#dialysis #uvahealth
If your kidney function is declining and medications and other treatments aren’t working, dialysis can offer life-saving care. UVA has one of the largest dialysis programs in the country. Nephrologist Daphne Knicely, MD, explains the types of home dialysis and how they can work to fit your life.

Find out more at: https://uvahealth.com/services/dialysis

Transcript

Dialysis is just a way to replace the kidneys when they're not working anymore. So when the kidneys stop working, they stop getting rid of water, stop balancing the chemistry, stop getting rid of the toxins. Then dialysis does its job by balancing the chemistries, getting rid of the toxins, and help remove fluid. It doesn't fix the kidneys. It just replaces them.

I usually think of dialysis as two components. There's hemodialysis and peritoneal dialysis. So peritoneal dialysis can only be done at home. Hemodialysis can be done in a center, or it can be done at home.

Hemodialysis is where you have some sort of access to the blood. Either some sort of shunt in the arm that connects an artery and vein, or a catheter. And it allows for blood to leave you, go through a machine, get cleaned, chemistries balanced, and then comes back to you.

For home hemodialysis, the patient actually learns how to do that treatment. It's a very simple machine, very user-friendly. Training is usually about anywhere from four weeks up to eight weeks, and you work one-on-one with a nurse. You still see the physician. You come in about once a month, maybe twice a month, to get labs. You'll see a social worker, and a nutritionist at the same time.

Peritoneal dialysis takes place by putting a tube into your abdomen. And we take dialysis fluid that's chemically balanced. When we put it into the abdomen, it uses those little blood vessels to pull toxins out, to balance chemistries, kind of like little filters. Now, after it sits in there for several hours, we drain it out.

Anyone that needs dialysis is a candidate for home dialysis. There's not one type of dialysis that's going to make you live longer. They're all equal. The goal is to pick the type of dialysis that fits with your life.

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This is one of the most interesting medical topics to discuss. What are the responsibilities of a doctor? What are the basic skills a doctor needs to have? and what are the responsibilities of a doctor?

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Detroit TV meteorologist Jessica Starr posted a heart-wrenching video on social media a month before dying by suicide this week. She had told viewers she was struggling in the aftermath of undergoing Lasik surgery. After learning of her death, her heartbroken colleagues on WJBK fought back tears live on TV. Twelve people have died by suicide after suffering pain and even blindness after the operation. Inside Edition also spoke to a doctor who wants the surgery banned. #InsideEdition

In this video, Dr. Robert Rozbruch, chief of Limb Lengthening and Complex Reconstruction at Hospital for Special Surgery performs an osseointegration after a primary amputation. The patient, a 40 year old woman, had chronic nerve pain and compromised function of her residual limb.

For more information, visit: https://www.limblengthening.com/

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key words: Osseointegration, Amputee, Amputation, Limb Replacement, Tibia, Osseointegration

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In this video “How To Do An IM (Intramuscular) Injection” you will learn about:
►the steps in the administration of intramuscular medications
►the angle to position the syringe while administering an intramuscular injection
►the landmark to administer an intramuscular injection in the deltoid muscle
►5 tips for the safe administration of an intramuscular medication
►the steps of the Z-track method for intramuscular injections
►the role of aspirating blood during an intramuscular injection and evaluate whether this practice is currently in use

► This video is part of the Lecturio course “Fundamentals of Nursing: Clinical Skills”
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► THE PROF: Samantha Rhea MSN, RN has been a nurse since 2008 and a nursing faculty teacher since 2012. She has been recognized for clinical excellence as an interventional cardiology nurse and also led a Joint Commission Accredited Stroke Center. Ms. Rhea is an award-winning expert in clinical teaching and continues to maintain a current clinical practice and teaches at a University nursing program.

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Are you worried about getting a sports hernia exam? In this video, we'll show you exactly what to expect when you get your hernia exam.

We'll take you through the various steps that are taken during the hernia exam, so you can have a more comfortable and informative experience. After watching this video, you'll have a better idea of what to expect and be prepared for your hernia exam!
#sportshernia #groinpain #california

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Dr Raewyn Teirney - fertility specialist and Gynaecologist in Sydney shows a video recording of a laparoscopy for a woman with infertility and pelvic pain.

