Volunteering – what to expect and my experience so far.

I have recently managed to secure a place volunteering in a care home very close to where I live. The process of trying to get a place volunteering has probably taken me around 3 months since the initial email with myself visiting about twice a week in order to try and spur them on. Although it has been a pain to organise, I have enjoyed every aspect of the care home and it has provided me with a first-hand insight into the level of care that all workers there have to provide.

Currently, I am doing a few hours a week with the intent of moving up to around 5 hours in the summer holidays. Before this, I had never worked or even been a care home, with both grandparents being completely independent. Due to this, I had no real idea what to expect and I was completely reliant on the experiences of those around me to guide me. Beginning work in the care home, for me anyway, was very daunting, I entered the front door and was greeted with a vast array of names of job roles to learn. However, soon my nerves dissolved as those around me were extremely welcoming and very friendly.

Due to my age, I am not allowed to get involved in the personal care of any residents; nor can I help them get up or sit down due to the varying condition of the residents and certain restrictions that inhibit me doing so. My job is to make cups of tea, talk with the residents, observe medical rounds, ensure everyone has what they need. My favourite job to do is to take the blood pressures, pulses and the oxygen saturation of the residents (A senior care member is always present and all measurements are electronic due time constraints). This, in particular, has been the most valuable part of the job as it involves me having to adapt to each of the residents’ needs, whether it be they are deaf or blind, I have to inform them of what I need them to do. This really allows me to work first-hand with people of varying cognitive and physical abilities. Although at times this can be challenging due to certain residents’ conditions, I thoroughly enjoy the chance to work with residents and make sure they feel comfortable while I take the readings.

I think one of the big stigmas that people have towards care homes is that many believe they are quite lonely and dull places. However, one thing that has really struck me is that, although many of the residents are old and have many medical conditions, they all still have smiles on their faces and happiness still exists within. Another one of my favourite jobs is just sitting down and talking to one of the residents. This always puts a smile on my face as many delve into their pasts and tell me the stories of their childhood and all their happy memories. They also ask me how my life is and I always get asked how school is and if I am well behaved at school. What I love the most about these conversations is the sheer gratitude that the residents have that I have taken the time to speak to them, it is experiences like this which really brighten my day and make me love volunteering. I have learned from these experiences to cherish the good things in life so that further on in life I can think back to all the good times.

The care home I volunteer at has both residential and nursing home residents. This means that within the care home there is a wide range of conditions with residents at varying stages of illnesses. Although I have had experience of observing patients with Alzheimer’s disease, I had never experienced the level of care required to treat someone with Alzheimer’s. It pains me to see the decline in cognitive function of that the residents have undergone but I feel it has provided me with invaluable experience of how damaging the disease is. In care homes, it is expected that residents will come and go. This has taught me to show compassion without developing any emotional attachment to the resident, which is proving quite hard. It has further shown me the importance of improving the lives of those in the care home, even if only marginally, as at certain stages the quality of their life is more important than how much longer they do live. One resident that has really stuck with me is a patient that is completely immobile, blind, almost entirely deaf and has severe dementia. The reason she has stuck with me is that she showed me how destructive these diseases can be, which really spurred my inspiration to become a doctor and maybe prevent such conditions by diagnosis and early treatment.

Through the care home, i have learned how to adapt to different scenarios and the how much of an affect many of the conditions, mentioned previously, have on a person’s quality of life. I am thoroughly enjoying my time volunteering and always look forward to going there after school. Most of all it has further inspired and fueled my desire to study medicine.

I would definitely recommend volunteering in a care home or with the elderly to anyone as I have seen how beneficial it is to those that receive the help and attention.

Dangers of UV light.

As many of you will not be aware, May is ultraviolet awareness month. This is to try and make people conscious to the risk that UV light rays pose to your eyes. UV light increases your risk of cataracts and cancers of the eye especially in high-risk patients.

