The growing problems of Heart Disease and advancements into solutions?

Hi guys, it’s Jarred for another blog post. Firstly, I am soon to go on a residential to James Cook Hospital in Middlesbrough, where i’ll be participating in not only the shadowing of many different Doctors and specialties, but also learning many clinical skills and useful bits of knowledge! I am really excited for this, so I’ll give you a run down on it after I have visited. But now, I was looking at the Health section of BBC news, and found as the headliner an interesting advancement in Cardiology. Hence, today, I will be talking about the specialization of Cardiology, the problem of heart disease and the advancement that I saw (along with other essential medical health methods).

So, firstly, two simple definitions to set up for the detailed information: A tissue is a group of specialized cells working together to perform a similar function, and an organ is a group of specialized tissues that work together to perform a particular function. These two together describe the basic anatomy of the heart, in that of the fact that the heart is an extremely important organ in the body, created from cardiac tissue. Now, the function of the heart is to act as a pump to push blood around the body under pressure (to supply the cells with oxygen), hence being a main organ in the body. The fact that the heart is made from cardiac tissue is really useful, as cardiac tissue is a special type of tissue that is known to be myogenic- as it can create it’s own electrical excitation (hence can beat without impulses from the brain). So, the heart is made up of 4 chambers, the right and left atria and ventricles, with the right and left side being separated by the septum, and the atria and ventricles being separated by the atrio-ventricular valves. Finally, on the structure of the heart, the heart functions with waves of electrical excitation that are produced in two pacemaker nodes (SAN- Sinoatrial node, and the AVN- atrioventricular node), these cause the contraction of both the atria and the ventricles by traveling down the conductive Purkyne fibres, hence being the reason for the heart acting as a pump, and why it is able to squeeze blood around the body.

Now, the heart can malfunction in many different and varied ways, with most of the consequences being fatal. The main ways that this can happen are:
1)Changes in the rhythm of the heart beat (eg. due to changes in the impulses) causing abnormal rhythms.
2)Damaged valves.
3)Blockages in the arteries surrounding the heart (eg. coronary or pulmonary) causing Heart Disease.
So firstly, the heart beat can be shown by an ECG (electrocardiogram) which shows the electrical activity of the heart, and hence, they can also be used to identify arrhythmic heartbeats. Now, arrhythmic heartbeats can be anything from too fast (Tachycardia- caused by either exercise, or by disruptions in the activity) to too slow (Bradychardia- which can sometimes be found in professional athletes, or when the electrical activity is not as often). It can also include ectopic heartbeats – which are random extra heartbeats or missed ones – and even atrial/ventricular fibrillation, which is the random, irregular contractions of either of these chambers. Now, some of these can be harmless, but more than often they can cause problems, so treatment is necessary.
The next problem with the heart tends to be damaged valves. So, there are two types of valve damage: valve stenosis (the valve doesn’t open properly) which results in partial blockage and restriction of blood flow, and valve incompetence (the valve doesn’t close properly) which results in leakage and therefore extra strain on the heart. The causes of this damage, are cardiomypathy (thickness and stiffness of the walls), general aging of the heart tissue, damage of tissue due to heart attack etc.
The final huge problem is Heart Disease! This is also known as coronary heart disease, as it is caused by the blockage of the coronary arteries, which supply the the heart with blood and oxygen, by fat and cholesterol. The fatty substances will continue to build up, into what is called an Atheroma/plaque, by a process known as atherosclerosis. This causes a huge problem, as it narrows the blood vessel, reducing the amount of blood and consequently the amount of oxygen getting to the heart tissues. Hence, the heart muscle can end up dying (or partially dying), or an even bigger problem can occur, a Myocardial Infarction- heart attack. This is serious, as it can be fatal. Now, the original build up of fatty substances is down to many reasons: smoking, hypertension, high cholesterol levels and diabetes. So, to reduce the chances of CHD, lifestyle changes could occur.

Now, problems with the heart are some of the hugest killers in Britain, with it, “being the number 1 killer in Britain.” So extensive help and treatments are developed to help/prevent the diseases. Firstly, Angioplasty can be used, this is basically the use of balloons and stents to widen blood vessels and arteries. This will help increase the amount of blood reaching the heart, but requires invasive surgery. Next, artificial valves can be fitted in patients hearts who have damaged ones. These will perform the exact same function as normal valves, so are extreme life savers, however again, they require invasive open-heart surgery. In addition to these, a common treatment for arrhythmic heartbeats is either medication (which helps control it), a pacemaker- which is used in controlling the rhythms by producing electrical excitation to help. Finally, Cardioversion is used. This uses a defibrillator to shock the heart carefully, to attempt to restore normality. Now, advancements are constantly being made in methods of treatment for heart problems and one that I recently saw in the news was called the MiniVAD (VAD=Ventricular assist device). Now, this is aimed at starting clinical trials in 2018, and is one of the first heart pumps to not cause damage to the blood it pumps. The VAD will be fitted into seriously ill patients who have failing hearts, hence allowing it to take over the function of the heart. Therefore, you can see that this is clearly very important advancement in medicine, as it has the potential to save many lifes, by being the first fully automatic and non-damaging pump.

In conclusion, I believe that heart problems, due to their frequency and high death rate, are an extremely important part of medicine and the medical community. They make up a huge number of surgery patients due to different treatments that can be used, especially the open-heart surgery that can often be used. Advancements in the area of Cardiovascular treatment is something that should, in my opinion, be of a priority as it will be an increasingly big problem over the years.

