Don’t confuse faith/spirituality and religion

1/ Spirituality teaches you to be open to things beyond you.

Religion teaches you to label others as dirty, unclean & sinful.

2/

I worked with a new locum (agency/casual/temporary fill in) scrub nurse yesterday. He said there were more than 70 jobs listed for the day in Melbourne. He just went for the nearest and best paid option.

Think on that a bit… 70 gaps in theatre nursing position. Most nursing departments will first call their own staff to do extra shifts before looking to external agency to fill in (more expensive, unfamiliar staff)…

Oh dear!

The multiple replies to this tweet from @JoshBBornstein is making every ENT surgeon shake their heads. So many inaccuracies, myths and confusion.

An ear discussion here is ear-resistible. Read those replies, and return to my thread. Let’s chat. 1/

https://twitter.com/joshbbornstein/status/1578974749753237505

Surfers ear is not swimmers ears.
Inner ears is the cochlea and semicircular canal. What you refer to as inner ears is actually the middle ear anatomically speaking. Surgery ears and Eustachian tube dysfunction is unrelated.
Middle ear fluid has nothing to do with swimming.2/

John Farnham, an Aussie legend, sadly has one of the many kinds of Head & Neck Cancer. Just like Michael Douglas, Sigmund Freud, Sammy Davis Jr, George Harrison and many others did.

A thread on Head & Neck cancer:

1/ 2. Head & Neck cancer is a big group of cancer that arise from the Head & Neck region, involving the skin, inner lining of the airway & digestion, glands (saliva glands, thyroid), soft tissue, muscle, bone, sinuses, etc.

12 Tips on surviving a hospital admission in COVID times.

1. Prepare to wait. Staff overworked, doing double shifts. Hospitals at full capacity. Be patient.
2. Bring a book, a computer, a phone and necessary chargers.
3. Come alone if possible or with only 1 support person.

1/ 4. Bring small snacks if needed (free of nuts if possible) & drinks.
5. Prepare to be cancelled or have your plans changed. Cancellations are always last resort but sometimes there are no other options.
6. Summarise your health needs and history on a page. Staff exhausted.

2/

What makes me smile?

The facial nerve.

What made @justinbieber’s face droop?

His facial nerve stopped working.

Let’s talk about the journey of the facial nerve from brain to face.

1… 2. Here’s a schematic diagram from Grays with my additional labelling. This complex nerve meanders through really tight structures.

Facial nerve is also called Cranial Nerve VII (“seven” if you don’t do Roman numerals).

I love it and I spend hundreds of hours operating on it.

1. If a 3 year old presents with facial nerve paralysis, don’t call it Bell’s palsy unless you’ve ruled out middle ear disease. The facial nerve travels through the middle ear and mastoid. It could be compressed there.

Call it acute facial paralysis secondary to middle ear dz. 2. If an 83 year old presents with facial paralysis, don’t call it Bells unless you’ve ruled out stroke clinically or Ramsay Hunt syndrome (with vesicles/rash).

Call it acute facial paralysis for investigation.

Ramsay Hunt syndrome (Herpes Zoster Oticus) is facial nerve paralysis due to varicella zoster virus (same virus that causes chickenpox). There has to be vesicles/rash.

Without rash it’s just simply called facial nerve paralysis.

1/ Bell’s palsy is IDIOPATHIC facial nerve paralysis.

This means that EVERY cause of that facial nerve paralysis has been ruled out (brain tumour, nerve tumour, middle ear disease, mastoid disease, parotid tumour, nerve infection.) You can’t call Bell’s unless you’ve MRI’d.

2/

COVID IS IN DA HOUSE!

A couple of weeks ago my 13yo son had a sore throat and his RAT turned positive.

We then tested the rest of the household.

This might happen to your family as school reopens next week. What do you do? 1/ Just a background.

My wife and I are triple vaccinated. 13yo is double vaccinated. 8 & 6yo had first dose the days before Mr 13 turned positive.

We think he may have caught it during a badminton game in a COVID-safe hall. All 3 kids attended but only Mr 13 turned +.

2/

Do your know what

C

T

stand for on your Rapid Antigen Test tray? C does not stand for COVID.
C stands for Control. This is to check that the test is valid (controlled) and should appear when the test is done properly.

T is test.
A line on T that means you test positive.
No line means that the chemical has not bound to the protein/antigen.

