The Secret to Getting Good Sleep

April 21, 2017 in Everyday Medicine

 

Now I’m not particularly athletically inclined, try as I might, but the one thing that I could win at is getting good sleep. Of course practice makes perfect, but a few tips on how to fall asleep faster and sleep better can really make all the difference…

 

First of all, what should you be aiming for? It varies, but in general teenagers need around 9 hours and adults need about 8 hours. That’s the first step to winning; make sure you actually give your body enough time to grow, repair and everything else mentioned in my previous post, ‘The Science Behind Sleep’.

The next key aspects are the two R’s: regularity and routine. If you regularly go to bed and wake up at the same time everyday, your internal body clock will become ‘synchronised’ with your timings which will promote better sleep. And when I say everyday, I mean it! Weekend lie-ins can skew this schedule so try to wake up as close to your regular time as you can. This may seem like a real sacrifice but if you are able to improve your sleep quality and get enough sleep on weekdays, then weekend lie-ins will become redundant anyway.

Establishing a nightly routine before bed will indicate to your body that it’s time to wind down. Your routine could consist of a warm bath, relaxation exercises like yoga and reading a book or listening to music. Watching TV or using electronics, however, could hinder your sleep as the blue-wavelength light of bright screens can trick your body into thinking it’s daytime. This in turn causes hormones involved with falling asleep to be delayed. Therefore it is recommended you avoid such screens in the last 30 minutes before bed.

Make sure your sleeping environment is optimal with a comfortable mattress and pillow. The room should be dark, quiet, cool (between 18-24°C) and relaxing. Your diet should also work to your advantage when it comes to falling asleep. Avoid stimulants like caffeine and nicotine in the hours before sleep, and limit alcohol intake as too much alcohol before bed can disrupt sleep later at night.

Stress not only spoils the daytime, but can also cause insomnia by keeping you distracted and awake at night. It is important that you find ways to manage stress. The most obvious way of doing this would be to remove yourself from whatever is causing the stress but I’m well aware that it is not always that simple. Take basic steps to ensure at least some stress is relieved by being organised, allowing yourself to take breaks, eating well and doing exercise. Also, make time for hobbies and being with friends and do not be afraid to talk about your problems. Another good tip is to write a to-do list of what needs to be done the next day before you go to bed.

As little as 10 minutes of aerobic exercise daily can promote sleep as well as the numerous other health benefits to exercising, although in general you should avoid strenuous exercise close to bedtime. Finally, try to cap daytime sleeping to a maximum of 30 minutes. Even if you haven’t gotten enough sleep in the night, a daytime nap cannot make up for that. That said, a power nap between 20-30 minutes in the afternoon can improve alertness and mood.

The Science Behind Sleep

April 16, 2017 in Everyday Medicine, The Science Behind...

 

UntitledWe spend about a third of our lives sleeping, and many aspects of it remains a mystery to scientists but what they do know is that it is very important in brain development, muscle repair, memory consolidation and growth.

Historically, sleep was thought to be a way of conserving energy however the energy actually saved is minimal and sleeping for 8 hours only actually saves about 50kcal- the same amount of energy as a slice of toast! Another theory is that the sleep period keeps animals safe at a time of day most dangerous in terms of predator encounters. However, the lack of consciousness and response to stimuli leaves sleeping animals vulnerable so this theory is also not very strong.

The more widely accepted theory is that physical restoration occurs during sleep. During REM sleep, the majority of what happens is brain repair, restoration and development whilst non-REM sleep is mainly devoted for body repair and restoration. Many studies also show how sleep improves long-term memory processing and converting short-term memories into long term.

 

Sleep is generally split into REM and Non-REM (NREM), in which the NREM is sub-split into 3/4 other stages. NREM makes up about 75% of sleep whilst REM has the rest- in adult. Infants spend closer to 50% of sleep time in REM.

Stage 1 of NREM is Light Sleep, a state between asleep and awake. In light sleep muscle activity slows down, breathing and heart rate begins to slow down and people can be easily awoken. In stage 2, sometimes known as True Sleep, breathing and heart rate are regular, body temperature drops (by about 1o) and awareness of surroundings begins to fade. A sleeper spends more time in stage 2 than in any other.

Stages 3 and 4 are often lumped together as Deep Sleep. Breathing and heart rate reaches their lowest levels and responsiveness to the environment reduces even further. There is no eye movement or muscle activity and most of the information processing and memory consolidation takes place in deep sleep- although it does to some extent happen in stage 2 and REM. Stage 3/4 is where tissue growth and repair happens and hormones like growth hormone is released. Children may experience night terrors, bed-wetting or sleep walking during deep sleep.

Following Deep Sleep we move into REM which stands for Rapid Eye Movement. These side-to-side eye movements are intermittent and considered to be due to images seen internally during dreaming. The majority of dreams happen during REM although scientists do not know why we dream. Unlike in NREM, heart rate and blood pressure increases and breathing becomes faster and irregular. What’s more, most muscles become temporarily paralyzed during REM as brain impulses which control movement are suppressed. This is called atonia, and is thought to prevent us from acting out our dreams and possibly hurting ourselves. This theory was developed by Michel Jouvet who stopped this atonia from occurring in an experiment on cats, and consequently observed that the cats would physically run, jump and stalk prey during their dreams.

