Women in Medicine

I was reading the Student British Medical Journal (BMJ) and there was an article that really struck me. They had asked the question “Do you think wider society stills thinks of medicine as a more ‘male’ profession?”. The answer really surprised me as 60% of people had said yes where only 31% had said no. Being female myself, I am not prejudiced against woman taking a higher stance in the professional world and am very proud of what women have done in the past in order to get to where we are today and the response shocked me by thinking that things had not progressed as far as I had previously thought they had.

Dr James Barry (Margaret Ann Bulkley)

Dr James Barry (Margaret Ann Bulkley)

This made me think about the history of women in medicine and I did a little research. I came across some extraordinary findings that a woman (Margaret Ann Bulkley) had pretended to be a man, taking the name of her late uncle (James Barry), for 46 years in order for her to become a doctor. She had to do this due to the fact that no British medical school admitted women and her passion to become a doctor drove her to the extremes that she went to. I find it quite sad that any person would have to pretend to be someone they are not just because a group of people do not accept women in jobs in the field of medicine. It is also upsetting to know that no one knew who she really was despite all of her great achievements; not only was she the first woman to graduate as a medical doctor in 1812 (even if it was in secret), but she was also the first British surgeon to perform a successful Caesarean section, saving the lives of mother and baby. After six months as a pupil at St Thomas’ Hospital in London, Bulkley decided to join the army to continue her career as an army medical officer. To read more about her story, here is the link:
http://www.dailymail.co.uk/news/article-527128/Unmasked-Britains-female-doctor-pretended-man-46-years.html

Another important figurehead for women in the medical profession is Elizabeth Blackwell, the first openly identified woman to graduate from medical school on 23 January 1849. She had managed to secure the necessary school funds by taking a job as a music teacher and studied in secret by reading medical books and getting private tutoring from Dr Jonathon M Allen. She applied to 12 schools and despite all of the rejection and resistance being thrown at her, she was accepted into Geneva Medical College in New York.

Elizabeth Blackwell

Elizabeth Blackwell

After graduating, Blackwell decided to go to Europe to pursue her career and was met with a lot of hostility but also met with a few people who were voluntarily willing to work with her. She was mentored by Paul Dubois, a famous obstetrician, who voiced his opinion that she  would make the best obstetrician in the United States. Unfortunately, when she was treating an infant with ophthalmia neonatorum (a form of conjunctivitis contracted by newborns during delivery), she spurted some contaminated solution into her own eye accidentally, and contracted the infection. This caused her to become blind in her left eye ultimately destroying her chances to become a surgeon.

Elizabeth Blackwell then returned to the United States to open up her own practice. She was once again faced with resistance and did not have many patients. She published a couple of books and in 1874 was successful in opening the London School of Medicine for Women. She became quite successful and took other aspiring female doctors under her wing to train. Even in her late years, she was still quite active and even published an autobiography on her life in the medical profession.

Even after reading all of this, it still left me shocked to see the response and perhaps even more so. I understand that men and women are still not treated as equals and hopefully one day that will change but the work women had to put in to do something that men could easily grasp makes me slightly angry. Why should it be harder for women? It is probably because in the past men were seen as the doctors and women were only the nurses and things are still commonly seen this way; especially with the older generations. This made me think of the first episode of ‘Greys Anatomy’ where one of the interns called the main character (Meredith) a nurse despite knowing that she was a fellow surgeon. Men could be and probably were resentful to women partly because of their gender but also because they would have been a threat if they were better than them. I am glad that things are changing and it is acceptable for women to be doctors and even for men to be nurses but I wish that more of the wider society would keep up with the times and think in the same way.

Thanks for staying with me during my rant,

Rachel.

Human Embryonic Stem Cells Successful At Last!

On 15th May, a team of scientists at Oregon Health & Science University (lead by Shoukhrat Mitalipov) announced that they had successfully converted human skin cells into embryonic stem cells. They were created by SCNT (Somatic-Cell Nuclear Transfer) which is the same technique that was used in creating the first successful clone- Dolly the sheep.

In this process, the nucleus of the human egg cell is extracted and discarded, taking with it the DNA, and the donor skin cell’s nucleus is extracted and kept and then fused with the ‘host’ egg cell. This new cell is then shocked with electricity before it then starts to divide.

Extraction of nucleus of human egg cell

Extraction of nucleus of human egg cell

Human SCNT embryos- day 2

Human SCNT embryos- Day 2

 

After a lot of cell division (by mitosis), a blastocyst is formed (this is an early stage embryo containing around 100 cells). The blastocyst contains the exact DNA of the donor skin cell.

Single blastocyst of human SCNT

Single blastocyst of human SCNT

There is great controversy over this process and many argue that it is wrong, especially since it was revealed that 120 human embryos were destroyed in the process. The Church believes in protecting human life and this can be considered murder (in particular to Catholics who believe that life begins at conception). And although the university had said that they do not use fertilised embryos, others have said that as soon as human cells begin to divide into an embryo they are considered human life and to destroy this is immoral. I believe that as long as the embryos are used in a way to help medical advancements in a way that can save lives (like cloning cells to help in making new organs for those who are likely to reject a donated organ), this research should keep going and they should find a way to help those who are terminally ill and are in need of rescuing.

Another issue raised is that this method can be used for human cloning which is also considered unethical but Shoukhrat Mitalipov said that “our research is directed toward generating stem cells for use in future treatments to combat disease,” rather than for human reproductive cloning; he also believes that their research could not be used in aiding this type of cloning either.

On a more positive note, these human embryonic stem cells have been harvested from the cloned embryos and have been grown into beating heart cells! Here is a link to a video that shows these cells actually beating:

Beating heart cells

This is an amazing advancement in science and medicine and hopefully one day it will be considered an every day normal procedure in helping to cure the lives of those who need it.

