Knee Examination – The Procrastination Pen

Sleeping With ASMR

Reassuring for part time bloggers, such as myself, is the understanding that fitting in a bit of blog creation in a rush between other things is not supposed, necessarily, to lessen the quality of the output. (Well, the proof will be in blog items I have created of late, as the time to create them is definitely sandwiched between other demands). You will be the judge and feel free to feedback.

The playlist continues to grow in size and I continue to get more picky about the items in it. Such that the archive list of former members also continues to grow.

However, I have noticed a problem with YouTube. For example, yesterday I was watching the playlist and a set of adverts kicked in, there were a lot of them. After a few minutes the video started and them immediately another set of adverts kicked in. This then continued, I retried over the course of the next few hours with the same result. Of course, this is not conducive to sleep. I could not in all conscience recommend a set of videos if I knew this was going to be the experience.

I am hopeful this was an error on the part of YouTube and not some new revenue generation idea. If it turns out to be permanent, I will shut down the blog as I will not be watching YouTube any longer. I am now some months ahead with generated blog articles so we will see if by the time I get this one released, things have improved (or at least returned to how they were).

Shoulder Examination

This one has notes, now the established marker of a professionally created video:

“31 Jan 2021 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the shoulder. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

There is also a title page:

“McMaster MSK Examination Series, Shoulder Examination, RheumTutor.com, Raj Carmona, MBBS, FRCPC, Rheumatologist, Department of Medicine, McMaster University, Hamilton, Ontario, Canada”

So quite a lot to work with. The url is still current: https://www.rheumtutor.com/.

A page lists out the videos that can be seen (helpfully it appears these are all available on YouTube https://www.rheumtutor.com/msk-examination/videos/.

McMaster University of course has its own webpage https://www.mcmaster.ca/, the available programmes seem to feature health and medicine strongly https://future.mcmaster.ca/programs/.

And of course, the university has its own YouTube channel with 1.2K videos as at today’s date. Rather too many for any single review but perhaps a channel for a future visit.

Raj appears to be an associate professor at the university and has been at McMaster nearly fourteen years.

This video at just over seventeen and a half minutes is a decent length for a medical examination video.

Raj has a nice calm voice but the video is rather marred by continuous background noise of the variety we are used to enduring in these kinds of videos.

Helpfully the “patient” here is also identified as Dr Kim Legault MD FRCPC Rheumatology Fellow McMaster University.

As an educational video it seems (to the uninitiated) to be useful. The comments seem to reinforce this view. From our perspective it seems to also be a useful video for relaxing off to sleep.

The video is jam-packed with medical terminology. There is far too much for the odd definition to be helpful. (Although this would be my usual style). If you are watching, some definitions come up on screen, but I’m expecting that you’ll be listening so these will not be of much assistance.

I suggest for this one that you let the terminology wash over you but let me know if you find it frustrating. I always review the Procrastination Pen playlist and this could in the future find itself in the dreaded Procrastination Pen archive list i.e. those videos which do not stand up to long term examination.

Although the video shows as posted to YouTube in 2021, the tail page of the video indicates created in 2011 so it was already old by that time.

Not unexpectedly the channel is RheumTutor, thirty videos and six playlists. The choices are narrowed by the fact that a number of the playlists concern giving injections, which I am not certain would be a restful subject for some readers. The video we first looked at occurs in a playlist called RheumTutor MSK Examination Videos

This consists of seven videos of which this first one is video number six.

Ankle and Foot Exam – McMaster MSK Examination Series

At nearly twenty-three minutes in length this is another chunky video.

Again it has notes: “10 Nov 2019 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the ankle and foot. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

The title page is similar to the one we saw for the first video reviewed in this post.

The sound is consistent with that first video. Here the “patient” is not identified, possibly because we only see the foot which has been helpfully decorated to indicate some of the internal structures. I would guess the “patient” is male but given there is only one foot to go on that could be way off.

Later in the same video the credit goes to Dr Andrew Duncan MD, Internal Medicine Resident McMaster University. He appears to be the owner of the foot. Andrew appears to have been at McMaster until 2014.

The tail page of the video indicates it was recorded in 2012 which would fit with this time period. Some of the conditions described are a little off-putting to be honest, I think that this is too much for real restfulness. This will not be in the Procrastination Pen playlist.