Cheers guys for taking the time to read this and i hope you can see what a huge problem this is and appreciate the complicated science behind it.
Thanks, Jarred.

First Aid, Emergency Medicine and the situation we’re in!

Hey guys, Jarred again for another blog post. So as I said last time, I was to attend a first aid cause, and I did! It was an enjoyable night, and very informative for me, covering tons of procedures like: CPR (cardiopulmonary resuscitation), the recovery position, what to do if someone is choking and the signs of a heart attack. The evening used a series of videos followed by examples (from the man who hosted the course, who came from the charity FastAid, which is a valuable and deserving cause) and practicals, which made it extremely interactive and useful. This was so useful for my aspiration, as it is a perfect starting skill set to have and understand for a Doctor. However, this isn’t just some aside about WEX, but it also links in with todays topic; Emergency medicine and fast response to medical problems. Now, there are many aspects to emergency medicine, from fast response ambulance services to emergency Doctors in A&E departments in hospitals; this post will talk about what each aspect deals with, their methods and problems they face…

Firstly, what is the emergency branch of medicine: this is where Doctors or paramedics carry out the immediate assessment and treatment of patients who are critically ill or severely injured. These problems can range from injuries sustained in accidents to sudden illnesses like a heart attack or long-term but priority illnesses like cancer. Firstly, I shall address the process of a first response to a sudden emergency, the ambulatory emergency care service (also known as the ambulance service). So, the ambulance is called out to an emergency after a dial has been made to 999, if the accident or illness is seen as high enough concern. They often deal with problems which can be split into one of either trauma or medical. Trauma problems often include physical injuries, so car crashes, stabbings and brawls are among the main causes of an emergency call. With medical, incidents often include heart attacks, strokes and repercussions from shock. The method for the ambulance service uses a priority, coded, system: Category A Red 1 (no pulse and not breathing) will be responded to in 8 minutes, Category A Red 2 (strokes or fits) will be responded to in 9 minutes and with all other calls being handled in an average of 16.3 minutes. The methods deployed by paramedics at the scene will include CPR (Used when the patient no longer has a pulse in an attempt to prolong time before permanent brain damage), actions including those that stabilize bones (e.g. body boards and braces), administration of Intravenous fluids (IVs) and applying bandages to wounds in an attempt to stop serious bleeding. From this, we can see that emergency first aiders and paramedics provide a very useful first, emergency response to problems. The next step in the emergency treatment of patients are Accident and Emergency Departments at most hospitals, where seriously ill patients are taken by ambulances or even by people themselves. Here, nurses, paramedics and doctors trained especially in emergency care will be put in charge of your welfare, attempting to treat you to the best of their ability (there are often Consultant Doctors who oversee the whole team at the top of organisational chain). At A&E, they often treat a huge variety of illnesses and damage, with many physical problems such as severe bleeding and burns, persistant chest pains and allergic reactions, going hand in hand with problems like a loss of consciousness or acute confused states. These problems are all extreme emergencies, so the methods used are a huge variety, often corresponding with the problem in hand, so are hard to pin down. However, the patient will be assessed, and any treatment needed will follow.

So, what problems face these emergency services? Well, ambulance services face two major problems: 1)Major demand pressure while funding is cut and 2)Problems and violence at scenes of accidents. Problem 1 is a huge problem facing not only the ambulance service, but also the NHS as a whole (which I shall talk about in a later blog), as it means too little ambulances crews for too many emergency situations. There are purely not enough resources to go round, meaning that the ambulance crews often cannot reach incidents on time, or not at all. They are attempting to amend this by reducing the number of high priority calls, changing patient destinations and seeing what differences can be made to on site care, in an attempt to reduce time taken at emergencies and help with the major problem. Problem 2 however is more of a direct problem. Violence and hate towards ambulance crews is on a rise, with stats showing that the risk of non-fatal assault resulting in lost work time among paramedics is 0.6 cases per 100 workers a year; where the national average is about 1.8 per 10,000 workers. This cannot be allowed to happen, as those that are trying to save us are getting abused, putting them off their job and causing animosity. Next, the A&E department also face huge problems, with the main one being, yet again, too much demand and pressure on the service. The College of Emergency Medicine believes that 15%-30% of patients could be treated elsewhere, showing that over demand for A&E is a huge problem. There are not enough places, Doctors and resources to treat the huge number of patients which, according to Health Minister Anna Soubry,”have grown by a million in the last year.” Implications such as redirection of money and addition resources are being made in an attempt to solve the problem.

In conclusion, as you can see, the Emergency care and response that the NHS put out and support use a huge variety of methods, applying them to a massive diversity of problems and tasks. However, they face tons of problems, that, clearly are hard to solve. As you can tell, this is a huge part of a doctors life, and an important part of medicine, which will change greatly in the future.

Thanks for reading, I hope I have opened your eyes to something today, and you have learnt something.
Cheers Jarred.

Will a possibility to cure Parkinson’s Disease ever arise?

