Starting to love Neurology
A topic I hated, but now adore - also, Merry Christmas!
2 weeks into my neurology rotation:
I won’t lie. I used to HATE neurology.
I could not stand the diseases. Whenever we had anything to do with neuro, my brain (ha) would just shut off. Neurophysiology, pathology etc, anything, you name it and my brain shut off.
2 weeks ago when I was starting the rotation, I was just happy to be done with psychiatry so I entered neuro with an open mind.. and boy oh boy, have I been enjoying it.
It definitely has crept it’s way up into my top 3 rotations for now. All I can say about neuro is that it is a rotation where things make sense when you see them in a clinical setting. I used to hear all these diseases such myasthenia gravis etc, and I used to just be like yeah okay.. ( I don’t know why ). But then actually seeing a myasthenia gravis patient was super interesting.
Lessons learnt from one of the best neuro doctors:
Patients in ICU
The doctor I spent one rotation day with took me to the ICU with him while he examined patients. Most of the patients were in a coma. When we were done in the ICU, the doctor took me to the side and said: “One piece of advice I want you to take from me in this rotation is that, don’t think those patients cannot hear you”. He went on to explain that we don’t know whether the patients can hear us or not and they just can’t react or respond to us. He, therefore, said we should not speak about any bad prognosis in front of the patient assuming they cannot hear us because they probably can.
Cogwheel rigidity
A parkinson’s patient came in and the doctor asked me to examine the upper limbs for tone. One of the things we check for in parkinson’s is this thing called cogwheel rigidity. Trust me, it was just another word to me until I actually met a patient with it. It genuinely honestly feels like a cogwheel.
You basically just shake their hand, while stabilising the forearm and then you move the wrist in flexion, extension and rotation movements. I felt the cogwheel rigidity in both hands and the doctor asked where it was more prominent and I said the right side (we knew that this patient was mainly affected on the left side).
The doctor then asked me to continue checking for the rigidity on the right hand, while the patient was distracted. The doctor kept asking the patient to do something with their left hand while I examined the right. The rigidity wasn’t that bad in the right. We then swapped placed. I was examining the left and the patient was being distracted by the doctor on the right hand (asking her to do different movements with her hand). I kid you not, I could barely move her left hand because of how rigid it was.
The doctor explained that when checking for tone, when the patient is paying attention to what you are doing, they have the ability to make it look “normal” because they are concentrating on it. Therefore, if you distract the patient with something else, you will find the ‘true’ tone of that part of the body.
Merry Christmas
So yeah, that is all from this week, I hope you have a great Christmas and if you are spending this day away from family & friends because of Covid restrictions, don’t let your mood go down, watch movies, make / order great food, listen to good music etc. Do what you can do to make it as nice of a day as possible.
Song of the week:
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🚶🏻♂️ About me:
My name is Habib and I am a 5th-year Medical student currently in Cyprus. I grew up in Tanzania (Hakuna Matata is from the local language of my country and the second tallest mountain (Kilimanjaro) is found there).
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