The Menopause

Every female knows the physical and mental difficulty of menstruation, having to experience it once a month most commonly, starting during teenage years. Every child in the UK who sits GCSEs is taught basic reproduction and the 28-day reproductive cycle of a woman, including the roles of two key hormones; oestrogen and progesterone. However, only those going through or those who have already experienced the menopause are completely aware of what it is and its symptoms.

The menopause is ‘when a woman stops having periods and is no longer able to get pregnant naturally’, as described by the NHS and usually happens between the age of 45 and 55 but can happen prematurely, or after breast cancer treatment or an oophorectomy.

Low mood, sweats and vaginal dryness are all common symptoms of the menopause caused by significant fluctuation in release of oestrogen and progesterone, and the stopping of ovulationThe reduction of oestrogen and progesterone is due to the decreasing responsiveness of ovaries to the hormones FSH, which causes ova to mature in the ovary and controls release of oestrogen, and LH which stimulates release of the ovum. The menopause worsens quality of life as women sweat more so feel that they may not wear long sleeves, cannot wear makeup without it coming off and have to wear their hair up to be comfortable (as written in the Daily Telegraph on 10.4.17).

Both female and male gametes are required for reproduction in humans as we produce sexually, as opposed to asexually so once ovulation stops (the release of the female gamete), women are no longer able to have a child. Humans stop reproducing far sooner than other mammals and this is said to be an evolutionary advantage as reproducing late in life has various risks for the child, such as developing Down’s syndrome or a cleft palate, and for the mother, if they are in a less able physical state to give birth.

In the news lately there has been talk of a new drug called MLE4901which relieves the symptoms of the menopause – in particular sweats, with a lower risk than the most commonly used drug HRT which can lead to breast and ovarian cancer, and blood clots which can lead to strokes. The drug is said to improve many more lives as it would be available for far more people as HRT cannot be given to people who have previously had breast or ovarian cancer or high blood pressure for obvious reasons. MLE4901 does not increase oestrogen release like HRT, but works by preventing Neurokinin B (a hormone) being released. Neurokinin B is an important hormone shown by its increase in release during falling oestrogen levels so by decreasing Neurokinin B levels, decline in oestrogen level can be stopped. Neurokinin B also activates the metabolic pathway of thermoregulation, so by controlling its release, hot flushes are reduced.

A clinical trial was taken out by Imperial College London where people spoke about their moods during a four-week trial period of taking the drug and feedback was very successful. However, it is extremely hard to compare MLE4901 to HLE as emotion is a qualitative value so should be used with caution.

 

Emily Buchanan

Book Review: Trust Me I’m a Junior Doctor by Max Pemberton

Trust Me I’m a Junior Doctor is a diary of Dr Pemberton’s first year as a junior doctor in which he reveals the truth about what it is to be a doctor and how his work makes him feel  through description of real patients’ conditions which he had to face in his first foundation year.

“Competent”, “confident” and “loves the pressure” are three phrases which describe the qualities needed to be a successful and inspiring healthcare professional, showing that the qualities of a doctor are partly natural, with increased resilience being taught through five or six years at medical school. Following my hospital work experience, this book reminded me about the fact that doctors must not become emotionally attached to their patients, and that there must be a differentiation between the doctor and their patient – “usually good at being detached; clinical”, “everything moves on” and “not carrying any drama of the previous one”. The book also proved that being a doctor is far from easy and showed that even after the training at medical school, you will not know everything about every condition (“I felt out of my depth at times”) as there is such a large variation in presentation of conditions, in different people.

The job of a doctor is not only in a surgery or hospital, but in all of society as shown through the quote “‘I’m on holiday’ I felt like screaming” when someone fell under a train, Dr Pemberton realised that he was expected to attend to this casualty even though he was on his way home after a very long and tiring shift at work.

It is important to remember that your own health is just as important as your patients’ health. I believe that this is often forgotten by doctors as they work endless hours, making them extremely tired and therefore dwelling on the negatives of their job. This can be seen through the fact that he could tell that his colleague felt “inadequate” and like a “failure” and exclaimed that he often felt the same way as a junior doctor. The feelings as a junior doctor are often negative due to the extensive hours of extremely concentrated work leading to many people quitting the job – “spent the weekend backtracking on all her career plans”. ‘She’ did not end up quitting due to her love for the job and satisfaction that she gets out of her job. This shows that many doctors realise the positive impact they have on people, further reiterated in “I don’t do it for the glory, I do it for the love of seeing my patients’ faces when they are well.”

