Monday, 23 January 2012

Ward work and Hitler


A relatively calm week, compared to the busy time I had last week with all those early mornings, which is a nice break. I still spend some time on the wards, after I enjoyed it so much last week, as other than a Parkinson's disease clinic I have no time tabled clinical sessions, just lectures. I am not sure about the timetable for this rotation; it seems to vary massively between weeks, sometimes meaning you have plenty of early mornings (last week), other times (like this week) with a few lectures dotted around and little else. I have a presentation to do next week, and other out-of-uni commitments, so it is quite nice for me to have some control over my week and when I can go in and when I don't.

In general, neurology is a very 'post-graduate' type of subject. A lot of the things we are learning or seeing we will not be expected to do (or even necessarily know) as junior doctors, and wouldn't be expected to be doing unless we were specialising in neurology after completing our degree, and working as a doctor. While a lot of neurology is very interesting, with the strange symptoms and signs people can have (the brain is pretty damn complicated), it is also very complex. It does often feel as though a lot of the things we are learning we will never have to apply at all. Will I ever have to interpret an EEG to diagnose absence seizures? I very much doubt it, unless I am a neurologist, and in which case, I will need to be taught again as I will have forgotten by then. I suppose you do learn a lot of things you may never need to know again in medical school - though it is a lot more pronounced in the first few years with all of the microbiology that you learn!

I had a great day on the wards on Tuesday, where I just spent the day with the neurosurgery ward team helping with their ward work. The patient I saw last week who had the cranioplasty (skull reconstruction) is doing very well, and I am told that he could well improve faster now this construction has given his brain more space. I spend a full day examining people before operations, helping out with notes and clerking and other day to day activities. The neurosurgery ward is run by more junior doctors most of the time, as the more experienced registrars and consultants spend their days in surgery instead. I really enjoy working on the wards, which is a fantastic sign, as after I graduate, this is where I will be working for a few years at the very least!

The single timetabled slot I had this week was a Parkinson's clinic, where I was with a specialist nurse seeing patients with Parkinson's disease. I had come across specialist nurses before (for example a heart failure specialist nurse) and had been very impressed with them. This time was no different at all, and he clearly knew exactly what he was talking about. By managing a case load of patients, it means they get better treatment than if the GP was managing their Parkinson's (much more experience), and possibly better treatment than a neurologist because of the specialist knowledge of the nurse, though this is debatable. It is certainly cheaper for the NHS, though, which I am sure factors into it. As well as talking to and examining some lovely people with Parkinson's, I got a good amount of teaching. A lot of it was the pretty standard stuff about the difference between Idiopathic Parkinson's and Vascular Parkinson's, which is fantastic for me to learn, but some of the things I learnt were not entirely medical, but none the less interesting.

For one, I was told about 'Parkinson's trait' where people show traits in life which may make them more likely to get Parkinson's. The nurse was saying that many of the people who come in with Parkinson's have been very obsessive people, who have then developed Parkinson's disease. By obsessive, he means people who tend to focus on one aspect of life obsessively, such as model making or train spotting, and focus on this to the exclusion of other things. While (obviously) most 'obsessive' people do not develop Parkinson's later in life, it is very interesting to see that many of the people who do develop it have this 'personality type'. The nurse said that many of the patients who he sees have had mathsy / physicist / engineer type jobs, where its quite possible that being obsessive about small things can be beneficial. I don't know if it is some kind of genetic defect, predisposing people to Parkinson's later in life and making them obsessive early in life, or if it is the act of thinking about a few things obsessively (or gambling obsessively) which over stimulates neurones and can lead to Parkinson's, but it is a very interesting theory.

A video, watch until about 10 seconds in to see Hitler's Parkinsonian-like tremor in one hand behind his back, perhaps explaining why he usually had this hand behind his back or in a pocket.

The other thing I learnt, which I didn't know but probably should have, was that it is assumed that Hitler was developing Parkinson's towards the end of the war. The video above is 'real' footage of Hitler, and you can see up to about ten seconds in that he has a tremor, like that seen in Parkinson's, in his left hand which he keeps behind his back. Supposedly most of the footage showing these tremors was destroyed by the Germans, but some film (such as this Russian film) remains. Back then he would have been treated with anticholinergics. The nurse was telling me (and I don't know how much truth there is in this) that because of Hitler's Parkinson's disease, and the neurological problems it caused (thus ruining his leadership of the German army and nation) this was a reason that the Allies didn't attempt to assassinate him towards the end of the war, and possibly a reason why the Germans made an attempt on his life. Very interesting stuff, but probably more for historians than medical students! 

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