Christopher

The Assignment Rush

If you visit this site regularly, or follow the TSP twitter, you’ll hopefully be aware that I try to post updates and tweet fairly regularly. Sometimes they are in the form of personal pieces such as this, sometimes they are reviews or study guides, sometimes minor news updates or small tweaks to the site itself.

If you’ve visited this site recently, however, you might have noticed that I haven’t updated it for a little while. There’s one reason for this, and one reason alone: the assignment.

I’m seeing the light at the end of the tunnel as I type this, due to the fact that my extended case study is now submitted. It was a great piece of work to take on, too. Three sections in total, each with its own word count. The first was a patient case study, with a provided patient history, two electrocardiography traces to analyse and compare, and the subsequent report and treatment pathway to complete. This was probably the most fun of the three, but also the most time consuming.

The second was a broad topic that had to be condensed into a relatively small word count. This was, without question, the most difficult of the three sections and whilst I’m confident in the content I submitted, it’ll be interesting to read my feedback and see how well I interpreted the question.

The third, a brief similar to the second section only with a much more specific topic was initially fairly free-flowing, in terms of writing, but the further I progressed through it, the further away that word count looked. What began as a torrent of information on the page, soon trickled to a halt, as I realised I had explored all of the avenues in my plan without leaving room for branching out. As a result, I had to go back through every paragraph and find some wiggle room to potentially add another facet to the discussion.

I’m being intentionally vague so as not to disclose any details of the assignment, rather I’m confirming what we all know about assignments; there are some we like, and there are some that we loathe.

If you’re currently in the midst of a large piece of work, don’t panic! Just power through. Don’t worry about your friends posting Facebook updates from the pub, don’t worry about your Christmas shopping just yet. I know it’s easier said than done, of course, but despite the fact that (technology permitting) this article has gone live at around 3pm, as I type this, it’s 4.30am. Pressing that ‘submit’ button on my coursework has sent me into a state of fatigued euphoria, and all the late nights have been worth it.

I’ll add that on top of this assignment, I also have deadlines for an Inter-professional Collaboration self-reflective essay and a presentation on cardiac technology in the same week. Next week.

Until then, it’ll be a bit quieter around here…

Review: AliveCor Mobile ECG Monitor (3rd gen)

Download the android app: Free

Purchase the monitor: £75 approx.

Developer: AliveCor, David Albert

Thus far, my reviews have been mostly confined to apps, with the only exception being Windows/Linux software, simECG. This review is quite exciting for me, as it involves a physical monitor as well as a companion app. I picked up the now world-famous AliveCor Mobile ECG Monitor a couple of days ago to road test it, and I’m pleased to say that for patients, it’s fantastic, and for students, it’s just as good.

As far as functionality goes, this app serves as a personal event monitor with a particular focus on atrial fibrillation, and it has a ton of nice features that make it a worthwhile investment for patients regular to cardiac departments.

Out of the box, the dual-electrode plate can be attached to the back of your mobile device via an adhesive strip, or kept separate; AliveCor works either way, and if you do attach the monitor and change your phone, you can pick up additional attachment plates for around £6.

Obtaining a trace is a very quick process; it only took me a few seconds to open the app and begin recording, and the trace is saved automatically after 15 seconds, with the limit set at 30. The user is then presented with a series of tick-able boxes such as hand or chest ECG, and a notes section to document any symptoms. These are then stored with the trace.

In this video, you can see that AliveCor jumps straight into recording once fired up.

Heart rate and beat fluctuation are tracked and graphed automatically to allow patients to relate multiple recordings in conjunction with the particular activity being performed during monitor operation.

In addition to this, the app comes with an algorithm that determines the presence of atrial fibrillation and keeps track of how many instances this occurs.

AliveCor offers a great deal of options when it comes to sharing data and to physical useage: once the trace has been recorded, the user can email it, save it as a fully notated PDF and print either from the app or a different program.