Many qualities of a doctor cannot be taught like kindness and bedside manner, supported by the quote “there’s no assessment of whether someone will hold your hand and stay with you when you’re upset”. This highlights the importance of the interview in medical school applications to show your natural love and care for people.

A love for being busy is also very important and being able to stay organised as shown through the quote “constantly having to think ahead, juggle and plan the jobs that have to be done while moving effortlessly between patients”. In addition, this quote reminded me of what I saw at my hospital work experience where I noticed that however stressed and busy the doctors were, they always made time to speak to their patients and comfort them – not letting them know how truly stressed they are. Doctors are prepared to sacrifice their social life for their patients as they spend any time off “recovering from working”.

Problems in the NHS are highlighted in this book as Dr Pemberton explains about the strong emphasis on reaching NHS targets, taking over medical professionals’ ability to care for their patients – shown through an ambulance driver not being able to drive a man home when there were many ambulances not in use, “the mountain of paperwork and protocols means there is less and less time to spend with the actual patients”. Furthermore, we must provide better care for discharged patients in the future as many people, such as the elderly and homeless are extremely vulnerable once released from the safety of a hospital as shown through “Domestic violence is not medical. A head injury is. But teasing the two apart is incredibly difficult to do.” This leads to reoccurring patients in hospitals who use lots of the NHS’ resources. Dr Pemberton suggests that neglect may not be a case of poor healthcare assistants but of the NHS system due to its focus on meeting targets as “nurses’ time is increasingly taken up with reams of paper work rather than the job of actual nursing.” I found it extremely interesting that Dr Pemberton believes that nurses cannot prescribe medicine due to “cutting corners to reduce waiting times, to meet targets” “at no extra cost” rather than due to “clinical ability.”

I was reminded that getting into medical school is such an enormous challenge due to the fact it is impossible to be completely prepared for the interviews as there is “no set formula that can be easily copied” in approach to interaction with people. People must be understood in their “entirety” in order for a doctor to completely understand their medical condition, and to get them to open up to and trust them. Making a patient feel comfortable enough to speak to a doctor whom they may be meeting for the first time takes incredible “people skills”.

I learned so much from this book and would recommend it to anyone interested in finding out the true feelings of a doctor when treating patients.  It is easy to read as is written day by day in very short chapters and is very funny.

 

Emily Buchanan

MRI – magnetic resonance imaging

This week I went to a Physics talk at my school where a teacher spoke about MRI scans, their uses and the images produced.

Scans are mainly used in order to monitor or diagnose neurological, brain or muscular conditions. At this talk I noted the interdisciplinary skills used to create and use an MRI scanner including physicists for the mechanism, electricians for the servicing, mathematicians for quantitive analysis, radiologists for running the machine and doctors for overall analysis of pictures, before patients receive their results and prognosis.

I noted that MRI scans show up areas that are ‘soft’ as light grey and ‘hard’ materials in black eg. the brain looks light grey whilst the skull looks black. This directly contrasts images of X-Rays and CT scans which are lighter shades where ‘hard’ material is found in the body. The reason for MRI showing lighter colours in ‘soft’ areas is due to it highlighting areas of the body containing water and fat. The image is made by shooting low frequency and long wavelength radio waves at the cells – those containing water (H2O) absorb some energy due to the proton in each nuclei of H-atoms, and then reemit the waves at the same wavelength.

The MRI scanner looks like a large donut with a bed which slides in and out of the central hole. Along the bed is a very strong uniform magnetic field, like that of a coil, which must overcome the thermal limit of the body to magnetise the body (it is never turned off). The current flowing through the machine is very high, in order to significantly increase the magnetic field and create a ‘superconductor’ (a metal which does not have any electrical resistance), so liquid helium is used to ensure the scanner does not overheat.

