This week in inspiration

I enjoy watching youtube videos. I decided to search PhD on youtube recently to see what popped up, within a couple of days Professor Tara Brabazon's channel started popping up. The channel is called Office of Graduate Research at Flinders University. I'm loving this vlog. Her video on part time students filled me with a little bit of fear (so motivation), a little bit of hope and honestly a tear in my eye at the end. Yes it's hard being part time. But it's doable.

Other video's I've enjoyed so far have been on topics like starting a blog, completing your PhD, upsetting your supervisor and I noticed there is one on procrastination that I'll watch later.

Here's the link: https://www.youtube.com/channel/UCwdaNGhdSAwzdztgLTqyhgA/about

Writing vs clinical work

  

Pic from https://www.drivenow.com.au/blog/five-jacaranda-hot-spots-in-nsw/

I sat down on Friday with every intention of writing a protocol. I got bogged down on a small detail, something that my husband says happens to him in his work as well. I wanted to start my protocol off with a stat that I just know. Do you think I could find a reference for it? Nope.I thought I knew where to find it, but the online resource had been updated, and then I got preoccupied - I wanted to make sure I had the MOST RECENT stats. Plus the fact that I'm easing back into my research meant there were a series of small tasks that distracted me about every half hour. *Oh that's right, I need to email X*. *Oh no I still haven't found out how to XYZ*. After a few hours of completing small tasks and going around in circles on this ONE stat I gave up.

I sat down today, Monday and decided to write the rest of the document, by then I remembered where I'd stored a copy of the document with the stat that is no longer available online. And I managed to stay (relatively) focused and get a very rough draft off to my supervisor. 

It took way too long and I'm not entirely happy with the result. I hope this writing thing gets easier. 

When compared with clinical work, I'm still finding clinical work a lot easier. Probably a good thing seeing as I've been a speech pathologist for 9 years now, but I'm still surprised at how much I'm struggling to write about speech pathology considering I have been one for that long! The thing about clinical work it that it's a lot easier to get things done, the patient is showing up for therapy at 9am. Be ready. 

Perhaps tomorrow when I'm at work I'll be thinking about how I managed to get something written today in my PJs on the couch snuggled up next to our Cavoodle - writing will be more appealing. 

Sunday

A Sunday well spent brings a week of content.

I had intended to take the kids to a Halloween night at Roma St parklands last night, but I had a migraine for most of the day and burned through most of my energy existing. So today we decided to spend some time with the kids. We asked them where they'd like to go for lunch and we got a resounding response of "EAT STREET". 
Heck yeah I love Eat St too. On the way we past our future home and Immy said "I can't wait to move, we'll be so close to Eat St." My girl. Rhys pointed out that we will also be closer to her school and friends. Being two minutes from Eat St is on my list of favourite features of our new home. 
It was a nice two hour lunch, Immy tried an oyster (wasn't a fan), we got the new(ish) melon ice-cream serviced in a slice of watermelon (so good). 

https://www.ladybrisbaneqld.com/blog/2017/8/16/73amwl1untt6wqg16j5f3zjmze7kcm Photo from Lady Brisbane, because my photo of the watermelon dessert is awful, it was half melted... The article is called 

"Dessert dreams come true at Eat Street Northshore" and I'd agree. We had 4 savoury dishes to share and 4 desserts. 

After Eat St we had another open home. The house goes back under contract tomorrow, but we're having open homes every weekend until it goes unconditional. We've got numbers to call if the next contract falls through. I hope it doesn't. Settlement is set for the 31/11/17. We're getting awfully close to Christmas now. 

By the time we got home I had planned to do some PhD work but my brain hurts again. So I'm off to bed. Tomorrow is another day, and surely a day spent with the kids isn't a day wasted?

What I am reading for fun

Last year we went on an 18 day cruise from Honolulu to Sydney and I managed to read 1.5 books from a song of ice and fire. When we got back in mid October I found it difficult to find time to get back into it. For my birthday in September my brother bought me the disaster artist, the book about the making of the, it's so bad it's good movie The Room. I read most of it during my admission at Redcliffe hospital (when I was physically able to hold the book, yes the pain got so bad that my hands weren't able to grip this book, and it's not a big book). I really enjoyed the disaster artist. I'm not entirely sure why it was written, I don't think it answers any questions one might have about the movie, other than to say - yeah that [insert scene, set  or prop from the movie] was done intentionally and the rest of the crew did not understand it at the time. By the end of it I was feeling inspired. If Tommy Wiseau could make his movie, and finish it. Why shouldn't I be able to pick up on PhD where I left off in July and complete it? A well timed read. 