Holding the device in your hands, as shown in the app instructions gives you a trace in lead I, and it’s possible to obtain leads II and III by placing the two electrodes in different areas of the body (I have provided these instructions at the bottom of the page). Handily, AliveCor doesn’t just measure biopotentials in the peripherals, but also in the chest. A Lewis lead configuration is possible to view atrial activity with more clarity.

I experienced a minor issue with artefact at the start of recording, but this was almost definitely user error, as AliveCor ‘steadies’ itself pretty quickly if you remain relaxed and support you arms. This learning curve is honestly the only problem I had with the product, and after 10 or so minutes, it wasn’t a problem at all. I don’t want to speak for everyone, but I feel it’s fairly easy to get to grips with, so I doubt that your average patient would have too much trouble with it after a short while.

Traces themselves look very clean and, thanks to the standard calibration and the inclusion of a regular ECG paper grid, various amplitudes, intervals and waveforms can be measured manually. The trace screen also gives the option to invert the recording, and filter enhancement is selectable for each one.

As an event monitor, this device is invaluable. It comes with its own built-in symptom sheet and it’s incredibly quick and easy to record a good quality trace. AliveCor has been given the thumbs up from the FDA and NICE, so it’ll be interesting to see how the SCST view the monitor; I’ve reached out to them, but haven’t heard anything yet. If I do, I shall update accordingly.

I assume that in the U.S. this app allows patients to forgo some of the high cost of continued medical care by way of allowing the trace to be sent directly to a clinician for review. The UK version gives the option to send the trace to a Cardiac Physiologist for £5 and provides the analysis results within 24 hours, allowing the patient to present an official ECG report to their GP, should they need to.

As an added bonus, the AliveCor app has an educational area that features breakdowns of common arrhythmias and cardiac anatomy. The illustrations are aesthetically very pleasing and straightforward. The information contained within it is not as comprehensive as the information you’ll find in your lectures or textbooks, but it isn’t designed for the use of practitioners, so what is there is entirely sufficient.

All in all, AliveCor truly is a technical feat and not only does exactly what it sets out to do, but gives a glimpse of the future of ECG technology. This is an extremely good way for patients to become actively involved in their own heart health, with a relatively small price tag. The app provides a simple, intuitive UI and doesn’t require any Bluetooth connectivity between monitor and phone: it works right out of the box so that any patient can use it with ease. There’s a reason this product has garnered praise around the globe.

I will add that the device’s creator, Dr David Albert, is one of the nicest individuals with whom I have ever had the pleasure of conversing. His instructions for getting the most out of AliveCor for the purposes of this review have been invaluable, and even though he really didn’t have to, he answered every question I asked him, swiftly too. I’d like to thank David for being kind enough to help me get to grips with the product all the way from his residence in Oklahoma. Students need input such as this; it cements that we are valued and encourages learning outside of regular studies.

Positioning data:

Lead I: LH – RH

Lead II: LL (knee) – RH

Lead III: LL – LH

Lewis: Electrode 1 on V1, device angled vertically

Review: simECG: ECG Simulator v1.186

Download for Windows/Linux: Free

Developers: Antonio Cardoso Martins, Paulo Dias Costa, Joao Miguel Marques

I’ve been searching for a half-decent ECG simulator since last year, but hadn’t found one that costs less than “more than I have”, so I was pleasantly surprised to find the rather unnecessarily named simECG: ECG Simulator for free, on Windows and Linux.

simECG offers a number of functions in its current version. The operator can select from a series of common arrhythmias at the click of a button, and observe the associated waveform on the display. Unfortunately, only a handful of options are actually selectable, at present, with the others showing as greyed out, presumably, as with many Open Source programs, until they are finalised by the development team.

The custom settings tab provides the means to alter each area of the trace individually, adjusting heart rate, P wave amplitude/duration and more, and watching the displayed trace change in real time. The program hints at future save/load functions for your altered settings, too, which will be a nice inclusion for educators to make use of.