The loud sound during an MRI is due to the magnetic field and fast flowing current making a loudspeaker. Ear muffs must be worn to protect eardrums from permanent damage. Magnetic objects must never be bought near to the machine due to the extremely strong magnetic field of around 1.5 teslas (on earth the average background magnetic field strength is 50 microteslas), which would attract them into the machine, where the person is lying, at a very high speed.

Current research using MRIs includes its potential use in monitoring neurological conditions associated with losing muscle function due to fat coating the muscles. Researchers are looking for ways to monitor this condition using numbers (quantitive analysis) to get a more accurate representation of improvement or deterioration, as opposed to making a judgement using the less informative black and white pictures (qualitative data). They are looking at finding a way to count protons in the nuclei of fat molecules by monitoring the amount of radio waves reemitted from the body.

 

Emily Buchanan

 

Down’s Syndrome

Down’s syndrome is a learning disability caused by an extra copy of chromosome 21, making total chromosome count 47 instead of the ‘regular’ human count of 46. Physical characteristics are very recognisable of a broader, flatter face, smaller ears and nose and more space between the eyes whilst an associated medical issue is an increased risk of heart problems.

There are three ways in which Down’s syndrome can occur; through non-disjunction of chromosome 21 (94% of cases), by translocation (4% of cases) or mosaicism (2% of cases). Non-disjunction of chromosome 21 is when chromosomes do not separate properly during the anaphase stage of the cell cycle, translocation is when a part of a chromosome breaks off and attaches to another chromosome, and mosaicism is when people’s cells vary in number of specific chromosomes.

Translocation occurs specifically with the breaking off of part of chromosome 21 and it attaching to a different chromosome in the parent. After receiving two copies of chromosome 21 (one from mother and one from father) and an extra chromosome 21 attached to another chromosome by translocation, total count of chromosome 21 equals three in the offspring, causing Down’s syndrome. People with translocation do not always show Down’s syndrome characteristics but do pass on translocation, giving their child the extra chromosome 21. Translocation can also occur during meiosis, when the parents do not have translocation themselves.

Mosaicism occurs either by the fertilised ovum having three copies of chromosome 21 and losing one during mitosis, or when the ovum originally has cells with two copies of chromosome 21 and during mitosis gains an extra copy of this chromosome by mistake. If the ratio of cells containing three chromosome 21s to cells containing two chromosome 21s is large then Down’s syndrome is likely, and if the ratio is small, Down’s syndrome is less affective, shown by the person having fewer of the characteristics linked to Down’s syndrome.

The biggest risk factor of conceiving a child with Down’s syndrome is a women’s age with risk increasing with age. Figures by the NHS currently stage that maternal age of 20 gives you a risk factor of 1 in 1500, age 30 of 1 in 800, age 35 of 1 in 270 and age 40 of 1 in 100. Risk is also increased if the person has already conceived a baby with Down’s syndrome and further increased (up to 1 in 10) if one of the parents has translocated genes.

In today’s NHS, foetuses are tested for Down’s syndrome by amniocentesis and ultrasounds. Amniocentesis is the removal of some amniotic fluid which is taken to a laboratory to be stained and looked at under a microscope to look for extra copies of chromosome 21. However, some women choose not to have this test as it increases chance of miscarriage so other less invasive tests are taken first such as ultrasounds and blood tests, before referral for amniocentesis.

Ultrasound is high-frequency sound waves to create a moving image in order to see thickness of fluid between skin and foetal neck (taken between weeks 14 and 22), with a thickness greater than 3mm likely to imply chromosome abnormality. Taking a blood sample from a pregnant mother is another less invasive and therefore less risky test, from which alpha-fetoprotein concentration can be measured. If the mother’s concentration is 25% less than normal, it is significantly more likely that their child will have Down’s syndrome so will be referred for an amniocentesis for a more reliable test.

A test that may be available in the future is the analysis of a foetus’s DNA from their mother’s placenta by week 10 of pregnancy. It is currently 99% accurate at detection which is not considered high enough to be widely available on the NHS.

Test results give people a choice; to terminate or continue with their pregnancy – an extremely difficult decision for many.