Ultraviolet radiation, such as sunlight, is absorbed by the lens of the eye. It can cause chemicals called free radicals to form inside the lens. Over time, free radicals may damage the lens. This can cause cataracts.

The human eye is constantly exposed to sunlight and artificial lighting. Light transmission through the eye is fundamental and required for it to focus. However, exposure to the intense ambient radiation can pose a hazard particularly if the subjects is over 40 years of age. This radiation exposure can lead to impaired vision and short-term or permanent blindness. Ultraviolet light induces cataract formation and are not necessary for sight. Ultraviolet radiation is also a risk factor for damage to the retinas of children. The removal of these wavelengths from the spectrum will greatly reduce the risk of early cataract and retinal damage. One way this may be easily done is by wearing sunglasses that block wavelengths below 400 nm (marked 400 on the glasses). These glasses have to be 100% UV absorbent to both UV-A and UV-B and also be a certain shape to prevent any reflected rays entering the eye. It must also be noted that it is best to avoid any un-necessary exposure to UV such as tanning beds.

If you would like to learn more about the month then see the link below:

http://everharteyes.com/disordereyecare/eye-calendar/1027-healthy-vision-and-ultraviolet-awareness-month.html

Barium sulphate in medicine

Barium sulphate is an inorganic compound with the chemical formula BaSO4. It is completely soluble in water, which is a very useful property of the compound. It is also white crystalline solid that is odourless. The white opaque appearance and its high density are exploited in its main applications.

X-rays are very useful within modern medicine to identify broken bones and to diagnose a multitude of conditions. Bones absorb more X-rays than soft tissue because of the Calcium in the bones. The high atomic number of Calcium (20), dramatically increases the photoelectric effect, which is the main mechanism of X-ray absorption by bones. This means that X-rays are not very useful for soft tissue as they don’t absorb many X-ray photons. Therefore, Barium sulphate is used. Barium sulphate is very dense and opaque to X-rays, meaning that the X-rays are absorbed by it. This means that on X-rays they show very clearly on the X-ray.

Barium sulphate is used to help doctors examine the oesophagus, stomach, and intestine using x-rays or computed tomography (CAT scan, CT scan. Barium sulphate is in a class of medications called radiopaque contrast media. It works by coating the oesophagus, stomach, or intestine with a material that is not absorbed into the body so that diseased or damaged areas can be clearly seen by x-ray examination or CT scan. This is where another property of barium sulphate helps it excel in its function. As barium sulphate is completely insoluble in water it will not be dissolved within the human body, meaning that it can coat the entire oesophagus ready for X-ray without having inaccurate areas where it has been dissolved. Barium sulphate is toxic but it is safe to use because it is insoluble (does not dissolve). This prevents it from entering the blood.

Barium sulphate can come as a powder to be mixed with water, a suspension (liquid), a paste, and a tablet. The powder, water mixture and the suspension may be taken by mouth or may be given as an enema (liquid that is instilled into the rectum but must be done by a medical professional). However, the paste and tablet are only taken by mouth. Normally barium sulphate is taken 1 to 2 times before the scan within 2 hours of the scan.

Although very useful, barium sulphate does come with a range of side effects, including:

  • severe stomach pain;
  • severe cramping, diarrhoea, or constipation;
  • sweating;
  • ringing in your ears;
  • confusion, fast heart rate; or
  • pale skin, weakness.

Common side effects may include:

  • mild stomach cramps;
  • nausea, vomiting;
  • loose stools or mild constipation.

Scientists find a new mechanism that causes cancer cells to self-destruct

Cancer is the single name assigned to more than 100 diseases. It is the result of abnormal cells that multiply and spread out of control, damaging healthy cells along the way. Most cancers result in tumors but those that affect the blood do not. Many cancer patients struggle with the adverse effects of chemotherapy, still the most prescribed cancer treatment. These effects include hair loss, vomiting, fatigue and anaemia. However, in some ways, this is an improvement to patients with cancers that can’t be treated.

