Sunday, 17 November 2019

Top 5 Most Painful Medical Procedures

Top 5 Most Painful Medical Procedures

Alright, so anybody who's ever been admitted to hospital or needed a specialist medical investigation will have met with their fair share of uncomfortable procedures, whether it's blood tests or certain examinations. Some of course are more painful than others, particularly where needles are involved, so this is a list (in no particular order) of some of the most feared medical procedures carried out on patients.

Having often been the one doing and not receiving these tests, I also don't have much of a personal connection to these tests, hence why it's not a hierarchical list.

But trust me, it hurts me more than you :P

1. The arterial blood gas. (ABG)





One of the most useful and acute bedside tests available in modern hospitals today, the arterial blood gas, fondly abbreviated to ABG, has long been considered a fairly painful procedure. Although it's quick, the site of the test (often the radial artery at the wrist) and the angle in which the needle must strike the skin can be very off putting to patients, and it's often described as more painful than a regular blood test (venepuncture).

Why it's done: to check blood acid/base balance, oxygen and carbon dioxide levels, and other useful items like lactate and estimations of haemoglobin and electrolytes. The test is essential for lung or heart conditions or if there is severe organ failure, or if a patient is acutely unwell and there is no clear cause. It also gives an indication of severity of illness, and can be repeated to see if a treatment is working.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14767

2. Bone marrow aspiration and trephine/ biopsy


Though not that common a test, this is arguably THE most painful invasive investigation. In general solid organ biopsies aren't very comfortable, but the bone marrow aspiration is in a league of its own. This is where a direct tissue sampling of the bone marrow is performed on a conscious patient. Although this procedure does involve local anaesthetic, this is only injected on the superficial skin, and since bone is richly innervated it's very sensitive to large needles coming through and scraping out some marrow. For some patients it's too much, and it has to be done under a general anaesthetic, though this isn't common.

Why it's done: to investigate any bone marrow disorder, ranging from the leukaemias and lymphomas to the bone marrow diseases such as myelofibrosis.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14757

3. Lumbar puncture (CSF tap)

A lumbar puncture is where a spinal needle is inserted into the cerebrospinal space and the fluid here (cerebrospinal fluid, CSF) is tapped and sent for various investigations, including estimation of glucose and protein, looking under the microscope, and culturing to grow bugs. A special test also looks for something called xathochromia, which is indicative of an acute bleed within the brain. Again, while local anaesthesia is used for the skin, it can still be discomforting.

Why it's done: to look for nervous system disease, from acute problems like meningitis or subarachnoid haemorrhage, to other infections like tuberculosis, or for other diseases such as multiple scelrosis.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14865

4. Colonoscopy


A small bore camera is inserted via the back passage and allow for direct visualization, biopsy sampling and even treatment of diseases affected the large bowel. However, it does require a lot of preparation (the bowel needs to be 'purged' to allow for a good view, usually done two days prior with potent laxatives and a clear diet), and can be very discomforting as air needs to be inflated into the bowel. Some patients find the procedure intolerable after a certain distance in the bowel, and so the procedure has to be abandoned.

Why it's done: to check for bowel problems ranging from bowel cancer, inflammatory bowel disease, polyps, diverticulosis and many others. Samples can also be taken to be looked at under the microscope (histology), and polyps can even be removed at the same time as well.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14795

5. Transoesophageal echocardiography




Most people are familiar with ultrasound and the typical echocardiogram- a scan that looks at the heart- done via the chest wall (transthoracic). However, the scan can also be performed from the inside via the oesophagus (gullet), which allows for better views of other chambers. Similar to having an upper GI endoscopy (camera test looking at the stomach and upper intestines), an echo probe is placed down the mouth, via the throat, and the heart imaged in the chest. Sedation can be given and local anaesthetic spray to the back of the throat, but it can still cause a lot of discomfort to some patients.

Why it's done: to check the chambers of the heart, heart wall thickness and chamber size, function of the valves, how much blood the heart pumps, and if there are any blood clots sitting in the heart.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=191606

There are probably loads more tests I've skipped over, but these are the ones that stick out for me. What test have you had done that's made you cringe?

Thursday, 7 November 2019

Inktober- My Story So Far (Part Three)



Welcome back to Part Two of my Inktober journey! I recommend reading Part One first.

So October is the month of Inktober; an art challenge made by artist Jake Parker in 2009, where you have to draw 31 daily prompts in ink-based media. This has evolved over time, with people taking more liberties and using their own prompts/ themes/ media, and every year I say I will give it a go and every year I neglect to...

But 2019 is different! I plunged right in (3 days late mind) and have been able to keep up with the daily drawings. So, as well as share with you each drawing I've made, I also wanted to comment and reflect on the experience, as it's been very eye-opening and has made me want to pursue the medium of pen and ink further.