The first occurrence of REM lasts for around 90 minutes before the whole cycle begins again. Recurrence of REM becomes longer whilst periods of deep sleep become shorter over the course of the night.

 

So that’s what happens each night when you fall asleep, it’s not as simple as just ‘being unconscious’ as your body takes that opportunity to store memories, heal and dream. Watch this space for a follow up post on how to get that much needed sleep!

 

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The Science Behind the Sun

March 31, 2017 in The Science Behind...

 

As we approach Easter time, many of us will be noticing the blooming flowers and longer, sunnier days- for many of us, a reason to rejoice! The better weather definitely seems to cheer people up and boost ice cream sales, and whilst most people know to some degree that catching a bit of sun can both benefit and harm health, sun protection advice is increasingly ignored by teens wanting to tan and children wanting to play out in the sun. So I’m here to educate and tentatively advise a little bit about the sun.

 

As most people can confidently tell me, sunlight is a great- the best, in fact- source of vitamin D. But what is vitamin D? For one thing, it’s not technically a vitamin. Vitamins are generally defined as organic chemicals that are obtained from a person’s diet because they’re not produced by the body. Yet vitamin D is produced by the body and about 90-95% of it is obtained through sunlight. Also, it isn’t found in any natural foods except egg yolks and fish. Still, old habits die hard so it’s referred to as a vitamin even so.

Vitamin D is obtained from sunlight by using the sun’s ultraviolet B energy to turn a chemical in your skin into vitamin D3. D3 is then carried to your liver and kidneys, each time picking up oxygen and hydrogen molecules, to finally become 1,25(OH)2D aka calcitriol or vitamin D.

Now what vitamin D actually does is a bit more interesting. It’s best-known role is to keep bones healthy. The way it does this is by increasing the amount of calcium that can be absorbed in the intestines. Without enough vitamin D, the body only absorbs 10-15% of the calcium in our diets whilst 30-40% can be absorbed with the right amount of it. It also helps the body to absorb phosphate in our diet, which is also required for bone health.

Without sufficient vitamin D, bones can become soft and weak leading to bone deformities like rickets in children. Rickets is no longer as common as it used to be, but it causes bone pain, poor growth and deformities of the skeleton.

 

Sunlight has many other benefits, such as mood improvement. Exposure to sunlight can increase the brain’s release of the hormone serotonin, which is associated with mood boosting and a deficit of serotonin can lead to depression. There is also a correlation between the number of deaths from heart disease in the summer as opposed to the winter suggesting that the sun can reduce heart disease. UV radiation from sun exposure can be used to treat eczema (dry itchy skin), jaundice (yellowing of skin and whites of eyes) and acne and is sometimes recommended by doctors if they think light treatment would help. Finally, a moderate amount of sunlight may prevent cancer. According to a study from Environmental Health Perspectives, people who live in areas with less sun/daylight hours are more likely to have a variety of cancers including ovarian, pancreatic and colon cancer. However, too much sun can also cause cancer so it’s important to get the right balance.

 

As too many people have experienced first hand, staying out in the sun too much without protection can cause sunburn which not only is painful but also increases your chance of getting skin cancer. Sunburn is caused by the UV light from the sun which can damage the DNA in cells. As a result, the cell with damaged DNA ‘commits suicide’ (apoptosis). Cancer can occur if cells with damaged DNA do not die as they should, but instead continue to multiply. According to the Skin Cancer Foundation, people who have had 5+ sunburns have twice the risk of developing skin cancer. Another thing to be aware of is you can still get sunburnt in the UK and/or if it’s cloudy.

 

Heat exhaustion and stroke are two other serious conditions that can happen when you get too hot, sometimes from being in the direct sun but other times just from being in a hot climate.Heat exhaustion describe the condition in which you become very hot and begin to lose water and/or salt from your body leading to feelings of weakness, dizziness, sickness and various other symptoms.

If heat exhaustion is not treated it can lead to heatstroke, which is when your body can no longer cool itself so your body temperature becomes dangerously high. This puts a strain on multiple organs including the brain, heart and lungs and can be life-threatening. If you have heatstroke, symptoms of heat exhaustion can develop into more serious symptoms like seizures (fits) and loss of consciousness.

If a person displays signs of heat exhaustion, you should try to cool them down by moving them to a shaded or air conditioned area, using a wet flannel to cool their skin and rehydrating them. However, the best advice that can be given is to not get heat exhaustion, heatstroke or sunburnt in the first place.

