When is a stroke not a stroke?

Last week I attended a lecture at Newcastle University where 3 pHD students presented their research projects which had won a prestigious competition within their faculty at the university. One of which was presented by a local paramedic called Graham McClelland. His project was strikingly titled ‘When is a stroke not a stroke?’.

The main causes of a stroke are either a blockage within the blood vessels in the brain or from a bleed/weakness of these neurological blood vessels. fast-poster

Strokes are currently the 4th largest cause of death in the UK and are the leading cause of neurological disability. 1 in 6 of us will have a stroke before we reach the age of 75. For the successful treatment of a stroke (where the patient is thrombolysed using clot busting drugs) time is of the essence; in 1 minute 2 million brain cells are lost and for that reason a stroke can only be treated using these drugs within 4.5hours of the stroke occurring.

One of the most successful NHS campaigns has been the FAST technique to spot strokes in other individuals. We’ve all seen it advertised on the TV and it is still the method by which a stroke is detected by paramedics and other healthcare professionals. McClelland explained it is a foolproof method; it never fails to spot strokes.

However this method also identifies other underlying diseases, otherwise known as ‘stroke mimics’. These ‘mimics’ possess many of the same symptoms as strokes and for that reason are consistently treated as suspected strokes. According to McClelland’s findings approximately 1 in 5 suspected strokes are actually mimics. Some of these mimics included suffering from migraines, epilepsy, sepsis and hypoglycemia. These ‘false positive’ patients may still need urgent medical review. However, if they are transported to a stroke unit, the extra work could delay care for both the ‘mimic’ patient and other stroke patients and dilute the resources available for stroke care. This is a real issue.

To combat this issue McClelland is seeking the introduction of a similar campaign to the FAST campaign, but this time to spot these stroke mimics.

Is lifestyle the biggest threat to our life expectancy?

A study published by Lancet this week revealed that human lifestyle choices, including poor diet choices and unhealthy lifestyles, are posing a greater threat to life expectancy than infectious diseases.

While deaths caused by infectious diseases such as malaria and flu have fallen sharply, the proportion of fatalities fuelled by lifestyles have soared; according to the study 7 in 10 deaths are caused by our lifestyle choices. The research found that high blood pressure (fuelled by obesity and lack of exercise) was the top risk factor to individuals of our generation, contributing to over 9% of global health loss. This was followed by smoking (6.3%), high blood sugar (6.1%), and high body mass index (5%). Poor diet is also fuelling diseases such as type two diabetes, with a 60% rise in cases over the past decade whilst obesity is on course to overtake smoking as the leading cause of cancer.

Professor John Newton, chief knowledge officer at Public Health England said: “On one hand, it’s a sign of successfully preventing infections, but on the other, it tells us how much more we have to do.”

Most notably each of these risks posed to our health are largely self-inflicted and influenced by our attitude and choices regarding lifestyle. This is a largely avoidable issue if the attitude within our society changed and actions implemented by organisations such as Public Health England were able to have a direct influence on our life choices.

The promotion of public health is becoming an embedded priority of Public Health England  and global organisations. Findings from this research suggest it will most likely remain so unless an effort is made to steer us away from our poor lifestyle choices.

Is there a correlation between depression and dementia?

Recently on ‘The Medic Portal’ I read an article claiming those who suffer depression in adulthood have an increased risk of developing dementia in later years. This particularly caught my eye as I have decided to do my EPQ relating to dementia so I am particularly intrigued by this article.

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Scientists at the Erasmus University in Rotterdam tracked 3,325 people over 21 years and discovered that those who had experienced depression for more than three years were over a fifth more likely to go on to have dementia. However, people who suffered episodes of depression and then recovered were not at a greater risk.

The study used individuals with different severities of depression. They found that 21% of people whose depressive symptoms increased over time ended up being diagnosed with dementia. By comparison, only 10% of people with “low symptoms of depression” developed dementia.

