I wax and wane about how I feel about my career, as I’m sure most people do. It’s particularly troublesome given the blind passion with which I dove into the world of medicine. Blind and not blind, it wasn’t what I always wanted to do but once I started I was obsessed and refused to fail. I am told this is a typical Scorpio pattern, and since I have like nine thousand planets in Scorpios house or whatever it makes sense.
Well, yesterday I had a bit of an epiphany and decided to just let go. To give myself to this career and life, and let it become what it may. I spend way too much time thinking about everything, and it’s time to just start living it to find out what happens. Enough with the what ifs. Enough with the should haves and shouldn’t haves. Enough. I am here, I am this. We need to work hard, love hard, learn hard, and simply become what we are. We can’t think our ways into being, it just has to happen. I am trying to check out of my brain box, and into my body. If I am meant to be doing other things, it will happen; but nothing will happen if I am just sitting around thinking about it.
So yesterday and today were sort of beautiful. I truly connected with my patients, and I truly believe I made a difference in their lives. I taught a resident with honesty and integrity. This is important. This is enough. This is now. I am excited for what lies ahead.
I would like to find a way to make the hospital and surgical experience less cold and impersonal and scary for people. I would also like to write more. So here’s to meeting those two goals in a very small way over the last two days. Maybe I will learn how to get proficient at Tumblr with pictures and whatnot. Probably not, but hey, I have figured out more complicated shit than that. I fixed an ancient, busted ventilator in the Dominican Republic damn it!
What Is Aphasia? What Causes Aphasia?
Aphasia is a language disorder that negatively affects a person’s ability to talk, understand the spoken word and also their reading and writing. Originating from the Greek word "aphatos" which means speechless, aphasia is a symptom resultant of pre-existing brain damage, such as Alzheimer’s disease or stroke (with over 30% of stroke victims suffering aphasia to some degree).
Originally, aphasia was a term used only to describe complete impairment of the person’s communication and language. At the time the term dysphasia was used to describe partial language impairment, but it has been frequently mistaken for a swallowing disorder, dysphagia. Because of this, the term aphasia has taken on the meaning of both degrees of language impairment.
As there are three types of aphasia, the symptoms can differ for each type. Details of these differences are:
- Global aphasia - All parts of vocal and written interaction are affected. Both writing and reading is impaired, as well as speech and listening.
- Fluent aphasia - Speech is hard/not possible to understand. The ability to speak is not impaired, but the words spoken make no sense (word salad). Writing ability is usually effected in the same way, the writing is flowing but what is actually written is nonsense.
The person suffering from fluent aphasia may become annoyed and irritated if someone has trouble understanding them as they don’t always realize they have a language disorder. As for understanding, people with fluent aphasia more commonly have problems with speech than writing.
- Non-fluent aphasia - With this type, speech is slower and hesitant, the patient also struggles to get their words out. Sentences are rarely completed, and even though some words are missing, what they are saying can be made sense of. Again writing ability is usually the same as speech but comprehension is good.
Someone with non-fluent aphasia has more problems with grammar than words alone. People with this kind of aphasia are more aware of their disorder and may get annoyed when they struggle with words.
What Causes Aphasia?
The part of the brain that controls speech and language recognition is referred to as the language center. It is normally in the part of the brain opposite to side of the hand you write with (e.g. left side of brain for the right handed). These parts of the brain are known asBroca’s area and Wernicke’s area. Aphasia is caused when any of these parts of the brain or the neural pathways connecting them are damaged. This can be a result of the following:
- Traumatic brain injury
- Brain tumor
The type of aphasia is dependent on which part of the brain is damaged. The causes of each type of aphasia are:
- Global aphasia - caused by widespread damage right through the language center.
- Fluent aphasia - usually caused by damage to the temporal lobe (side of brain).
- Non-fluent aphasia - mostly the result of frontal lobe (front of brain) damage.
Disorders Confused with Aphasia:
A variety of other communication disorders may accompany aphasia or occur independently, yet be confused with aphasia. It is important to recognize these disorders and distinguish them from aphasia, as treatments and prognoses may vary.
With dysarthria, a person is unable to produce speech accurately due either to weakness of the muscles involved in speaking or a lack of coordination among these muscles. Dysarthria affects the production, not language itself — which distinguishes it from aphasia.
Dysarthria affects children and adults, with causes including stroke, head injury, cerebral palsy, and muscular dystrophy.
For a person with dysphagia, swallowing is difficult and may cause pain, sometimes making it difficult to take in enough calories and fluids to nourish the body. It occurs most often in the elderly as the result of conditions like Parkinson’s disease, cerebral palsy, stroke, head injury, or cancer.
Dementia is a loss of brain function that affects memory, thinking, language, judgment, and behavior. Some forms of dementia are progressive, such as Alzheimer’s disease. Because language difficulties are often prominent in dementia, it is often confused with aphasia. But the language difficulties in dementia are usually just one symptom of a more widespread intellectual loss.
Today’s Path Bite from Pathology Student!
Barrett esophagus is a metaplastic change that occurs in the lower portion of the esophagus. It is thought to be a complication of gastro-esophageal reflux disease - and that makes sense, because if you have constant reflux of acid up into your esophagus, the epithelium might want to change a bit to protect itself.Some important points:
- Intestinal-type columnar epithelium replaces normal squamous epithelium.
- Most common in white males between 40 and 60.
- Confers an increased risk of esophageal adenocarcinoma, especially if there is dysplasia present.
- Diagnosed by endoscopy and biopsy.
- Monitored with periodic endoscopy and biopsy to check for dysplasia.For more information on Barrett esophagus, see Robbins 8e, page 771.
Allergies to Sulfonamide-Containing Drugs Mnemonic: CCATS
- C elecoxib
- C arbonic Anhidrase Inhibitors
- A ll Loop Diuretics, *** EXCEPT: ETHACRYNIC ACID ***
- T hiazides
- S ulfa antibiotics
*** Clinical Vignette: Patient comes to the ER with Pulmonary Edema and is allergic to sulfas. Drug of choice? Ethacrynic Acid ***