#speciality

Day six of work experience. Or if we're keeping up with the trend of my previous post, it is day two of week two.

For today, and the remainder of the week, I am remaining with the ENT department because there is still so much to see. However, today in the inpatient procedure clinic, it was not too busy as at all. We only managed to see four patients, so I might be able to write less on this post :D

The first case was rare, even the consultant mentioned that a consultant only sees one or two of these in their lifetime. The rarity I am describing is singer's dystonia. A neurological disorder that causes vocal instability during singing only as the vocal chords spasm. This often results in the singer being unable to reach the high pitches they used to hit in the early years of their career. And it is unfixable by technique. Thus, the consultant decided for some temporary injections in order to relax the vocal cords for greater coordination, allowing the singer to immediately reach higher notes. On the other hand, as a result, her range of lower notes was slightly misaligned. After some voice rest (typically 3 days), as with any vocal chord procedure, the patient would be able to return to practice.

The cause of dystonia is unknown and the singer is likely to require similar procedures in the future - likely a couple of months if they are considering to continue their professional career.

The second patient was admitted again for a laser treatment due to his RRP (recurrent respiratory papillomatosis) that has caused benign wart-like growths on the vocal chords and surrounding tissue. Vocal chords were not able to adduct (close) fully because of this obstruction so the patient had a lower, whispering tone. HPV is the source of the problem, where benign tumours tend to recur as the virus persists even after the growth has been removed.

A CO2 laser removes carefully the lesions temporarily without damaging the underlying vocal chords, it does not treat the underlying cause: HPV. Multiple surgeries are recommended to minimise the effect of RRP on the voice box.

The last two procedures were basic of nature. Biopsies were taken to check for cancerous or precancerous cells later in the lab. If of that nature, the patients would be informed for laser treatment and managed with the oncology team.

Before each admission, a nebuliser was given to each patient to provide general anaesthetics and numb the area. Typically, the patient experiences minimal discomfort when the endoscope is lowered with the following required equipment.

Below is an image of healthy vocal chords:

(on the left are the adducted vocal chords and on the right are the abducted vocal chords)

The next image below shows a vocal chord with RRP.

Benign tumour is visible here, obstructing closure.

BingQiu Week day 1: Fire / Speciality / Culinary AU

Title: Cocineros Celestiales

Author: Marian Nightroad

Raiting: General Audiences

Warnings: Creator Chose Not To Use Archive Warnings

Summary: Cocineros Celestiales era el reality culinario más popular de los últimos años. Luo Binghe había intentado sin éxito ganar un lugar en el programa desde que tenía quince años. En su tercer y último intento, la buena fortuna finalmente llamó a su puerta, acompañada del amor. Entonces su suerte se acabó.

[El AU de Master Chef que nadie pidió]

Cocineros Celestiales

Cocineros Celestiales era el reality culinario más popular de los últimos años. Luo Binghe había intentado ganar un lugar en el programa desde que tenía quince años, pero nunca había conseguido avanzar más allá del segundo filtro. En su tercer año, durante las pruebas de ese temido segundo filtro y mientras observaba a uno de los examinadores probar su plato, pudo sentir como el sudor frío resbalaba por su espalda.

Su madre había sido muy comprensiva con él, apoyándolo y motivándolo a seguir su sueño de convertirse en chef profesional, pero él sabía el enorme esfuerzo que suponía para ella conseguir el dinero para enviarlo a cada una de esas pruebas. Siendo una humilde lavandera, cada centavo que gastaba en su sueño era dinero que podían haber usado para comer un mes completo. Por eso, se había prometido a sí mismo que esta sería la última vez. Si no era seleccionado ese año, no volvería a intentarlo.

The Venetian flag is still used by the Italian Army's Lagunari amphibious speciality and by the San Marco Marine Brigade of the Italian Navy.