 

Emily Buchanan

Work Experience in a Hospital – day five

I shadowed a Consultant on a ward round this morning, noticing their extreme patience when speaking to an ill patient who demanded to leave the hospital, wanting to return home. The Consultant remained calm and collected, explaining the severity of the patient’s condition and  why hospital, surrounded by healthcare professionals, was the best place for the patient until they became stable. The Consultant calmly stated that the move home could easily be arranged, as long as the patient understood that there was an extremely high chance that they would die or be admitted to hospital again in an emergency.

I went on to learn about two predominant types of pneumonia; legionella and mycoplasma. Legionella presents symptoms such as a persistent cough bringing up phlegm and flu-like symptoms which can be cured by erythromycin or clarithromycin. Mycoplasma is very much more serious, presenting itself in a dry cough and fever and it can damage the heart or central nervous system in extreme circumstances. Mycoplasma pneumonia is far more contagious than that of legionella so could cause an epidemic.

I saw that the Junior Doctors were tired, stressed and frustrated as they followed Consultants making accurate recordings of observations, medicines and dosages whilst being questioned by the patient’s families and nurses for help. This in turn frustrated the Consultants as they did not believe the Junior Doctors were completely focused on what was supposed to be written down on the ward round. I believe this is very important for all people going into medicine to see as we must have a realistic understanding of the stressful, and at times frustrating, profession that we are potentially going in to.

During the afternoon I went to a teaching of ‘wellbeing’ to medical students in which a lecturer spoke to students about the role of diet and exercise in maintaining a healthy mind and body. The lecturer spoke of the fact that most medical students are perfectionists so have extremely high expectations of themselves leading to severe burnout. Burnout can lead to depression, heart disease and a weakened immune system which is reflected in patient care, decreasing patient satisfaction and increasing recovery times. The lecturer focused on resilience as an extremely important quality of a doctor saying that it is a natural quality of people which can also be taught throughout time at medical school. I learned about foods containing sugar, caffeine, nitrites and salt and how they affect sleeping routine, perception and increase risk of diseases.

Emily Buchanan

Work Experience in a Hospital – day four

I was in a respiratory clinic again this morning with an inspiring Consultant where I learned more about qualities of a doctor. I noticed their reassurance and truthfulness when telling a patient about the severity of their illness – approaching the subject politely and respectfully whilst always reminding the patient the negative consequences of their condition.

I was reminded today of the disastrous impact of smoking when meeting people with extreme reduction of lung capacity – the lowest was 11% (measured using a spirometer). I try to prevent many of my peers from smoking and would love to expand this to the wider community in the future. I noted the patients’ responses to finding out that they have poorly functioning lungs. A particularly interesting response was thinking that they could easily get a new pair of lungs from a donor. This is incorrect as there is a shortage of donors and if there is a donor, the lungs will go to a child with cystic fibrosis due to them having a greater need. I noticed the doctor’s calm response to their patients, explaining clearly the plan for their future relief of breathlessness using medication. Patients often forget about the large risks associated with replacement of vital organs which could completely change their quality of life (for example after the operation they may be bed bound meaning they have a high reliance on other people, or if the organ is rejected they may die in extreme cases).

I found that by using the number (in a percentage) of lung capacity the doctor was able to show the extreme severity of this patient’s lung condition in order to tell them a truthful prognosis so that they completely understood that they were in a bad state.

As a doctor is it extremely important to have a strong relationship with your patients in order to be able to talk to them about anything – even if a little embarrassing in the eyes of the patient. The doctor advised about depression and the effects of being overweight to their patients using knowledge to comfort them whilst telling them about the best medicinal decisions for their future. Telling people they are overweight is sometimes extremely difficult and therefore whether it is acceptable is being debated at the moment within our NHS due to extra bodily weight leading to health conditions in itself, for example type 2 Diabetes.

I saw a hernia which was the intestine sticking out due to intense pressure around the lungs – hernias can be found all over the body. I will be writing another blog about a condition called Sarcoidosis as this condition particularly interested me in the clinic today.

Structure and function are the key to understanding every disease. Structure is determined by doing a scan eg. X-Ray, CT scan, MRI and function is determined by tests eg. blood tests, lung capacity test.

I was particularly interested in hearing about a new innovative surgery which allows patients to have less invasive surgery of the heart to fuse arteries by a small incision in the side of the body (a new type of keyhole surgery).

