Member postings for Raphael Golez

We are all fully aware of the limited supply of PPE in our hospital. We have colour coded zones to deal with the inlflux of symptomatic patient that needs admission. Those that are doing a very high risk procedure (intubation, CPR, nebs, suctioning etc) in a ward full of COVID19 (including ITU and Theatres) are obliged to wear high level protection PPE and the mask we use is a 3M FFP3 provided you have been fit tested and a face shield and if this does not provide a proper seal for you then you wear a full head suit to cover all your head plus full suit. If you are in a suspected COVID19 ward awaiting test results and does not require pulmonary support then we wear a full face shield with a surgical mask and an apron. of course if we have a high index of clinical suspicion then we have to wear FFP3 especially if a coughing patient is in front of us. Full gloves also. Once we get out of the bay we have to carefully do proper doffing procedures. All PPE should be single use however if we stay inside the bay we use it all day long. If we exit the bay we are now required to wear face mask on the nurses station and inside the ward premises. If we go out of the ward into the corridor of the hospital we have to take of the surgical mask everytime we exit the ward. We are all mindful of the limited supply. We should all be provided with a single use PPE and change when needed for our own protection. I can feel the tiredness and the stress that are all impacting us but we have to carry on the fight and continue the care we provide. Our case load is still climbing up, 2 of our nurse are intubated and one had a tracheostomy. My senior house officer was admitted and he is positive although he was hypoxic he is doing ok. We have a constant update, constant communication with our fellow consultants and colleagues. I estimate that we are still on the rise. Going home today I am surprise that a young couple together with their kids are again walking outside and they are in close proximity to the hospital. I saw them yesterday. If they can only see what's going on in our ward, maybe they will think twice in stepping out of their doors. I still see a lot out and running and walking their dogs. I understand they are giving distance but then again maybe they are not worried at all. I am worried for my wife and daughter hence I am self isolating strictly in the house. I have fallen to the illness roughly 3 1/2 weeks ago. Recovered and went back to work after clearing from our head of medicine. I would not risk going out of my house unless I got to buy food. During weekends I still self isolate and stay at home. i will do this until all this crisis resolved. So far I'm almost 4 weeks since I last hugg my family. Only contact is through face time even when we are in the same house.

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:24:46

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:26:42

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:28:02

If they only knew what we are facing and going through. People that don't follow simple rules to help us fight this pandemic will realise how serious this is. I have seen 32 new admitted patient on my last on call duty and 12 suspected COVID19. 8 pending, 4 positive and 2 sadly went. I have to face this day in day out, I see what it can do and instill great anxiety and respect (i would avoid saying fear). If they can only see what I can see then maybe they might decide to lock down themselves. I would again go to work tomorrow and do a head count. It is getting worse and we have to do our best. I can only say stay safe and follow the advice. We from the medical fields are trying our best to help and we are learning as we go along.

Edited By RAPHAEL VAL GOLEZ 1 on 06/04/2020 00:45:54

Hi Peter, the principle behind this is to prevent the spread of the COVID19 virus from person to person. Close proximity to an infected person increases the risk of getting the infection (as far as we currently know). By doing isolation you deny the virus of potential host and spread thereby it will run its course and no one to re-infect. Currently there are no proven treatment for this other than supportive treatment (organ support, antibiotics for secondary bacterial infection etc.) Hopefully we will get our answers soon as research is on going.

1. If you are not having symptoms or proven COVID19 positive you still have to self isolate and social distancing because you are helping control the spread of the COVID19 virus and denying it of potential host. At the same time you are keeping your self safe.

2. If you have symptoms there is a guideline help line to call. If you are well and not requiring hospitalisation you will still self isolate as to still contribute to the society by not potentially spreading the virus and thereby help our fight against this issue. Symptomatic treatment and supportive measures. Provided that you don't require hospitalisation and organ support the virus will ran its course and if your immune system is well enough it will greatly help with the recovery.