But how are the two conditions interlinked? The researchers explained that signs of depression may be an early signal that dementia is developing in the brain before the more recognisable signs such as memory loss are acknowledged. There are a number of potential explanations including that depression and dementia may both be symptoms of a common underlying cause or that increasing depressive symptoms are on the starting end of a dementia continuum in older adults

“The questions are if, and how, the presence of depression modifies the risk for dementia,” Dr Simone Reppermund said. “The study … provides an answer to the first question: Depression, especially steadily increasing depressive symptoms, seems to increase the risk for dementia. However, the question of how the presence of depressive symptoms modifies the risk of dementia still remains.”

Is the new junior doctors’ contract discriminatory against women?

I read an article last week that shed light upon a specific aspect on the junior doctor debate that was of particular interest for me as it was undoubtedly going to affect me (assuming all goes well – touch wood!).

The Guardian wrote an article last week speaking of how the new junior doctors’ contract was in fact discriminatory towards women. Two presidents of medical royal colleges have said it may force female doctors to QUIT. In a joint statement they said:

“We are very concerned by the language in the government’s own equality analysis of the contract, which warns that features of the new contract ‘impact disproportionately on women’. Recent commitments from government to support women in business are greatly welcome. We view the wording of the equality analysis as incompatible with this approach.”

So here are the details…

  • Female junior doctors will experience a widening pay gap between them and their male colleagues
  • Single mothers and those with families will face further backlash as the new contract proposes extended working hours from 7pm on weekdays to 10pm and will include Saturday from 7am to 5pm for the first time ever. This will prove difficult for parents with young children who require childcare as many services do not operate within this time frame. This would hence breach junior doctors’ right to a family life under the Human Rights Act.

Dr Roshana Mehdian, one of the leaders of the junior doctors’ campaign against the contract, criticised the department of health for saying that women should make “informal childcare arrangements” if they are affected by having to work more antisocial hours. She said:

“This is ludicrous in the 21st century when childcare costs are spiralling and access to out-of-hours childcare is limited. This discriminates against women, single parents and working couples. It is a regressive and draconian contract, undoing years of work to improve equality.”

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The department of health’s response to these claims follows:

“Our equality analysis shows doctors on the new contract will benefit from a fairer pay model that better rewards those who work the most intense and unsocial hours and will improve patient care across seven days. Part-time trainees will now benefit from the same benefits as those working full time, including the same pay protection on a pro-rata basis.”

As the BMA launch legal action against the new junior doctors’ contract, I personally have a firm foot on the side of the junior doctors. The thought of these prospects is detrimental (for both the patients and the doctors themselves).

 

 

 

Nut Allergies and can parents actions prevent them?

Nut allergies are an area of interest for me, especially as I myself am allergic to hazelnuts. In light of my diagnosis I wanted to do some extensive research into how allergies develop and where they stem for. I thought I would share what I found.

An allergic reaction is triggered by the particular substance (allergen) that you are allergic to. Your body perceives it to be a foreign invader.The allergen then binds to the IgE (Immunoglobin E) antibodies. When this happens, the mast cell breaks open to release inflammatory substances which quickly travels through your body to fight off what it senses as harmful. The histamine affects the body tissue and causes an inflammation. It all begins with exposure. Even if you’ve inhaled an allergen many times before with no trouble, at some point, for some reason, the body flags it as an invader and you are now “sensitized” to the allergen.

diagram-of-an-anaphylactic-reaction

 

Your risk of developing an allergy starts in your genes. While specific allergies are not inherited, a tendency toward having allergies is. Children with one allergic parent have a 33% chance of developing allergies; with two allergic parents, it’s a 70% chance. I found this particularly interesting as nobody in my family has an allergy to anything (let alone nuts). They say allergies affect around 1 in 5 people but the severity varies significantly (from watery eyes to anaphylactic shock)and can be developed at anytime during life. Although there is a degree of ambiguity in the knowledge of my allergy I seem to have a fairly severe allergy meaning I have to consistently carry precautionary measures in case a reaction is triggered. This includes to EpiPens and strong antihistamine tablets.