In the afternoon I spent my time in the AMU ward with a Consultant where I saw lots of patients with respiratory problems. I enjoyed looking at and learning how to interpret CT scans and X-Rays and listened to the Consultant advising Junior Doctors about which treatment to use for which patients. Everyone respected the Consultant’s wishes for their patients as the Consultant was leading the way for the chance of a healthier future for everyone.

 

Emily Buchanan

Work Experience in a Hospital – day three

This morning as I sat in a respiratory clinic at the hospital, I was greatly inspired by the Consultant that I shadowed. They were intelligent, compassionate and clearly respected by all of their fellow doctors and members of the healthcare team. Junior Doctors constantly came to the Consultant asking questions and for second opinions about treatments and the best plan for their patients, while nurses were extremely happy to support them in any way they could. It appeared that the Consultant made their patients feel comfortable, relaxed and positive even when the prognosis was not so positive. Whilst they always showed that they were in control to their patients, once they leave the room the Consultants were extremely busy answering calls whilst looking at other patients’ test results and giving second opinions for Junior Doctors. I learned that a doctor must be able to multitask to a high enough standard that they can be focusing accurately on more than one patient at the same time. The Consultant approached talking to their patients in a very different way to the two Consultants that I shadowed on Monday as the Consultant today explained what they thought was their current problem and history, allowing the patients to correct them, whereas on Monday the Consultants would let their patients do the talking then prompt with questions. Both methods seemed to please the patients.

As a doctor you must explain everything that you are doing. The Consultant was very empathetic when they delivered less positive news – always concerned about questions that may be in patients’  heads, so the Consultant always explained their decisions of medication to them so that the patient was not concerned or confused. The Consultant attempted to explain patients’ conditions without them feeling awkward, embarrassed or less able, speaking scientifically and empathetically appearing to understand exactly how the patient was feeling. The Consultant also offered them professional psychological help due to their frustration of the disease.

Many illnesses affect peoples’ state of mind due to it causing a lower quality of life. An example of this is when patients are unable to walk due to not having enough energy (from lack of oxygen) when their legs do in fact work perfectly. Patients often explained that this not only had a negative effect on them but also on their families who they were extremely reliant upon to transport them from place to place.

Today I also learned about drugs that may be able to replace antibiotics in the future. These drugs are a much lower dose of antibiotic to boost your own immune system to fight the pathogenic bacteria that has infected your body cells. I hope that more doctors use these drugs as it will reduce antibiotic resistance, although I have to say that I am not educated in the knowledge of their side effects and I was told by the doctor that they currently only work in very select cases.

During the afternoon I shadowed a fourth year medical student in the Acute Medicine ward (AMU). I was interested to hear a heart murmur which was confirmed by a Junior Doctor after the medical student hypothesised the specific type of heart murmur. I noticed how knowledgeable the medical student was when they explained in detail everything about the specific heart condition to the Junior Doctor.

It was interesting to see the dynamic in the ward with students reporting to Junior Doctors and Junior Doctors reporting to Consultants. There was clearly a hierarchy in amount of experience but everyone respected and supported each other, concerned about one another especially about those who were on call last night.

I encountered patients who suffer or have suffered recently from bronchiectasis (had also had had a thoracotomy) causing wheezing and coughing after having a lung tumour removed, lung scars causing nodules to appear on their CT scan,  recurring chest infection, osteoporosis, chronic asthma, polymyalgia rheumatica, exercise induced desaturation causing breathlessness, pulmonary embolism, lung collapse, breast cancer, severe emphysema, low T Killer cell count and a heart murmur.

Emily Buchanan

 

Work Experience in a Hospital – day two

Today I was fortunate to experience a meeting in which Consultants met with other Consultants (over the internet) to discuss current patients to ensure that everyone agreed about the plan of their future treatment. I was particularly interested to see that there were also representatives from a sister hospital as some procedures take place there as opposed to in the hospital where I had my experience.

In this meeting, one doctor whom I assume was the most senior led the discussion and concluded it by giving the best solution using all of the present doctors’ advice.

