Butterflies in my tummy: I clicked send

This week was a very busy week. I had a test, a bunch of homework, but what caused me the most stress was my dreaded UCAS application for medical school. I have enjoyed the last 2 years of my life attending conferences about medicine, studying for the grades and doing things that would enhance my application for medical school, but all of a sudden, it all seemed too real. All of that hard work for an online form. I have spent the last 5 months agonising over my personal statement. It is a torturous process, and whenever I had to delete something, it was like taking a knife to my soul. Then my choice of medical school: that was another long conversation. For a while, it seemed like it was all that my family and I could talk about! All of the Saturdays given to open days, all of the complaints from my sister when she was informed that she would have to wake up at 6 am at the weekend so that we could go to some odd corner of the country to visit a university: all of these thoughts were jumbled up in my head. But amongst the chaos during the week, and the chaos inside my head, there were a number of recurring questions I kept having: What if I get no interviews? Even if I get an interview, what if I don’t get any offers? Even if I get an offer, what if I don’t make the grades? Even if I make the grades, what if I hate my university? What if I hate being a medical student? What kind of a doctor would that make me if I hate my job from day 1? The butterflies in my tummy were causing a ruckus when I finally just closed my eyes and clicked the red send button.

Butterflies in the stomach is a sensation you will probably also be familiar with: when we feel anxious, or nervous it feels like a tingling sensation in your tummy. You may even feel nauseated. Well, it turns out that science has an explanation for these butterflies too! Our mood is very much dependent on our stomach, as our digestive system is closely linked to our central nervous system [1]. Stomach butterflies actually form part of our instinctive fight-or-flight response: a defensive cascade of events that our brain sets off when it detects a threat to our survival. This cascade of events may include an increase in heart rate, blood pressure and breathing rate (which is often also why people with panic disorder begin to hyperventilate during a panic attack) [2]. The nervous system simultaneously sends signals to the adrenal gland so it can secrete the hormones adrenaline and cortisol, which causes the body to become tense and sweaty. The muscle tension caused by the spike in cortisol [3] leads to extra sensitivity in the smooth muscles of the stomach. This added sensitivity is believed to be partly responsible for the sensation of butterflies.

The brain and stomach are in fact so closely related that some researchers refer to the stomach as a ‘second brain’ due to the discovery of the fact that the stomach contains a whopping 100 million neurons linking it to the Brain (which is known as the ‘brain-gut axis’) [4]. Nausea caused by butterflies happens because the adrenaline rush temporarily causes digestion to stop. This is part of the fight-or-flight response because blood leaves the places the brain thinks it is not needed: blood will leave the stomach and go to the legs and arms so it can provide the power for you to run away from the threat. [5] [6]

The fight-or-flight response was very prominent when our ancestors (cavemen and the like) were living in the age where they would get hunted by tigers and bears etc. Today, we get this sensation of butterflies in many different situations. Most commonly, it is in times when we feel nervous e.g. before a presentation or an interview. However, you might also have heard (or felt) butterflies in the stomach when you are in love or talking to a crush! Each of these different scenarios can elicit a fight-or-flight response which is slightly altered to another because different neurochemicals and hormones are being released. It’s kind of funny to think that in the past, my fight-or-flight response would have been activated by me being chased down by a literal tiger, but today it was activated when I saw a computer screen with UCAS’s logo on it!

These butterflies cause all the problems. They flutter around and distract me from remembering the things I need to remember. In this case, they distracted me from remembering how much fun I have actually had during this whole application process. All the friends I have made and the knowledge I have gained. I have genuinely enjoyed all of the conferences I attended, and even if I don’t get into medicine this time round, I can confidently say that I have at least grown as a person—which will only make me better prepared for the next application round!

[1] https://www.naturopathiccurrents.com/articles/probiotics-gut-brain-axis

[2] https://www.verywellmind.com/the-fight-or-flight-theory-of-panic-disorder-2583916

[3] http://www.stresshack.com/cortisol-and-stress.html

[4] https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain-axis/

[5] https://greatist.com/happiness/why-do-i-get-butterflies-my-stomach

[6] https://www.nytimes.com/1996/01/23/science/complex-and-hidden-brain-in-gut-makes-stomachaches-and-butterflies.html?pagewanted=all&src=pm

By Muskaan Jonathan

Relationship between Mood and Gut Bacteria

Humans: Same but Different

As individuals of the same species, we all have the same general features,
such as two arms, two legs, a head, and a torso. However, due to variation within a
species, ours being Homo sapiens, we are not identical copies of each other. Some
of these variations can cause beneficial, harmful or neutral characteristics.
Anatomical variations change the way that the human body forms, most being
relatively harmless to the person. Textbooks of anatomy usually describe the most
common form of structured found in the body, yet there are many examples of
variations from the textbook example that are frequently encountered.