 

To ensure you are safe in the sun, you should spend time in the shade when the sun is at it’s strongest (between 11am-3pm in the UK) and use at least factor 15 suncream. Even if you are wearing water resistant suncream, it should be reapplied after you’ve been in water or if you’ve been sweating. You should protect your eyes using sunglasses with the CE mark and wear a wide-brimmed hat to shade your face and neck. Children are especially at risk as their skin is more sensitive than adult skin, so children should be encouraged to play in the shade, cover up in loose cotton clothes and wear lots of suncream. Finally, you should not spend a longer time in the sun wearing suncream than you would normally spend without it- my mum’s general rule of thumb is to limit it to 20 minutes of being in direct sunlight at any one time.

 

Whilst the sun does present some dangers, it’s warmth is also essential for human life to even exist and I still encourage you to enjoy it this spring and summer. All I ask is that you do so sensibly, because no sane person enjoys sunburn and heatstroke.

Does the 5-second rule really work?

March 24, 2017 in Everyday Medicine, In the News, The Science Behind...

 

I’m sure you’re familiar with and maybe even ‘daring’ enough to use the 5-second rule, but a news article this week has brought this question to my attention as Professor Anthony Hilton has decreed that it’s indeed true, to a degree. For those of you who actually don’t know what it is, the 5-second rule suggests that if food is dropped on the floor, it can still be eaten if it is picked up within a window of 5 seconds.

 

Notably since 2003, scientists have been making attempts to prove or disprove this theory with Jillian Clarke starting the proceedings by proving that foods will be contaminated- even with brief exposure- to a floor inoculated with E.coli. She did, however, also find that there was little evidence that public floors are in fact contaminated. In 2006, another study found that bacteria could thrive under dry conditions for over a month and that contamination does increase as the food is left on the floor for longer.

Researchers at Rutgers University tested extensively using different surfaces and foods with a total of 2,560 measurements to find that wet foods pick up more contaminants than dry, and that carpet is surprisingly a better surface than steel or tile when it comes to transference of bacteria. Lead researcher Professor Schaffner states, “Bacteria can contaminate instantaneously” and the evidence agrees, but does that answer the question?

As previously mentioned, Anthony Hilton at Aston University led a study in 2014 which found much the same as Schaffner’s yet suggests such results support the 5-second claim. Whilst he accepts that bacteria is inevitably picked up and that eating food from the floor is never “entirely risk-free”, he also points out that the research shows food is unlikely to pick up harmful bacteria from the few seconds spent on the floor. Furthermore, he has said there should be little concern about food that has touched the floor for such a short time. I think that this conclusion rings true with more of the general public than the latter, with 79% of 2000 people admitting to eating food that had fallen on the floor.

 

My view is that most people do not truly believe zero bacteria is picked up in those precious 5 seconds, but assume that the amount is negligible and neither numerous nor dangerous enough to cause any harm. The science does show that the longer food is on the floor, the more bacteria is picked up and in those first 5 seconds any harm from said bacteria is unlikely. Therefore, I would argue that the 5-second rule does work, but really it is up to personal preference and circumstance. But if you’ve dropped a slice of watermelon (made up of 97% water) on a visibly dirty tile, I’d say give it a miss- it’s just common sense…

A Look Back at Anaesthesia

March 18, 2017 in History

 

An anaesthetic is a substance that induces insensitivity to pain with anaesthesia literally meaning ‘without sensation’. Anaesthesia is used in modern times on a day to day basis, during tests and surgical operations in order to numb areas of the body or induce sleep. The types which you are probably most aware of, local and general, are the two most common but there are other types such as regional anaesthetics and sedatives.

Anaesthetics may not be perfect, with c.10 deaths for every million anaesthetics given in the UK, however developments over the years has made the use of anaesthesia to be considered very safe with serious problems being rare. I’m taking a look back in time to see how anaesthesia- more specifically general- has changed over the last 2 centuries.

 

 

Starting in the 1820s, Henry Hickman explored the use of carbon dioxide as an anaesthetic to perform painless surgery on animals. Carbon dioxide could be used to effectively suffocate the animals out of consciousness for a long enough time to perform the surgery. This is considered to have been a major breakthrough in surgery and anaesthesia, however carbon dioxide wasn’t used widespread due to the risks associated with partial asphyxiation and Hickman’s work was heavily criticised at the time. In more recent times, carbon dioxide was said to be used for medicine in the USA during the 1950s and is currently used before slaughter in numerous slaughterhouses.

 

Ether had a reputation as a recreational drug during the 1800s but in 1842 it was used for the first time as an anaesthetic by American physician William Clarke in a tooth extraction. That same year, Crawford Long used it to remove a tumour from a man’s neck although he did not publish an account of until several years later, in which he described that the patient felt nothing throughout the procedure.

Morton gave the use of ether popularity when in 1846 he removed a tumour from a man’s jaw. News of the operation travelled round the world quickly and ether became a widely adopted method with Morton often being credited as the pioneer of general anaesthesia. Ether did have it’s drawbacks though, causing coughing in patients and being highly flammable meaning research in anaesthesia continued to develop.