Hey guys, Jarred back again with another blog post. But first, an update. I recently secured myself a WEX placement at a GP surgery, which will be coming up towards the start of May! I look forward to recounting my experience and anything I learnt there for you, so look forward to that blog. However, today’s blog topic will be (if you didn’t guess from the title) about Parkinson’s Disease. This is a disease that I am familiar with due to my Nan suffering of it throughout her life, so is why I am writing about it. I’ll start with a brief overview: what it is and it’s symptoms, go on to explain in detail about it and why it is currently incurable and finish with the developments in the field. Here we go…

To start with, a definition: Parkinson’s Disease- Parkinson’s is a progressive neurological condition causing problems in the brain whilst progressively worsening over time. In other words, it is a disability which damages the brain throughout life. Parkinson’s is a disease that affects up to 5 million people worldwide, hence is a great concern and high priority to researchers everywhere. The illness manifests itself in a variety of symptoms -all of which relate to the mobility of a person- with common examples being reduced movement (e.g. through stiffness and slowness), shaking (tremors) and even smaller symptoms (usually to start with) like reduced size of handwriting. These symptoms will in most cases reduce the quality of life in many sufferers points of view, as they debilitate and affect them. Examples such as Helen Mirren (whose friend suffered) who said,”The difficulty facing people with it is that they never quite know ‘can I or can’t I do this today'” and Michael Fox who said,”I don’t have a choice whether I have Parkinson’s or not, but surrounding that non-choice is a million other choices I can make…” show the widespread effects of Parkinson’s and how it effects those that it does.

What causes Parkinson’s Disease? Well, the reason for the symptoms of it are due to the death of some very significant cells in the brain; the dopamine producing cells (found in the Substantia Nigra). The dopamine produced by these cells is extremely important in that they coordinate movement of the body from the brain by acting as messengers. Therefore, if the cells producing this are dying, then less dopamine is produced and movement is limited. It is unknown what damages and kills the cells, but the lack of them is the problem, so is what is trying to be solved. Whilst there are drugs and treatments -such as supportive therapy, levodopa and deep brain surgery- which have a chance of reducing symptoms, the actually illness is currently incurable, due to the unknown cause of death, and tricky position of the problem. Hence, extensive research is being done into cures. New and advancing developments are arising which show promise in curing the incurable. Recently, scientists have found that some cells already present in the brain can be programmed using a cocktail of drugs into becoming near-identical cells to dopamine producing cells. This is still in the early stages though, and although shows promise may not be viable. However, one of the scientists, David Dexter, who discovered this said, “If successful, it would turn this approach into a viable therapy that could improve the lives of people with Parkinson’s and, ultimately, lead to the cure that millions are waiting for.” So could this advancement be viable… Another recent advancement is the finding of 2 current drugs (an antidepressant and trial cancer drug) which slow the process significantly. This is being hailed a major breakthrough with Professor Mallucci reporting, “We could know in 2 to 3 years whether this approach can slow down disease progression, which would be a very exciting first step in treating these disorders.”

In conclusion, I believe that in the future, this currently incurable disease will have been advanced in hugely as a well-researched and important field in Biology and Medicine. The prospects of a cure are greatly increasing, and this field will become a must watch.

Thanks for spending time reading this, and I hope you enjoyed and now feel educated,
Cheers, Jarred.

Orthopaedics and Fractures

Hi all, it’s Jarred back again for a blog post. As you guys know, I went on work experience last week at the local hospital, New Cross, where I attended the Fracture and Orthopaedic clinics. Whilst there, I experienced so many different opportunities, and enjoyed all of them immensely. One of the main things I did was observe the plaster technicians as they did their work on patients who had been sent with injuries. I learnt tons of different types of casts/splints, such as a blackslab (which is used as an emergency A&E cast as temporary immobilisation), posterior casts (the general type of casts used to relieve pain and immobilise) and gutter casts (which tend to include two or more fingers). On top of this, they taught me of the different materials that casts can be made from: plaster of paris, Fibreglass and synthetic plaster. All of these have different benefits to being used. Plaster of Paris is cheap, solid and perfect for regular breaks. Fibreglass is extremely hard, so useful to make weight-bearing casts, whilst also perfect for immobilisation. Finally, synthetic soft cast is beneficial as it does not turn solid. This means that it is much lighter, and also better for use with kids, as it can be cut off instead of using a plaster saw to cause less distress.

In addition to observing the plaster technicians, I also sat in on two types of clinics ran by the orthopaedic Doctors, the trauma clinic and the review clinic. In the trauma clinics, the Doctors will see patients who come in with new injuries – often from A&E – which need clinically examining, assessing, a diagnosis made and treatment decided on. During this I saw many different injuries (which I’ll mention later) and started to learn how to interpret X-rays, which personally I found extremely interesting and it piqued my interest. What happens next is a prime example of how a multidisciplinary team works within a hospital. The patient tends to come from the A&E Doctors and will see Doctors who will diagnose them. They are then handed off to a nurse for minor treatments (like splints or wound treatment), the nurse will then pass them on to the plaster technicians for any complex casts etc. Often here, the clinic Doctor will come back in to check on the patient, and they are then sent to another team to get an X-ray. From there, the Doctor will interpret an X-ray and the patient is either let go, or a porter is called to transport them… Now, as you can see, this process involves 5/6 different types of staff (often with multiple of each) so is clearly an example of good teamwork as the patients are treated successfully, and also of excellent communication, as the same patients information goes through many people and everything goes smooth! In the review clinics, patients are seen who have previous injuries that need checking, or have been operated on and the work needs checking. These were very interesting, as I got to witness the after-care of patients by the Doctors, and was able to identify the more relaxed but attentive attitude the Doctors had with the patients.