All of the aforementioned are easy to use and clearly marked, even if there aren’t currently all that many of them.

The option exists to change the background between ECG paper and a monitor screen, although the ECG paper skin is purely cosmetic. It would have been nice if the paper option was more in correlation with the amplitudes and durations selectable in the readout options. Greyed out sections of the “preferences” tab hint that calibration will soon be able to be changed by the user, so it would be preferable for beginners and students if these proposed calibration options had a realistic background to use in conjunction with the created trace.

I couldn’t find an option to reset the trace at all, even in a greyed out form, and as a result, returning to the default custom settings is something of a chore. Hopefully this is something the developers will consider including in future iterations.

By now you may have noticed the appearance of the waveforms in the above trace. The trace waveform was one of the first things I noticed, as the whole thing doesn’t look right. The P and T waves look malformed, with the latter presenting almost as though the patient was displaying hyperkalaemia despite this being labeled as a normal sinus ECG.

The assessment quiz tab gives the user an opportunity to identify 10 rhythms in 60 seconds. It’s fun, sure, but given the odd appearance of the waveforms, it becomes a case of memorising the traces present in this program alone, as they aren’t all applicable to real life.

I’ll be honest, it’s hard to criticise something that the developers admit will “never be finished” due to its Open Source status, but the nature of this website and Open Source in general means it pays to remain objective. In actuality, whilst I have highlighted a few issues, the fact that this tool is ever-evolving and totally free, means I can only commend the development team for their ethos and hard work.

Martins, Costa and Marquez state their belief that education shouldn’t be a corporate tool, or purchasable commodity, rather it should be accessible to all. The more people there are to flag issues, the better an idea the team can have of what functionality to add, what bugs to fix, and what other changes are felt to be necessary by users. Despite being generally incomplete at present, it’s not only one to watch for in the future, but one I’d ask every cardiac physiologist to download and play around with.

Due to this version still being in the 1.n phase, I have high hopes for the future of this software, as it has great potential as a learning tool. With the addition of more options in the preset tab, further wave/interval customisation, and more accurate waveforms in general, simECG could help physiology students consolidate their knowledge without carting loads of textbooks around, making it an essential bit of kit.

Is Mobile Echocardiography On The Horizon?

Smartphone and tablet technology is advancing at a rapid rate, so it should come as no surprise that it is being used for a variety of different purposes. Healthcare companies are finding novel ways to encourage patients to take charge of their own health; peripherals allow for BP measurement and three lead ECG monitoring in one’s own home, and it’s possible to measure your heart rate at rest and during exercise now, with software that comes as a pre-installed fitness suite on most modern devices.

It stands to reason, then, that these same companies would create clinical grade applications and device extensions that would benefit practitioners, also. I covered the use of Google Glass in revascularisation, already, but another device is making its way to the market at the moment, too; mobile ultrasound.

After unveiling it in 2014, Philips were granted FDA approval of their Luimfy system only a couple of weeks ago and have announced that it is now available for purchase in the US.

A $199 per month subscription, an Android phone/tablet and a micro USB probe are all you need, as the app and it’s peripheral are designed to work with compatible devices off-the-shelf.

In its current form, the scanning app allows practitioners to examine the gall bladder, abdomen and lungs, in addition to having obstetric, vascular, superficial, musculoskeletal and soft tissue functionality, so the device isn’t suitable for echocardiography, but I’m certain that in the future, given the power already available in modern devices, it’s a real possibility.

In UK hospitals, where space is a deciding factor for treatment options, having an ultrasound monitor that can fit in a small case would be a real boon. Emergency and critical care ultrasound is actually what the system was designed for, so it makes sense that the most obvious impact relates to time and accessibility.