 

Humphrey Davy discovered that nitrous oxide could dull pain in 1799, however the use of nitrous oxide as an anaesthetic wasn’t fully realised until 1844. Horace Wells attended a public demonstration of nitrous oxide by Gardner Colton and the very next day Wells himself underwent the first ever reported painless tooth extraction while Colton administered nitrous oxide. Nitrous oxide is still used today, you may know it better as ‘laughing gas’, in dentistry and childbirth and even recreationally as the 4th most used drug in the UK (according the Global Drug Survey 2015). Of course, nitrous oxide only dulls pain so could not and cannot be used in major surgery unless used in conjunction with other anaesthetics.

 

You may have heard that Queen Victoria used chloroform during the birth of her 8th child in 1853, but it had actually been around 6 years beforehand and was met with a lot of opposition preceding said event. Scottish obstetrician James Simpson was the first to use chloroform to relieve the pain of childbirth in 1847, and it widely replaced the use of ether as it was quicker acting, didn’t smell as pungent and had fewer side effects. Nevertheless, it was met with opposition mainly due to deaths and religion.

Some religious people believed it was God’s intention for women to feel pain during childbirth so such pain should be endured, not relieved. At the time religion held a lot of power so this scared many God-fearing people away from chloroform. Meanwhile administration required great skill, as surgeons had to be experienced enough to give the right dose. As such the first reported death from chloroform overdose was in 1848. Chloroform fatalities were widely publicised but were mainly caused from poor administration, which was overcome when John Snow invented the chloroform inhaler which controlled the dosage to make the anaesthetic safer and more effective. When Snow used the inhaler to anaesthetise Queen Victoria, the positive publicity left little opposition remaining. The use of chloroform has since been discontinued as it was realised that chloroform could cause liver and heart damage.

 

Skipping forward to 1934, when sodium thiopental was made as the first intravenous aesthetic (injected into bloodstream). It was founded by Ernest Volwiler and Donalee Tabern, both working for Abbott Laboratories and a clinical trial of thiopental at the Mayo Clinic was conducted 3 months later. It rapidly entered common practice as it was short and fast acting (4-7 minutes and 30 seconds respectively), and the fact that it was intravenous allowed for more precise dosage. Volwiler and Tabern were inducted into the National Inventors Hall of Fame in 1986, and thiopental is still used in conjunction/before other anaesthetics although not alone because its effects do not last long enough to be of practical value. Since the 1980s thiopental has been slowly replaced by propofol as it too is short and fast acting but also has antiemetic properties (prevents nausea and vomiting).

 

Halogenated inhaled agents are routinely used today and it could be argued that their emergence transformed anaesthesia as much as chloroform did over 100 years prior. Halothane was first synthesised by C. Suckling in 1951 and first used clinically by Dr Johnstone in Manchester 5 years later and is still widely used in developing countries and veterinary surgery because it is low cost. Following halothane came enflurane(1966), isoflurane(1979), sevoflurane(1990) and finally desflurane(1990s). These halogenated inhaled agents have the beneficial properties of low solubility (meaning they take rapid effect), minimal cardiorespiratory depression and non-flammability. Despite these characteristics, halogenated agents only cause lack of consciousness and do not relieve pain so are used in conjunction with other anaesthetics.

 

Curare was traditionally used on poison darts and arrows by aboriginal people and became the first non-depolarising muscle relaxant (blocks the agonist from binding to receptors) in 1942. Neuromuscular blocking drugs like curare can be used to produce paralysis, allowing intubation of the trachea and to optimise the surgical field. Endotracheal intubation is important as it is used to administer gases like the halogenated inhaled agents, and to aid ventilation of the lungs. The fact that muscle relaxants basically paralyse the muscle means that muscles cannot contract, enabling surgery to be performed as best and safely as possible. Patients can still feel pain at full intensity with the use of muscle relaxants but cannot move, so analgesics (pain relieving drugs) are often also given to prevent anaesthesia awareness.

 

As you can see, anaesthetics has changed a lot in the last 200 years and anaesthesia is now an entire section of medicine in its own right. Nowadays, general anaesthetic cannot be given to a patient without a trained anaesthetist, dosage is carefully controlled and a combination of anaesthetics can be used to achieve the ideal effect.

The Science Behind Clinodactyly

March 10, 2017 in The Science Behind...

 

The word ‘clinodactyly’ stems from the Ancient Greek meaning “to bend” and “digit”, and that is basically what this genetic abnormality is. I first became interested in this when I noticed my younger sister’s little finger was bent inwards, although until now I’d always assumed that it was nothing…

 

Clinodactyly is the medical term used to describe when a finger or toe is curved or bent at an angle, usually with an incline between 15° and 30°. The condition affects about 10% of the population and is passed on through inheritance. It may present either as an isolated anomaly or as part of an associated syndrome, for example a significant percentage of individuals with Down syndrome also have clinodactyly. The condition occurs more in boys than girls and is visible as soon as the child is born.