Histamine is a chemical the immune system uses to help protect the body’s cells against infection. The histamine causes small blood vessels to expand and the surrounding skin to swell. This is known as inflammation.Histamine is usually a useful substance, but if you’re having an allergic reaction it’s sometimes necessary to block its effects. This is done by antihistamines. Antihistamines work by blocking the receptors in each cell, so histamine can’t activate the receptors and affect the cell.

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EpiPen’s contain adrenaline (sometimes called epinephrine) and is given by injection to treat a life-threatening allergic reaction called anaphylactic shock. Anaphylatic shock is a severe, potentially life-threatening allergic reaction. An injection of adrenaline rapidly reverses the symptoms of anaphylaxis by acting on alpha and beta adrenergic receptors in the body. The alpha receptors are found on the walls of blood vessels. When adrenaline stimulates these receptors this causes the blood vessels to narrow, which stops the blood pressure from falling too low. It also redirects blood to vital organs like the heart and brain. The beta receptors are found in the heart and lungs. When adrenaline stimulates these receptors this relaxes and opens the airways, making breathing easier. It also stimulates the heart, making it beat faster and stronger. Adrenaline also relieves itching, hives and swelling. Obviously whenever it is injected an ambulance must be called ASAP so that heart rate can be monitored.

So can allergies be prevented..

Scientists at Kings College say feeding babies with peanuts at least three times a week protects them from developing nut allergies in later life. Having followed hundreds of children for more than 10 years to see if early exposure to nuts could prevent the emergence of potentially lethal allergies, they discovered that introducing nuts regularly in the first year of life was enough to build up a tolerance by the age of six even if the child stopped eating them for 12 months. All the children tested had a family history of peanut allergies, placing them at high risk. Currently the NHS recommends that children at risk should avoid nuts for the first three years of life. But the new study suggests that could do more harm than good. Professor Gideon Lack, Head of Department of Paediatric Allergy, King’s College London said “It clearly demonstrates that the majority of infants did in fact remain protected and that the protection was long-lasting”.

Clearly early exposure could inhibit the number of cases of allergic reactions that since 1996 the number of reported NHS cases has increased by 615%. Perhaps the actions of parents could limit allergies becoming dangerously prevalent..

 

 

 

This week’s medical news: have we found a potential drug to treat Huntington’s disease?

This week has been an exciting week in the drug industry with it being revealed that a new drug to treat Huntington’s disease is being trialled in humans after success in both mice and monkeys.

The new drug, called IONIS-HTTRx, silences the gene known to be responsible for the production of a protein causing Huntington’s disease and is believed to be able to reverse the symptoms.

What is Huntington’s Disease?

Huntington’s disease is a neurodegenerative condition which damages nerve cells in the brain. This brain damage gets progressively worse over time and can affect movement, cognition (perception, awareness, thinking, judgement) and behaviour.

What is the cause of Huntington’s disease?

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The condition all stems from a faulty gene. The normal copy of the gene produces a protein called huntingtin, but the faulty gene contains an abnormal region of what are called CAG repeats. This area is larger than normal and produces a mutant form of huntingtin.

What is the probability of inheriting it from a parent?

autosomal-dominant

50:50. A parent with the Huntington’s disease gene has one good copy of the gene and one faulty copy. Their child will inherit one of these genes. However it cannot be determined when the condition will develop in a child, it may not be until their adulthood until the symptoms progress.

How many people in the UK are affected by the condition?

12 people per 100,000 are affected by the condition.

The latest in the drug development..

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When they tested IONIS-HTTRx on mice with the disease their motor function improved within a month and within two months their health was restored to normal. In monkeys the drug was found to decrease the HTT protein throughout the central nervous system by 50 per cent. The drug is delivered into the cerebral spinal fluid via lumbar injection, as antisense drugs do not cross the blood brain barrier – a protective sheath that prevents toxins entering the brain. The drug is now being trialled in humans in low doses (participants are given four spinal injections each separated by a month) to check that it is safe for larger trials into its efficacy to begin.