Streamlining the healthcare process is paramount, and the fact that this system is based around an app could be a real advantage. The images gained by the practitioner can be shared via the cloud, so the network of professionals involved with one patient can have near instant access to the relevant materials needed for diagnosis. Philips could also provide continued software support and provide updates based on user feedback, without the need for engineer call outs.

Now, I’m no app developer (I’m trying. It’s rather complex…), but I do use them, so I can identify some common problems in cloud storage and functionality.

Firstly, as this is an Android app, it may present issues in performance across devices. There are a number of latency issues with apps for this OS and further issues regarding app performance in general from one device to another, especially if the base OS differs slightly between manufacturers (if you’ve tried to compare performance between Samsung and Google Nexus, you’ll know what I mean). In this case, Philips would have to be fairly on the ball with their customer support, especially given the subscription costs for practitioners.

I guess the issue with cloud storage brings us to patient confidentiality, as the last couple of years have seen some high profile cloud hacks leak “sensitive” data to the public, but many hospitals are already digital, so surely it’s a case of ensuring the level of security is appropriate.

As far as echo goes, the advantage of switchable probes and live, cloud updating comes into its own; echo features could be added with an update, in theory. It’s a case of making it happen. It’s unlikely, but if I ever get a chance to try one, I’ll make sure to tell you of my experience.

For more information, go here: http://www.ifa.philips.com/news/digital-innovations/philips-lumify

Virtual Reality In The Cath Lab

If you’ve kept abreast of tech news in the last few years, specifically with regard to Google Glass, you’ll probably be aware of two things: 1. it has been met with scepticism and apprehension, and 2. at present it’s largely pointless.

I’ll admit that the second point is subjective, but now, this (my) subjective view is likely to change. A team of cardiologists from Warsaw have used Glass’ virtual reality capabilities to tackle what is referred to as the “final frontier in interventional cardiology” by repairing a total occlusion of the right coronary artery.

An effective visualisation of the coronary arteries is often lacking using normal angiography radiology techniques, but by employing coronary computed tomography angiography (CTA), a smartphone app and a headset based on Google Glass, the team at the Institute of Cardiology have successfully restored blood flow in the right coronary artery of a 49y/o male, with two drug- eluting stents.

“This case demonstrates the novel application of wearable devices for display of CTA data sets in the catheterization laboratory that can be used for better planning and guidance of interventional procedures, and provides proof of concept that wearable devices can improve operator comfort and procedure efficiency in interventional cardiology,” says lead investigator Maksymilian P. Opolski, of the Department of Interventional Cardiology and Angiology at the Institute of Cardiology, Warsaw.

The set up itself projects the three- dimensional CTA images onto the Glass-based head mounted display via a mobile app featuring voice command and a zoom function. The combination allows for digital viewing of the coronary artery, the occlusion and the placement of the guide wire for stent implantation. Thanks to its basis in Google Glass, the device can record video, view images and also allow the practitioner to see the surrounding environment, simultaneously. The possibility for the lenses to be fitted with filters that protect the user from x-rays only cement this technology as one that cardiologists will look to use increasingly, after this first success.

103607_web — A. Surgeon using the Glass-based monitor to view CTA images on the lens. B & C. 3D images on lens show trajectory of distal right coronary and occlusion.

Virtual Reality might not be having the impact on video games that the industry had hoped, but it would appear to be having a profound impact on healthcare.

Ref: Canadian Journal of Cardiology, Elsevier Health Sciences

Review: Analyze ECG Reporting

Download for Google Play: Free

Download for iOS: Free

Developer: Cathal Breen

When you’re just beginning to get to grips with analysing a 12-lead, taking a methodical approach is recommended, but in practice that’s easier said than done. Remembering what you’re measuring, and in what order you’re measuring it, is sometimes confusing, especially when, like me, you’re still getting your head around the various concepts behind the plethora of arrhythmias and pathological morphologies you’re likely to find in a patient ECG.