In most cases, clinodactyly is caused by the growth plate in the hand (or foot) being an abnormal shape or having an abnormal orientation, so the bones do not grow at 90° to the finger axis. Treatment is only necessary if the digit is bent enough to cause disability or emotional distress, in most cases a person with Clinodactyly can use their hands or feet normally. If surgery is required due to inference with function, the procedure involves making a small incision on the affected finger or toe and cutting the bone to correct the deformity. The finger is then stabilised until the bone and soft tissue has healed. Most of the time, surgery is successful however there is a risk that the digit reverts resulting in the need for future surgery.

 

So that’s just a short and simple post about a minor abnormality that you’re likely to see everywhere, now that you know about what you’re looking for.

Technology & Medicine

February 24, 2017 in In the News

 

Technology has integrated itself every aspect of life and medicine is no exception. From 3D printing of organs to genetic engineering of embryos, advances in technology directly link to advances in medicine and here’s just a couple examples of present and future applications of it…

 

Walking around a city centre, you probably don’t notice the AED machines that you may pass in train stations, shopping centres and leisure centres but from now on I implore you to take a notice, as you could save a life. Yes, you! The great thing about the automated external defibrillator is that it’s designed for non-medical people (laypersons) with simple audio and visual commands to guide the user through the appropriate steps to be taken- although it would ideally be used by someone who has received AED training.

It is used in cases of cardiac arrhythmia  (irregular heartbeat) leading to cardiac arrest. However, AEDs aren’t designed to shock asystolic patients (flatline) so it is very important that CPR is carried out before the AED is used, and during if you are instructed. An AED is ‘automated’ because of the unit’s ability to automatically diagnose the heart rhythm and determine if a shock is needed. Following a shock, most devices will analyse the patient and either instruct the user to give CPR or administer another shock. An AED is likely to have an ‘event memory’ also, which stores the ECG of the patient along with details of the number, strength and time of any shocks delivered. So keep a look out for any AED machines in public settings and should you ever be in a position where have to use one, be grateful that in that admittedly pressured environment the automated external defibrillator will do most of the legwork for you.

 

Virtual reality is an immersive simulation of a 3D environment, created by technology and experienced by movement of the body. It has been used in gaming for some time now, but has been branching out into many more sectors including usage in museums, education and military training as the technology for VR has advanced. And now, a team of Cardiff University psychologists are working to develop virtual reality environments to help with the diagnosis and rehabilitation of patients suffering from visual vertigo.

Symptoms of visual vertigo include dizziness and nausea, these can be sparked by various environments depending on the sufferer and can be so debilitating that in some cases a patient cannot even leave their house. It is very difficult to rehabilitate patients as it cannot be fixed quickly and patients have to be seen multiple times. By using VR, the team in Cardiff have flexibility over the different environments they can show to patients- this will allow them to find out a patient’s individual trigger and subsequently tailor specific rehabilitation therapies.

Immersive VR therapy could also be used to rehabilitate stroke and brain injury victims to help them regain motor and cognitive function faster. What’s more, the exercises could be made to feel like games to motivate patients to practice everyday. Whilst little in the way of virtual reality in medicine has been implemented yet, it does look very promising and I am keen to see further research into it…

 

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Euthanasia- Should it be legalised in the UK?

February 18, 2017 in Difficult Debates

 

Untitled

There is no doubt that euthanasia is a difficult debate, with passionate views  both for and against it. Assisted suicide has been legal in Oregon since 1997, and assisted suicide and euthanasia have been legal in the Netherlands since 2002- so why, in 2017, is no form of assisted suicide or euthanasia legal in the UK?

 

First, what is euthanasia? Euthanasia is the act of deliberately ending a person’s life to relieve suffering. Meanwhile, assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves.

Euthanasia can be defined as active or passive and voluntary, non-voluntary or involuntary. Active euthanasia is when a person directly ends someone’s life, for example giving a person a lethal injection. Passive euthanasia is when a person causes death by withholding or withdrawing treatment which is necessary to maintain life, for example taking a person off a life-support machine.

Voluntary euthanasia is when a person wants to die and involuntary euthanasia is when a person is killed against their express wishes. Non-voluntary euthanasia is when a person is unable to give consent so another person makes the decision on their behalf, for example if a person is in a coma.

 

Under English law, euthanasia is regarded as either manslaughter or murder and is punishable with a maximum penalty of life imprisonment. Assisted suicide is also illegal and punishable with up to 14 years imprisonment.

Active euthanasia is legal in Belgium, the Netherlands, Luxembourg and Colombia. Assisted suicide is legal in the Netherlands, Oregon, Washington, Vermont, Montana and Switzerland.

One of the few doctors in Britain charged with attempted murder was Dr Nigel Cox in 1992. He injected his patient of 13 years, Lillian Boyes (70 years old) who had rheumatoid arthritis, with potassium chloride in order to stop her heart. She was said to have pleaded with him to end her life and during the court case, Ms Boyes’ family never wavered in their support of the doctor’s actions. Dr Cox was charged with attempted murder because it couldn’t be proved that the injection itself killed her and he was given a 12-month suspended sentence.