WARNING: Explicit and Educational Surgical Content.

Visage Clinic's Dr. Marc DuPéré - located in Toronto, Ontario, Canada discusses Liposuction (upper bra, back rolls, lower back rolls, love handles & abdomen) and "Tummy Tuck" (Abdominoplasty): Skin excision, muscle repair and umbilicoplasty.

For more info and to book a consultation visit www.VisageClinic.com/cosmetic-....surgery/mommy-makeov or call (416) 929-9800.

Angioplasty Procedure Animation Video

Emergency angioplasty is an operation that is performed directly after a heart attack, on admission to the hospital. It involves the insertion of a catheter into the blocked blood vessel that caused the heart attack. This opens it up and allows blood to flow again, thus minimizing damage to the heart.
If one or more arteries become clogged, it may result in a heart attack. This normally presents with chest pain, sweating and a feeling of anxiety, among other symptoms. Urgent medical assistance should be sought. A heart attack is a medical emergency requiring intervention as soon as possible.

Know more: http://www.emergencyangioplasty.com/

This patient presented to the ER for umbilical pain and had a history of umbilical hernia. He was concerned about the possibility of incarceration of the hernia.

In this video we explain how the clinical exam helps to differentiate a simple painful hernia from an incarcerated one.

***Thanks to the patient for sharing his history and exam with YouTube world***

Do you think you have a hernia?
What are hernias?
The hernias we address in this http://DoctorsExpressHartsdale.com Medical Minute are inguinal, or groin, hernias. More common in men than women, an inguinal hernia can occur when part of the small intestine protrudes through a weakness or tear in the area between your abdomen and your thigh- or your groin. It's possible for anyone to get an inguinal hernia, but it is more commonly found in males.

Hernias form a bulge and can be accompanied by pain. Men have an approximate 26% lifetime risk of having hernia at some point in their life, where as women have a much lower chance of one- only about 3% of women will experience a hernia at some point in their life. There are other types of hernias, such as abdominal, or "hiatal" hernias but groin hernias outnumber abdominal hernias by about 3 to 1.

What causes a hernia?
The cause of a hernia is not always known, but hernias are often the result of weak spots in the abdominal wall. Weaknesses can be due to congenital defects (present at birth) or formed later in life. Some risk factors for inguinal hernia include:
• fluid or pressure in the abdomen
• heavy lifting
• straining during urination or bowel movements
• obesity
• chronic cough
• pregnancy

Hernias often form in people with weakened abdominal muscles or in those who do a lot of heavy lifting or straining, which is why we see it quite often in young men. Physiology plays a part: men have testicles and scrotum which descend through the inguinal canal-much larger in men than in women. That is part of the reason men tend to be more susceptible to hernias than women.

Symptoms of hernia

Symptoms of inguinal hernia usually include a bulge in the groin area and pain, pressure, or aching at the bulge—especially when lifting, bending, or coughing. These symptoms usually subside during rest periods. Men may also experience swelling around the testicles.


Screening and Diagnosis of Hernias
If you are having abdominal pain or pelvic bulge and pain, you want to see physician, and he or she will do an exam. They will use their finger, to see if you have a bulge in your scrotum or on your groin and they'll see if its reducible or not. If the exam doesn't give them the answer, they can then perform an ultrasound, an inexpensive test that can tell you the same day whether a hernia is present.


What to do if you think you have a hernia
Most of the time hernias do not cause problems. People often live with hernias their entire life without them becoming aggravated or painful. When they do cause pain though, there is concern that complications may have arisen. Most common hernias are what we call reducible; you can take your finger or you can lie down in bed and due to the effects of gravity, the bulge in the groin will actually disappear, which means the intestinal contents actually go back into the abdominal cavity or to the correct location. If it's not reducible by lying down or using a finger or having a physician trying to reduce it, then there are concerns about complications such as strangulation, or incarceration occurring. If those concerns are there, then you need to see a surgeon, and there may be a need for surgery.

How to Treat a Hernia
As stated earlier, hernias can often be watched for years without being treated. If however, they are causing pain, we generally refer you to a surgeon who can do a very simple laparoscopic surgery.