Each drawing was made using Derwent HB pencil, eraser and Staedtler pigment liners drawn on sketchbook paper- no digital means at all (apart from adding the prompt title).

I'm going to split the post into 3 parts, as it'll be quite an eyeful to go through all 31 drawings in a single post, so this will cover prompts 21-31.

You can see all of my artwork from Inktober plus all my artwork on my Instagram, @maddoctorartist

Let's get into it, shall we?

DAY 21- TREASURE

This was a fun one to do! I immediately thought of magpies and how they love to collect the shiny things. I actually used my own photo reference of a crow in this pose, then added all the trinkets. It took some time to come up with what sort of items a magpie might steal, so there's an assortment of watches, coins, mirrors, jewellery, cogs, screws and keys in there!

I also tried the feathering strokes again- it didn't really seem to work for the head and body, so it was something to look at for future.

DAY 22- GHOST

Another tricky prompt, as I didn't want to draw the stereotypical ghost in white sheet. Ghost can also mean spirit, however, so I thought I could do a haunted elk skull. Initially I was going to do a wolf in the sky with the northern lights, but once I did the skull I felt it was detailed enough to be its own thing.

As you can see here I really started to get to grips with shading, adding it to the trees, rocks and skull itself. I quite enjoy doing crosshatching, it's quite relaxing! I did make a lighting mistake on the left antler, which I only realised afterwards. Thus this has made me try to think about light sourcing and where to put the strokes, something I hadn't really done consciously before, and this is a good thing!

DAY 23- ANCIENT

As I mentioned in Part Two, I think this would have been better suited to Day 15 'Legend', and would have neatly swapped (as Virgo is an ancient constellation). Regardless, I chose to draw Pegasus wandering the ruins of Ephesus (in southern Turkey). I visited this place while on a cruise with school, and found it quite fascinating. I always like the style of Greek ruins, but aside from Athens (which I also saw on the same cruise) I haven't seen many.

I enjoyed coming up with a background for this one along with doing the feathers. Pegasus is often draw with his wings open so to be different I did him with one wing folded. I also really liked how the shading on the pillars came out.

DAY 24- DIZZY

This one I struggled with for a long while. Then I recalled a piece of fanart I had seen years ago from Fire Emblem, involving a character who could transform into an eagle. The fanart showed him twisting through a ravine (you can see if here if you wish), and I thought that 'dizzying' feat would work well for a bird. Initially I was going to do a peregrine falcon, but once I found a great reference picture of a bald eagle flying upside down, I decided to go for an osprey instead.

As you can see it was a very challenging pose, but great fun to do. I was also starting to think about how to convey 'colour' when I only have black and white. As odd as this sounds, if you desaturate a colour, it has a natural 'brightness' (so a desaturated red looks different to a desaturated blue, even if the colour is missing). In art terms this is called a value, and it also depends on how much light is hitting the object.

With pen and ink though, conveying 'colour' and shadows uses the same sort of idea. In this case the belly of an osprey is white, while its wings are brown. I perhaps could have done without drawing the individual breast feathers and made it more 'fluffy' to convey white, but that is the fun of Inktober- it has let me experiment and try things out. While not everything has come to what I had in mind, I haven't been upset with any result. It has all been a grand learning experience and has taught me a lot more than digital art has, and I'm super happy about it!

DAY 25- TASTY

Another prompt that I already knew what I was going to do! Following my very challenging Royal College of General Practitioner's practical exam (which was super nerve-wracking), I found a fun photo of two owls devouring a mouse, which I posted to Facebook saying that I felt just like the mouse and the owls were the examiners!

I remembered this photo and thus thought to use it as a basis for this prompt. For all the bird art I do, I've only ever drawn an owl once, so I decided to go for a barn owl this time. This was a nice straightforward pose, and I decided to focus more on the 'colour' of the owl rather than the shading. Hence it looks a bit 'flatter' than the previous drawings but I liked doing the stippled effect on the feathers. I was also able to make the head more 'fluffy' by not drawing individual feathers, as I had done with the osprey.

DAY 26- DARK

Is it me, or do the prompts seem much easier for these later days? Maybe it's because I was very into thinking up ideas by now, or just they seemed to translate to wildlife themes better. Either way, this was another one I knew exactly what I wanted to do- a blank panther hunting at night. Now this was going to be a challenge, as how could I render the black fur but also make it look shaded?

The answer is not to use solid black! Thus I went with layering of crosshatching and avoided any solid shades, saving this for the background to emphasis the night-time. I loved how this came out- it feels like a full fledged ink drawing, rather than the simple sketches I was doing to start with. This also took a lot longer- around 3 hours! It reminds me a lot of published novel illustrations that you used to get- I enjoyed looking at these and always wondered how the artists could convey so much detail with only black ink.