Now, there are two cases that I saw whilst there that I’d like to mention: a case of Carpal Tunnel (which I researched and was intrigued by) and also a scaphoid fracture (which is extremely rare). Firstly, what is Carpal Tunnel? Well, this is where the nerve in the wrist (median nerve) is being pressed on by something, so there is a lot of pressure on it. The most common causes of this are underlying medial conditions, such as swelling, diabetes and high blood pressure – although trauma to the wrist is also a frequent cause. Now, carpal tunnel syndrome has some rather annoying symptoms: a weak thumb and grip, tingling in the fingers and a burning sensation in the arm, which can all contribute to an overall debilitation of the the arm, as it can be painful and made worse by overextending… Since it can be so awful for a sufferer, it tends to be treated quickly using one main surgical method, or through minor treatments. The first step of treatment is a self-help splint from a shop, but if this doesn’t help, a GP can prescribe steroid injections (eg corticosteroids) to help. However, if all this fails to help, then carpal tunnel syndrome surgery can be used… This involves a local anaesthetic to numb pain, an incision in the wrist and then the carpal tunnel cut to relieve pressure! So, as you can see, carpal tunnel syndrome is rather easy to fix, but a pain to have. So to have seen multiple cases of this in one week, makes me realise how common it is, and reveals to me how interesting it is.

The next case I saw whilst at New Cross was a scaphoid fracture. These fractures, I was told, are very rare in
occurrence. This is mainly due to the fact that they are often missed by the X-ray and fracture Doctors. Scaphoid fractures are notoriously small (hence why they are missed) but also notoriously hard to heal, hence they make for a pretty interesting case. On further research, I have found out why they are so hard healing, in that they have a really bad blood supply – a bone heals with nutrients brought by the blood. Therefore, since the scaphoid is 80% covered in cartilage, the lack of the blood to the fractured part of the scaphoid can mean that it struggles to heal properly. So, when a scaphoid fracture occurs, they can often not heal at all… Due to this lack of visibility, and lack of healing, a clinicians main ideology is to treat for a scaphoid fracture, erring on caution, and hence, the most common treatment is actually to put the hand/lower wrist in a cast. For me, this was a greatly interesting example of a Doctor using deduction and inference skills, to find the fracture.

In conclusion then, I have experienced an absolutely amazing week at New Cross shadowing the Doctors, nurses and technicians of the Fracture and Orthopaedic Clinics/Department, having seen some exemplary team work and multi-disciplinary skills. In addition, I was able to bear witness to two rather interesting problems, and many more on top of that.

Cheers, Jarred.

A worry to all musicians…

Hey guys, I’m back for another blog post. Firstly though, in three weeks time I will be undertaking my final bit of work experience before the UCAS deadline for medicine (which is slowly creeping up on us) at New Cross Hospital, Wolverhampton in the Orthopaedics department. I am greatly looking forward to this, as it is a block placement in which I will spend a huge amount of time with a Doctor, so I will be able to closely watch, shadow, analyse and learn from professionals. Thus, allowing me to learn and experience first hand the skills needed by a Doctor themselves. This work experience will be hugely important and useful to put on my personal statement, and I believe will help greatly.

However, the main topic of this blog is something that has recently affected a friend of mine, and can be in actual fact a huge worry to me as a musician, that I didn’t even know about until recently when my friend was affected. The disorder, known as Dystonia, has many different forms – one of which is the specific one for musicians – but overall is generally defined as, ‘a range of movement disorders that cause muscle spasms and contractions.’ The problem of dystonia is that it causes either random or sustained involuntary muscle movements which can be both painful and disruptive to everyday life, and which are also accompanied by body parts jerking randomly and a twisted posture (further causing a harsh time). Now, there are five different groupings of Dystonia: Hemidystonia (where one whole half of the body is affected), Generalised Dystonia (in which the trunk and at least two other body parts are affected), Multifocal Dystonia (Where two unconnected body parts are affected), Segmental Dystonia (which is where two connected body parts are affected) and finally Focal Dystonia (where only a small specific region is affected). Now, all of these are just as debilitating as the others, but relating to the title of the post, the one that is affecting my friend is Focal Dystonia. Being a musician, fingers and and hands are essential to playing eg. moving hands in drumming or fingers in violins etc. Hence, Focal Dystonia (affecting a specific part) can be a disaster for a musician if it affects the hands or fingers. The person in reality has Focal Dystonia of the hands, where their hands will randomly jerk, hence not allowing them to play their music. Focal dystonia can be caused by repetitive movements of the part affected, thus when say repeating a pattern as a drummer, it can be a great – but relatively unheard of – risk.

Research into Dystonia is always being done, but at the current moment the actual cause of the disorder is not known. The Doctors and scientists who look into Dystonia have managed to learn that it is a neurological problem (thought to originate in the basal ganglia region of the brain) where the electrical impulses are faulty, causing the spasms. The types of Dystonia can be categorised into primary and secondary, where primary is due to an unknown reason, and secondary is where it is caused as a symptom of another illness – like Parkinsons or Huntingtons Disease. Therefore, it can be caused by many different things. Treatments for Dystonia however, are available! They focus on 4 main groups: medication, surgery, physiotherapy and botulinim toxin. Firstly, medication is used to help Dystonia, with common medications being muscle relaxants (for relaxing effected muscles) and anticholinergics (the most successful drug which works by blocking the neurone transmitters for the chemicals causing spasms), while physiotherapy can be used in two ways – pain therapy and speech therapy – to relieve the symptoms. The next treatment is Botulinim Toxin. This is essentially the same as the anticholinergics but as an injection directly into the muscle, preventing the chemical causing the muscle spasms from being transmitted. Finally, surgery can be used to treat dystonia in two ways. Deep Brain Stimulation is a relatively new method, in which an electrical impulse is run through the brain, stimulating the brains electrical activity in the basal ganglia, thus helping reduce muscle spasms – however, since it is so new, there is little data on effectiveness. The other method is used to only cervical dystonia, and is called ‘Selective peripheral denervation’ – this is where the nerves in the spine that attach to the spasm affected muscles are severed.