I found my research on these sites:

http://www.guardian.co.uk/science/2013/may/15/human-embryonic-stem-cells-adult-tissue

http://ncronline.org/news/politics/researchers-embryonic-stem-cell-advance-decried-morally-troubling

http://en.wikipedia.org/wiki/Somatic-cell_nuclear_transfer

Paediatrics to Cardiothoracics…

I have wanted to be a surgeon for a long time and have wanted to be a paediatric surgeon for just a little bit less than that.

However, I recently read in the Student BMJ that paediatric surgeons only perform 11% of the surgeries on children; the rest are performed by the other specialties. When I heard this, I realised that I wanted to do more than that- therefore I researched the other specialties and I had always wanted to do something in cardio.

Because of this, I researched all about cardiothoracic surgeons and the journey I would have to take to get there.

You start with the 5 years studying medicine at university and then you spend 2 years in a hospital (foundation year 1 and 2). After those two years, you decide to take up surgery and begin your surgical training. The cardiothoracic specialty does not allow you to start training specifically in only that specialty and so you have to do 2 or 3 years doing general surgical training before you can apply to work in cardiothoracics.

Cardiothoracic surgery deals with illnesses of the heart, lungs, oesophagus and chest. These include cardiac surgery (heart and great vessels), thoracic surgery (organs within the thorax, excluding the heart), transplantation and heart failure surgery, oesophageal surgery and congenital surgery in adults and children. All procedures are usually major and often complex. Within cardiac surgery, coronary artery bypass grafting and valve operations and most commonly performed and within thoracic surgery, the most common operations are lobectomy or pneumonectomy for carcinoma of the lung (lung cancer).

cthome

Pulmonary Embolism

A pulmonary embolism is a blood clot in the pulmonary artery, which is the blood vessel that transports blood from the heart to the lungs.

PE

When blood leaves the heart, it is low in oxygen and therefore needs to reach the lungs to pick up oxygen. Therefore, pulmonary embolism is a serious and life-threatening condition as it can prevent the blood from reaching the lungs.

Causes of Pulmonary Embolism

Pulmonary Embolism (PE) can originate from DVT (Deep Vein Thrombosis) which is a blood cot in one of the deep veins of the legs. PE occurs when a piece of the blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs. DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

 Some of the main causes of blood clots are:dvt

  • Slow Blood Flow
  • Blood Vessel Damage
  • Blood that clots too easily

Other risks of forming pulmonary embolism are:

  • Age (people aged 40+ are more at risk)
  • Smoking
  • Being pregnant
  • Previous VTE
  • Being overweight or obese
  • Having a family member who has had a blood clot
  • General anasthesia for more than 30 minutes
  • Paralysis
  • Major or lower limb trauma
  • Lower limb orthopaedic surgery

Symptoms of Pulmonary Embolism

It can be difficult to recognise the symptoms and signs of PE as they can vary between each person, due to the extent of the pulmonary embolism and any other underlying cardiopulmonary impairment.

Extensive PE may present with syncope (fainting) due to acute lowering of cardiac output (the volume of blood being pumped by the heart).

Patients may also be found to have hypertension (high blood pressure in the arteries), evidence of poor perfusion (blood flow), and elevated jugular venous pressure (the indirectly observed pressure over the vein via visualisation of the internal jugular vein). 

Most patients experience breathlessness and pleuritic chest pain is caused by pulmonary infarction (when a portion of lung tissue dies due to an interruption of its blood supply), which occurs more often with non-massive PE and may be associated with haemoptysis (coughing up blood from the lungs).

Other signs may also include:

  • Anxiety 
  • Sweating
  • Feeling light-headed or dizzy

Unexplained tachycardia (heart rate that exceeds the normal range), tachypnoea (abnormally rapid breathing) or low arterial oxygen saturation may also suggest PE.

How is Pulmonary Embolism Diagnosed?

It is important that pulmonary embolisms are correctly diagnosed because treating them is not easy and can lead to side-effects.

To confirm whether you have a pulmonary embolism, there are a few tests that can be taken:

  • D-dimer test

D-dimer is a protein formed and found in the blood after a blood clot has broken down. Levels are almost always increased in cases of venous thromboembolism and therefore a normal D-dimer level helps to rule out PE. However, high D-dimer levels are commonly found in other conditions and for that reason, it has a low positive predictive value for pulmonary embolism. ctpa

  •  Computed Tomography Pulmonary Angiography (CTPA)

During a CTPA, dye is injected into the blood vessels of your lungs and a CT scan is taken. If there is a pulmonary embolism in one of your lungs, it will show up as a gap in your blood supply.

  • Ventilation- perfusion lung scanning

A ventilation or perfusion scan measures the amount of air and the blood flow in your lungs. If part of your lung has air in it, but no blood supply, it may be the result of a pulmonary embolism.

 Treatments for Pulmonary Embolism

If you have PE, emergency treatment may need to be taken in order to dissolve the blood clot and you may need to take medication to stop the blood from clotting so easily.

If your pulmonary embolism is severe and life-threatening, medication to dissolve the blood clot will be prescribed. This is known as thrombolytic therapy. Then, action would be taken to prevent any further blood clots by giving the patient anticoagulant medicines. Anticoagulants are usually referred to as blood-thinners but they do not actually thin the blood; they alter chemicals in the blood to prevent clots forming so easily.

Heparin and Warfarin are the two anticoagulants that are usually prescribed to treat pulmonary embolisms. Heparin is usually used first because it immediately prevents another clot from forming. Warfarin can take longer to start working but it is also effective in preventing further blood clots.

 lungs-pulmonary-embolism-PU (1)

I found my research in the Student BMJ (British Medical Journal) and the NHS website.