TWS - Pre-Op Clinic, Gigantism, and Culture

📝 Rx

Hi friends,

Recently spent a shift in pre-op clinic where we do a risk analysis for patients to see if they are fit for surgery. To do that, my doctor goes through a patient's entire medical record and looks at all current meds, imaging, and diagnosis in their history to get a clear idea of how safe surgery would be for them. Since we only see the patient once, it takes a lot of time to talk to them about everything in their history but I absolutely loved how my doc took his time to talk about every single medication and diagnosis with the patient.

What I noticed was that most people forget why they're even taking certain meds, or don't know what conditions they've been diagnosed with. This meant having everything in their file be talked about within one appointment was super informative for them (and for me as a student).

It's been hard to get this level of thorough attention in any other service because there is usually one specific issue to target as opposed to doing a holistic review of someone's medical file. I don't think every visit should be like this, but I think having a yearly review with patients about what is going on in detail would be extremely beneficial for both parties so this is something I will definitely take onwards with me into practice for the future.

🩻 Diagnosis of the Week:

Acromegaly (Gigantism in pediatrics, which sounds more interesting)

What is it: Acromegaly is the adult condition where your body is making too much growth hormone so parts of your body grow abnormally. It tends to happen around age 40-50ish and it's usually associated with a benign tumor in the brain. This tumor is specifically on the "pituitary gland" which is responsible for secreting different hormones. One of these hormones is growth hormone which is very important during puberty to literally grow bigger, but also in adulthood to maintain body functions.

Since adults no longer have the growth plates children have, our bones are not capable of making us taller, but they can become thicker and coarser which is what happens in acromegaly. The classical patient is someone with increasing glove or shoe size well into adulthood.

Key signs:

• Increasing shoe, ring, or glove size as adult
• Headache with vision loss on the lateral sides
• Increasingly large facial features, specifically nose, forehead, and jaw

🤓 Dose of the Week

At this point in third year I've been through quite a few different departments in the hospital and I've really grown to appreciate how they all have their own quirks. I was talking with a mate how the culture and people in whatever service you're placed in has such a strong influence over whether or not you "vibe" with a specialty or not. I think inherently we all have some idea of what interests us specialty wise, but the other half of a residency decision really comes down to the department your school has you rotate through.

To give an example, I never thought bariatrics would be something I'd like, but the people there were so welcoming that it really made the rotation stand out. General surgery as a whole has been surprisingly welcoming which is something I wasn't prepared for. Others have not been what I expected, which is fine. Just wanted to emphasize the "human factor" on picking specialties this week.