A newly-discovered mechanism involves the modification of specific proteins that affect the construction and stability of the spindle, the microtubular structure that prepares duplicated chromosomes for segregation into “daughter” cells during cell division.

The researchers found that certain compounds called Phenanthridine derivatives were able to diminish the activity of these proteins, which can distort the spindle structure and prevent the segregation of chromosomes. Once the proteins were modified, the cell was prevented from splitting, and this induced the cell’s rapid self-destruction.

“The mechanism we identified during the mitosis of cancer cells is specifically targeted by the Phenanthridine derivatives we tested,” Prof. Cohen-Armon stated. “However, a variety of additional drugs that also modify these specific proteins may now be developed for cancer cell self-destruction during cell division. The faster the cancer cells proliferate, the more quickly they are expected to die.”

Research was conducted using both cancer cell cultures and mice transplanted with human cancer cells. Furthermore, mice transplanted with triple negative treat cancer cells, currently resistant to available therapies, revealed the arrest of tumor growth.

“Identifying the mechanism and showing its relevance in treating developed tumors opens new avenues for the eradication of rapidly developing aggressive cancers without damaging healthy tissues,” said Prof. Cohen-Armon.

Current research is being carried out with Phenanthridine to see if it has any effect against two forms of aggressive cancer.

This research holds a lot of promise in looking for an alternative method to treating cancer, which is far less damaging than chemotherapy.

Prof. Cohen-Armon has said that “the discovery of an exclusive mechanism that kills cancer cells without impairing healthy cells, and the fact that this mechanism works on a variety of rapidly proliferating human cancer cells, is very exciting,”

He further states “According to the mechanism we discovered, the faster cancer cells proliferate, the faster and more efficiently they will be eradicated. The mechanism unleashed during mitosis may be suitable for treating aggressive cancers that are unaffected by traditional chemotherapy.”

*Note: Phenanthridine is a nitrogen heterocyclic compound that is the basis of DNA-binding fluorescent dyesthrough intercalation.*

My experience of vasectomies

Last Tuesday I was lucky enough to gain some valuable work experience by shadowing a local GP at their vasectomy clinic. I therefore saw it very fitting to make a post about vasectomies and what I saw.

First of all, what is a vasectomy? A vasectomy is a surgical operation intended to sterilise a man. This is achieved by cutting the tubes which carry the sperm to the sex fluid to make semen. This prevents the sperm reaching the female’s egg cells during intercourse and therefore prevents fertilisation.

info-diagram

The vasectomies I witnessed did not involve the use of scalpels, which I was not aware were available. Instead of the use of the scalpel, an instrument it is used which essentially burns its way through the skin. In doing so it also cauterises any small blood vessels and prevents any bleeding.

The patient is initially administered a local anaesthetic into the operation area, which as I was told is the only painful part of the operation but I’m sure a couple of the patients will disagree with me.

During a no-scalpel vasectomy, the doctor will feel the vas deferens underneath the skin of your scrotum and then hold them in place using a small clamp.

The scalpel alternative is then used to make a tiny puncture hole in the skin of the scrotum. A small pair of forceps is used to open up the hole, allowing the surgeon to access the vas deferens without needing to cut the skin with a scalpel. The tubes are then closed in the same way as in a conventional vasectomy, either by being tied or sealed.

What also surprised me during the operation was the fact that no stitches were needed and once the vas deferent were cut and cauterised the operation was pretty much over. Further to this, what really struck me was how calm the theatre was and how the doctor was able to maintain a flowing conversation with the patient. This taught me the importance of communication with the patient, not only to inform them of what happens but also in order to keep their mind off what is happening.

Overall, this was a very interesting operation to watch and I am very grateful for the opportunity to watch it. On the other hand, I did find myself grimacing at some points when, being male myself, I thought about how it was in the patient’s shoes.

If you would like to learn more then the link below is a good place to start.

http://www.nhs.uk/Conditions/contraception-guide/pages/vasectomy-male-sterilisation.aspx#No-scalpel

Alzheimer’s and stem cells.