DAY 27- COAT

This is hands down my favourite of all the prompts. Of course I wanted to pick an animal coat/ pelt, and the contenders were bear and snow leopard. Snow leopards have such lovely thick winter coats, so I went with that. Here I applied everything I'd learned so far in Inktober and I love how it came out. I went all in with shading, including the background. Some parts didn't quite blend as I hoped, such as the belly fur and leg, and the background shades are a bit too close to the fur itself so it merges into each other, but I really was please with the fur texture- a dramatic improvement over Day 6 'Husky'!.

DAY 28- RIDE

I seem to have lost my momentum with this one, I feel it's not as good as some of the previous ones, but I did enjoy coming up with the concept, and I also learned a new fact!

So, as you might be aware, Hinduism has many gods. Many of these gods have what is known as 'vahan'- literally translated this means 'vehicle', but the English 'steed' is a better approximation, as these are the animals the gods use to travel. I was going to draw all of them, but a quick search showed me there's over 30, which was far too much for a single prompt!

Hence instead I decided to choose the major goddesses- Durga (she rides a tiger), Lakshami (she rides an elephant or a white owl), Saraswati (she rides a white swan) and Parvati (who rides a lion- a fact I didn't actually know!). Parvati also sometimes rides a bull, which is her husband Shiva's steed.

Thus that was the mystery connect between the four animals and the prompt 'Ride'!.

DAY 29- INJURED


I had to think a bit for this one, as there were a lot of potential possibilities. I was thinking to do a Monster Hunter monster again, but then thought of something simpler- a stag fighting a wolf. I enjoyed the stag, but the wolf still seems a bit 'cartoony', which was not what I was going for. I didn't have a direct reference, but I did use several photos to help. Overall though I liked th emoment captured, and how I was able to shade the fur on the stag.

Here I was starting to see how difficult it can be to make consistent strokes- see the trees for example- but I was playing with different ways to hold the pen, so I wasn't too frustrated with it.


DAY 30- CATCH

This one competes with the snow leopard for my favourite. I was initially going to draw an eagle or osprey fishing, but as I had already used these birds in previous prompts, I chose to do a kingfisher instead.

I was finally starting to get the hand of blending with ink- that is, layering strokes with different distances between the lines to get a gradient of light and shadow. I also didn't try to draw individual feathers too much, apart from the head and neck, which on kingfishers are quite prominent.

Very happy with how this one turned out!

DAY 31- RIPE

And here we are, the final prompt! Once again I changed my mind last minute, as I discovered I could slip in another bird! So, instead of drawing strawberries, I went for a macaw eating a fruit, as this is part of their natural diet.

I think I went back a bit here- I was a bit too heavy handed with the head feathers, and I could've made the breast feathers bigger so they don't look so 'tiled'. Again, it's a decision between wanting to convey 'colour' and wanting to convey shadow, so this is something I can work on in future drawings.

Thus, I completed all 31 prompts, with only a single delay at the start! I am particularly thrilled to see such an evolution of my art style, from the single line flat sketches to this much more detailed and textured forms. I still have a lot to learn, and have in fact purchased some books to further my studies! I don't think I will abandon digital art either, but it is really lovely to experiment with a new medium.

I hope you enjoyed taking this journey with me, and I'll be sure to post more artwork soon!

Friday, 1 November 2019

Inktober- My Story So Far (Part Two)



Welcome back to Part Two of my Inktober journey! I recommend reading Part One first.

So October is the month of Inktober; an art challenge made by artist Jake Parker in 2009, where you have to draw 31 daily prompts in ink-based media. This has evolved over time, with people taking more liberties and using their own prompts/ themes/ media, and every year I say I will give it a go and every year I neglect to...

But 2019 is different! I plunged right in (3 days late mind) and have been able to keep up with the daily drawings. So, as well as share with you each drawing I've made, I also wanted to comment and reflect on the experience, as it's been very eye-opening and has made me want to pursue the medium of pen and ink further.

Each drawing was made using Derwent HB pencil, eraser and Staedtler pigment liners drawn on sketchbook paper- no digital means at all (apart from adding the prompt title).

I'm going to split the post into 3 parts, as it'll be quite an eyeful to go through all 31 drawings in a single post, so this will cover prompts 11-20.

You can see all of my artwork from Inktober plus all my artwork on my Instagram, @maddoctorartist

Let's get into it, shall we?

DAY 11- SNOW

This was another theme that had a wide range of possibilities, so I chatted with a friend again and she suggested an arctic fox. This was a new challenge for me, and it also made me decide that if possible, I would like to stick to drawing wildlife for each prompt.

Given the white fur of the fox, I was reluctant to add any shading so I left it blank, and added some snow. As a result it does look a bit flat, which is something I work on as we go on.