“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease,” said clinical study principal investigator Dr Blair Leavitt, of the University of British Columbia in Vancouver.

Some positive news in the world of drug trials…a story to watch!

Food for thought: Mental Health

Mental health is highly stigmatised and is rarely spoke about in public, however it has recently becoming a prevalent topic of discussion in terms of the NHS budget as it was revealed last week that mental health spending has fallen by 2%. Frankly this is not on. After attending a mental health first aid course last week, the surprising and shocking statistics really highlight the need for more to be done.

So do you have mental health? Perhaps a difficult question to answer? What actually is mental health?

Mental health is defined as the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of wellbeing with an underlying belief in ones self worth.

What are the influences on a child’s mental wellbeing?

A child’s upbringing has a significant influence in their wellbeing in the future, whether this be in terms of parenting styles or family relationships. Additionally the education of the child becomes a determining factor, especially in terms of exam pressures, bullying and friendship pressures.

Why is mental health so hard to talk about?

During this talk we did an exercise in groups in which task one was to write down as many derogatory terms for a person with poor mental health; and this was surprisingly easy. Task two was to articulate as many supportive phrases you could offer to one with a mental health problem; this task was much more onerous task. The moral of the task was to highlight the derogatory terms associated with mental health has become second nature and perhaps more ought to be done in learning to display effective support. Its important to remember that often the stigma and discrimination hurts mental health sufferers more than the illness itself. This is the reason why those affected are reluctant to open up about their experiences.

I recently saw an article which displayed a series of comic strip images which are changing the way social media view mental health. The artist said “I wasn’t really drawing anyone  but clearly it has deep resonance”. I truly believe this depiction is a strong message which really makes it easier to interpret exactly how those experiencing problems feel, plus being displayed on social media makes it ever more accessible to the everyday person. Perhaps as more people see these images, the social stigmas will begin to change.

_88246361_print-image1 _88246363_helpful-advice _88246365_tumblr_mub0l5zjw81qbehyfo1_1280 _88246367_unspecified _88274125_2014-06-24-morehelpfuladvice _88247349_unspecified_88274127_tumblr_nz5mqnncxn1qglhc3o1_500_88274133_tumblr_inline_nyzmfbebfj1qg00mm_500mentalhealth2_88274131_tumblr_inline_nyzlk1r2ne1qg00mm_500The six key points taken from my mental health first aid course were:

  1. We all have mental health needs
  2. 1 in 4 people will experience mental health issues
  3. People do recover, mental health can be managed
  4. To be supportive all you need to do is listen
  5. Treat people as though you want to be treated
  6. Take it easy and learn to look after yourself

 

A few ideas on what makes a good doctor

Whilst attending my school’s MedSoc a doctor from outside school lead a discussion in which we discussed “what makes a good doctor?”. I thought I would share some of the ideas presented in our discussions:

Our schools thoughts on attributes of a good doctor:

  • Compassionate
  • A good listener
  • Good at articulating their words with clear, precise and understandable explanations
  • Decisive
  • Show strong signs of professionalism in terms of confidentiality
  • Able to recognise their own personal limitations of knowledge and be able to accept help from colleagues
  • Level headed with a strong focus
  • Empathetic
  • Confidence which does not be perceived as arrogance
  • Attentive
  • A strong and advanced knowledge
  • Thorough
  • Someone who would never be discriminatory towards a patient, treating them all with equal respect

Sir Peter Rubin, chair of the GMC (general medical council) said:

“Doctors have the enormous privilege of touching and changing lives. Through all the changes driven by research and public expectations, some of the art and science of medicine has endured down the ages and defines medicine as a profession, whatever a doctor’s area of practice.  Doctors:

  • synthesise conflicting and incomplete information to reach a diagnosis;
  • deal with uncertainty – protocols are great, but doctors often must work off-protocol in the best interests of the patient, for example when the best treatment for one condition may make a co-existing condition worse;
  • manage risk – many patients are alive today because doctors took risks and as doctors we bring all our professional experience to bear on knowing when acceptable, informed and carefully considered risk ends and recklessness begins – and we share that information openly and honestly with our patients, always respecting that the final decision is theirs;
  • recognise that change both in medicine and society is constant, ensuring that those standards which are immutable are preserved while those that are simply a product of their time are consigned to history
  • carry and accept ultimate responsibility for our actions. “

Another nurse said:

“To me and my patients I have always found the following qualities essential ingredients for the making of a good doctor:

  • Approachable, confident, decisive, intelligent, interested, compassionate and caring – being able to absorb people’s pain and anxieties without losing focus, treating patients as a human being rather than a symptom or collection of symptoms.  Their integrity is without question.
  • Takes time to listen and communicate honestly and effectively with patients, relatives, staff teams, managers, peers and dignitaries pitched at the appropriate level whilst putting everyone at ease.
    Respect for everyone’s capabilities and their contribution to the team.  Knowing everyone’s name in the team regardless of their position.  Being fair and non-judgmental.
  • Having technical skills, being competent, knowledgeable using evidence based practice.  The ability to remain calm and proficient when under pressure and still make clear and timely decisions.
  • Inspiring, always learning and teaching without fear of humiliation, lead and train the team as a team.
  • Trustworthy, loyal, dedicated, thorough, a mentor, reliable, respected rather than revered and dedicated to up holding their Hippocratic Oath.
  • A visionary leader who is confident about their standards and stands firm to up hold their and the team’s values and beliefs.

A great doctor knows and remembers his/her patients and treats them with a kind heart and gentle hands as if they were one of their own family, dedicating their working life of service to creating and preserving health.”

All doctors that have spoken at our weekly MedSoc have stressed the concept that you must treat the patient and not the disease and as stressed by the visiting doctor the communication aspect of being a doctor is becoming increasingly more important. People skills were once overlooked in the past, now they reign the list of the most important qualities of a good doctor.

More about Alzheimers and Dementia…and the implications for the carers.

This has always been a topic of interest for me. After having both my grandmothers suffer from the condition it has incentivised me to find out more about the everyday occurring disease that scientists often turn a blind eye too.

Dementia-image

Ultimately, Alzheimers disease is caused by the death of brain cells and being a neurodegenerative disease it worsens over time, often leading to dementia.

Each sufferer has their own individual relationship with the condition but most experience significant cognitive symptoms such as:

  • Problems with their day to day memory with difficulties recalling recent events
  • Difficulties with concentration and organising with strong indecisiveness and the inability to carry out a sequence of tasks
  • Lack of visuospatial skills with issues judging distances and visualising 3D objects
  • Losing track of the date and their location
  • Difficulties with language and following a conversation or finding the right work to express themselves

Additionally many sufferers battle with severe mood changes causing them to be anxious or unusually sad in particular situations.

So what actually causes Alzheimers?

Clumps of protein, known as “plaques” and “tangles”, gradually form in the brain. The plaques and tangles are thought to be responsible for the increasing loss of brain cells. These brain cells become surrounded by an abnormal protein which leads to an alteration of their internal structure which ultimately interferes with the chemical connections within the brain.

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How is the Alzheimers and Dementia diagnosed?

Making a diagnosis of dementia is often difficult, particularly in the early stages. This is because there is no one simple test and early symptoms can be similar to those of lots of other common conditions. The first port of call, as usual, is the GP. They often prefer to assess and observe their behaviour in the patients home as the person is in a familiar environment. The GP will assess the person through the following procedures:

  • The GP will spend some time talking to the person and someone who knows them well and will ask about how and when the symptoms started and how they are affecting the person’s life. The GP will look at the person’s medical history and those of other family members. They will also review the medicines the person is taking.
  • The GP may also carry out a physical examination, particularly if a stroke or Parkinson’s disease is suspected. They will also take samples (blood and possibly urine) to send off for tests. These may identify other conditions that are causing the symptoms.
  • The GP will ask the person a series of questions or give them a short pen-and-paper test. These are designed to test thinking, memory and orientation.