Back Examination – McMaster MSK Examination Series

Notes again: “10 Nov 2019 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the back. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

This is just as with the previous videos in terms of approach, voice, presenter, location, noises, structure. This one credits Brendan Flowers MSc Clinical Clerk McMaster University it looks like Brendan attended in 2012 which fits with the filming of the video.

Elbow Examination – McMaster MSK Examination Series

If you have seen one of these videos, then you are going to be at home with the look-feel of the rest. Same layout, same voice, same background noise. If you liked the first one this is a breeze, but not so great if you did not like it.

Again there are notes:

“10 Nov 2019 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the elbow. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

The format of this will by now also be familiar. The tail page of the video indicates it was filmed in 2012 and it was posted to YouTube in 2019.

The “patient” is credited again this time Dr Arthur Lau MD FRCPC Theumatology Fellow McMaster University. Arthur seems to have been there from 2011 to date so one would imagine a true asset.

It is just over thirteen and a half minutes so a bit shorter than the last one.

The great thing about professional videos is the lack of surprises. The last thing you want when trying to fall asleep is to find that someone thought a brass band backtrack was fantastic in this video whereas the previous two did not include it. The downside is that if you do not like the style it is very unlikely you will find a video in the series that is any different.

For example, thus far the patients do not get a lot of contribution so if this bothers you this particular series is just not for you. I accept feedback if you want to indicate your displeasure about it.

Hip Examination: McMaster MSK Examination Series

Notes: “10 Nov 2019 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the hip. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

Almost exactly as before.

A return of Dr Kim Legault (who we saw in the first video). By comparison with the other videos a real short one at just over twelve and a half minutes. This one is filmed in 2011 so possibly the earliest one we have seen thus far.

Knee Exam – McMaster MSK Examination Series

notes: “11 Nov 2019 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the knee. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

Dr Kim Legault is turning into a bit of a favourite it seems as she appears again in this one. This one is just less than fifteen and a half minutes.

The video is consistent with all those we have so far seen (quite an achievement). It is filmed in 2011 so as for the previous video.

Shoulder Examination

This is where we came in.

Hand and Wrist Examination

The final video in this playlist

It starts in a different way. No shot of a seated Dr Carmona in this one. It is quite long for this series at nearly twenty-one and a half minutes.

Back to Brendan Flowers. It was filmed in 2012 and posted to YouTube in 2021.

There are notes: “3 Feb 2021 RheumTutor MSK Examination Videos

This video was created by Dr. Raj Carmona. It is a step-by-step instructional video for examination of the hand and wrist. It is designed for medical students, residents and rheumatology fellows, but would also be beneficial to general practitioners and allied health professionals.”

The breakdown of the video is not as structured as in the previous videos – perhaps the style was evolving at this stage. But presentation in all other respects seems the same.

In summary this is no Dr James Gill but I think all of them deserve a place in the Procrastination Pen playlist. (Assuming YouTube stop deluging me with adverts I’ll keep reviewing that list for less deserving videos.

The RheumTutor playlist on the Procrastination Pen is here:

The Procrastination Pen playlist (which is no-doubt what you have all been reading this in order to locate) is found here:

I have been listening to this playlist most nights and some of the videos that were members have now been removed. If any of your favourites are missing from that main playlist you can find them here in the archive list:

Quite often the videos getting removed have no faults other than occasional intrusive noises.

The playlist of items that are great for ASMR (but contain an age verification function), usually a great way to interrupt your listening in the middle of the night, is here:

I hope that you find the playlists restful and that you get a good night’s sleep.

Hope to see you again back here for the next blog article.

If you liked this blog item, why not subscribe to this blog.

Until next time.

Photo by krakenimages on Unsplash

Sleeping With ASMR

The Procrastination Pen playlist continues to grow in length. I think soon it will be at such a length that even if you leave it playing along in the background whilst you sleep, you will wake up and find that it is still going.

I am weeding the odd video out at intervals that does not seem to be as good as when first I heard it. However, I take suggestions, if you find any of the videos in that playlist just aren’t that helpful in getting some shut eye, let me know and I might remove the ones that you do not like.

As always if you’re too tired to read (and I don’t blame you) the playlist will be at the end of this article, such that you can scroll all the way there and pick it up without reading anything else.