I had hoped to pick up a song of ice and fire again, but all of our books are packed, so we went to target and I saw a Philippa Gregory book. A few years ago I was obsessed with her books and read as many as I could get my hand on at the time. I'm only a little way into it, but it's the story of Lady Jane and I know history well enough to know that this chapter isn't going to be a long one. I've seen Horrible Histories. It's good to be reading and writing again. 

Intra-arterial thrombolysis

Image from http://www.ajnr.org/content/33/7/1292/F1: The article is called

Reperfusion Rates Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Influence of the Method for Alteplase Delivery (2012) G.A. Christoforidis, A. Slivka, Y. Mohammad, C. Karakasis, M. Kontzialis and M. Khadir

In a previous post I wrote about thrombolysis, a method where a medication for dissolving blood clots, the most common one used at the moment is known as alteplase. The most common delivery method at the moment is intravenously. Now I would like to explain an alternative form of reperfusion therapy (in total I'm going to talk about three methods). Intra-arterial thrombolysis (IAT) involves delivering the same medications used in IV-rtPA (alteplase) by inserting a catheter into the blocked artery and delivering the rtPA directly into the clot. This method is said to be significantly more effect than IV rtPA and reduced the risk of bleeding/systemic side effects.
The barriers for providing IAT vs IV rtPA is that it requires more time, there is longer time between arriving in the emergency department and receiving treatment. IAT does have a larger window to treat because of the reduced risk of bleeding, patients can receive it up to 6 hours after the onset of stroke vs 4.5 hours with rtPA. This technique also requires additional specialised staff and equipment. 

Procrastination

 I used to be almost proud of my power of procrastination, I'm not anymore, but I'm finding out that old habits die hard. I think, for me, a lot of it comes from my inability to balance my life. I'm either working hard and burning myself out or exhausted and falling asleep - at which point I give myself permission to have some downtime. When you have a chronic illness like rheumatoid arthritis rest can get addictive. There is another level to it, I need to find the motivation to do the work and push through the pain. I think that I've spent a lot of my life in denial about how RA impacts on my energy levels. You've got to face the physical limitations and build your world around what you can/can't do physically. But the energy thing is really popping up as an issue this year. It might be because my RA has not been controlled well at all this year. I sit down to write something and fall asleep. I have every intention of going into my research site to do some writing, but I hear bad news before I go and that burns through my energy before I get the chance to leave the house. Below is an outline of something called the 'spoon theory' which basically explains how people with chronic illness need to prioritise how they use their energy. It's a good thing to know about if you have a loved one with a chronic illness. Especially if they come across as flakey or cancel on you a lot, often they hate it as much as you do, if not more. 

The flip side of all this is that everything that I have achieved in my life so far I have done with rheumatoid arthritis. I've had it since 1987. Admitting that I've been feeling the fatigue more this year just feels like I am "making up" excuses. I'm always going to have RA so if I want to do this, if I want my PhD, then I just need to do it. I just wish my biologic would kick in. 

tomorrow (noun) a mystical land where 99% of all human productivity, motivation and achievement is stored 

How do you deal with rejection?

I'm having a bad day. As predicted the buyer of our house failed to secure finance, and when I look back at it, they effectively wasted five weeks of our time, I think in an attempt to get us to accept a lower offer at the end of this. Which we did not do, instead we've ended that contract and organised more open homes. They took a week to sign the contract, asked for 3 weeks to get finance and THEN asked for an additional week to secure finance. I was so annoyed when my husband gave them that extra week. They gave us a number last night, $12,000 less than their original offer, but I suspect that it was always going to be their best offer.

