Much time has passed since my last post partly because I am nursing broken bones of my left ankle. I am working off an iPad, instead of my desktop computer, so it is slow going. đ±
Todayâs lesson details Mr. Walter Woodcockâs dilemma as presented in Outlander episode 705, Singapore.
You will recall, Walter lies in the infirmary at Fort Ticonderoga with a significant injury to his right foot. The wound has turned gangrenous so an amputation is required.
Claire arrives to witness a medical dispute between Dr. Denzel Hunter and the pompous, Lieutenant Stactoe.
Curious Claire asks, what is going on? đ€
Denzel recommends an above-knee amputation for Walter. Stactoe is adamant that a below-knee amputation makes for a more functional limb.
Stactoe is correct that in most circumstances, every attempt is made to salvage as much of a limb as is possible.
However, Denzel explains that Walter has a popliteal aneurysm, thus, an above-the-knee amputation is necessary! Claire palpates Walterâs calf and agrees with Denny.
Oh, oh! This changes everything! đ€
There ensues a wee strammash when Stactoe says Claire will not use boiling water on HIS instruments. This is a direct quote from Dianaâs An Echo in the Bone:
You will ruin the temper of the metal, subjecting it to boiling water!â
âNo,â I said, keeping my own temperâfor the moment. âHot water will do nothing but clean it. And I will not use a dirty blade on this man.â
âOh, wonât you?â Something like satisfaction glimmered in his eyes, and he clutched the blade protectively to his bosom.â
In the episode, Stactoe stomps off. But, no worries, Denzel to the rescue with his own set of fine surgical instruments!
To understand the implications of a popliteal artery aneurysm, letâs look at the anatomy of the arterial supply to the knee.
Essentially all of the lower limb is supplied by the huge femoral artery which begins at the groin and descends through the front of thigh. Near the top of the knee, the artery passes to the back of the knee and is renamed the popliteal artery (next figure). It then descends behind the knee joint. At the bottom of the joint, it splits into two and then into a third artery, all of which receive new names and supply lower leg and foot.
The hollow behind the knee joint is the popliteal fossa.
Try This: Â Make a fist, bend opposite knee slightly, and tuck your fist into the hollow behind your knee. This is the popliteal fossa. Remove your fist and insert middle and ring fingers into the hollow. Press. You may be able to feel the pulsing of the popliteal artery in the popliteal fossa.
Feel it? Good job, students! đ€
 Â
Next. The aneurysm! đ€
A popliteal artery aneurysm, known by the acronym PAA, is a weak spot in the wall of the popliteal artery. Pressure exerted by arterial blood causes the weak spot to balloon into a palpable bulge behind the knee joint. This is of concern because if the aneurysm should burst, the blood loss would be difficult to control especially in an amputee.
Some causes of PAA are:
Atherosclerosis
High blood pressure
Wear and tear of the popliteal artery due to over use of knee joint
Weakening of the artery wall
The image show a couple different types of PAA.
Now, back to the episode!
Claire palpates Walterâs leg and agrees with Denzel. An above-knee amputation is best to avoid the aneurysm bursting with uncontrolled hemorrhaging.
A clear view of his damaged, gangrenous foot can be seen in the next image.
Unfortunately, Claire places her hands on either side of his calf. She cannot feel a PAA in this location because there is no popliteal artery behind the calf. Her hands should be up in the hollow of the knee.
Also, in real life, the stench of gangrene would likely require them to mask and use some type of ointment under the nose to distract from the odor. đź
And, today, imaging modalities would be used to determine the type and extent of a PAA.
In the final scene with Walter, Claire breaks the sad news that his condition does not permit him to be evacuated with the other patients. Â He is to be left behind. đą
Claire has a wonderful bedside manner which comes from her compassionate and caring heart. Hopefully,  the British will treat Walter well. đ€đ»
Mercy! đ
I hope you enjoyed todayâs lesson. Just remember, if you ever feel a pulsing bulge behind  the knee, make an appointment swiftly or get into urgent care. A PAA is no joke!
Three weeks ago, after posting Anatomy Lesson #41, The Sad Demise of Angus Mohr, I promised I would blog about my Scotland Outlander Immersion Tour. Family and friend’s summer visits are also over so it is âshow and tellâ time.
What follows in this blog is part one of my splendid 2016 Scotland Outlander Immersion Tour. Mind, I did not know Scotland was on the horizon this year. The trip was a gift from conniving hubby of 53 years aided by an equally sly oldest daughter.