A question frequently asked in hospitals is whether to give frail elderly patients invasive surgery or whether the risk carried with the operations is too high. Doctors make decisions on the basis of amount of risk. Medication and surgery all come with risks and the decision to prescribe medicine or carry out surgery is done on a basis of severity of the patient’s condition and therefore whether it will improve the patient’s health in the long term. The lead doctor suggested that surgery must be the least invasive but most informative as possible. In the meeting I also noticed cost was a significant factor when deciding whether to allow multiple scans for the same person.

After discussing all current respiratory patients, the doctors went on to talk about the meeting of NHS deadlines. I was discouraged that they said that it was physically impossible to reach the NHS’ deadline to release results of CT scans when checking for lung cancer within 3 days. They announced that there was not enough money in the budget to employ another staff member to improve quality of service so they were forced to move their patients to other hospitals where they may receive a better quality of care.

I also visited the respiratory ward where I shadowed a Consultant and a Junior Doctor on their ward round. I was told that a ward round happens twice a day to check progress of the patients in order to ensure medication is working and therefore to advise the nurses about changing dosage or type of medicine being given to the patient. I noticed that Consultants were completely reliant on their teams of Junior Doctors who were prepared to check up on all other cases that the Consultant did not get round to seeing, and the nurses to give attention and medication where needed. I saw the doctors as kind, understanding, encouraging, intelligent and trustworthy.

I was interested to see that a teenage patient was brought to the adult ward even though their age suggested that they should be in the paediatric ward as the doctors from the paediatric ward believed that this was the best place for them due to the severity of their condition. I noticed a dynamic change in behaviour of healthcare professionals when the nurses failed to confirm with the Consultants and Junior Doctors about bringing young patients to adult wards. This is a growing issue in the NHS as mentioned in the program Hospital by BBC where they raise the debate about whether an empty intensive care bed in the children’s ward can be given to an adult if there are none left in the adult ward.

I enjoyed speaking to patients about quality of care in a private ward and feel that I improved their days by giving them my time to listen to their medical story – something which I enjoy doing weekly at the care home I work at. I loved speaking to them after my hectic time in the non-private respiratory ward as it felt more relaxed and enjoyable – it is a shame that every person cannot afford this quality of care. From talking to these people I learned the complexity of some people’s illness can stem from a simple lifestyle choice from many years ago which is most commonly smoking.

It is impossible for me to remember every condition I saw today however the most memorable thing was seeing the draining of the lungs into a transparent glass jar. It was so fascinating and the doctor explained to me that all the liquid is infection between the lungs and pleural membrane.

I look forward to my day in clinic tomorrow.

Emily Buchanan

 

Work Experience in a Hospital – day one

This week I am extremely fortunate to be gaining work experience at a hospital working with doctors, nurses, healthcare assistants and foundation-year doctors in the respiratory department. Over the next week I will be documenting what I learn from my experience, using my blog as a diary. Every day I am scheduled to be visiting a different area of the respiratory department including clinics, meetings, ward rounds, as well as sitting in teaching of radiology, respiratory and wellbeing to medical students.

Today I sat in a respiratory clinic with two doctors, both very different in their approach to dealing with patients. The first doctor was a very good listener, allowing their patients to explain their concerns and then prompted them in order to understand the background of their problem. The Consultant then went on to ask about timescale, dosage and medication whilst using the words better, worse or the same to measure improvement or deterioration in a patient’s illness. Once the doctor had listened to the full background of the condition from the patient’s point of view, the doctor told them the scientific reasons for their discomfort (even taking the effort to draw a diagram of the heart in one circumstance) and concluded with their plans for their medication now and for the future, then asked if they have any questions.

It was very interesting that the doctor had not previously seen these patients even though they had visited the respiratory ward many times before, as the doctor was covering for another doctor who was on a ward round. I believe that this lack of continuity of doctors is unacceptable for a patient’s care as the doctor had to rush to read the patients’ history as they waited outside for long periods of time – the doctor said that they felt they must hurry as they did not want grumpy patients. I also felt uncomfortable with the fact that the Consultant could not prescribe a drug for more than 28 days even though some patients had long-term conditions so were required to come into the clinic every month to get a new prescription, using doctors’ time. The patients could not get their medicine from their GPs due to the GP surgery not being allowed to prescribe the drugs due to lack of demand in the area so the cost was too great.