During the Renaissance period in the 15th century, artists become increasingly
interested in the accurate representation of the human body. Famous artists, such as
Michelangelo and Leonardo da Vinci used dissection in order to portray the human
body accurately. Da Vinci excelled in the study of muscles and he produced many
remarkable and detailed diagrams showing actions and movement.
Textbooks of anatomy usually describe the most common form of structured
found in the body, yet there are many examples of variations from the textbook
example that are frequently encountered.

Examples of anatomical variations are the palmaris longus in the forearm
which is absent in about 14% of humans on one or both arms, and the plantaris in
the leg, which is absent is 6%. Another rare variation (1 in 7,000) is situs inversus,
which is a complete reversal of asymmetry in all the organs, usually with normal
physiology. For example, one part of this is dextrocardia, meaning that the heart is
on the right side of the torso, rather than the left. Human variations such as these
provide insight into developmental anatomy.

Double-jointedness, more accurately known as persistent generalised joint
hypermobility, occurs in about 5% of people. This means that the knees and elbows
can be extended beyond 180 degrees (hyperextended) and the hands and feet can
attain unusual positions. Hypermobile joints are not necessarily unstable, as
demonstrated by in performances of acrobats and gymnasts, but they are associated
with a tendency to have reoccurring dislocations of the patella or shoulder.
The human body is a complex machine, with different systems working in
harmony, with the points above being a few of the most interesting ones. Each
human body is different, but one of the same kind.

https://news.softpedia.com/news/The-10-Most-Common-Human-Mutations-57223.shtml

By Karis

Brexit and our NHS

We have all heard the word ‘Brexit’ many times. It is often associated with the economy, trading and businesses failing but have you ever thought about the impact it can have on OUR healthcare system?

For those not aware of what Brexit means let me give you a very brief explanation. It is the idea of leaving the EU (which we have been a part of since the 1990’s). A referendum was held in June 2016 in which 52% of the British population decided to leave the EU [1]. Britain is scheduled to leave the EU in March next year.

The main issue that may arise within the health and social care sector is staffing. Many of the staff and professionals currently working in the NHS come from other EU countries. The figure equates to roughly 130,000 staff of the 1.3 million working in the NHS. It is important to realise that even before we have left the EU the NHS has been struggling due to staff shortages [4].

The Royal College of Nursing has said that there has been a 92% drop in the number of registrations that they received from the EU (March 2017). This may be because people are uncertain about the security of a career in the UK in the future [2]. It is worrying to think what may happen AFTER we leave the EU. One of the reasons why providers recruit the NHS staff from outside the EU is because there are not enough resident workers to fill up the available vacancies. Article 50 only provides protection for those already working in the NHS and not for possible future employees [2]. However, in June 2018, the government did announce that they were ‘relaxing immigration rules’ so that more doctors/ nurses coming from outside the EU were still able to work in the UK [3]. Despite this reassurance, many of the NHS staff could decide to work in other countries. The question here is: If doctors go to work in other countries will that result in the doctors staying having to work extra hours (above the 48-hour limit)? Will that mean that pay will have to increase? And if so where will all the funding come from?

The next potential issue that may come with Brexit is the ability to access treatment in the UK and abroad. Currently, all EU citizens are allowed to have a European Health Insurance Card (EHIC). Holders of this card are able to access the necessary medical health care during their stay in a European Economic Area (EEA). The cost of these treatments can also be reclaimed. Also, EU nationals who currently live in the UK (and vice versa) can access health care the same way all the nationals of that country can access it. If, after Brexit, this can no longer take place then pensioners of UK nationality may decide to come back to the UK and this can have its own negative impact on the system. [4]

Funding and finance. The UK government pays a fee of £350 million A WEEK for membership of the EU. When we leave, we will have billions of pounds to spend on other things such as the NHS. Well, that is what has been promised! The funding of the NHS is dependent on the British economy and the treasury doesn’t seem so satisfied with how Brexit will affect it. The HM Treasury has said: leaving the EU will cause ‘an immediate and profound economic shock creating instability and uncertainty’.

 If the government decides to protect the health service budget and NOT the social care budget this can still affect the NHS indirectly. This is because, in 2016, the lack of social care funding resulted in approximately 400,000 fewer people receiving the social care that they require.[4]. If the £350 million is still not enough where will the government get extra funding from? Will they need to increase tax or will we be required to pay for our healthcare?

Brexit could also have an impact on cancer research.  The EU and UK have worked well together for cancer research and the teamwork is very strong. Leaving the EU can impact the level of research carried out and affect the patients. Fewer patients will be able to access treatments and there may be delays in new trials beginning. Another point to add is that once the UK has left we will have less of an impact in medicine and clinical sciences.  Limited cooperation could result in the UK being deprived of the top researchers that the EU has to offer. [5]

It is clear that the majority of the scientists and healthcare staff are against Brexit. These people can see how Brexit will impact their field of work and society as a whole. As we have already voted to leave the EU only time will tell whether this was an advantageous or a damaging decision.