We left the Pacific Northwest in early June, over-nighted in D.C., flew to Reykjavik, Iceland (Photo A), and finally landed in Glasgow. Why did we fly 8,312 convoluted miles when only 4, 572 miles separate Oregon and Glasgow? Only hubby knows!  Just joshing. It is because these days, Icelandair tickets are very affordable.
Photo A
Arriving at noon in Glasgow, we immediately hailed a taxi to Every Day Athlete (EDA) Gym as I was late, I was late, for a very important date: a personal training (PT) session with this handsome Irish lad, Patrick O’Brien, co-owner of EDA Gym (Photo B). A multi-talented man, he also acts in theater, films, and some TV.
EDA Gym is the establishment that partners with Sam Heughan to produce the MyPeakChallenge (MPC) program. If you are not a MPC member, you might consider joining. The program focuses on improving personal health through exercise and diet while raising money for Samâs Bloodwise charity, a worthy cause supporting research into all forms of blood cancers. This year the MPC raised a staggering ÂŁ225,000 ($295,000 US).
Photo B
Gentleman Patrick wasnât prepared for my almost 74 y.o. body (I did not warn him about my age) and given that I had flown all night, went fairly easy on me despite pushups, lunges, kettle bells, and shoving around this nasty hunk of steel affectionately known as âthe prowlerâ (Photo C). The apparatus, which in my view should be more aptly named âThe Beast,â had only 25kg added weight – a nearby prowler held an additional 75kg! A young laddie walked by and taking pity on my (ahem) struggles with the metal monster offered encouraging words. I needed them!
Patrick was friendly, welcoming, helpful, competent, and professional and gave me a great PT session. Thank you, Patrick! More about him in my next installment.
Photo C
After the PT session, I found a quiet corner and zoned into my usual 45 minute yoga routine while the room echoed with grunts, blows, and whacks from male and female members who were sparring with Muay Thai combat sport (Photo D). Grins were apparent despite the intense competition. Cooling down, a very friendly Jamie, cousin to John Valbone (co-owner), wanted to talk. Guess what we talked about? Anatomy and physiology, naturally!
Photo D
Being retired academics, the next day found my husband and I trekking to the University of Glasgow. Crossing the River Kelvin, we were greeted by a statue of Lord Kelvin, the great mathematical physicist and engineer (Photo E). This Irish-Scottish scientist taught at the University of Glasgow for 55 years! During that time, he invented a maritime compass and a tide gauge, worked out problems for laying the first transatlantic telegraph cable, and accurately determined the temperature of absolute zero for which he is rightly honored by the temperature measurement, degrees kelvin.
Photo E
If we thought the University of Glasgow was just another academic institution (we did not!), we were quickly disabused of that notion as it was founded in 1451 and is the fourth oldest university in the English-speaking world! It has produced some of the most famous physicians, mathematicians, and engineers of the scientific arena. Its iconic stone bell tower dominates the horizon making it very easy to locate (Photo F).
Photo F
At the University, I quickly made a bee-line for The Hunterian Museum, the oldest public museum in Scotland. Named for William Hunter (1718-1783), physician, scientist, and anatomist (fist pump!), he is famous for studies of cartilage and bone. The museum houses not only his anatomical, zoological, and scientific instruments, but also a fine array of coins, minerals, paintings, prints, and books as well as geological, archaeological, and ethnographic collections (Photo G). A reminder to book readers: Diana briefly writes about Williamâs brother, John (also physician and anatomist), in her 7th book, âAn Echo in the Bone.â
Photo G
This poorly healed fracture of a left tibia is one among many fascinating Hunterian specimens (Photo H). The fracture was not reduced properly (or at all) so the bony parts healed in an overlapped position (Anatomy Lesson #40, âSnap, Crackle, Pop! or How Bones Healâ). The healed leg was likely 2-3 inches shorter than the presumably normal right leg and the sufferer undoubtedly had great difficulty walking; reminded me of Columâs poorly mended limbs (Anatomy Lesson #27, âColumâs Legs and Other Things too!â).
Photo H
Last image is Williamâs microscope (Photo I). Although a beautiful instrument, it is a far cry from todayâs powerful light microscopes (Anatomy Lesson #34, The Amazing Saga of Human Anatomy). William lived during the Scottish age of enlightenment (1600-1800) when scientists challenged superstition and injustice by arguing for the use of reason. Scotland was a leader in that movement causing the French philosopher, Voltaire, to comment âWe look to Scotland for all our ideas of civilization.â Oh, and in case book readers forgot, Diana also includes Voltaire in her third book, âVoyager.â Go, Diana! Rah!