In conclusion, Dystonia is a very unheard of problem within the community, but in my opinion, can be a really serious illness which can affect someones life greatly. With the small amount of research into dystonia (although research into other nervous illnesses like Parkinsons can contribute) in comparison to other illnesses, I fear that it will take a long time to find a cure. In the mean time, all that people can do is get treatment and find as good of a quality of life as possible.

Thank you reading this blog post, and I hope that you have learnt something new today. I can’t wait to tell you about the WEX next week, and I’ll see you next time.
Cheers, Jarred.

MS as an important illness in society.

Hi guys, Jarred back again for another blog post! First, only yesterday I went on a short work experience placement at the Birmingham Children’s Hospital, where I visited the PICU (Psychiatric Intensive Care Unit) and shadowed a nurse on duty. Whilst there, I observed the patient case of a 30 week old baby with a precious airway who was therefore intubated- many times during my visit the baby ‘Bradyed’ in which his heartbeat dropped very low very quickly before coming back up! Now, this was not necessarily due to his condition be was agitated by it so that every time he was disturbed these moments occurred. The baby will hopefully grow stronger and get better, but the chance he has problems breathing when he is older is very high! In addition to visiting this, multiple Doctors came in during the time, and I had many chats with them about their jobs, what they do and what skills they need and use. This visit was very beneficial to me, as it provided me with another insight into a Nurse’s everyday life – thus that of a NHS Healthcare worker – and also allowed me to acknowledge and understand where to improve myself in order to have the right skills and qualities needed by a Doctor according to one.

Now, the main topic of today’s blog is to be MS – also known as Multiple Sclerosis. Firstly, Multiple Sclerosis is defined as,’ a condition which can affect the brain and/or the spinal cord.’ From this we know that MS affects the nerves (as these are the components of the spinal cord and brain) and obviously does something to them that affects their function. Now, the symptoms of MS are varied by person, but I believe they can be split into physical and mental: the physical problems occurring are vision problems, fatigue, shaking, numbness and muscle stiffness, whilst the mental include problems with balance, coordination and thinking. Now these symptoms are quite clearly debilitating, and they effect a huge number of people with statistics saying that 400,000 people in Britain are sufferers whilst 2.1 million world wide are too! Now, the scientists and doctors who have researched MS are actually still in the dark about what causes it. They have many hypotheses of why it happens, with the major one being that MS is an autoimmune disease in which the body’s immune system attacks and damages the mylon sheath (outside of the nerve cells) of the nerve cell, and potentially damages the nerve underneath- this causes the electrical impulses to either be slowed down, delayed or not sent, hence causing the symptoms of MS. But, as I said before, the doctors and researchers do not know why the immune system does this although much time and effort has been put into researching it.

Treatment for MS is available for the patients, however, the premise of it is to help alleviate the problem and to give them a better quality of life, as at the current moment, there is no cure available (possibly due to the fact that they do not fully understand MS yet). Now, a big part of coping with MS is learning how to live with it as part of your life, so it is integral that the patient keeps up a good self-care scheme. They should also make lifestyle changes like quitting smoking, eating a more healthy and balanced diet and also integrating in regular health check-ups! But, treatments that are available vary hugely in their methods, with the newest and most important being DMTs (disease modifying therapies) including Ocrelizumab. Now DMTs act as relapse preventives as they reduce the frequency of them with Ocrelizumab being stated to – by phase 3 – reduce relapses by 47% and also reduce the number of brain lesions. Thus, this makes it a very important and useful drug in treating MS. However, there are quite a few other new treatments being tested/approved, such as: Laquinimod (which prevents immune cells from reaching the brain), AHSCT (which involves rebooting the immune system-using extremely risky chemotherapy), MD1003 (which hopefully stimulates creation of myelin producing cells) and Siponimod (prevents T and B immune cells from reaching the brain).

As you can see, MS is clearly a big center for research within the scientific community, and for obvious reasons. Currently, clinical trials are a big part of the research being done, so I would recommend watching out for developments within these clinical trials for MS as they have a large capability to either be the route towards a cure, life-saving treatment or life-improving ones.

I hope you have all enjoyed my blog post today – sorry it’s shorter than usual – but I hope I have inspired and informed you to be more aware about MS and will leave you with a quote from patients which will hopefully help raise awareness of MS, “MS symptoms are mostly felt not seen. I might look good, but my body is throwing a fit inside.”
Thanks everybody, Jarred.

