Dr. Steve Siope

MBChB 💉🔬
One man life🤞.
Former @SCORE_Ke social media manager. Champion for African culture.
SINGLE bond.
Who knows about tomorrow?

[Dr. Steve Siope @SirStevetyping]

"If you can't explain it simply, you don't understand it well enough."
~Albert Einstein

[KenyaCardiacSociety @kenyacardiacs]

📢Introducing the KCS ECG Series 2026!

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Explore advanced systematic ECG interpretation and more

📅 22 Sept 2026
💻 Weekly webinars
💰 KES 1,000 for the full course

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https://t.co/NZtAxx5kZX

[Dr. Steve Siope @SirStevetyping]

@SafaricomPLC @Safaricom_Care I have never subscribed to any betting, loans or advertising services.
Why am I getting their messages?
Where did they get my data from?
Can this be sorted amicably, or do we have to involve suits?

[Dr. Steve Siope @SirStevetyping]

@lunadreaamy 5

[Dr. Steve Siope @SirStevetyping]

@AlexaBliz_ 2 people ( the couple only as explicitly stated in opening sentence)

[Dr. Gatimu, PhD @Gatimu]

the smart young ugandan intern can teach you one thing or two about negotiation.

[Dr. Steve Siope @SirStevetyping]

@Ausbones Hemoconcentration 2⁰ Dehy

[Dr. Steve Siope @SirStevetyping]

@Ausbones Paradoxical embolus in pt with a PFO(RT>Lt shunt manner)

[sikandar adwani @SikandarAdwani]

Bowel and bladder localisation becomes much easier when you stop memorising nerves and start thinking in layers.

I teach to my RMOs like this:

The bladder has 3 levels of control.

1. S2–S4: the machinery

This is the basic reflex system.

Bladder fills
↓
Sacral circuit responds
↓
Bladder can empty
This is the oldest, most automatic part of the system.

2. Pons: the coordinator

Emptying is not enough.
The bladder must contract while the sphincter relaxes.

So the pons acts like a conductor:

Bladder → CONTRACT
Sphincter → RELAX

Smooth voiding needs both to happen together.

3. Cortex: the permission system

Humans added another problem.

The bladder may be full, but you may be:
in OPD
in an operation theatre
driving
in a meeting

So the question is no longer only:

Can I pass urine?

It becomes:

Should I pass urine NOW?

That is higher cortical control.

Now localisation becomes beautifully simple.

BRAIN LESION
The machinery is intact.
The coordinator is intact.

What is lost?

PERMISSION.

So the patient tends to develop:

urgency
frequency
urge incontinence

The plumbing works.

The social brake has weakened.

SPINAL CORD LESION ABOVE S2–S4

The brain and pons are intact.
S2–S4 is also intact.

But the communication between them is cut.

Higher control cannot properly reach the local reflex system.

So the bladder may become reflex/overactive.

And here comes the important part:
Bladder says CONTRACT.
Sphincter says CONTRACT too.

Accelerator + brake together.

That is detrusor-sphincter dyssynergia.

This is why a patient can have:

urgency
AND
high residual urine.

The bladder is active.

It is simply fighting against a closed gate.

CONUS / CAUDA / S2–S4 LESION

Now we have gone one level lower.

This time communication is not the main problem.

The machinery itself is damaged.

Bladder fills.

And fills.

But cannot contract effectively.

So think:

large bladder
retention
overflow dribbling
reduced sacral sensation/reflexes
And suddenly bowel localisation also becomes easy.
The bowel is simply another department using much of the same sacral infrastructure.

Above the sacral centre:

reflex machinery survives
→ reflex bowel
→ poor voluntary coordination
→ constipation / difficult evacuation

Damage the conus, cauda or sacral roots:

local machinery is damaged
→ poor rectal emptying
→ reduced anal tone
→ impaction ± fecal leakage

So at the bedside I ask only 4 things:

Urgency or retention?

Legs UMN or LMN?

Saddle sensation intact or lost?

Anal tone/sacral reflexes intact or lost?

Then localise.

The easiest way to remember the whole chapter:
Brain lesion loses PERMISSION.
Cord lesion loses COMMUNICATION.
Conus/cauda lesion loses the MACHINERY.

Or even shorter:

Cortex decides WHEN.
Pons coordinates HOW.
S2–S4 makes it HAPPEN.

Once this picture is clear, bowel and bladder localisation is no longer something you need to memorise.

You can reconstruct it at the bedside.

Teaching note: this is a physiological memory model, not a literal step-by-step claim about human evolutionary history.

Acute spinal shock and mixed neurogenic bladder patterns can also break the simple rule.

#NeuroX #MedX #Bowel #Bladder

[shiks Githinji @_marywanjiku]

I never imagined I'd be the one asking for help.
I've spent my life on the other side checking pulses, holding hands, telling patients "you'll be okay." Today, I'm the one who needs to hear that.

This is Day One of appealing to my 30 Followers,online community and well-wishers to help me raise the Sh6 million needed for my kidney transplant.
THREAD

[Dr. Steve Siope @SirStevetyping]

Deserved win - FIFA 2026 WORLD CUP.
#ESPARG

[Dr. Steve Siope @SirStevetyping]

@andreyjosephs 😂

[mühendisyen @muhendisyenn]

Bir adam, tavuklarını 45 gün boyunca dışarı çıkmalarına veya gün ışığı görmelerine izin vermeden bir kümese hapsetti...

[CardiovascularCorner @TrackYourHeart]

The Right- sided 12-Lead ECG

[Dr. AK 🇮🇳 @docakx]

Medical saw can cut through a cast yet won't harm the skin.

How is this possible?

[CardiovascularCorner @TrackYourHeart]

Ventricular Tachycardia Successfully Converted to Sinus Rhythm

Bonus: The conduit seen anastomosed to the LAD in this video is the
A. Great saphenous vein
B. Radial artery
C. RIMA
D. LIMA

[Dr. Steve Siope @SirStevetyping]

@SlySilva7 @Magical_papii Legends that don't require introduction 🤝

[Internal Medicine @pgMedicine]

Mechanisms of action of antibiotics

[Dr. Steve Siope @SirStevetyping]

@MsMiriti I have seen more absurd lab reports,same day, within 2hrs,same patient.
These wouldn't worry me.

[Dr. Steve Siope @SirStevetyping]

@pump_upthejam_ 😂

[Dr. Steve Siope @SirStevetyping]

@Dr___MD 😂😂