1. “The tests are useless because even fruit test positive for COVID!” (Click on pic to see full tweet)

No. This is a basic science misunderstanding of how the Rapid Antigen Test work. The fruits do not have COVID. The test is chemically fooled because of the chemical reaction. 2. PCR test captures viral RNA which is then amplified to DNA. Hence the sensitivity and specificity is much higher.

Rapid Antigen Test or Lateral Flow Test, however, seeks out protein that binds to the buffer solution and hence create a chemical reaction.

Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger

Some interesting findings. No surprises here.

Survey of 13,000 doctors (they use the term “physician” to include all docs including surgeons, pathologists, paediatricians, the lot) medscape.com/slideshow/2022… Which specialties are most burned out? Click on the pic.

No surprises. Emergency, ICU and Infectious diseases are the top 4 worst hit. Perhaps the OBGYN in the group can tell us why they’re also quite burned out?

1. Here are 3 important videos on Rapid Antigen Tests

GO LOW. GO SLOW.

Going up is painful (narrow roof, deviated septum common).
Going fast is interpreted by the nose as pain.
Going low and slow reduces pain and allows time for swab to absorb samples. Rotate gently.

Self-swab

https://twitter.com/DrEricLevi/status/1477057391212449793

2. Swab on kids.

It does not have to be scary or painful. Let kids see this to reduce their worry.

Gently rest head on pillow or arm.

Swabbing hand needs to rest on lip, cheek or chin in case the child suddenly moves.

https://twitter.com/drericlevi/status/1480495377237168131

Just a note about dying “with” and dying “of” COVID. It’s a horrible thing to differentiate and best not to do it. But if you really have to do it, let me illustrate with another condition.

1/ Acoustic neuroma is tumour of the hearing nerve. It’s rare. About 0.02% of the population may have it without knowing. It does not spread or cause any systemic effects.

If one dies & had a postmortem scan & incidentally, AN was found, that’s dying “with” not “of” AN.
2/

There are many subtypes of Human papillomavirus. For example HPV6 & 11 cause warts & some paediatric airway papillomatosis. HPV16 & 18 are cancer causing - cervical cancer &oropharyngeal (tonsil & base of tongue) cancer. Others in the HPV family are not clinically significant. 1/ Coronavirus is also a big family. They’ve been around for thousands of years. This one causing havoc is specifically called SARS-CoV2. It has many variants. And variants of concern have been called Alpha, Delta, Omicron. Other coronaviruses don’t cause such severe disease. 2/

If we had a mass casualty incident with 1200 patients, many of these patients will be cleared & discharged over a few days.

Having reduced staff & managing over 1000 patients daily for weeks (it’s not yet peaked) means thousands of other routine care patients will be cancelled.

https://twitter.com/VicGovDH/status/1483931428564107264

A code brown is about resource allocation and leadership structures to rapidly respond to resource provision.

It’s not to say the system has failed. The code brown is designed for this kind of strain on the system to allow quick redistribution of resources.

Eric, just stick with the dad jokes will you?

Ok.

https://twitter.com/drericlevi/status/1483578671776641035

In our friendly local hospital today:

3 out of 4 doctors in training under me are down.
Cases are cancelled because not enough nurses to staff theatres and ward beds.
ICU is full capacity. Elective cases needing ICU bed cancelled.

Those who turn up are doing multiple jobs. Take care friends.

Buckle up for the next few weeks. (Again).

Today I had several heart breaking conversations.

I spoke to several parents who were anxious that their kids’ surgeries are now postponed due to COVID restrictions. I am as frustrated as they are.

I spoke to a parent of a child with disability who is yet to be vaccinated. 1/ I spoke to a nurse who works the childrens ward at a private hospital who had to be re-deployed in 2020 to look after elderly patients with COVID, many of whom died before the vaccine was available. She is still traumatised by that experience. 2/

If “living with COVID” means that the two biggest Australian states need to cancel all but urgent and emergency operative cases to meet the workload demands, then that’s not a good place to be, right? We can mitigate the effects as a community. We can manage it to a certain degree.

Letting it spread too quickly overwhelm the system.

Your actions matter. Be kind to others.

Vaccinate. Mask up. Ventilate indoors. Choose outdoor.

I love patients who “do their own research”. That means they’re engaged and want to gather information.

The challenge is that “research” is a broad description.

When scientists and specialists talk about research, it’s about a lifetime of skills acquisition. 1/ During my Science degree, we had whole semesters of subjects purely dedicated to the art, science and foundation of research. That’s hundreds of hours on understanding the process itself.

We all did hundreds of research paper reviews, analysis and dissection. 2/