For those who are continuing to read, welcome, and here is the subject of today’s blog post:

Shoulder Exam (Stanford Medicine 25)

This is very brief for the kind of video we usually see on the Procrastination Pen, at only one minute twenty seconds. It is narrated and the narrators voice is not as quiet as I would like. Because it is a professional video it comes with notes: “16 Mar 2014 Stanford Medicine 25: Musculoskeletal Exam

This Stanford Medicine 25 video was created in conjunction with Stanford’s AIM lab teaching the examination of the shoulder.

The Stanford Medicine 25 is a Stanford School of Medicine initiative to teach and promote the bedside physical exam. Here you will find videos teaching bedside physical exam techniques.

Please subscribe, like and visit our websites:

Main Website: http://stanfordmedicine25.stanford.edu/

Blog: http://stanford25blog.stanford.edu/

Facebook: https://www.facebook.com/StanfordMedi…

Twitter: https://twitter.com/StanfordMed25

Google+: http://goo.gl/UBM7SP”

The notes have done most of the work for me in that is states who it is by and where you can find them.

The video has a little background noise, but strangely this does not sound like air conditioning. This time it sounds more like the audio was recorded onto tape (I guess you need to be a certain age to know what that sounds like).

The channel is Stanford Medicine 25

This has eighty-five videos at the time I am looking at it. Thankfully for the purposes of writing a blog post (of hopefully short length). The videos are organised into playlists and ours is in a suitable playlist i.e.:

Stanford Medicine 25: Musculoskeletal Exam

This playlist has eight videos in it and just for a change
they are all visible.

The one above is the first in this playlist and so we can

cover them in order.

Knee Examination (Stanford Medicine 25)

Again, this is brief at just over one and a half minutes. It
is consistent with the first – the same narrator, the same background noise. Indeed, this is often the benefit of professional videos once you have seen one, you have a good idea what it is that you’re going to get. Of course, if the first
one is a tad loud, sadly it means that there is little variability in that volume. Still, the approach is methodical and calm which is helpful.

Approach to Low Back Pain Physical Exam – Stanford Medicine 25

This is a more “usual” length at just over eight and a half minutes.

Oh dear, start music, the thing designed to strike wakefulness into the slumbering person.

This is unlike the previous two videos in this set in that the medical professional in the video is the one doing the talking.

The medical professional is Baldeep Singh MD Clinical Professor, Medicine, Stanford School of Medicine.

The professor actually has quite a reasonable voice for our purposes, although due to the instructional nature of the video he isn’t as quiet as we would like. However, he is calm, methodical and even better, the video lacks background noise.

The “patient” is Steve here, sadly, we don’t have any further info about Steve.

The examination looks like something of a torture for anyone who actually has back pain. I imagine on the days I am suffering, there would be screaming involved. Best ignore that when listening to this video and trying to get some kip.

Approach to Hip Region Pain Physical Exam – Stanford Medicine 25

Unfortunately for us, the introductory music now seems to be the standard. Farewell to videos with no introduction hello introduction which is less conducive to sleep. I have heard a great deal worse however.

At least one comment indicates that an ASMR fan has already found this one, which isn’t surprising. From the video comments I’ve seen on YouTube, ASMR fans are even more voracious than I am (and I have made it my mission to write blog articles about it).

Here we have Dr Singh again with our old chum “Steve” as “patient”. Dr Singh starts a little fast but slows right down within seconds. The volume is a little variable. At six- and three-quarter minutes it is of reasonable length for one of these instruction videos.

The best way to watch a set of these from the Procrastination Pen playlist is to watch it on YouTube (rather than use the embedded videos on the blog). Then you can use the shuffle function. Without the shuffle function you will get a number of similar videos one after the other and you may quickly tire of that.

Again, the examination appears, to me, to be designed to elicit pain. I’m sure on the days I have hip pain I would not enjoy my leg being manipulated in the way demonstrated. However, I think as a video to fall asleep to, it actually works. Mainly because of the calm, methodical presentation.

Iliotibial Band Syndrome Physical Exam – Stanford Medicine 25

Definition: Iliotibial Band a thick band of tissue running down the length of the outside of the thigh.

Again the “Noble test” seems designed to cause pain, perhaps these doctors were trained in a torture chamber. Probably wise to ignore the scope for suffering with this one as well. Dr Singh remains consistent as before and Steve remains compliant.

And now the playlist moves onto a different medical professional and a different patient so it seems a good time to end this, we can recommence in a future blog post. Stanford Medicine 25 certainly seems worthy of more attention.