I’ve already covered the tutorial apps documenting normal and abnormal values that I felt were most beneficial to PTP students, but Analyze ECG Reporting by Cathal Breen exists solely to guide the practitioner through each, single analysis and serves as a methodical reminder of everything that should be documented in your report.

Analyse is nicely presented, with a very simple user interface set up for each section. The display contains boxes for measured values, buttons to advance to the next measurement, or to go back to make corrections and some pop-up menus for comments on the ECG waves. It doesn’t suffer from a text overload, or clutter in any way. The colour scheme is visually appealing, but conservative, so when using the app, you’re kept on task and not distracted by needless images or too many different colours.

This app is merely a way to educate practitioners into using the same approach to study each trace. It may seem like an obvious thing to point out, as ECG cannot provide a diagnosis on its own, but Analyse is not an algorithm that will diagnose a pathology for you.
This is not to diminish this app’s merits whatsoever, though. Analyse does a great job of clarifying the process of ECG analysis and provides a list of the necessary things to include when reporting. Since installing it, I have used it to methodically review lots of the traces I’ve obtained, including those set in my coursework.

In fact, my only problem with Analyse ECG Reporting is in correcting mistakes from the drop down menu. A long press on the option that you have selected will remove it from the final list, but this isn’t explained at any point. It took me a little while to figure it out, so some brief instructions wouldn’t have gone amiss upon starting up the app for the first time. It’s a minor niggle and it didn’t detract from my overall experience with Analyse, however.

Consistency and a methodological approach are key parts of analysis, and Analyse ECG Reporting is a great trainer. This app is a must have for PTP students, but I’d recommend it to any student who’ll have more than a passing dalliance with electrocardiograms.

SCST National Update

Yesterday, on the 20^th of November, Oli and I attended the SCST annual update meeting. It’s the first physiology conference I’ve attended that wasn’t tied to one specific trust (the last one I attended was the Royal United Hospital’s respiratory medicine conference), rather, it was applicable to and attended by cardiac scientists from across the four home nations. The day was packed with talks, networking opportunities and insight into the future of the science. Speakers hailed from a variety of professions and organisations, but all were entrenched in the science of cardiology and education.

Due to the long distance travel and Birmingham’s seemingly city-wide roadworks, Oli and I missed the introduction, but we were present for the rest of the day and we recorded and annotated everything else, so whilst I’ll provide an overview here, detailed breakdowns of everything relevant to PTP study will be supplied separately, as and when time and my coursework volume allows.

Of particular note is the information on preceptorship qualification, delivered by Sophie Blackman of SCST and Boston Scientific. I collared her after the event proper, and she kindly agreed to provide the literature pertaining to this, so as soon as it’s available, I’ll add it for you all to have a mosey over. It seems like a great opportunity for newly- qualified practitioners to become super confident in all aspects of their job, so I highly recommend that you read the contents when they’re available.

Dr Patricia Oakley of King’s College outlined the plans for a new variety of health clinic: the centre that isn’t home and isn’t a hospital, but the “place in the middle”. These will be networked, multidisciplinary centres, featuring social workers, scientists, psychiatrists, GP’s, etc, so cardiac physiologists will most likely be a necessity in their implementation. The whole session really drove home the emerging importance of this profession, but also the requirement of all of us, student and qualified, to ensure that the cardiac physiologist is recognised as being at the forefront of innovation so as not to be overlooked. It was mentioned more than once, that if we don’t put ourselves forward for emerging structures, someone else will.

Dr Oakley told of the need to reduce treatment variability by region. Her example was the treatment of amputation as a result of diabetes; Devon has, by far, the highest number of below-hip amputations when compared with the rest of the UK, due to the fact that the majority of Devonian surgeons trained under a surgeon who has a penchant for this level of removal. The advent of these networked clinics will reduce this level of variability and promote consistency across the home nations.

The president of the AHCS, Dr Brendan Cooper delivered the final talk of the day, discussing the future role of the healthcare scientist in wider healthcare and medicine, and the need for physiologist prescribing. I’ll provide a detailed breakdown of this talk next, and shall hopefully post it in this coming week.