 

The principle of autonomy can be used to argue for the legalisation of euthanasia. In medicine, autonomy is the right of competent adults to make informed decisions about their own medical care. This means that patients have the right to refuse medical treatments and to decide what happens to their body after they die (for example, donating organs). It could then be argued that patients should also have the right to die, and that making euthanasia illegal does not allow for complete patient autonomy.

This must be weighed against beneficence. Doctors are meant to ‘do no harm’ and do what’s in the best interest of the patient. Therefore, it is questionable whether or not ending a patient’s life is breaking a doctor’s code of conduct. However, one could argue that as long as the patient understands every facet of the decision at hand and would still like to end their life, then it is a doctor’s duty to help them do so. As well as beneficence, there is fear that the legalisation of euthanasia could damage the doctor-patient relationship. Patients could begin to lose trust in their doctors, and believe that the doctor does not have the patient’s best interest at heart but instead just want to ‘get rid of them’.

 

The law against euthanasia can be unfair, as it does not allow those wanting to end their lives to do so in a safe and peaceful manner. Without an assisted dying or euthanasia law people try to commit suicide in private, ending their lives at home and alone as they cannot talk to their family or doctor about the decision. People should not be forced into such circumstances, and should be able to say a proper goodbye and be with loved ones if they still make the decision to die.

Also, people may instead decide to travel abroad to die (e.g: Dignitas in Switzerland) because they cannot die how they want to in the UK. A trip like this can cost up to £10, 000 and people are often in pain, so travelling may put them in distress. Furthermore, a person wanting to die may journey abroad sooner than is necessary as they fear that if they stay in the UK, they will miss their chance to leave by becoming too ill to travel.

 

Many people believe that the government should not be able to intervene in personal matters like death. In the past and even currently, should the government introduce a policy for vaccination it is met with a flood of opposition and yet the government can make assisted dying illegal? It is a fair argument to say that the state should not create laws that prevent people from being able to choose when or how they die, as that is not the purpose of the government.

Despite that, the government do have a duty to protect those who are vulnerable such as the ill, elderly and disabled from feeling pressured into ending their lives and being exploited. In 2015, MPs rejected the legalisation of assisted dying in England and Wales with 330 votes against and 118 in favour- this shows that clearly the government is nowhere near legalising assisted suicide or euthanasia with such an overwhelming majority voting against it.

 

A sizeable proportion of those opposing euthanasia argue on religious grounds; human life is sacred and only God has the right to take life away. Some go as far as to say that the pain terminally ill people may experience in death is just another test set by God, similar to some of the reasoning behind refusal of chloroform use during childbirth when it was first discovered in Victorian times.

However, not all religious people do oppose euthanasia. In the above mentioned rejected bill a Rabbi said, “We are saddened that it failed to progress, as it dashes the hopes of those who wish to avoid ending their days in pain or incapacity”. Like with many other things in religion, opinions of euthanasia is dependent on personal understanding and observance of religious teachings thus can vary from person to person.

 

Religious and atheist people alike argue that euthanasia devalues life in society’s eyes, making it easier to end lives and accepting that some lives are worth less than others. This is one of the more potent arguments against euthanasia, as it links to the ever prevalent ‘slippery slope’ issue. The concern that legalising voluntary euthanasia might lead to allowing non-voluntary and involuntary euthanasia is at the forefront of most people’s mind when discussing euthanasia, and with good reason.

Nevertheless, the very fact that people are so apprehensive of the ‘slippery slope’ means that if euthanasia or assisted suicide was legalised, people would be vigilant and safeguarding would be put into effect to ensure no one was pressured into ending their lives and that any euthanasia carried out was definitely voluntary. What’s more, Oregon is a working model and proof that the slippery slope is not inevitable. Assisted suicide for the terminally ill has been legal for almost 20 years in Oregon and there have been absolutely no cases of abuse reported. The UK would not be the first to legalise euthanasia and we could use the methods in places like Oregon and the Netherlands as a template for our own laws.

Likewise, another case made against euthanasia is that it could lead to a lack of compassion in doctors as they become used to ending lives although I think this is unlikely as such fears are voiced about abortion yet it has not happened in the 50 years that abortion has been legalised.

 

The final and perhaps simplest argument against legalising euthanasia: with modern medical care and pain relief, there is no reason that in the right environment a person can’t have a dignified and painless death. So is legalisation of euthanasia or assisted suicide really necessary?

Sadly, not all people would agree. Quality of life is very subjective and impossible to truly measure, so we cannot decide for other people whether they’re life is worth living or not. Despite the alternatives to ending one’s life, such as palliative care, if a person believes their pain is too great for them to  bear then no matter how great the alternatives are, euthanasia should be available to them should they request it as it is almost cruel to force people to live and adds to their pain.

