gone.  This will resolve itself but if it continues beyond a few weeks you should see your doctor.

Does a cough syrup help?

Cough syrups vary in their active ingredients.  Some contain drugs that suppress the cough reflex.  Think about that.  It stops your body from trying to remove foreign particles from your airway!  Some contain decongestants that make your mucus more runny, easier to cough up.  Most contain sugar.

No systematic study of cough medicines have shown that they have any effect on coughs (either good or bad).  Continue to administer your favourite cough syrup if you want but be aware what you are administering is the placebo effect.

 

Alternative cough treatments

When you have a cough or cold your body increases the amount of mucus that it makes.  This can be around 2L a day so you need to make sure you drink a lot of fluid.

You can decongest your airways with a hot shower.  Damp warm air will make it easier for you to breath.

Honey or lemon (or a hot toddy) will be as effective as any cough syrup. (All of which are as effective as doing nothing so just do what makes you feel good.)

 

 

 

Winged Scapula…Really?

There seems to be a great propensity within exercise professionals to diagnose, and the unfortunate thing is that a lot of the time they don’t even realise they are doing it.

At a recent training sessions I noticed that a lot of instructors were quite comfortable telling their partners that they had ‘winged scapula’.

Now you could argue that that is a generic term for having shoulder blades that stick out from your rib cage but it is the technical term for shoulder blades that stick out from your back because of a neurological issue.

If a member of the public in a class took that phrase to their doctors we would be faced with two scenarios:-

A – the GP would panic they had missed a diagnosis of a neurological condition,

B- the GP would have a wry smile and think ‘Exercise professional talking bollocks again.’

Either scenario is not great for the professional involved and both leave the member of public doubting the knowledge of the experts.

To be fair, when it was pointed out to the exercise professionals that winged scapula was a medical sign of the long thoracic nerve not functioning, which is quite a rare medical disorder, they were horrified they had ever been introduced to the term.  When shown a picture of a genuine winged scapula, none of them had ever seen it.

Let’s compare two pictures.

This is a genuine winged scapula caused by the long thoracic nerve not working.  This nerve innervates the serratus anterior muscle and with it not contracting and holding the shoulder blade (scapula) to the rib cage, the scapula sticks out if pressure is put on the extended arm.

 

You can imagine that this would display itself during press ups.

There is a difference between the person whose shoulders blades stick up in a press up because they are not used to contracting the serratus anterior and the person who can’t contract that muscle. (It’s the subtle difference between ‘you have a winged scapula’ and ‘your scapula are winging’ although the second phrase is usually used by people who don’t appreciate the difference and have grammatically stumbled on the phrase)

 

This second picture is from a site aimed at exercise professional.  It is claiming that this is a winged scapula and that you can fix it with their exercises.  There exercises engage the Serratus so would pull the scapula in but you can see that the person’s scapula isn’t winging, in fact the arrow points to a depression on their back where their scapula is, over hung by the development of their Traps.   Is it any wonder that people get confused.

To further add to the confusion the same site overs to fix something else that isn’t a problem.

Here we can see someone with their finger tips inserted between a scapula and a rib cage – this must be a problem!  Surely this is winging?

No, look at the pose.  The man has his hand around behind him in the small of his back.  This is the pose that body workers use to release the shoulder blade so that they can work on the muscles around it.  If your shoulder blade didn’t come away from your rib cage in this pose you would never be able to get into the pose, your arm wouldn’t go behind you.

Maybe its just trying to demonstrate the problem on someone whose nervous system is functionally properly.  I think they would have been better using a press up and asking him to relax his serratus.  If you can contract it, you can relax it and allow your shoulder blades to splay out (not wing).

The bottom line is that words are powerful.  If you have taken a technical term from another profession then you need to be careful how you use it.  Particularly if the person you are using it with is likely to go across professions (like the public).

The public’s understanding on how their body works is often dubious.  The professions don’t need to add to the confusion by not appreciating what they are communicating.

 

There be dragons…

I would not describe myself as a cryptozoologist – the jury still seems to be out on what that means.

If it is someone who tries to justify the existence of mythical creatures, then count me out.  If it is someone who studies mythical creatures then, guilty as charged.  Many hours have been spent debating whether four legs and wings would work and they are a fantastic ‘in’ to the public for science communication.

I’ve recently had an article published that used zombies to explain neuroanatomy (available here).  I asked everyone at the event to give me a zombie impression – they all stood up and did the same thing.  If zombies don’t exist then how did they do that?  We very quickly get into philosophical discussion about ‘existence’ and phrases such as ‘social constructs maintained in the societal collective’

Moving on….let’s talk mermaids!

There is a very rare (1 in 100,000 births) congenital deformity where babies are born with their lower limbs fused together.  This is called Sirenomelia or mermaid syndrome.  Its cause it debated.

Here I am talking about the mythical creature who lures sailors to their deaths – they generally aren’t nice – you need to think about Harry Potter and Peter Pan as opposed to Ariel.

Mermaids (and mermen) are another creature that almost everybody knows what they look like.  Another useful ‘in’ to describe movement and spinal musculature.

Almost everyone describes a merperson’s tail as seen in this picture. (I was going to use the statue of the mermaid from Copenhagen but it has legs).  The merperson has a lower half that is covered in scales and the fins of the tail are in the same orientation as the arms – they stick out to the sides.

They are described as being half human, half fish.

A fish has a tail that looks like this.

The fins are vertical.  The main musculature on a fish sits either side of the spine, anyone who has ever filleted a fish can confirm that.  As a fish swims it moves its tail from side to side.  There is an argument that this is the evolutionary advantage of having the left side of your brain control the right side of your body and vice versa.  When danger approaches a fish from the right, it has to contract the left side of its body to move away.  The few milliseconds advantage that it gets from having the right side of its brain control the left side of its body could mean life or death.  (This gets complicated when we appreciate that the visual field might cross over too, but I did say it was an argument, as opposed to the truth)

To use their tail in the same way as a fish, a merperson would have to swim on their side.

The main musculature in the torso of a mammal is at the front and back.  Aquatic mammals have tails that look like this and the movement in the water is up and down rather than side to side.

This is the way that merpeople are usually depicted as swimming in films.  That would make sense, the top half of the merperson is mammalian, its musculature would be at the front and back, the tail movement is usually orientated that way.

What is with the scales then?

Is the half fish bit just the scales and the appearance of the fins?  A quick look at their suggested anatomy and movement would say that they are more likely to be half person, half dolphin.

That probably doesn’t look quite so photogenic in films.

Either way, you probably will never look at mermaids in the same way again.

(Let’s just gloss over the fact they sit on rock with no pelvis and they bend their tails at the ‘knee’ joint)