Interview With A Distance Learner

The fact that this specialist degree exists primarily in universities is a relatively new event; before the shakeup by Modernising Scientific Careers, the majority of training was completed in-house with an element of distance learning thrown in to assist with the theory behind the practical concepts.

As physiological science makes the transition to a 100% university- led discipline, there remain students that are still learning the “old way”. Sarah is one of those people, and I had the pleasure of working with her this year during my rotations between respiratory medicine and cardiology. In order to get a bit of insight into exactly how the course differs between bases, she kindly agreed to be interviewed for TSP.

Hello Sarah! Could you outline the structure of your week, with regards to working in your department and studying the degree simultaneously?

I’m employed by the hospital, so have to work my set hours which are Monday – Friday 08.30-16.30. Although I’m studying, I am not employed as a student, rather, I am an Assistant Technical Officer, which basically means I help around the department doing admin, portering and some clinical work. I have certain responsibilities with regards to admin that I have to keep on top of regardless of what clinical work I need to be learning.

Monday is my main admin day, so I spend the entire day sorting through referrals, checking messages & booking appointments for certain procedures that only I book. I need to keep on top of this as some of the procedures have extremely long waiting lists, so if a patient cancels last minute I need to try my best to fill that slot. Once my admin is complete I normally help out my colleague in the office with some of her work load. If there is no porter to bring inpatients up & back for echocardiograms then it is part of my job to do this as well, which means I can’t get my necessary admin work completed.

Tuesday is the start of my clinical week, unless I have been portering the previous day. At the moment I am spending all day Tuesday in analysis, analysing 24 hour and 48 hour tapes. I am able to analyse a tape independently, but as I am still learning they all need to be checked after, just in case I’ve missed something or worded my report incorrectly.

Wednesday is a half day in the department for me as I have a collaborate session starting at 12.00 so I need to be set up in the library ready to start. After my collaborate session I catch up on any studying I need to do, such as looking over lectures that have been released for the following week, researching/ writing an assignment or revising for upcoming exams. On a Wednesday morning I will either be fitting ambulatory blood pressure monitors (supervised, as I am not confident to do them alone yet) or analysing.

Thursday mornings I am in Electrocardiography, either in the department or going down to the ward, and in the afternoon I analyse.

Friday mornings I do tape clinic which occupies the entire morning and keeps me very busy, especially if I have patients returning that have had symptoms of dizziness & I need to get the tapes checked before I can let them go. I spend Friday afternoons in analysis.

That is my current working week, but I will start going on the rota soon to sit in on exercise treadmill tests as well. Most mornings I get into work at around 07.30 so I can get some studying done before work and I try to do an hour or so in the evening as well. Most weekends I keep to myself, but if I have an assignment due or exams I will do a couple of hours each day.

That’s a hectic week. This might now be a silly question, but do you feel that this is this enough?

In terms of clinical exposure … yes! But it is very hard to keep up with the academic work load when there is very little time to fit things in. I commute for over 2 hours a day so this eats into my potential study time, but I try to keep a balance of work, study and actually having a life!

Do you feel that working in the same department as you study helps you to learn more and keep you motivated?

I feel that second year especially has helped me learn, but most of the academic work in our first year wasn’t particularly relevant to cardiology. I feel like I learnt more in the last 2 months from analysing tapes than I have in the whole 2 years that I’ve worked in the department. I definitely think it has helped to keep me motivated as I’m constantly surrounded by people that are doing the job I am training for, so I’ve got a clear goal at the end of it.

You’re one of the last sets of the distance intake. Do you think, if you had the choice, you’d still do the degree in the manner you currently are, or would you choose to be based at the university?