Follow-up Residential and Potentially Pioneering Help

Hey guys, it’s Jarred back again for another post finally. I am really sorry for the huge delay that there has been between the last post and this, but I’ve been incredibly busy! In the last post, i mentioned a residential to the James Cooke Hospital, I have now been on that, and can say that I had a marvelous week! It provided me with such an insight not only into medicine as a subject, but into some specialties, clinical skills, and how to apply successfully. A brief over view of the week was: On Monday, we had a career carousel, which was basically meeting many different leading Doctors from many different areas and learning quickly about their jobs. This was hugely interesting and informative, as it detailed to me the pathways I can take in medicine, and actually piqued my interest in becoming a GP in the future. Next, on Tuesday, we attended some clinical skills sessions, and I learnt plenty of essential medical skills eg. first aid, how to use many gadgets such as an ophthalmoscope etc, I practised hand eye coordination for surgery and many other things. Wednesday consisted of a talk from a neurologist, followed by watching live surgery of tonsil removal! Now, both of these helped provide a proper insight into medicine, and I found them extremely interesting. Finally, on Thursday, we repeated more clinical skill sessions, but this time, I learnt how to tie a surgeons knot, how to make a plaster of Paris cast, how to do percussion on lungs to find out if they healthy, and many more interesting and fun necessities of a Doctor. All throughout the week the hosts also put together help sessions on interview techniques, networking and personal statements which were outstanding. I have no doubt that this week spent here (even if you guys only get a brief overview) is going to strengthen my application for medicine profoundly!

Now, the medicine topic for today is Diabetes. I recently went on a music tour to Spain and one of my friends there has type 1 diabetes, which needs constant monitoring. Now this presents quite a lot of challenges and is quite dangerous to the person if not controlled. So during this time, I watched him use a newish, still being tested treatment which I will talk about later, along with a new pioneering treatment that has recently been confirmed safe. But first, what is Type 1 Diabetes? Well, Type 1 Diabetes ‘is a life long condition that causes a person’s blood sugar (glucose) level to become too high.’ In other words, it is an illness in which the person cannot control their glucose levels due to problems with the amount of insulin they have. There are two types of diabetes: Type 1 – which I mentioned earlier – and Type 2, with both having different causes. Firstly, the body regulates blood sugar levels (glucose) by secreting insulin from the pancreas which controls the amount that is used or stored by the body. This means that a problem within this system can lead to an imbalance in either too much glucose or too little… Now, the two types of diabetes are caused by two different problems within the system and have different symptoms etc. Type 1 is due to the pancreas no longer producing insulin at all. Now, more scientifically, this is because it is an auto-immune disease (where the bodies own immune system attacks it’s own cells due to the antigens on the surface being similiar to a pathogens) in which the insulin-producing pancreatic cells are destroyed so that the pancreas can no longer produce any insulin at all! This means that more often than not, the blood sugar levels can get too high if not carefully controlled – as the insulin is not doing it’s job of storing the glucose as glycogen – and can be dangerous. Now, type 1 presents itself in symptoms most commonly like passing urine more often, feeling tired, weight loss and thirst. However, when glucose levels get too low, then a ‘hypo’ can occur. This is short for hypoglycaemia, and is where the diabetic can get shaky, confused, get pins and needles around the lips and many other symptoms. On to Type 2 diabetes now. Type 2 presents when the pancreas does one of two things, either does not produce enough insulin, or even becomes resistant to the effects of it. In the case of these, the person becomes unable to metabolise the glucose, so a huge amount of it will build up, hence causing problems. Many different factors affect this type of diabetes. Factors such as age, genetics and weight can increase the risk of developing it later in life. Type 2 presents itself in many different ways eg. hypoerglycaemia (extremely high levels), unexplained wight loss and many other similar factors to Type 1.

So far, diabetes has many different treatments that can be used; however, there is no cure yet (but I will later briefly talk about a pioneering opportunity)! For Type 2 diabetes, one of the only effective treatments is to monitor the blood sugar level with regular checks (using a blood glucose monitor) and use lifestyle changes to lessen the severity of it, like reducing sugar intake and losing weight etc. Now, medicine can be used as a treatment if symptoms worsen over time. Metformin, Sulphonylureas and Pioglitazone are all examples of the types that could be given, with the most common form being tablets. Type 1 diabetes is another thing however, with a main treatment being insulin pump therapy. This involves the semi-permanent use of a pump that allows the user to inject insulin with their own control and without continued injections. Therefore, this makes life much easier for the diabetic patient, improving quality of life. There are other treatments that help like a few medicines eg. aspirin and statins – however these do not cause much change. The future however is looking good for diabetics however, as a lot of research and development is being done to help them out. During tour, I witnessed my friend using his pump in conjunction with an app, which allowed him to check his levels off of his and a teachers phone, hence making it much safer for him! Now, developments like these are helpful, but the real need is a cure. A new trial is being done and been shown safe in retraining the immune system to no longer attack the pancreatic insulin creating cells, so is aimed at those Type 1 diabetics who have only been diagnosed within a year. However, the treatment is one of the first close stabs at a cure, and hence is a pioneering technique of the time and must be watched.

In conclusion, diabetes is a huge problem within society today, and medically, it is a topic that is constantly within Doctors and researchers sights! ‘Diabetes affect 25.8 million people,’ and,’is the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults.’ Hence, this is definitely a topic to watch and keep up to date on in the years to come.

Thanks everyone for reading this and taking the time out of your day to support me. Sorry again for the huge delay, and I hope you’ve found this interesting and educational.
Cheers, Jarred.