Alzheimer’s disease is the most common cause of dementia. The initial effects of Alzheimer’s often include lapses in memory or the inability to say the right words. Over time, symptoms such as confusion, mood swings or memory loss develop and become increasingly severe.

The cause of the disease is still very cloudy, but researchers have found that people affected by Alzheimer’s have an abnormal build-up of certain proteins in the brain. One of these proteins, called amyloid beta, clumps together to form ‘plaques’.

Below you can see an image that I copied from http://www.alz.org/facts/ . Although it may be hard to read, I am sure you will be able to make out some of the key facts and figures.

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Currently, there is no cure for Alzheimer’s, however, there are a range of medicines available that can prevent the progress of Alzheimer’s through the body. Most of these drugs belong to a class called cholinesterase inhibitors. They can help prevent the breakdown of a natural substance in the brain called acetylcholine, which carries signals between neurones.

A lot of money is being invested into the research of Alzheimer’s and the next big step towards its treatment lies in the use of stem cells. The hope is that neural stem cells will be able to be transplanted into the brain of Alzheimer’s sufferers, in an attempt to replenish the neurones in the brain. Although many remain speculative, recent research has shown that the human brain may be more malleable than previously thought.

Another possible approach to stem cell therapies might be to use certain types of stem cells to deliver proteins called neurotrophins to the brain. Neutrophin levels are normally low within Alzheimer’s patients and this does not encourage the growth and survival of healthy neurones.

At present, research is using a certain type of stem cells called induced pluripotent stem (iPS) cells (more can be found about these by clicking the hyperlink). These are created by using already specialised cells and almost ‘reprogramming’ them into other, more useful, cells. This ultimately has the potential to act as a source of cells that are otherwise difficult to obtain, such as the neurons found in the brain. 

So far, scientists have managed to use iPS technology to take skin cells from an Alzheimer’s patient and use them to grow neurones. The lab-grown neurons release the beta amyloid protein that forms plaques in patients’ brains. Furthermore, scientists have used iPS neurones to study the build up of tau protein, which forms the tangles in patients’ brains in Alzheimer’s Disease. Overall, this provides scientists to study and conduct tests on the neurones and gain a greater understanding of how to treat Alzheimer’s.

To conclude, the use if iPS stem cells holds great promise for the future development of preventative treatment of Alzheimer’s. Although there may be no treatment available using stem cells for Alzheimer’s, their use has already provided invaluable information and continues to be a useful resource.

Daily consumption of tea may protect the elderly from cognitive decline

Being from the UK, I am very used to coming home from school and almost instinctively putting the kettle on for a cup of tea. Tea, at least in the UK it is, is used as a means of relaxation and is one of, if not the most, renowned symbol of Britain. But now, it seems that tea is not just a great tasting beverage but also something that has further medical properties.

A cup of tea a day can keep dementia away, and this is especially so for those who are genetically predisposed to the debilitating disease, according to a recent study led by Assistant Professor Feng Lei from the Department of Psychological Medicine at National University of Singapore’s (NUS) Yong Loo Lin School of Medicine.

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A study on 957 Chinese seniors has shown that the regular consumption of tea can decrease the chances of cognitive decline by 50%. Arguably ever better than this, APOE e4 (class of apolipoprotein) gene carriers who are genetically at risk of developing Alzheimer’s disease may experience a reduction in cognitive impairment risk by as much as 86 per cent.

Now you may be thinking that this is only the case for specific tea but research has shown that it is true for any tea that is brewed from tea leaves.

The conductor of the study, Asst Prof Feng stated that, “while the study was conducted on Chinese elderly, the results could apply to other races as well. Our findings have important implications for dementia prevention. Despite high quality drug trials, effective pharmacological therapy for neurocognitive disorders such as dementia remains elusive and current prevention strategies are far from satisfactory. Tea is one of the most widely consumed beverages in the world. The data from our study suggests that a simple and inexpensive lifestyle measure such as daily tea drinking can reduce a person’s risk of developing neurocognitive disorders in late life,”.

