@dresmerelda

ID/Micro Academic Doctor & Smiley-faced lover of purple

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Category: Healthy Living

Time (or in reality ‘Me’) Management

November 27, 2017November 27, 2017Leave a comment

I'm pleased to say that I've managed to achieve a fair bit so far in my career while being utterly useless at time. How? Read on...

Rejection and the ‘Science’ of Recovery

August 1, 2017August 1, 2017Leave a comment

Thinking positively isn't always that easy. Here I discuss how I learnt self confidence and coping strategies for a healthier mind.

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In a corner of the lab is a secret door... 🤫 • Sort of- it’s the Category 3 organism area, where the BMSs process some of the most high risk organisms. Take that possible Salmonella paratyphi! 👊 • I say possible because it needed to go off to a reference lab for checking (seniors don’t like it if you run Cat 3s through the MALDI...?! 😂). But there were clues to its identity. 🤔 • Salmonella expresses different antigens (signals on its surface that trigger the immune system) and Kauffman & White created a system of identification based on these: 1️⃣ the O antigen- oligosaccharide region of the lipopolysaccharide cell wall. Testing this with special antigen-testing kits, the BMS will find that, for example, ‘number 4’ is reactive; ie, it generates a “number” corresponding to a ‘type’ of O antigen. 2️⃣ the two H antigens- relating to flagellar proteins: testing as above generates a letter and a number 3️⃣ the Vi antigen- “virulence” antigen associated with paratyphi and in particular typhi. It’s either positive or negative. But it can be switched off, the tricky soandso. 😏 • When our BMS tested the H and O antigens, she found that only a handful of Salmonellae expressed the same types of O and Hs- the most high risk one being Salmonella paratyphi. This could fit with the patient history we had too. So off to Cat 3 she went and off to ring the referring team and Public Health I went! 👩🏻‍⚕️ • • • • • • • #micriobiology #labtime #cat3 #salmonella #typhoid #infectiousdiseases #publichealth #globalhealth #diagnostics #maldi #mediclife #whitecoat #wearescience #alwayslearning #scicomm #teamwork

Pretty snowy-white Candida on a Sabouraud plate. Happy #friyay everyone. • • • • • • • #agar #arty #science #microbiology #microbes #petridish #wearescience #doctorslife #infection #beautiful

I’m not the only person that sees beautiful, bare-footed, beach holiday yoga pics on Instagram and thinks, “WOW!” but also.... “Hookworm, Strongyloides and Cutaneous Larva Migrans (CLM)”.... right? 😂😜🤪👩🏻‍⚕️🙄 • • • • • In reality, only one of the above might be seen ‘commonly’ in the UK/returning traveller. These are soil-transmitted helminths (parasitic worms) and these 3 use SKIN PENETRATION to get into the human host, often through bare feet. 👩🏻 • Strongyloides doesn’t usually cause many symptoms in the host- it’s the “House” type diagnosis. Hookworm tends to show itself as anaemia and tummy pain in children in some of the poorest parts of the world that unfortunately have the least access to sanitation. 😔👩🏻‍⚕️ • CLM is actually an animal hookworm- and consequently the one we more commonly see in the returning traveller on a beach holiday around dogs. It presents with an S-shaped mark on the skin (usually the foot) that changes shape and position- the parasite moving about. 🙈 • All of these are treated with anti-helminthic agents such as albendazole and ivermectin but if you’re treating a patient that has lived for a long time in an endemic area, always think of checking for Strongyloides too and treating that first. 👍 • • PS: I’m loving learning yoga ☺️ • •

A cup of tea and a kind ear often go a long way. In recent weeks the last 3 years of my life feel like they’ve caught up with me... 😕 • To summarise without dwelling on good or less-good, I’ve moved jobs and cities, protested the government, completed 2 years of training in 9 months, disagreed with National training bodies, become a registrar, learnt lab techniques I’ve never done before, and run a research project. And that’s not including my own social circle stuff like trying to be a good friend/family member, getting married and buying our beautiful house! I’m NOT complaining because I’m very happy; even with the hard times, I consider myself incredibly lucky too 🤩 • But as my sister and I were discussing recently, being medics resets the bar a little sometimes. I find it hard to complain about things most might find a struggle because I work with some of the most vulnerable people in society- I see how unfair life can really be, so I just figure I should suck it up and get on with it. It’s only now I’ve got to a point where I can kind of stop ‘fighting’ that I realise just HOW MUCH has happened in the last 3 years- I mean, no wonder I’m tired!! Thankfully, I also try hard to listen to my body and take breaks- and when I forget, I have great loved ones, friends and colleagues to remind me 😁❤️ • Working hard all the time is not the meaning of life! We can all slip up though. One of the most important things to come out of the time of the doctor strikes in the UK has been things like the Tea and Empathy group. If you need an ear as UK doctor then check them out. Sometimes just catching up with yourself and having a moan to a friend can help you rebalance and unload. Sometimes, a cup of tea solves everything. 💕

The theme of this week has been TB! 💊 • On Tuesday we had a teaching session to mark World TB Day (in March) and the opening of our new ward (brand spanking and coming soon! 😁❤️). Our current and new ward feature rooms with specialised air flow systems to protect the rest of the ward. On entering, if a patient has active infection, we have to mask up. We tend to do this for the first two weeks of therapy for non-resistant TB. 😷 • TB on the whole has decreased in the UK in recent years. It’s still a fascinating disease to treat though- it can present in a whole variety of ways and affect any organ. Treatment is with at least 6 months of therapy. 👊 • This week has been about getting my head back into medicine and thankfully it hasn’t all left me!! In summary: I’ve seen chronic bone infections, strep infections, staph aureus bacteraemias, HIV, hepatitis and TB patients; I’ve comforted tearful, fed up patients and calmed down agitated ones; I’ve done my first cannula in 10months (and done another 2); caught up with old friends; forgotten and remembered drug doses; reviewed scans and echo results and been to two mdts; I’ve done gym, yoga and my first aerial exercise class (can’t move my arms); “induced” some new doctors to the unit, seen a new ward and sorted out rotas! Bring on the weekend- happy #friyay ☺️

Is it just me that looks at a microscope and thinks of Johnny 5 (or for you younger folk, Wall•E)?! 😂

Name an infection (either a micro-organism or part of the body) that would make you want to look at the back of the patient’s eye. Not an eye infection but somewhere else!! Go! 👇 • PS: or scroll for further photos where we got the giggles as I “worked it”

BOOM! This week I’m back on Infectious Diseases: HIV, hepatitis, global health, chronic infection, general medicine and often the medical mysteries! But NOW backed up by everything I’ve learnt in Micro. ☺️Bring it on! 🙌

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