Photo I
A quick hike down the street To visit Glasgowâs Botanic Gardens, featuring the famous and stunning Kibble Palace, erected in 1873 (Photo J). The site includes several glass buildings each containing a wondrous array of everything plant.
Photo J
My personal favorite was a room titled âDangerous Plantsâ which contains âLittle House of Horrorsâ – type specimens (Photo K) such as these ethereal but deadly pitcher plants, able to digest insects as well as small vertebrates such as frogs and wee snakes. I felt right at home as we have our own version of pitcher plants here in the Pacific Northwest at Darlingtonia State Natural Site.
Photo K
Evening found us back at the inn, foot weary but deeply gratified after 6+ miles of stumping Glasgowâs streets and sidewalks. That evening our seven tour members met for a personal concert by GillebrĂŹde MacMillan, better known to us as Gwyllyn the Bard. He shared a number of Gaelic ballads rendered in his fabulous a cappella tenor voice.
He also shared this fun story: Planning to arrive well-groomed, he got a hair cut before filming his wonderful singing sequence for Starz episode 103, The Way Back. However, Outlander hair folks were bummed because they had planned to attach a wig using his own locks! Sans that option, they resorted to glue. According to GillebrÏde, removing the sticky stuff was verra painful!
GillebrĂŹde ended his performance by showing a painting recently presented to him by a fan (Photo L). We all agreed it was an excellent rendering of him as Gwyllyn the Bard. As Jamie once said, “The Welshman would be welcome at any Laird’s hearth” (Starz episode 103, The Way Out).
Photo L
The following morning, we boarded a comfortable, roomy, custom-made van. Our group included folks from Canada, Florida, Indiana, and Oregon. Our tour guide was Scotsman, Hugh Allison. Tall, ginger-haired, gregarious, and knowledgeable, he was the perfect resource for us Outlander-hungry fans. Topping it all off, Hugh is also a Gaelic-speaker so he was able to translate the language and was an endless source of Highland tales and history. Off to a grand start!
Our first stop was Doune Castle in the Sterling district (Photo M). This imposing ediface served as Castle Leoch and was also featured in that delightful British film, Monty Python and The Holy Grail.
We happily climbed stairs, visited the kitchen, admired the great hall, and saw the lordâs tower, curtain wall, music gallery, cellars, and courtyard.
Photo M
Clearly, Castle Doune and Castle Leoch are dopplegangers as evident from this scene when Claire, Jamie and  Dougal’s party approach the castle courtyard (Starz episode 102, Castle Leoch).
The Doune kitchen sports a massive 16â open oven, large enough to roast an entire ox with room to spare (Photo N)! It even has its own drain (left back corner) into which residues were flushed.
Photo N
Doune oven served as prototype for the set version of Castle Leochâs puir oven (or so says Letitia) – the one used to roast dozens of birds as beloved Mrs. F trills, âBaste it, girl, baste it!â (Starz episode 104, The Gathering).
Outdoors, along the east wall of Castle Doune, a charming, grassy flower-strewn field grabbed our attention (Photo O).
Photo O
We were delighted to discover this verdant pasture was also site of the shinty game (Starz, episode 104, The Gathering) where team-Jamie was doing swell until Dougal laid waste to a number of combatants as he wielded his kilt-kick and shinty-stick! There’s Jamie hoofing it down the center!
Leaving Castle Doune, we motored to Falkland, the village posing as 1945 Inverness. Here we wandered the streets, checked out sites, and enjoyed a delicious lunch at a local pub. A beautiful stone fountain dominates the town square (Photo P).
Photo P
You have seen this fountain before. Recall Starz episode 101, Sassenach? Of course ye do! Jamie’s ghost waits at the fountain, standing in the pouring rain, as he watches Claire fight her curls and swear in the upper right window of Mrs. Bairdâs Bed & Breakfast. Same corner window, same corner of fountain. Score!
On main street is a quaint general store specializing in curios (Photo Q).
Photo Q
Mayhap you recognize it as the same window where Claire, who has never owned a vase, contemplates buying one (Starz, episode 101, Sassenach). From Outlander book:
My gaze lingered on a shop window filled with household goodsâembroidered tea cloths and cozies, pitchers and glasses, a stack of quite homely pie tins, and a set of three vases.