He added, “Based on current knowledge, this long term benefit of tea consumption is due to the bioactive compounds in tea leaves, such as catechins, theaflavins, thearubigins and L-theanine. These compounds exhibit anti-inflammatory and antioxidant potential and other bioactive properties that may protect the brain from vascular damage and neurodegeneration. Our understanding of the detailed biological mechanisms is still very limited so we do need more research to find out definitive answers.”

This research provides very promising information on how lifestyle may be able to reduce the risk of cognitive decline.

So, next time someone asks if you want a ‘cuppa’, just remember that every sip may be preventing cognitive decline.

Ultrasound used to measure fluid within the lungs.

Normally, ultrasound is not the go-to way of getting quantitative information about the lungs, which is due to the properties of ultrasound waves. The problem with these waves is that ultrasound waves don’t get great results when travelling through air and, funnily enough, the lungs are full of air. Ultrasound waves do, however, have a reflective nature when meeting pockets of air and this is what is used to calculate the amount of fluid in the lungs.

When ultrasound waves travel through the body, the vast majority of the waves is absorbed by tissue but some returns to the transmitter as reflected waves (echoes). The time taken for the wave to return and also monitoring the waves that do return can be a helpful insight into the tissues of our body and how far they are under the surface.

When ultrasound hits air, unlike with tissue, it is completely reflected and that is why ultrasound is not useful for imaging the lungs. This was the case until a team of scientists lead by Marie Muller found a way to use the waves effectively (in respect to the lungs).

When ultrasound waves hit pockets of air in the lungs, or the alveoli, they scatter. These scattered waves are likely to further hit more air pockets, further scattering them. This cumulatively means that the ultrasound echo takes much longer to return that normally observed. No two ultrasound waves take the same path, some may reflect in one direction and another may do quite the opposite. By looking at the echoes, and how they change, Muller and her team were able to get quantitative data as to what extent the air spaces were filled with fluid.

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The above shows how ultrasound is normally used.

The technique makes use of conventional ultrasound scanning equipment, though the algorithm used by the researchers would need to be incorporated into the ultrasound software. Regardless of that, this method would be relatively simple to implement into the conventional ultrasound departments of hospitals.

The technique, overall, offers a non-invasive way to track progress in treating pulmonary edema (i.e. fluid in the lungs), which often occurs in patients with congestive heart failure. The approach, which has been demonstrated in rats, also holds promise for diagnosing scarring, or fibrosis, in the lung.

Korsakoff’s syndrome – ‘Alcohol induced brain damage’

The Man Who Mistook His Wife for a Hat – Oliver Sacks

Recently I have been reading the book titled above, which has sparked a lot of interest and provoked a lot of thought for me. The book provides detailed accounts of patients with bazaar and often rare neurological disorders. Neurology and the disorders of the brain have always been of great interest to me, inspiring me to research into conditions affecting the brain. What attracts me to conditions of the brain is the fact that often they remain almost hidden within a person and are almost impossible to diagnose by just looking at a patient. In order to treat a patient with a neurological disease you must first, very closely, observe their behaviour and listen to every single word they say as it may provide a little hint towards what they are suffering from. This truly interests me and the process of application of knowledge to form an overall conclusion to help a person is one of the main reasons that I would love to go into medicine.

In the second chapter of this book Sacks speaks of a patient who at first seems perfectly normal but had a very sinister underlying neurological condition. When speaking to the patient it soon became very apparent that they were suffering with very severe memory loss as within minutes the patient would forget who were they were talking to and why they were there. What amazed me was that even with the short term memory loss, the patient’s general kind and happy demeanour was perfectly preserved from when they first began to suffer, as though nothing with them had changed. This leads on to the next part of the story. When questioned, the patient knew nothing of where they were and how they had come to be there, their last known memory being that of sailing with the navy during the war. However, this patient had not been in the war for many years and was now of age and physically very different to the person who had been on that ship. Although there were many attempts to try and convince the patient that it was no longer 1943 as he believed, nothing  would sway him away from what his mind told him. If they were told anything different then they would become very disorientated and the questioning would have to stop.