I've had a clumsy recommencement of my research and I'm feeling a little vulnerable, I haven't been rejected from anything, but I'm feeling like a reject. So I googled "how to cope with rejection in academia" and found this wonder article that I recommend you read, if you're having a bad day in the world of research.  Here's the link: http://makewritelearn.com/rejection-letter
In it a researcher writes a letter to their younger self. Here are a couple of my favourite parts:
"You don’t know this yet, but the path you’ve chosen is one of brutal, unrelenting rejection."
"You’ll question whether you belong. And even when you start succeeding, you’ll continue failing, a lot, in between each success." 
"Here’s the thing: academia is all about rejection."

One of the tips is to not take yourself too seriously

They go on to offer six tips on handling rejection. I find myself breathing a little easier.  
I've got a protocol and a database to finish. I just needed to shake this feeling off. I'm a hard worker, I love what I do and I'm passionate about finding out what will come next. I just hope that it is enough. 

Thrombolysis rtPA

Image from https://www.emaze.com/@ALRRWOTC

I like to make sure that I reference all of the images that I use, the website https://www.emaze.com/@ALRRWOTC actually has a pretty good video that describes thrombolysis. If I'm perfectly honest on a chemical level I still do not entirely understand how this rtPA works. I spent a year reading about thrombolysis and a day of a smart strokes conference only attending the doctors lectures on thrombolysis to help me wrap my head around this procedure. I'm not a doctor. Yet. And even after I earn my PhD I won't be one of those doctors. The real ones.

Here is a very brief run down on thrombolysis:

1) Time is brain 

The most important thing to know about this treatment is that "time is brain", there is a ticking clock that starts from the moment that you've had the stroke. You only have 4.5 hours to get to the hospital, have a CT scan to exclude bleeding in the brain and start the process. This is why it is important to know the signs of a stroke and act quickly. Thrombolysis comes with a small yet significant chance of having a bleed in the brain. Once you pass the 4.5 hour mark the risks start to outweigh the benefits.

2) Things happen quickly
I've met a patient who said no to thrombolysis for two reasons, the first was they were not entirely convinced that they had the onset time of the stroke correct, and the second was because they had to make the decision so quickly they saying no seemed like the best option at the time. They'd already had a minor stroke, why risk an additional bleed on the brain? His doctors were a bit salty about this decision, from the patients reports anyway. I understand both the patient and the doctor (if they were indeed a bit frustrated). Some people just don't like making decisions quickly. But also we have the cool up and coming procedure, let it work for you too! So what happens quickly? They do a CT, complete a set of bloods, complete a medical history to ensure no contraindications and they complete the NIHSS (see below) and if you score within a certain range you're eligible.

https://www.medscape.com/viewarticle/550818_2 NIHSS

3) How to be included. 
I think that the inclusion/exclusion criteria will change with time and further research. Right now to be included, besides getting a goldilocks NIHSS score, and a CT that shows no bleeding or trauma. You need to be over the age of 18 and under the age of 80*. Not pregnant*. Not had the stroke in your sleep or a Wake Up Stroke (WUS)*. Your BP need to be under control. No previous strokes in the past three months. No use of heparin in the last 48 hours.
For all of the * criteria, I am seeing literature emerge that is saying that these shouldn't be automatic exclusions, there are a few authors arguing for a less black and white approach to identifying who is eligible. A "case by case" approach, if you will.

4) Would I consent?
I've read the word small yet significant chance of haemorrhage so many times that I think that it's lost all meaning. I've read so many studies about the amazing functional gains that I don't think I would hesitate in consenting for me or any of my loved ones who've given me EPOA. Yes, I would.

Ischaemic stroke

http://ischemicstroke.org/tag/ischemic-stroke/

Yesterday I wrote about Aphasia, which is my area of interest. My research is looking at one cause of Aphasia, I'm looking at ischaemic stroke.

What is an ischaemic stroke?

There are two different types of strokes, a hemorrhagic stroke which is a burst blood vessel, bleeding in the brain, this type of stroke makes up about 20% of strokes is the western world. An ischaemic stroke is a blood clot in the brain cutting off the blood flow. 

The reason why I'm only looking at ischaemic strokes is because I am looking at these patients after they have received a procedure in the emergency room that dissolves or removes the blood clot. How are these new treatments impacting on the presentation of Aphasia?