 

In conclusion, euthanasia is possibly one of the toughest and most serious medical ethics debate but it is important to think and form opinions about it. The 2015 vote was the first ever serious attempt to change Britain’s assisted suicide laws in the House of Commons in at least 20 years, but that was only the beginning. Currently, a man with Motor Neuron Disease (Noel Conway) is seeking a judicial review of the Suicide Act of 1961 and other countries have increasingly been changing their laws to support assisted suicide and even euthanasia in the last 10 years.

I think, on balance, that I would support a change to the law regarding assisted suicide and euthanasia. Whether or not I agree with euthanasia is besides the point because for me, I see this as a choice issue and I believe people should be given that choice as it is not fair that the law forces the opinions of those opposed to euthanasia on those in need. That said, if it ever is legalised in the UK, the law must support and protect both those who wish to end their lives and those who do not to ensure that there is no abuse at the same time as providing mercy to those who ask.

 

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The Science Behind Popcorn

February 4, 2017 in The Science Behind...

 

London Empire

Ever wondered why popcorn pops? Or how a little kernel of corn becomes a tasty snack with just a little bit of heat? Well, whether you have or not I am about to explain the science behind popcorn!

 

First, how does the kernel become popcorn? The kernel is made up of three parts; the pericarp, germ and endosperm. The pericarp is the outer shell surrounding the kernel which is the key to making it pop, and the endosperm contains some trapped water-as well as starch granules which serve as food  for the germ when it sprouts.

Anatomy of a kernel

When heated to above 180°C this trapped water expands into steam, building up pressure inside the pericarp. This steam transforms the soft starch grains in the endosperm into gelatinous material, making it softer and more pliable. When the pressure builds up to above 930 kPa, the pericarp ruptures thus releasing the steam and gelatinous starch (basically turning the kernel inside-out) that solidifies when cooled.

 

So that’s what’s happening in the microwave, but when does the familiar popping sound occur? A study carried out by two French physicists shows the sound is caused by the release of the water vapour. The sudden change in pressure when the steam escapes causes the cavities in the kernel to vibrate and produce that ‘pop’ sound. The researchers also found out why popcorn flies about whilst being cooked, and it’s not actually due to the pop sound. From the ruptured pericarp, a ‘leg’ shaped structure made of starch forms which is compressed under the heat, and then propelled into the air by the ‘leg’ as it expands. The shape of this jump actually mirrors the movement of a gymnast doing a somersault!

 

Popcorn is the only grain in the corn family that pops when heated in this way, but we all know that not every kernel does pop. At the bottom of every bag of popcorn, there’s a handful or less (if you’re lucky) of unpopped popcorn kernels, but why? To start, the optimum percentage of water in kernels for best popping is 14%. Any lower, and the kernels are smaller and fewer will pop. Most popcorn is harvested in the autumn with a moisture level of 16-20% but are then dried out by forced air to reach that optimum level.

Another thing to think about is the structure of the pericarp. In a study comparing 14 different genetic varieties of popcorn they found that best popping kernels had a stronger, more ordered crystalline structure of cellulose (which is what the pericarp is mostly made up of). This is because during heating, the pericarp acts as a pressure cooker that locks the steam inside the kernel until enough pressure builds up for the kernel to rupture and pop. The researchers showed that the stronger crystalline structure tended to maximise moisture retention, leading to a more complete rupture and fewer unpopped kernels. How this information can be used to ensure that we find fewer kernels at the bottom of the bag isn’t clear, but possible techniques include selective breeding of the best kernel varieties or genetic engineering of the corn plant.

 

Regardless of those few disappointing kernels, popcorn is one of the world’s favourite snacks with some nutritionists calling it a perfect snack food because it is whole grain, a source of fibre and low in fat. It also has more protein that crisps gram for gram and is a great way to stave off hunger cravings as it’s mostly air. So treat yourself with this fabulous snack and listen out for that snap, crackle and most importantly: pop!

 

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The Immeasurable Weight of Music

January 27, 2017 in Everyday Medicine

 

Piano

I feel confident in saying that music is part of everyone’s lives and for many it plays a big part. Playing, producing and writing music brings enjoyment to those who do it and to those who listen and there are so many different types that you are sure to love at least one. I’m sure everyone has heard the theory ‘Mozart makes you smarter’ but there are actually a multitude of proven effects that music has on your brain and body, and I’d like to fill you in on them…

 

Medically, music can be used as it’s own form of treatment as it can reduce pain, blood pressure and boost immunity. Listening to music has been known to reduce pain from a range of conditions including arthritis. Part of this could be thanks to the endorphin release caused by music which counteracts the pain, but another fact is that music distracts and relaxes patients thus making the pain less predominant in the patient’s mind. This tends to work best if the patient listens to their own preferred music, whatever that may be, meanwhile playing relaxing or classical music is necessary to reduce blood pressure as well as slow breathing and heart rate.