So what caused this patient to be trapped perpetually in the year of 1943? The answer lies in his habit of drinking and having a good time during his time in the navy. Sack’s diagnosed the patient with Korsakoff’s syndrome, which I decided to research to find out more about the condition.

What is Korsakoff’s syndrome (KS) and what is it caused by?

Korsakoff’s syndrome is a syndrome often seen within alcoholics and only about 20% of people with the syndrome are diagnosed with it before their death. It is caused by the central nervous system being exhausted of vitamin B1. Thiamine, also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. The human body itself cannot produce thiamine but must ingest it with the diet. Lack of it causes vision changes, uncontrollable muscle movements (ataxia) and memory impairment, which our patient, mentioned previously, suffered from.  As a result of so many not being diagnosed with KS, many with the syndrome suffer long term brain damage.

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Our patient developed Korsakoff’s syndrome as a result of his alcoholism, leading to a deficiency of thiamine. The thiamine is usually used for certain chemicals in the brain that mean the brain can no longer function properly, resulting in KS and his perculiar case of his mind being  encapsulated in the past.

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What can be done to treat it?

The memory loss component of KS is unfortunately untreatable and no medicine can help. However, injection of thiamine into the veins of a suffer can help to reduce the symptoms of confusion, restricted eye movement and reduced muscle co-ordination.

Overall I am finding this book highly interesting and I would definitely recommend it to anyone interested in neurology. For those interested you can get a copy below:

https://www.amazon.co.uk/d/Books/Man-Who-Mistook-His-Wife/0330523627#productDescription_secondary_view_div_1485561515958

Motor Neurone Disease

As I’m sure many of you who sat down to watch the Six Nations rugby tournament this weekend will be aware of the untimely passing of Joost van Der Westhuizen. In short Joost was a South African number 9, who played 89 test matches over his career. Unfortunately, on Monday, at the age of just 45 he lost his battle against Motor Neurone Disease. This inspired me to create a post on the horrible disease which he suffered from.

First of all, what are motor neurones? A motor neurone is a nerve cell, which is located in the spinal cord of humans. These cells are essentially the cells that allow our brain to control muscle contraction and relaxation. Without them, we would be completely immobile. There are three types of motor neurone: alpha, beta and gamma.

MotorNeuron

Motor Neurone Disease (MND) is a rare condition that progressively damages the motor neurones in the body, causing a slow deterioration in a person’s ability to carry out everyday physical activities. Motor neurone disease, also known as amyotrophic lateral sclerosis (ALS), which causes neurodegeneration and affects 2 in 100,000 people in the UK a year. The most widely known symptoms of MND are a: weakened grip of objects; inability/struggle to raise arms above the shoulders; struggle to speak, resulting in slurred speech.

As damage progresses, symptoms spread to other parts of the body and the condition becomes more debilitating.

Eventually, a person with motor neurone disease may be unable to move. Communicating, swallowing and breathing may also become very difficult. This can be seen in the case of Stephen Hawking who is completely reliant on technology.

In up to 15% of cases, motor neurone disease is associated with a type of dementia that can affect personality and behaviour. This is called frontotemporal dementia, and is often an early feature when it occurs in motor neurone disease. The affected person may not realise that their personality or behaviour is different.

Unfortunately, there is currently no cure for this disease but there is a lot of research into understanding how the disease can be combatted. Overall the disease is extremely life-shortening and most patients die within 3 years of being diagnosed with some living up to years after diagnosis.

Hopefully this helps you understand what patients with MND and the family around them have to deal with. This is a horrible disease that ultimately leaves a person mentally stable but physically unable to move.