I had never owned a vase in my life.
Evening found us in the quaint town of Aberfeldy where we enjoyed superb lodgings, nestled amid beautiful highland hills. We spied an iconic red British phone box (Photo R) but, sadly, no Dr. Who with his blue tardis to whisk us back to 18th century Jamie!
Photo R
Next morning, I enjoyed an awesome breakfast (Photo S) – steamy, creamy parritch laced with whisky! Oats were cooked in cream with just a hint of whisky flavor. Divine!
King Louis really didn’t know what he was missing (although Jamie did leave out the whisky bit). Instead, Louis declares through gritted teeth âThe King has never acquired a taste for peasant food…â (Starz episode 202, “Not in Scotland Anymore.” ). Course, that is why he was straining on the royal pot, puir king!
Photo S
After breakfast, our group assembled on the steps of the inn where we were joined by guess who (Photo T)? No, not Rupert and Angus (although that would have been fun!) but our favorite Highland couple were waiting to greet us. They were rarin’ to go!
Photo T
Our travels quickly took us past the Scottish village of Dull, sister âcityâ of Boring, Oregon (Photo U). I know Boring very well as my hair dresser has a salon there, a scant ten miles from my home. Dull and Boring – a match made in heaven. Snort!
Photo U
Later that day as we motored under bright blue skies dotted with white, fluffy clouds, Hugh pulled the van over and suggested we take a little âwalk in the heather.â Stepping out of the van, we were thunderstruck at the sight! In the distance was a modest grass-covered dun, itâs only inhabitants a herd of beautiful Highland Cheviot sheep.
We approached the site with an almost reverential attitude because we had arrived at Craigh na Dun (Photo V)! There stood the grassy knoll where Claire and Frank watched Mrs. Graham lead her followers in the ancient Druid ritual to call up the sun. This was the hill where Claire Beauchamp Randall places her hands on a standing stone and travels 202 years into the past! Here was the site where Claire’s heart breaks as she leaves Jamie to return to her own time. OK, I confess, I shed a few tears, and the place gave me goose flesh (Anatomy Lesson # 6, âClaireâs Hair – Jamieâs Maneâ or âJesus H. Roosevelt Christ!â)!
Photo V
Atop the dun, the site enjoys no standing stones but it was a perfect place to re-recreate that pivotal moment when time performs its daring flip-flop. The hill bears patches of turf where the stones were erected and then removed. Kudos to the Outlander crew for returning the site to what appeared to be its original state (Photo W)!
Photo W
A friendly wooly ewe and two darling lambs eyed us a little warily (Photo X – one babe is behind her rump). She was very curious about us time travelers. Apparently, we were messing with her fairy hill.
I swear the place is more than a bit eerie. Weather started out quiet and very still; moments later, the sky changed from bright blue to overcast and the wind came up sharply and bit through our jackets. Unlike the ewe, we had no wooly coat to keep us toasty warm.
Photo X
Turning to the west, ewe, oops, I mean you might recognize the next view. Atop the grassy Craigh, we see distant lochs visible in Starz episodes101, 108, 111, and 213 (Photo Y).
Photo Y
Different time of year and different photo angle but the same site where Jamie and Claire prepare for her passing through the stones, back to her own timeâŠ.back to Frank (Starz episode 213, Dragonfly in Amber). Sob!
Are you a wee bit dubious that this is âthe placeâ? Then, please note the bent tree on the far side of the hill, a sure sign of Craigh na Dun (Photo Z)! âGreen, green, itâs green they say, on the far side of the hill!â
BTW, the rosy hue of the sky and treetops isnât due to sunset or the northern lights, it is caused by finger-near-the-lens syndrome – sure sign of a freshman photographer. Let’s just say the fairies did it!
Photo Z
This is the same bent tree the dancing Druid sits on after returning for a lost bauble (Starz episode 101, Sassenach).
And, the same bent tree from the last scene of Outlander season two as Claire watches a glorious sunrise over the largest stone – her precious portal back to Jamie (Starz episode 213, Dragonfly in Amber)!
Then, it was our time to depart. Buh bye, Craigh na Dun (Photo ZZ)! So sad, feeling bad, but time to go. Tick tock; tick tock
Photo ZZ
From A to ZZ, you have seen the first part of my marvelous Outlander tour. More fun Outlander sights and sites in the next blog. Watch for it!