If there is cause for concern the patient is often referred to a specialist and CT scans can be taken for further diagnostics. The image below shows a CT scan of a patient with Alzheimers.

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After the consultation the following information will become known:

  • details on symptoms and the prognosis for the future
  • type of dementia one has
  • potential appropriate treatments for the patient
  • care and support services
  • information on financial and legal advice

What increases your risk of Alzheimers?

Risk factors associated with this disease include age (as the disorder is more prevalent in older patients) and family history (the inheritance of genes which have stimulated the disorder has been proven to increase your risk of Alzheimers)

What are the implications for the carers?

In the UK there are over 700,000 carers of demential patients who are unpaid. These carers release the burden on the NHS by over £12billion but there knock on effects for those taking on the mammoth task.

A recent survey revealed 9 in 10 carers for people with dementia experience feelings of stress or anxiety several times a week and a further 80 per cent find it difficult to talk about the emotional impact of caring. This is a worrying statistic and has certainly made me reflect upon my family’s personal experiences with the disease. However there is no doubt the unconditional love for the family member makes each tough day worthwhile. There is currently an extensive research programme surveying potential cognitive behavioural therapy with the hope of with further information on the disease. With this comes greater guidance for carers on how to cope with the every day struggles.

The unpredictable nature of a dementia patients can lead to caring being an incredible arduous task, incomparable to those with physical disabilities. Often being a carer can have detrimental problems to one’s health including sleep deprivation and can lead to an individual losing the social aspect of their lifestyle.

I can say from family experience that caring for someone with dementia is an emotionally discerning experience, seeing the person you know and love so well become less and less like themselves to such an extent where they no longer recognise who you are is truly heartbreaking. I strongly believe more should be done to ease the pressure on carers and help them cope with this life changing experience.

 

 

My volunteering last summer…

Last summer I gave up 4 weeks of my holiday to volunteer at a local summer sports school which I have attended from a young age. I thought it would be a brilliant opportunity to combine volunteering with my love of sport. For the 4 weeks I was assigned a group of children to be a leader of and luckily in the final 2 weeks I was assigned the role of paying careful attention to two children with behavioural and physical disabilities and ensuring they were able to fully participate in all the brilliant activities.

Although this was a very challenging position (of which all the other staff were very complementary on how I coped – I even earned myself an extra freddo at the end of the week) I started to enjoy the opportunity, developing a good relationship with the two children who had a brilliant sense of humour. The young boy had hearing and speech difficulties so learning to comprehend what he was saying was an onerous task but I was personally impressed at how quickly I adapted and began to communicate with him well (unlike many of the other members of staff who continued to struggle). I feel this enabled him to feel comfortable and confident in an unfamiliar environment with a large group of children with a wide range of ages. I also had the opportunity to support him in activities such as swimming which enabled me to offer guidance and develop my communication skills in a particularly challenging environment (especially as the pool was full with 40 more children!). An important aspect of my role was to maintain contact with their parents, reporting on how their behaviour had been throughout the day and how much they had participated in activities. I believe these communicative skills are an important aspect of the qualities a good doctor should have, and this opportunity has developed them in me.

My employer said:

“Lauren demonstrated impressive personal qualities such as tolerance and patience. She remained calm but assertive, maintaining her friendly manner throughout. Her mature, common sense approach led her to seek  advice and assistance when needed but it was her own determination and resilience which created a successful outcome for the child in her care. Furthermore, she showed the initiative to liaise confidently with the boy’s parent,  dealing effectively with their enquiries. ”

The highlight of my experience was at the end of the 2 week period, the farewell and thanks from both the children and parents made me feel that the strenuous task had been completely worthwhile.

I hope to have many more experiences working alongside a varied group of people to develop my communication and leadership skills further.

Thanks of reading again! Please rate and comment – I would love to hear your opinion.