If you suspect a hernia, but have not been diagnosed, you should see your doctor, and of course, we are happy to see you here at Doctors Express

Hear what course directors Drs. T. Sloane Guy, Joseph A. Dearani, and Husam H. Balkhy have to say about the STS Workshop on Robotic Cardiac Surgery: Hands-on Team Training in Robotic Mitral Valve Repair, Coronary Bypass & More, including program highlights, who should attend, and what to expect on March 29-30, 2019. Visit http://www.sts.org/roboticcardiac to view the agenda and register.

From our beginnings in 1990 in primary healthcare, Healthway Medical has grown to become a respected medical group in Singapore. With over 100 clinics and medical centres, Healthway Medical has a wide network of medical centres and clinics in Singapore.

We offer comprehensive services including GP & family medicine clinics, health screening, adult specialists, baby & child specialists, dental services and allied healthcare services.

Shoulder Clinical Examination - Medical School Clinical Skills - Dr Gill

Personally, I find the shoulder examination the most complex examination possibly as there are so many variations and special tests. Some of which overlap and some will relate specifically to a patients presentation.

Often in a medical school syllabus, only select special tests will be used. In this shoulder exam demonstration, we include the Hawkins-Kennedy Test looking for impingement. This is dovetailed with examination for bicipital tendonitis as this is another possible cause of impingement type symptoms.

This shoulder upper limb exam follows the standard "Look, Feel, Move" orthopaedic exam approach, and overall order as set out in MacLeods Clinical Examination

Watch further orthopaedic examinations for your OSCE revision:

The Spine Examination:
https://youtu.be/pJxMHa6SCgU

Knee Examination
https://youtu.be/oyKH4EYfJDM

Hip Joint Clinical Examination
https://youtu.be/JC9GKq5nSdQ
________

Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.

However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.

The examination demonstrated here is derived from Macleods Clinical Examination - a recognized standard textbook for clinical skills.


#ShoulderExamination #ClinicalSkills #DrGill

Dr. Alex Campbell and Dr. Carolina Restrepo of Premium Care Plastic Surgery in Cartagena, Colombia perform a Mommy Makeover on an international patient. Watch the procedure as Dr. Campbell and Dr. Restrepo work together to offer this patient more surgery in less time, which leads to a quicker recovery and better results.

Watch this clinical examination video to learn how to diagnose inguinal related groin pain.

This video clip is part of the FIFA Diploma in Football Medicine and the FIFA Medical Network. To enrol or to find our more click on the following link http://www.fifamedicalnetwork.com

The Diploma is a free online course designed to help clinicians learn how to diagnose and manage common football-related injuries and illnesses. There are a total of 42 modules created by football medicine experts. Visit a single page, complete individual modules or finish the entire course.

The network provides the opportunity for clinicians around the world to meet and share ideas relating to football medicine. Ask about an interesting case, debate current practice and discuss treatment strategies. Create a profile and log on to interact with other health professionals from around the globe.

This is not medical advice. The content is intended as educational content for health care professionals and students. If you are a patient, seek care of a health care professional.

For more than 25 years, The Children's Hospital of Philadelphia — the first Level 1 Pediatric Trauma Center in Pennsylvania — has provided unparalleled medical and surgical care for all injured children, including those with the most severe injuries.

Learn what makes the Trauma Center at CHOP a Level 1 Pediatric Trauma Center, and how our work toward trauma prevention, research advances and overall trauma awareness provides hope for reduced injuries in the future.

Learn more about the Trauma Center at CHOP: http://www.chop.edu/trauma.

Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

This minimally invasive technique allows surgeons to remove skull base tumors as large as softballs through the nose, with less trauma to the brain and critical nerves than with a traditional craniotomy.

To learn more, please visit https://www.upmc.com/

Neurosurgeon Sujit Prabhu, M.D., discusses what happens after surgery and how a patient recovers.

Learn more: http://www.mdanderson.org/educ....ation-and-research/d

Request an appointment at MD Anderson by calling 1-877-632-6789 or online: https://my.mdanderson.org/requestappointment