Research shows that listening to music with a repeated 10-second rhythm results in a lower blood pressure. Examples of such music include Beethoven’s symphony no. 9 adagio from the 3rd movement or Schubert’s Ave Maria in Latin (translations change the pace and rhythm). Other research shows that by playing such music for 30 minutes everyday, people with high blood pressure can ‘train themselves’ to have a lower blood pressure. In this case, using rock, pop or faster classical music has no effect on blood pressure, and could even cause an increase. Whilst you may be unexcited at the prospect of having to listen to classical music, this would make further introduction of music therapy in medicine very simple as it wouldn’t need to be tailored to each patient.

Studies also show that listening to music can boost your immune system. Scientists found that after listening to 50 minutes of happy dance music, the levels of antibodies in the 300 test subjects had increased and cortisol levels (which can weaken the immune system) had decreased. However, the researchers didn’t test the affect of different music genres on immunity, so listening to your favourite music (if it’s not dance) could boost immunity just as much as dance music might.

 

Now here’s a fun tip which might’ve been handy to my mum 16 years ago, as it could’ve saved her quite a few sleepless nights. Playing music to your babies before and after childbirth could make them fall asleep in those testing first weeks. In 2001 the University of Leicester’s Music Research Group followed a group of mothers who played the same piece of music to their babies during the last trimester, and found that the babies could recognise that same music up to 12 months after being born. As a result when mothers played the music, the babies would fall asleep faster and sleep longer than babies who didn’t hear music.

As for intelligence, scientists aren’t 100% sure that ‘Mozart makes babies smarter’ but music does have the power to enhance reading and literacy skills, mathematical abilities, emotional intelligence, creativity and memory. Music with a 60bpm beat pattern, such as Mozart and Baroque music, activates both sides of the brain. This maximises learning and your ability to absorb information. Plus, listening to the same music that you learnt/revised with (or ‘playing’ the songs in your head) helps you to recall information- although this only works if the music doesn’t have words.

Learning to play music can be even more beneficial, as there is evidence that musicians develop a better memory than non-musicians and when playing music both sides of your brain is engaged, making the brain more capable of processing information. One study showed that children that had been learning to play an instrument for three or more years performed better in fine motor skills and nonverbal reasoning. What’s more, a recent study at the University of Montreal has revealed that musicians have faster reaction times, performing on average 30% better than non-musicians. This leads us to believe that people that have played an instrument for a long enough time may be safer drivers due to these faster reactions. That said, another study has been done to show that when people listen to their choice of music as opposed to silence, drivers make more mistakes and drive more aggressively so perhaps music lovers don’t have the upper hand on the road.

Now, back to the listening of music. Anyone with writer’s block might want to try listening to music at a moderate noise level to improve creativity. The volume is important because the ambient noise increases processing difficulty, which stimulates our brains to think more abstract and creatively.  However in high noise levels, creative thinking is impaired and we struggle to process information.

Alternatively, you can crank up both the volume and tempo when trying to get a good workout. Music improves athletic performance by combatting fatigue, and improving motor coordination. In the same way that music can distract you from chronic pain, it also helps reduce the feeling of fatigue so that you can push through the pain and exercise longer and harder.

And after an optimal workout, you can use music to beat insomnia with Bach. Many people suffering from insomnia find that Bach music helps them, and research shows that just 45 minutes of relaxing music before bed can make for a restful night. Why? Relaxing music reduces sympathetic nervous system activity, decreases anxiety, blood pressure, heart and respiratory rate and promotes relaxation of tense muscles.

 

I’m sure that everyone knows of Albert Einstein to some degree, but a perhaps less well known fact is that music was the key that helped Einstein unlock that potential. Having done poorly at school and being advised to take a manual labour job, Einstein’s parents bought him a violin and Einstein himself claimed that the reason he was so smart was because he played the violin. He loved the music of Mozart and Bach the most, and a friend of his said that the way Einstein figured out his problems and equations was by improvising on the violin. I think that puts the power of music into some perspective, and is pretty inspiring.

To finish, whilst most studies look at the benefits of listening to classical music in particular, I would say that every music genre can be valued for it’s positive effects on listeners, even if it’s effects are as seemingly simple as making someone happy.

 

In addition to this week’s blog, I’ve also put together a table of supposed traits linked to different music genre fans. I’m curious to see if this information is any good, so why not compare yourself to your ‘assigned’ traits and comment to let me know if it’s accurate or not?

 

Self-esteem

Creative

Outgoing

Gentle

At ease

Hard-working

Pop

⬆︎

⬇︎

⬆︎

⬆︎

⬇︎

⬆︎

Rock

⬇︎

⬆︎

⬇︎

⬆︎

⬆︎

⬇︎

Soul

⬆︎

⬆︎

⬆︎

⬆︎

⬆︎

Indie

⬇︎

⬆︎

⬇︎

⬇︎

Classical

⬆︎

⬆︎

⬇︎

⬆︎

Jazz/Blues

⬆︎

⬆︎

⬆︎

⬆︎

⬆︎

Dance

⬆︎

⬆︎

⬇︎

Opera

⬆︎

⬆︎

⬆︎

Country

⬆︎

⬆︎

Rap

⬆︎

⬆︎

 

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