3. If your are COVID19 positive you have 2 options: 1. if you are having mild symptoms and well enough not requiring hospitalisation then you have to self isolate. This is for you to protect other people from getting it and denying the virus of another potential host and thereby stopping the spread and controlling it. Unless your are very unwell and needs hospitalisation. 2. If you are unwell and requiring hospitalisation then you need to be admitted to the hospital.

Our situation is difficult in our local hospital. I was unwell with flu symptoms 2 weeks ago. I immediately self isolated very strictly ( like im a prisoner in my own home) and the only contact I have with me wife and daughter is through face time despite we are in the same house. I made one of our room as an isolate area. My food is being given to me on my doorstep by my wife. I have not been tested as when this first rolled out our hospital guidelines is to immediately self isolate and not to go to hospital unless I'm very unwell requiring admission. I have a total of 15 days strict self isolation. I might have caught this in one of many patients I see and treated. The problem is the incubation period where in there are very mild to non existent symptoms. I cleared myself and spoken to our chief of medicine colleague and I am now back to work treating patients again. Why I do this is my personal choice to continue to help sick people and to do my part to help with this issue. Re-infection is highly likely, I still practice full precaution when I go home and continue to self Isolate from my wife and daughter as I am now back working in the hospital. Hope my experience will shed light to some of your questions and also to help others here. Stay safe everyone and lets contribute to help with our situations and hopefully we all get over this soon.

Raphael

I have been following through the thread and read all the posting here. Everyone has a point and a valid opinion. As it stands we have statistical estimates and maybe a prediction model based on data that we have gathered and observed in the last few months this started. However in my opinion it is difficult to be accurate. This is because this virus is new with no previous exact past experience. It is very complex, especially the interconnections it plays with the whole society. We all react differently including the psychological response, survival instinct, rational or irrational thinking/reasoning etc. This may be one of the driving factor why we are in this situation. The rapid spread of this virus is embedded in our modern society. I myself have already accepted that it is a matter of time that I get expose looking after my patients and I do worry a lot (I have a family and a 8 years old daughter). If and when I do get it I already planned to self isolate and "sit the storm out". Hope my immune system is good enough to take it. I worry for my elderly patient who have so many co-morbidities and thinking how are they going to fight back. I'm worried how I'm going to help them. Reality is we need to be ready as this is a serious situation. I see patient come and go in the hospital however I could not imagine the impact of this virus. I am hoping that all this estimates are wrong and we will be all ok. We have to take this in a serious and sensitive way. Hope I didn't offend people here in the forum. We could all give our opinions and what we personally think about this situation and work together for solutions to address this issue.

Raphael

It has been a very stressful week and making sure all my patients are safe and well looked after with weekend plans. We have been constantly updated with up to date guidelines and flow plans in preparation for this situation. Not to be negative but my chances of exposure is very high and its a matter of time for me. I will accept this and continue to look after my elderly patients until I can't. Hoping that our NHS can cope with this. Best way to minimise chances of getting this is to avoid going out in public unless it is important. Hand washing and properly scrubbing all your fingers and applying alcohol gel if you have it. Be safe everyone.

Raphael

The link you gave me Bill is very informative. I was reading through the page you gave me and get to know this mic better. It could be a variant in terms of its main frame/body hence the different arrangement of the spindle lock. What is interesting is the 0-1 version was discontinued long time ago hence it is very rare to find. The metric version which is the only current production is also very expensive. I’m very thankful that I did not restore the paint otherwise I will loose the patina and the character of this micrometer thereby loosing its historical value. It is very nice and in clean condition. I’m also happy that this is the 0-1 micrometer. It will be part of my collection instead. Thanks again Bill for directing me to this information.

Raphael

Thanks for the link Bill. Yes the "feel" for this micrometer is very different, very smooth and precise despite how it looks its still very good. I have cleaned it gently with alcohol and now grit free. It is very easy to read the timble scale actually. I was surprised at that price, maybe it is because its a newer model though mechanically and functionally it looks and works exactly the same. Is it really that expensive?

