vodka grapefruit!

28 04 2013

I wonder a lot and I don’t always find answers to my questions, but when I do, it’s fabulous 🙂

Caveat: Ain’t encouragin’ no drinkin’ here. Photo by Vikingfjord US

This is a story of how a bunch of researchers discovered the wonders of Grapefruit. All medics know that grapefruit juice has certain compounds which affect how the body processes certain drugs. I took that for granted until one fine day, I asked myself, “How did they figure that out?”. Did doctors, while taking a history of a patient with some trouble with their drugs, ask if they had soy sauce, maple syrup on their waffles or grapefruit juice for breakfast? Did they then do the same thing with other patients with similar problems and see a pattern? I have rarely heard a physician go into that much detail about diet so I doubted that explanation. I looked up the literature (kidding, I just googled it) and uncovered an interesting story.

Sometime, either in the late 80s or early 90s, David Bailey and his team of Canadian researchers were doing experiments to see if consuming alcohol together with the blood pressure drug felodipine made any difference to the drug’s effectiveness. The participants were split into two groups, one was given alcohol plus the drug, and one, just the drug. To avoid the placebo effect, the experiment needed to be conducted in such a way that the subjects did not know whether they were having alcohol or not.  Turns out one way to do this is to use a mixer. Specifically grapefruit juice, the sharp taste of which would mask the taste of alcohol. When they ran tests on the levels of drug in the subjects’ blood, they found out that the drug levels were way higher than expected, even in the grapefruit juice group.  And that friends, is how we discovered the effects of grapefruit juice.

It turns out that pomelo and lime juice can also affect drug processing, while orange juice seems safe.

Welcome to Hell Part I – The Skillsets

2 06 2012

Imagine the pan is M3, and the egg is your brain.

I vividly recall this day. We had packed up all our equipment and were merrily marching and screaming Army songs as we made our way to the campsite where we were to spend the next three days for an insane field camp. When we finally reached our campsite, our officer greeted us with a “Welcome to Hell Week” with a beaming smile and proceeded the knock us down (i.e make us do pushups). We saw that one coming.

Unless you have siblings in med school, you might not have seen M3 coming. You might have done a rotation after junior college, but I think this one is going to be different. My seniors have helped me immensely and I’d like to pay it forward, so I’m going to outline a couple of things in the days or weeks to come which will hopefully make your M3 ride a little more enjoyable and effective [I didn’t say easy 😉 ].

I am going to start by laying down some groundwork and talking about what you will expect to learn, overall. Then perhaps I’ll take you through some study techniques, logistical stuff, lifestyle tips and so forth. I doubt there’s a single best way to do this so feel free to mix and match, corroborate this with other people and add your own flavour to it!

For a start, remember you are studying for a professional degree. That means you are training to do a job which has a huge scope and many nuances to it. Here is a bunch of skills you need to master.

Diagnosing disease. This will be the main focus of M3. Not at easy as it seems, but when it comes to diagnosis, doctors call the shots. A lot of allied health professionals are highly specialised in other areas, especially related to management, but diagnosing disease is still largely doctors’ territory and you better be good at this. Caveat. This is not a single skill. It involves knowing the patient’s background, doing a clinical exam (visual, auditory and tactile skills), interpreting imaging scans and looking at lab tests. And doing it all over again if the patient has a new symptom. On the birght side, you can train your gut instinct to handle the pattern recognition.
Treating patients. Well no sh*t right? This is more than prescribing drugs. It can include surgery, other kinds of therapy and lifestyle modification. Even when it’s just drugs, you still need to figure out things like, what is the BEST treatment for THIS patient? What if the patient has a drug allergy? What if the patient cannot affort the best? What if your precribed treatment doesn’t gel in with the patient’s lifestyle? You also need to be able to convince the patient to take his or her drugs. Your Family Medicine posting will emphasise this a fair bit but it’s important everywhere.
Knowing how to handle the people around you. These include other doctors, nurses, allied health professionals, the Family, the hospital administration, your own inner demons and the list goes on. No one is actually going to test you on this, but it’s a damn important skill. Don’t worry, this is not your priorty in M3, but keep your eyes open and start now. Observe the team dynamics, know each person’s job scope, learn from what they do (trust me the nurses know a lot more than we give them credit for), make friends with them. I am not going to tell you explicitly to be nice and respectful to everyone, don’t, that’s fake. However, once you take a step back and look at the role they’re all playing, I think respect and appreciation will follow.
Communicating information. There is a very specific way that medical information is communicated across medical professionals. The first time you encounter it, it might seem a little counter intuitive and unnatural, but I think it’s quite appropriate and functional. The most important thing you need to know here is that when you verbally transmit information, it’s not the quantity but the quality that counts. Therefore, a succinct summary will impress (and be more useful) than a detailed one. That being said, when you do analyse any case, be extremely thorough and be prepared to answer any question about that patient.
Explaining. Yeah, these days, you need to explain disease processes and treatments to patients in a way that they can digest and act upon. Not as difficult as it sounds, some of the techniques I’ll show you later will have this built it.
Manual skills. How to put in an IV line, how do you differentiate a woman’s vagina from her urethra (I got laughed at for this one, but turns out my senior was wrong), how to give an injection and so forth. Still not a priority for M3, but start learning the correct techniques now and practise (under supervision) whenever you can.
Advance the discipline. Gotcha on this one right? I haven’t heard many people say this explicitly, but you are the future. You in your specialness actually have (or will have) a lot to bring to the table. Develop your own style (within scientific principles) of doing things, ask questions, demand answers, observe the system and its successes and failures and figure out how you can improve things, not just administratively but also scientifically, through research and so forth.

I’m off to an evening of duty at the trauma department. The interesting thing here is that whoever needs an MC (be it for a dog bite, cut or car accident) the forensic pathologist is the person in charge of writing you one. Leave a comment! ask questions! There is more where that came from!