DAY 12- DRAGON

I didn't want to be too obvious with this prompt, and so in order to also stick to my general theme of wildlife, I chose a Komodo dragon. With this drawing I played with the different pen width sizes, which wasn't something I had done much until now. This was really useful to get the scales done, though it was also very time consuming!

I was very happy with the form of this one, and the detailing. Again avoided the shading so it's not quite as three dimensional as it could be, but I learnt a lot about pen strokes with this one. I also made a mistake on the left leg as I didn't follow the right contour, which was worth noting.

DAY 13- ASH


This one was difficult to come up with an idea, as it doesn't really lend itself to animals! However in the end I had a spark of brilliance, as I realised I could draw a mythical creature. Thus using a peacock base, I drew a phoenix rising from the ashes (or at least bursting from flame). It was tricky to get nice smooth curves, mostly because my drawings were in an A5 sketchbook and I usually draw in my lap rather than on a table! However this is something I made a note to work on in future drawings.

At this point my drawings were taking around 10-30 minutes, as I preferred quick sketches rather than full blown shaded pieces, but you'll see how that changes!

DAY 14- OVERGROWN

I already had an idea in mind for this prompt, although the type of bird I was going to draw changed when I saw photos of a Phillipines eagle. This was very interesting to draw as I started using different penstrokes to simulate different textures. I really liked how the feathers came out in particular, and how I could use broken lines to simulate the edge of feather strands.

DAY 15- LEGEND

This was another difficult prompt (and looking back, what I ended up doing for Day 23 'Ancient' probably would have swapped nicely with this one). In the end I decided to draw the constellation of my zodiac sign, Virgo. This depicts a young girl or maiden holding a sheaf of wheat. In ancient times she was often associated with the goddess of the harvest, Demeter/ Ceres, given that Virgo spans over the harvest season (August 23rd- September 22nd).

I kept this one simple, thus I didn't give her any facial features as I wanted to convey it as a more symbolic form.

DAY 16- WILD

I was happy to get this as a prompt, as it fit very well into my wildlife theme! Since I had enjoyed the tiger so much, I decided to draw another big cat, this time a jaguar with some prey. I added a bit more of a background to this one so it wasn't so stuck-on, and tried to contrast the prey with the predator by giving it a darker coat. I also tried to follow lines of fur, which I didn't really do with the Day 6 'Husky' prompt. It still looks artificial and not flowing like real fur, but it was a start as I didn't know how to simulate the texture at all.

DAY 17- ORNAMENT

As I mentioned in the last post, I tried not to be too obvious with each prompt if I could help it. I wasn't keen on drawing any inanimate objects, which made it tricky to come up with an idea for this one! Initially I was going to do a Diwali decoration, as the festival was coming up soon, but then I thought why not do something else? So I went with a bull with an 'ornament' of flowers on its horns. I was also tempted to go with a stag, but decided for a bull in the end. This ended up working out, as I used a stag and antelope skull in future prompts.

Again I left it quite plain, wanting to stick to simple sketches.

DAY 18- MISFIT

This was a bit of a special one for me. I'm sure there are lots of 'misfit' creatures in the animal kingdom, but ever since I learned about the Aesop fable of the raven and the swan, I've been fascinated by the two species as you don't often see them together (though I do have a photo of the two together on the river Thames!).

The raven and swan!

In the fable, the raven is jealous of the swan's white feathers and ability to swim. So it tries to swim and ends up drowning, while the swan muses that creatures should stick to what they are made to do. I didn't like this rather morbid ending, so I wrote my own story with the two birds. You can read it on my Facebook Page (it's also illustrated!).



DAY 19- SLING

Another prompt that took a bit of thought, and I did consult a thesaurus to see what else I could do with it. Sling can also mean suspend, thus that gave me the idea to draw a cat trapped in some vertical blinds!

This was very tricky to draw, as I didn't have a reference and I was trying to work out which parts of the blind would sink given the cat's weight. I also made a line mistake, but one thing Inktober has taught me is that I do not need to be scared of making errors. It is good to leave them there as reminders, especially with ink as it's not erasable. Overall though I was happy with how it came out.

DAY 20- TREAD

You will start to see a shift in the detailing after this one! This was fun to come up with, and very enjoyable to draw. I liked getting the detailing of the baby elephant's skin down, and I tried my hand at crosshatching to get some shading. This was the first time I committed to trying to shade with ink, and while I didn't lay down too much contrast I liked how it was coming out. Here I learned that shading with smaller widths gave different textures than shading with bigger ones, and is something I take forward with the next prompts.

And so concludes Part Two of my Inktober Journey! Next week I will post the last set of drawings 21-31, and you can see how my ink style evolves to the next level!