Edited By RAPHAEL VAL GOLEZ 1 on 05/03/2020 12:55:46

Edited By RAPHAEL VAL GOLEZ 1 on 05/03/2020 12:56:24

Hi to all, I would like your help in identifying this micrometer. I have looked into a lot of on line search. The closest I got is the Etalon Microrapid Micrometer but there are subtle differences such as the spindle lock mechanism which is in different location and on this micrometer in looks to be broken and not moving (please see pictures) and the other difference is its a 0-1 inch. It is vintage and its functioning ok. It measure spot on on my gauge blocks and compared to my Mitutoyo Quantum Micrometer it is acceptable. This is my first Imperial Micrometer. I bought this to help me understand how to read this vernier type scale. I was wondering what brand it is as the name on the plastic protection is totally faded. It is a nice vintage tool that I really like. Hope somebody here can shed information on this and thanks in advance.

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 05/03/2020 12:19:37

Edited By RAPHAEL VAL GOLEZ 1 on 05/03/2020 12:20:19

Hi Peter,

Normally we start high dose statin (in your case 80 mg of Atorvastatin) in cases of acute myocardial infarction as a higher dose (80mg) due to the pleiotropic effect of statins IE arterial plaque stabilisation, improve endothelial dysfunction and anti-inflammatory response (yes a heart attack is an inflammatory process). After which we reduce it to 40 mg as a maintenance for secondary prevention.

Folic acid is given if you have low folate. Some medication have anti folate activity such as methotrexate. One other cause of low folate is low dietary intake of folate rich food.

Raphael

Totally agree with JA.

As I mentioned previously BP is dynamic. Managing Essential hypertension can be challenging at times depending on other co-morbidities.

David, did your doctor set a target BP for you. Your current BP seems to be very acceptable. As we get older our arteries get "stiffer" and less compliance thereby increasing vascular resistance and increasing our BP. They have given you Amlodipine which is a non selective calcium channel blocker which acts on the calcium channels to reduce BP and arterial resistance (muscle membrane have Calcium channels). Arteries have a thick muscle layers to control vascular compliance, this constricts or dilates and as a result generates resistance or reduce resistance thereby increasing or reducing BP. Think of it as a Hydraulic system if I may site an engineering example.This is just one system that our body adjust BP. Our nervous system also plays a role as well as our kidneys and fluid balance. ACEi acts on the RAAS system (renin-angiotensin system), Betablocker acts on negative chronothropic effect on the heart, Mineralocorticoid antagonist acts on the fluids and also mineralocorticoids, Diuretics acts on the preload to the heart (fluids exchange/absorption in the kidneys), alpha channel blockers etc. Its a dynamic system and very complicated. In clinical practice you have a target BP and aim for that range. Identify the cause of hypertension,lifestyle modification and managed other co-morbidities. Most common cause of hypertension in the general population is Essential hypertension. In my practice, especially our ageing population my main worry is polypharmacy and very tight BP control that elderly patient run the risk of hypotension and causing them to fall as a result of strict BP control. This can suppress autonomic nervous system control and hypo perfusion especially brain hypo perfusion and orthostatic hypotension. My aim for target BP for the elderly will be around 140-155 systolic. Again it would be wise to get an ambulatory 24 hour BP monitoring for they can map out your BP.

Raphael

Good day to all! Getting ready for my morning ward rounds at work. Just scanning through. Chest pain as a clinical presentation had a vast differential diagnosis ranging from a benign musculoskeletal cause to a life threatening condition such as acute myocardial infarction and pulmonary embolism. An experience clinician, one can tell this right away (patience presenting very unwell). However experience will guide a clinician to take a very good and detailed clinical history supported by a very good clinical examination and diagnostic work up. A disease or pathological condition can presents in so many ways and sometimes even the best professors in medicine will take a while to diagnosis conditions that are very difficult and rare. We do discuss constantly with our colleaagues for second opinions and we don't work alone. So many different fields and specialities. Even in my practice I sometimes see cases that are very hard to diagnose despite extensive work up. Each case are also different and as one would find cases that would present as a "classical" text book presentation, one can also find "atypical" presentation and a diagnostic challenge.