I noticed that there was two healthcare professionals in the room at one time, the nurse guiding the patient to use the spirometer and helping with paperwork and the doctor who analyses the results of tests and puts together a healthcare plan for the patient whilst listening to their requests and concerns. I was pleasantly surprised to hear that often there are two doctors in one clinic as a patient’s condition may overlap with two specialities, although none of these appointments were taking place today.

I also noticed the encouragement of exercising to all patients, proving the importance of exercise in improving respiratory conditions due to it being more efficient (and cheaper) than using drugs. One scheme that was recommended to more than one patient was a pulmonary rehab program in local gyms that consists of exercises from Physiotherapists to do in-session and at home. Unsurprisingly most people that came into the clinic were smokers or past smokers and I was pleased to hear that all but one patient had given up smoking within the last five years – I believe this is a success on the NHS’ part as smoking has become less fashionable.

Good care is essential for every patient, shown through equal treating of all people, whether the person is able bodied or disabled. From my work in a care home and at this hospital I learned that some wheelchair-bound people prefer being greeted sitting down in order to make them feel comfortable and at ease. Whilst this is true for all people and patients I have greeted, it is important to check with the person for their own personal preference. I would describe doctors as gentle, kind, welcoming, open, trustworthy, organised, knowledgeable, empathetic and reassuring.

Some medical conditions that I witnessed today were a heart murmur, respiratory tract infection, systemic sclerosis, heart strain causing leaky valves, arthritis, COPD, lung clots, glaucoma, post infective hypersensitivity, severe asthma and scarring on the lungs.

 

Emily Buchanan

 

The Power of the Potato

I am extremely lucky to have a family roast dinner every Sunday and fish and chips every Friday lunchtime but in the light of the recent potato scandal this may change.

The Food Standards Agency, who research about food safety and nutrition-related diseases in order to make the UK population’s food as safe as possible, have noticed a link between cancer and foods full of starch that are cooked at high temperatures. New Scientist magazine have suggested that this is due to ‘sugars and amino acids reacting together’ on heating to release chemicals. The chemical that the FSA are most concerned about currently is acrylamide which is said to be a carcinogen (causes cancer). There is no scientific evidence for this link in humans, however acrylamide does not seem to be a very healthy chemical to be ingesting.

Acrylamide is C3H5NO which is prop-2-enamide and decomposes without heat to form ammonia, carbon dioxide, carbon monoxide and nitrogen oxide, putting it on the US’s list of extremely dangerous substances. It is clear why we should not be ingesting this dangerous substance from what we know from basic GCSE knowledge that carbon monoxide is a colourless, odourless gas which binds irreversibly to haemoglobin, in turn preventing oxygen forming oxyhaemoglobin and therefore causing cells to respire anaerobically. Ammonia is also a very unpleasant, pungent smelling gas (at school we only use dilute ammonia in chemistry lessons due to its smell and it also being known as an ‘extremely dangerous substance’.)

In the body acrylamide is thought to cause damage by converting to another compound causing DNA mutation during transcription. This can lead to uncontrollable divisions of cells in the body in numerous locations. [Please read my skin cancer blog for more detailed information about a particular cancer.]

The FSA’s hypothesis that acrylamide causes cancer derives from their study of giving water containing different concentrations of acrylamide to rats and mice in laboratories. The results from this were that several cancers were caused however we do not know if this is the same in humans as it would be unethical to do the same test on humans.

Interestingly, as waste water is treated with this chemical, it has been estimated that one glass of water contains around 500 times the amount of acrylamide as one portion of roast potatoes! Perhaps we should be worrying about our water intake instead!

This leads me to believe that we do not have to cut out roasted potatoes, baked jacket potatoes and fried chips all together but should reduce our intake or cook them at a lower heat and for less time in order to significantly decrease the amount of acrylamide entering the body. The FSA’s official advice is to ‘go for gold’ in colour of starchy foods, check the packaging for recommended cooking instructions and to not keep raw potatoes in the fridge releasing more sugars that could bind to amino acids making acrylamide when heated.

 

Emily Buchanan