I’ve already done a previous degree so I’ve experienced the whole student life thing, so I’m not missing out by doing it this way. At the moment I am essentially being paid to learn, which is ideal. I wouldn’t be able to afford to do this degree if I was based at the university, as I’ve already had a student loan so I’m not entitled to another. I think I get a good amount of exposure in the clinical setting, but I just have to do some of the boring admin jobs to make up for it. At the end of my degree I will have a job and I know 100% that this is the career I want for myself. I wasn’t passionate about my previous degree subject so I lost interest and didn’t want to spend the rest of my life doing it, whereas I know from working in this department and from studying the way I am, that this is what I want to do. I don’t think I’d have that level of clarity if I was based more at the university than the hospital.

That’s fair. When we worked together during my placement, I was aware of the fact that you were much more comfortable in the clinic environment than I was (obviously), so what do you feel we at the university have by way of an advantage?

I definitely think that as I’m exposed to patients and the environment all day every day that I am more confident and comfortable than yourself, but I would say that full time students based at the university have a lot more academic knowledge. We have 1/2 hours a week of contact time with our lecturers so we need to go out and research ourselves, whereas it is clear that you guys have a lot more academic time although you miss out a lot with the lack of placement.

Thanks, Sarah!

As you can probably tell, despite the fact that Sarah and myself are in the same cohort, our academic years have a vastly different focus. As I (rightly) assumed just from working with her on the department, both routes present their pros and cons, and seeing as this is a vastly understaffed form of diagnostic science, it does, in my opinion, open the career up to a greater number of people now it will be university- led.

If you’ve got an opinion, or a question regarding anything you’ve read, sound off in the comments below.

Photo courtesy of Facebook

Mental Health

This post is something of a departure from the usual fayre, in that it is far more personal, and, for a number of reasons, much more difficult to write.

I know more than a couple of people who decided against a career in healthcare due to their mental health issues, with depression and bipolar being cited as the chief afflictions. They felt they would be judged by colleagues and potential employers, perhaps being overlooked for postgraduate positions or being seen as an inferior member of staff.

The very nature of mental health conditions such as these means that every day is a struggle in and of itself regardless, and this is only exacerbated when depression is at a particularly debilitating level. Often, once the sufferer has climbed the seemingly impossible mountain that is just getting out of bed, having to face an interview wherein the disclose or discussion of one’s pertinent medical history would be a requirement, is akin to reaching the top of Everest, only to find that it’s doubled in size. It’s overwhelming. The fear of being judged and viewed as damaged can stop a person for whom depression is an issue, from doing a multitude of things.

I know this, because I suffer with these things.

I was diagnosed as being bipolar when I was 16. Since then I’ve overheard colleagues in various places say (not about or directed at me, I’ll add)“it’s just the grumps- get over it”, “everyone has bad days and THEY manage to pull themselves together without attention-seeking” or that they “don’t believe in rubbish like [depression]”.

I’ll just add, that I’ve been slightly misleading: these three comments weren’t from a variety of places. They were from the staff in a hospital. One hospital ward, to be more specific.

These comments emanated from people who deal with and treat illness on a daily basis, and often these illnesses aren’t directly visible. Why, then, is a mental health illness less credible than a physiological one, even if it also, can’t be seen?

Hospitals have upped their game when it comes to mental health training, so I’d assume that due to the increased awareness, opinions such as these are slightly less commonplace, but there is still a lot more that can be done; subjects like this are still difficult to discuss and there still exists a fear upon doing so.

I have no doubts in my abilities as a healthcare scientist. I’m confident in everything I have learned thus far, and have proved as such through testing and assessment. I’m not frightened of learning everything else that I have to in order to qualify and more, either; I relish the challenge. My issues lie in the everyday tasks that my colleagues seem to be able to do, that I cannot. For example, I have of late, found it incredibly difficult to climb the aforementioned first mountain, and get out of bed, and I hate how weak I feel it makes me. I have a crippling fear of failure, despite enjoying challenge and I sometimes loathe that one is quite often more powerful than the other despite my best efforts.