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 30/01/2020 06:05:56

Interesting discussion gents. Appreciated all the experience here and reading your posts. The field fo Medicine is always dynamic. New research and land mark studies pop up left and right and I can barely cope with it. I'm a Geriatrician and proud to work on our NHS. I agree it is not perfect but one of the best in the world as I am a consultant in Internal Medicine in the Philippines before I migrated here in the UK some 15 years ago. I also accept that there are excellent doctors and clinicians and others are not so blessed (putting it in a nice way). Although I'm sure that most of them are doing what's best for their patient. A good clinician can pick through the difficulty of presenting complaints of the patient and have a very good and sensible working diagnosis and plans. I also supervise our young doctors and being a clinical supervisor myself I always emphasise a very good history taking and clinical examination to solve and have a very good management plans. We are also super stretch in our service in the NHS, this is a highly stress environment to work with and sometimes we also get tired and exhausted. I also admit that we are not perfect. Medicine is an art and always challenging. I just hope that our NHS is here to stay as it is very important to the British population.

As with regards to medication discussed here, Ramipril is a proven medication and it has been around for a long time. It is a family of medication called ACEi (Angiotensin Converting Enzyme Inhibitor) first discovered from a venomous snake (which cause BP to drop). Captopril is the first of its kind. Directed towards lowering the "after load" from the heart. The mechanism is directed towards blocking the ACE (see above definition) thereby causing dilatation of the blood vessel systematically (arterial side) and as a result lowers your BP. This is just one way to drop BP. Physiologically there are other ways.

BP is dynamic and can vary depending on any physiological response, pathological or disease (cardiovascular, renal, endocrine etc), emotional and stress, exercise, medication, etc. BP needs to be monitored in order to diagnose HYPERTENSION per se. 24 hour abulatory BP monitoring is the go to test to clarify this.

We can talk medicine especially geriatric medicine as I love this field but of course it is a very broad topic. Your own GP can explain your condition to you however they are very hard to pin down (I myself have never seen my GP since my old GP retired) and yes even as a consultant geriatrician I need my GP to prescribe my meds for my gout! Most of the GP in my locality was my trainee foundation year 1 junior doctors several years ago!!!

Keep the discussion coming gents!

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 29/01/2020 19:49:52

Edited By RAPHAEL VAL GOLEZ 1 on 29/01/2020 20:15:25

Hi CJ, You can still do it. If it was me I will get my 40mm round bar's dimension (length) and add an extra distance to the whole length to provide a grip for the chuck. Drill and then bore to the right length, with the extra distance you don't need to go all through your work piece. Just enough bore to get you a bit passed your decide length and then part off near the chuck. Ofcoures you will have a bit of a waste but I think its better than buying a new chuck with a desired diameter to allow a bore through it if there is one for the myford. Other option if the length of your work is all set is to have a Keats plate and angle to adjust the distance from the chuck plate if this allows and finally in-between center boring if your are fully equipped. Others who are more experience here than me might have better approach.

Hope this helps.

Raphael

Hi Derek, the 14 x 1.5 spindle is the old version. Did you purchased the Cowells lathe in ebay that was sold lately with an indexed back gear? It is a very good example of the earlier version. The problem with it is finding a M14 x 1.5 chucks. It also have a fewer speed range as evident in the motor pulleys.

I have the newer M14 x 1 spindle. It also have a full adjustable micrometers on all handle and a reversing switch with a start stop buttons. The advantage of the newer spindle thread is you can fit the Unimat 3 chucks which are very easy to get. I was nearly tempted to sell mine but decided to hold on to it as it hold its value well especially the M14 x 1 spindle. I was also selling my full Unimat 3 lathe with Milling machine and with motor which is an excellent example. I was so insulted when somebody offered me 30 GBP for it. I know his plans as he buys it and sells it a a chopped parts for extortionate price. I know how much this lathes worth and with a top condition it commands a good price. I pulled it out as it looks perfect on my collection display. Enjoy your new lathe!