The Stanford Medicine playlist on the Procrastination Pen is here:

The Procrastination Pen playlist (which is no-doubt what you have all been reading this in order to locate) is found here:

Quite often the videos getting removed have no faults other than occasional intrusive noises.

The playlist of items that are great for ASMR (but contain an age verification function), usually a great way to interrupt your listening in the middle of the night, is here:

I hope that you find the playlists restful and that you get a good night’s sleep.

I hope to see you again back here for the next blog article.

If you liked this blog item why not subscribe to this blog.

Until next time.

Photo by Shona Macrae

Sleeping With ASMR

If you’ve been following the blog for a while by now, you know the drill. I browse around YouTube and find a video which might cause ASMR symptoms in those lucky enough to feel such symptoms. For others, I hope it proves relaxing enough that, if you were listening to it and trying to sleep, it might prove to be helpful.

If you’re new to the blog, welcome, as an explanation the outcome of each one of these articles is a review of the video (and possibly some associated videos) and ultimately a playlist that contains the best ones.

Each week I also review and weed the playlist, so that some of the videos that have not stood the test of time are removed from that playlist. But in case you miss them, I have an archive list of such videos to enable you to find them again.

This week the video commences with an image of a textbook so I think it safe to assume it is all about education. It appears the basis of study is going to be a textbook called Macleod’s which is probably some kind of medical bible to those in the know about such things.

Macleod’s Examination of the Hand

This is just over six minutes long so it isn’t going to be hanging about. We have been used to videos which are substantially longer.

There is a title telling us all about it: “Video taken from Macleod’s Clinical Examination 13^th edition By Graham Douglas, Fiona Nicol & Colin Robertson”

One key to the professional nature of the presentation is a nice comprehensive set of notes: “New! Macleod’s Clinical examination 13th edition

This video demonstrates clinical examination techniques, as described in Macleod’s Clinical Examination. The textbook with access to the full set of videos is available at http://www.elsevierhealth.co.uk/macleod More info about the director www.iainhennessey.com”

It is possible that Elsevier Health may be worthy of a future review.

The video itself is a bit strange. I get the sense that the voices don’t actually belong to the participants, either that or it is just subtly out of sync. The first time I saw the beginning, I was convinced that they were artificially generated images rather than real people. But given we will not be watching, but lying there worrying about that meeting first thing and distracting ourselves with the soundtrack, that will almost certainly go unnoticed.

It is a video designed for education and therefore is heavily narrated. Fortunately, the narrator has quite a good voice. Not as good as Shane Brun, but pretty good nonetheless.

Part way through the sound abruptly cuts off as if the narrator intended to continue and there is instead a few seconds silence. It has the feel of a bad edit.

There are way too many terms in here for me to attempt definition of them all – in any case this isn’t a medical blog.

However:

Crepitus noises occurring on movement of a joint.

Sinovitus – swelling of the joint.

The custom with this blog (once the one video has been viewed) is to take a look at the channel which it is from, and determine if there is other ASMR-y (official term) material available there.

The channel is called Farsight Channel.

It contains fifty-nine videos and five playlists as at today’s date.

With this quantity of videos, it has now become customary to choose one playlist and to stick with it. However, the playlists which might be of interest are twenty-four videos long. That seems a bit much and will most probably test your patience.

Therefore, the established route is to find videos featuring the same medical professional or the same “patient”.

This, still leaves us with a long list. In this case I think we can choose between two playlists:Macleod’s Clinical Examination Videos 12th Edition

and

New! Macleod’s Clinical examination 13th edition

and then focus on the patient (who only appears in a subset of the videos).

Taking the first playlist, we find the patient occurs in the following:

Macleod’s Gastrointestinal Examination

Here we establish that the medical professional is “Ben”. Although given the strange “dubbed” nature of the soundtrack, he could be anyone at all and for our purposes I do not suppose that it matters.

The notes state “Macleod’s Clinical Examination Videos 12th Edition

Sample of DVD content available with Macleod’s Clinical Examination 12th edition. A further 24 DVD quality clinical examinations available with the textbook and on student consult. The 13th edition has just been released and its content found at New! Macleod’s Cl…

More info about the director www.iainhennessey.com”

There is also a comment on the channel: “The character of the bowel sounds is unlikely to be changed by palpation. Bruits will also not change. Hutchisons, Tally, Ford and Macleod’s textbooks examine in this order and it is standard exam convention (in the UK). However, tailor your examination to local practices for exam purposes”

It is quite remarkable for a professional video series that comments are permitted at all (we have seen how brutal comments can be).