My GP experience and one of the most common ailments through summer…

Hey guys, Jarred back for another post, however sorry for the delayed post, I had a break whilst I studied for my exams but I should be pretty regular from now on! First, I wanted to talk about my WEX that I mentioned 2 posts ago; the time I spent in a GP surgery. So a couple of weeks back I spent three days shadowing the Doctors of Thornley Street Surgery including some amazing people like Dr Dobie, Dr Mahmood, Dr Kashif and Dr Richardson, who were extremely useful in helping prepare and inform me of a life in medicine. During the time, I observed many different patient case eg. a range from the common cold to 1st baby check-ups and vaccinations to abscesses. These cases gave me such a broad view of medicine, and made me even more determined to pursue this career. During the work experience, I also watched and learned from the Doctors and receptionists about the admin side of medicine. Now, I learned that a huge part of being a Doctor is being able to organize, manage and cope with huge amounts of data (like prescriptions, patient descriptions and problems and in the Duty Doctors case, making sure all the other Doctors are working well) so therefore, the skills needed by a Doctor are very wide-ranging and often difficult! So to conclude this aspect of the post, I absolutely loved my work experience whilst there and further improved so many skills (like communication, patient contact, empathy and deduction), hence I believe it really furthered me along the path to my aspiration…

Right, so the main topic of today was to talk about ‘one of the most common ailments through summer,’ which you may have guessed, is Hay Fever! Throughout the post, I will outline what Hay Fever is, the symptoms -although most of you probably know them already- the causes and any possible treatments/relievers. So first, what is Hay Fever? Well, the more scientific name for it is actually Seasonal Allergic rhinitis, and it is an extremely common minor problem, suffered by 1 in 5 people throughout the world. Hay Fever is caused by an allergic reaction to pollen, grass and air-borne mold spores, so hence has the same symptoms to many mild allergic reactions. Many people will suffer from sneezing, coughing, headaches, loss of smell, runny eyes and feeling tired. In addition, if the person also is a sufferer of asthma, then the problem can become more severe, like lack of breath and a tightening of the chest! Now, the causes of these symptoms are due to substances within the pollen etc. called allergens. The bodies immune system reacts to these allergens (although not all people react to those allergens, hence why not everyone has hay fever). The body registers the harmless allergens as foreign objects and the immune response kicks in, releasing the antibody immunoglobulin E. The cells affected by the antibody (mast cells and basophils) release chemicals called histamines. These histamines are what cause the problems of hay fever (eg. by swelling the sinuses, making the throat and eyes inflamed and constricting the trachea and bronchioles) due to the fact that they cause an inflammatory response.

Hay fever is a weird illness to cure/treat, as it is technically just an allergic reaction, hence the typical relievers can be used as a basic help. However, specific medications can be utilized in an attempt to soothe the symptoms. The three main medications are: Antihistamines, these produce the chemicals cetirizine and loratadine which prevent histamine action (they bind to the receptors instead of histamines, hence inhibiting them), Sodium Cromoglycate, which prevents the release of histamines (by making the fore-mentioned mast cells more stable, and finally Corticosteroids which can often be used to reduce the effects of the inflammatory symptom (eg. Beclametasone which does not affect the histamine cause, but is aimed at reducing the effects). Now, the different delivery methods for these are often very varied, but can include nasal sprays for antihistamines, eye drops for Sodium Cromoglycate and tablets for Corticosteroids. Therefore, as you can see there are many methods, so it is often simple to alleviate and relieve the problems of Hay Fever. However, as a last resort solution to extreme persistent symptoms of Allergic rhinitis, a GP can refer for Immunotherapy. This introduces small amounts of the allergens to the patient, hence helping to build immunity to them, and therefore helping in the long run. Finally, there is a huge range of herbal remedies that can be utilized which often help by containing Vitamins A and C and many other natural substances to help. However, many Doctors would recommend these more as supplements than as actual cures.

In conclusion, my experience at the GP surgery was something I shall never forget, and has given me a good insight into such an important aspect of medicine, hence allowing me to improve many qualities. The problem of Hay Fever (Allergic Rhinitis) is a very interesting one scientifically to me, as such a small problem can cause such hindering problems, and since it affects so many, it is an interesting and relevant topic to medicine at this moment.

Thanks everyone for reading this blog post, sorry again for the delay between them, but I hope that you found it interesting learning about something that is probably very close to you during these summer months.
Cheers everyone, Jarred.

The deadly Ebola virus may have a cure after all…

Hey there guys, back again for another blog post! A bit of an update first, I got accepted onto a first aid course next Tuesday, where i’ll be learning basic first aid training, I can’t wait, so i’ll mention it next week in the blog. So today, we had a talk from Emma Bausch (part of the admissions team from Oriel College Oxford), and although the talk was very interesting and informative, what really struck me was something she mentioned in passing about Oxford. They discovered the Ebola vaccine! Now, I didn’t know that there was a vaccine to the Ebola virus, hence, it intrigued me, and I did some research on the virus (eg. what it is, it’s symptoms and why it causes them) and discovered some facts about the cure. Therefore, todays topic is Ebola and it’s vaccine.