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 20/01/2020 21:24:14

Getting along great Steve. I like what you did to your topside and reducing the height down by 4mm will allow you clearance to get the 12mm lathe tools to center height ok and can also rotate the tool holder on to the top slide if you want to do thread cutting and still use the same 12 mm lathe tools. What I did to mine was to change the whole top slide to the newer design. I have bought years ago a new topslide. Its an original Myford parts and was intended for the ML7 but was told it can be used onto the Super 7. I never did the conversion straight away as Im ok with the original top slide until I went and did it. Things will fit straight on including the dove tails but the difference is on the part where the top slide end plate attached. In the S7 the top slide feed screw had a larger diameter end that sets onto the S7 endplate. I have made an adaptor brass plate to secure this and all went according to plan. The adaptor have to be match to the top slide including the dove tail and the area recessed to accommodate the larger end of the feed screw. The advantage of this set up is you can reduce the top side the same as what you did on yours.

With regards to the table top, I understand that it is thick enough to carry the weight of your lathe and you have a thick metal tray to bolt it on and I understand its more than enough support. I was just wondering about its rigidity, would it flex? The reason I ask is when you fine tune your bed twist to get an accurate cuts later on you have to adjust your tailstock end feet to achieve this with the full metal cabinet that can somehow be supported and minimise the flexing as compared to the wood support, but then again there are hundreds of people and Myfords that are set up this way so I guess it would be just fine. Keep us posted of your progress.

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 15/01/2020 06:58:38

Thanks everyone. Problem solved. I managed to zero in and eliminated the taper issue from the tailstock. Its now cutting perfectly fine again, no more taper cuts.

Cheers,

Raphael

Steve, is it like a mandrel type of attachment to the chuck? I can only think (from the picture) that the chuck is secured by this single screw? I think you need more leverage to unlock the screw itself. Get proper fitting flat head driver bit and attach to a long socket drive connected to a long handle ratchet wrench. You can apply enough leverage this way. You must secure the chuck on your vice with a vee block to increase the gripping force. Hope this helps.

Old Mart, Thanks.

I am planning to use a MT2 dead center on the headstock attached straight within the spindle bore to eliminate the chuck. I can see that you mentioned to use the chuck and turn a 60 degree round stock to align the chuck itself. I can do both but which would be more accurate, chuck or straight onto the spindle bore?

Thanks for the input gents.

Peak, thanks for the advice. I have more or less check the bed twist and it seems ok on my test cut unsupported. I will get a tailstock test bar and indicate it. I don't have a large drive dog to accommodate a steel round stock sturdy enough to make the in-between center test. A ground test bar will be faster and I can see how much to adjust the tail alignment. The bed is not that bad but I was just thinking of what Journeyman have said. How do you verify the vertical plane? height gauge?

Hi,

Im just wondering about the bed twist on a Myford lathe. I do regular diagnostic checks on my S7. I always follow the recommendation of setting the bed twist to avoid issues with tapering especially on long materials being turned. I did the check on a 1 inch stock over 8 inch long from the chuck without any tail stock support and used a micrometer to check both the distal and proximal cuts. This came back as equal measurements. All is aligned and cutting as expected.

The problem I noted is when a turned down an aluminium round stock from a 12mm down to 10mm over 8 inch long. This was supported by a tail stock with proper live center (center drilled) and properly set. Im surprise to see a very slight taper. 10mm distally (away from the chuck) and 10.2mm proximally (near the chuck). Cuts are light around 1-2 thou with a brand new CCGT insert. All are tight on the set up. No loose gibs cross slide are locked. The tailstock was not adjusted and I can see the witness marked on the tailstock dead on. Is this just deflection? is this due to the length of the aluminium? I don't have a round steel that size to test at the moment. If anybody can help with this it would be much appreciated.

Thanks,

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 23/12/2019 11:06:07