The thing is, when I’m happy, I’m REALLY happy. I’m enthusiastic, talkative, and willing to do anything, but in the back of my mind, there’s always the knowledge that it isn’t going to last; I’m going to come crashing down and revert back to a miserable person to be around. It’s these days that I can’t face leaving the house unless I absolutely have to. It’s these days that I’d rather complete lectures from home, in solitude.

I haven’t missed a day’s work in my life, without good reason (case in point: nearly losing the end of an index finger in a professional kitchen blender, getting it stitched and, despite everyone but my boss telling me how moronic it was, returning to work on the same day), so it isn’t as though I choose to stay home and work because I’m lazy or work shy, or that I simply can’t be bothered, I think it’s because of the fact that because the work material is provided online, it means I can if I need to. I take some solace in the fact that my mental health issues have never stopped me from going to work, so I know that they won’t stop me from doing my job in the future, just that I might be less exuberant sometimes, as I do so.

The one thing I took on board from my ex-colleagues was that everyone does indeed, have bad days. The majority of people get through these bad days, too. I’m going to do the same. I won’t quit, no matter how difficult it may be, because I’ve worked very hard to get here. I’ve been in a battle with my own brain for a long time, and I’ve been winning, so there’s no way I’m going to stop now.

The more people that speak up about issues like this, the less taboo it will become, and the less room for stigmatism there will be. It isn’t something that falls squarely at the feet of sufferers, either, it’s something that everyone has to recognise and talk about. It isn’t easy, but it’s necessary. Mental health issues aren’t going to go away, but the ability to manage them has moved forward tenfold in recent years. Attitudes towards the subject now need to catch up.

If you, like some of my friends, are put off pursuing a career in healthcare because of mental health issues, don’t! You’ll be surprised at just how strong you can be. You’ll have bad days and good days, sure, but you’d have them anyway, wouldn’t you? Your good days will feel so much better if you’re doing something you want to do.

Thank you for reading. This is far from my whole story and I apologise if it seems slightly disjointed in places, but this is the hardest thing I’ve ever had to write.

The Lewis Lead

Scouring the web for cheap textbooks, I happened upon something of which I wasn’t even remotely aware: alternate ECG lead placements. As has been highlighted in previous posts by myself and others, cardiac scientists have strict guidelines that ensure we perform an ECG procedure to an accurate and repeatable standard, so it came as a bit of a surprise to discover that there existed a different way of carrying out the test with an aim to view specific activity.

The Lewis lead, named after Sir Thomas Lewis, is an alternate placement that can be used to better view atrial activity in relation to that of the ventricles. In many ECGs, it can be rather difficult to assess P waves; whilst they are represented using standard lead configuration, they are much less apparent than ventricular activity, due to the nature of the ECG’s detection mechanisms.

Using the Lewis lead configuration, it is possible to increase the detection of atrial activity and diminish that of the ventricles and gain a clearer picture of atrial fibrillation, flutter and, in the case of the article that brought my attention to this system, improving P wave recognition in wide QRS complex tachycardia.

The configuration is as follows:

RA electrode on the manubrium
LA electrode on the 5th IC space, right sternal border
LL on the right lower coastal margin
RL remains in the standard SCST position
Adjust calibration to 20mm/mV

As shown on the diagram, a three lead configuration is still present, as in Einthoven’s triangle, but Lead I now travels directly over atrial activity. For this reason, Lead I is used as the monitor lead and the one from which a rhythm strip should be taken.

On the trace itself, there is a marked visual difference. The following were recorder on the same patient and we begin with the standard electrode configuration:

And now introducing the Lewis lead setup:

The P waves present in these altered leads are much more pronounced.

There are more lead systems that are used in the diagnosis a variety of different conditions such as Brugada syndrome. I’ll research and cover these and try to get some more traces using the Lewis lead system throughout the year.

Traces courtesy of ekgcasestudies.com