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 there 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.

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.