From the comments we can see that other ASMR fans have found this one before.

Definitions again

Palmar erythema: Redness of the palm of the hand.

Spider Naevi – enlarged blood vessels in the skin with the appearance of a spider.

Xiphisternum lowest part of the breastbone.

Ascites – accumulation of fluid in the abdomen.

Gastroparesis – slower than usual passing of food through the stomach.

Hypoalbuminemia – low levels of albumin in the blood.

Macleod’s Knee Examination

The notes state “Macleod’s Clinical Examination Videos 12th Edition

Sample of DVD content available with Macleod’s Clinical Examination 12th Edition. Further videos are available with purchase of the textbook or online at student consult.

More information about the director www.iainhennessey.com”

Now we discover that the patient is called “Abby” (I imagine that there are many spellings of that name and I have probably selected the wrong one). As pointed out previously given the nature of the video this is in all probability not the “patient’s” real name in any case.

Definitions:

Genu valgum – knee misalignment.

Tibial Tuberosity – an image is best for this one:

Macleod’s examination of the Hands (joints)

The notes are: “Macleod’s Clinical Examination Videos 12th Edition

Sample of DVD content available with Macleod’s Clinical Examination 12th Edition. Further videos are available with purchase of the textbook or online at student consult.

More information about the director www.iainhennessey.com”

Definition:

Vasculitis – inflammation of the blood vessels.

Rheumatoid nodule – swelling normally near a joint.

Bouchard’s nodes – hard bony growths associated with arthritis.

It’s probably wise to let the medical terminology wash right over you or it may be easy to convince yourself that you have all kinds of nasty conditions. The odd comment with some of these videos seems to indicate the occasional viewer is heading down just such a rabbit hole.

Macleod’s examination of cranial nerves 2,3,4 and 6

The dubbed soundtrack is definitely off with the way the people are behaving in the video, it’s as if they are artificial people. But that surrealness only comes across if you are actually watching it. Here we have a medical professional “Amy”, who like “Ben” is probably not Amy because the desire from such videos presumably is anonymity. Perhaps the voice has been electronically masked to the same end, at points it is so clipped that the participants seem abrupt or as one commentator states – robotic.

The notes with the video state “Macleod’s Clinical Examination Videos 12th Edition

Macleod’s Clinical Examination video. Demonstrating clinical examination technique as described in Macleod’s clinical examination. Textbook and accompanying video available in full quality at http://www.amazon.com/Macleods-Clinic…”

The comments indicate that the narration is “boring”, however, in terms of relaxing for sleep, I think the narration track is actually pretty good. Obviously every video should be the quality of Dr James Gill in an ideal world, but I’d say this set has been consistent so far and I see no reason to exclude any of them from The Procrastination Pen playlist.

Macleod’s Thyroid examination

The final video for this post and a very brief one at two and a quarter minutes. The channel has been a consistent resource so we will be back, I think.

The notes state “Macleod’s Clinical Examination Videos 12th Edition

Thyroid examination from Macleod’s clinical examination

More information about the director www.iainhennessey.com”

I am almost convinced now that the people in these videos are artificially generated, the only way you’ll spot this when drifting off to sleep is the odd intonation of the voice and the very clipped interactive manner which to a real person would probably be deemed to be rude.

In terms of sleep though I think it is consistent – almost monotonal – and relaxing. After all, you will not be actually watching, unless sleep really isn’t happening for you and you need something to distract you from the fact that you’re lying awake and you’re in the office in only three hours’ time…

The Procrastination Pen playlist for Farsight is here:

The overall playlist for all videos featured on the blog so far is here:

I have been working through that playlist repeatedly and some of the videos that were members have now fallen from favour. If any of your favourites are in there you can find them here in the archive list:

Quite often the videos getting removed have no faults other than occasional equipment noises which can get irritating on repeated listening.

The playlist of items that are great for ASMR (but contain an age verification function), usually a great way to interrupt your listening in the middle of the night, is here:

I hope that you find the playlists restful and that you get a good night’s sleep.

Hope to see you again back here for the next blog article.

If you liked this blog item why not subscribe to this blog.

Until next time.

Photo by Shona Macrae