So, what is the Ebola virus: Ebola is a rare but deadly viral disease, that causes severe hemorrhagic fevers. In other words, it is a virus that causes many symptoms, common to 4 different types of virus ( Ebola, yellow fever, Marburg and Lassa fever). The structure of an Ebola virus, can be simplified into that of a normal virus: an RNA strand coated by a viral layer with glycoproteins embedded in the membrane surface. Being a viral pathogen, Ebola is very dangerous, as there can be many different strains (as explained in my first post, Immunology!), and this type of pathogen is what gives rise to it’s symptoms. The main symptoms of the Ebola virus are a severe fever and sore throat, followed by not only vomiting, but often internal and external bleeding. These symptoms are often fatal, and often occur with a low blood cell count and high liver enzyme count, showing a possible correlation between the two? Symptoms only occur after 2-21 days, as is often to a viral pathogen, as the pathogen must be incubated in the cell before it can cause symptoms (by killing cells, or via toxins it releases), hence making Ebola easily identifiable as a harmful disease, as it can quickly be detected. Major outbreaks of the Ebola virus have occurred in the past, that caused many deaths. Statistically, 50% of cases end up in fatality, with the first out break of it being recorded in 1976 near the Ebola river in Africa, and the most recent being the 2014 outbreak in Guinea, Liberia and Sierra Leone, where 28,000 people were infected, with 11,000 deaths (nearly the average 50%). Since the virus is transmitted by vectors such as humans, the outbreak spread to the US, and other countries, but was contained. As can be seen by this data, the Ebola virus is clearly very dangerous and in need of a cure, as Doctor Samel Edzang said,”At any time we could have another epidemic. It’s very important now to be able to fight the Ebola virus any time, anywhere it appears…”

From the title, you can probably tell that a cure is on the horizon for the Ebola virus. A lot of work, trials and effort have gone into curing Ebola, and at the current moment, there are two big advancements approaching, which, have huge chances of being big successes. The first attempt is the WHO (World Health Organisation) backed one, started in Guinea and in collaboration with the Médecins Sans Frontières and Canada etc. This cure is named ‘rVSV-ZEBOV’, and has been trialed on over 11,000 people, with a 100% success rate so far! Although the vaccine only works for one strain, it is the most deadly, and only has minor side effects in a small proportion of those vaccinated, so is a very promising advancement. This vaccine uses a ring method of protection, that provides herd immunity to other non-vaccinated people. The next vaccine is the one mentioned above, named ‘ebovac2’ which is being developed by Oxford University alongside the French Institute of Health and Medical Research. This vaccine is in the start of the second phase, and so far has been 100% successful too. Firstly, a dose is given as a primer to stimulate immunity, and then a few weeks after, a booster shot is given to strengthen it. This is an important and different approach to vaccination, as it does not provide any chance to be infected by Ebola in any way! Another similar approach is being gradually made in the ‘ChAd3 EBOZ’ Ebola vaccine, which has the potential to be extremely useful in the future.

In conclusion, I believe that since Ebola is such a huge killer, not only is the production of the vaccine been started too late compared to the number of deaths that have occurred, but that from now on, we should be aiming at a preventative vaccine like those being developed. As an area of medicine currently very public due to the recent outbreak, the vaccines can only improve, and soon, we should have a vaccine for Ebola.

Thank you for reading this post, and I hope you enjoyed it and have learnt something new. Next weeks blog will have a bit of information on the First Aid Course, so see you next time.
Cheers, Jarred.

The beginning…

Hey guys, Jarred here! A bit about me first: I’m an aspiring medical student currently in year 12, studying Chemistry, Biology, History and Maths. My aim is in the title, I would love to become a Doctor and help out the world! Therefore, this blog is going to be my journey, from start to finish, documenting any thoughts I have on topics or advancements in medicine and the opportunities and experiences I have during WEX. I hope you readers enjoy my blog, and enjoy following me on my adventure, thanks guys!

Today, the topic is Immunology. Recently, in Biology, we have been studying about the immune system and disease. This has got me interested, and I decided to do a bit of research! Here’s what I found…

To start with, a definition: Immunology- The branch of medicine regarding and dealing with immunity. This will therefore encompass many things e.g. the immune system, diseases and pathogens and advancements in medicine such as vaccines. During my research, I found out how the immune system works, which briefly, is due to the antigens (proteins on pathogen membrane surfaces) being recognized by white blood cells, followed by the Primary Immune response encompassing T cells, B cells and antibodies, which will lead to the destruction of the pathogen and the immunological memory. This therefore can lead to many advancements or problems. The main problem around at the moment in my opinion is the Influenza virus.  “The unique nature of the influenza virus is it’s great potential for change, for mutation.” This quote from Margaret Chan (Chinese WHO director) reveals to us the major problem that makes influenza such a deadly and concerning disease. Due to antigen shift, the influenza pathogen is extremely hard to map, and hence hard to prevent or vaccinate against, as different strains appear constantly. Therefore, at the moment, the best we can do is to vaccinate the most vulnerable against the pre-existing strains, and attempt to find a solution to the problem.  Recent advancements have included the creation of a quadrivalent influenza vaccine which has further prevented influenza followed by a serious advancement in the manufacture of the vaccine. This is a recombinant influenza vaccine, that no longer requires fertilized eggs, thus speeding up the production, and an intradermal vaccine (less antigen required) which will spread the vaccine around, further helping prevent influenza, as it also presents a serious problem in effectiveness globally as confirmed by “kids die of influenza, both in the United States and Japan, and if you give the drug to people at risk of dying, there will be people who die who got the drug” by Robert Nelson. Finally, the influenza virus can be dangerous when it undergoes a mutation causing a species jump. An example is the Avian flu (H5N1) scare of the early 21st century and late 90s. The bird strain of the virus mutated and spread to humans, thus causing many deaths before a vaccine was created. Hence, since an influenza virus molecule can do this, it prevents a huge risk.

In conclusion, I believe that immunology is going to be a serious part of medicine during the years to come, with growing priority being given to preventing and protecting against communicable diseases such as the influenza virus. Therefore, advancements in this area will be extremely proliferant, and hence an amazing part of Medicine!

Thanks for spending time reading this, and I hope you enjoyed and were educated, thanks Jarred.