By Kashaf Imran

Bibliography:

https://www.vox.com/2016/6/25/12029962/why-did-britain-leave-the-eu [1]

http://ukandeu.ac.uk/the-impact-of-brexit-on-nhs-staff/ [2]

https://www.bbc.co.uk/news/uk-wales-politics-44703552 [3]

https://www.kingsfund.org.uk/publications/articles/brexit-and-nhs [4]

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30025-0/fulltext [5]

‘It’s Not Just Pain. Period’

Periods are a part of many women’s lives, and with them can come cramps, headaches and pain. However, for many women, the pain that comes with their periods is excruciating and can prevent them from living their lives normally. If you are one of these women, experiencing such painful periods, you may have endometriosis.

Endometriosis is a condition where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes, where it induces a chronic inflammatory reaction that may result in scar tissue. (1) It is a fairly common condition, affecting approximately 176 million women around the world. (2)

Normally, as part of the menstrual cycle, estrogen causes the lining of the uterus to grow and thicken, preparing the uterus to receive a fertilised egg. If an egg doesn’t get fertilised, the lining of the uterus breaks down. This lining then leaves the body as menstrual blood. However, in endometriosis, the endometrial tissue that would normally line the uterus is found outside it. This tissue will thicken, break down and bleed with your menstrual cycle, but this tissue and blood have no way of leaving the body. This can lead to pain, swelling and scarring. (3)

The symptoms of endometriosis include: pain in the lower tummy or back (pelvic pain), painful periods that prevent you from doing normal activities, painful ovulation, infertility (due to the changes in structure and functions of the reproductive organs),  pain during or after sexual intercourse, pain when urinating or pooing during your period,  heavy bleeding, fatigue, nausea, constipation, diarrhea or blood in your pee during your period. Endometriosis can have a huge impact on general physical health and social well being, as it makes it hard to do many things. It can also have an impact on your mental health and can lead to feelings of depression which could be due to the mental strain of coping with symptoms. (1)(2)(3)

If you have symptoms of endometriosis, you should see your doctor. It can be difficult to diagnose endometriosis because the symptoms can vary considerably, and many other conditions can cause similar symptoms. You will be asked about your symptoms, and an examination may be completed on your tummy and vagina, to be able to recommend the best treatment for you. If these don’t help, your doctor may refer you to a gynaecologist for some further tests, such as an ultrasound scan or laparoscopy. A laparoscopy is where a surgeon makes a tiny incision in the skin and passes a thin tube through so they can see any patches of endometriosis tissue. This is the only way to be certain you have endometriosis. A laparoscopy can provide information about the location, extent and size of the endometrial implants (abnormal growth of endometrial outside of the uterus) to help determine the best treatment options.  (1)(4)(5)

Currently, there is no cure for endometriosis, but there are a number of treatments that can help to manage symptoms. Treatments include:

  • painkillers – such as ibuprofen and paracetamol.
  • hormone medicines and contraceptives – including the combined pill, the contraceptive patch, and medicines called gonadotrophin-releasing hormone (GnRH) agonists and antagonists.
  • aromatase inhibitors – a class of medicines that reduce the amount of estrogen in the body.
  • progestin therapy – can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
  • surgery to cut away patches of endometriosis tissue
  • an operation to remove part or all of the organs affected by endometriosis – such as surgery to remove the womb (hysterectomy) (1)(4)

It is not yet known what causes endometriosis to occur but there are lots of theories and ideas about how it develop, including: genetics, a problem with the immune system, endometrium cells spreading through the body in the bloodstream and retrograde menstruation (when some of the womb lining flows up through the fallopian tubes and embeds itself on the organs of the pelvis, rather than leaving the body as a period). It is likely that endometriosis is caused by a combination of various factors. (1)

 

By Bernice Mangundu.

References:

  1. https://www.nhs.uk/conditions/endometriosis/
  2. http://endometriosis.org/resources/articles/facts-about-endometriosis/
  3. https://www.bupa.co.uk/health-information/womens-health/endometriosis
  4. https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
  5. https://www.medicinenet.com/endometriosis/article.htm

 

 

 

Gaming Disorder – Are Video Games Playing You?

Hey guys, it’s Joerel again and today I’m going to be talking – more like arguing actually – about the whole “gaming disorder” which the World Health Organisation (WHO) has officially recognised as a disorder around June of this year. This is going to be a doozy. In any case, let’s go for it.

So, you might be wondering, why did the World Health Organisation consider this as a disorder? Well, on their website, they see gaming disorder as (and I quote straight off the page) “a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.”[1] Okay, that does not sound so bad, does it? I personally believe that whatever the addiction is, whether it be something as hardcore as drugs and alcoholism or smoking, it should be taken seriously and should be treated as much as possible to return them back into a generally better state than they were before. Gaming can be addictive, and while gaming is quite relaxing and entertaining, too much of anything can kill. Everything should be kept at a reasonable limit (depending on what it is of course – drugs do not count for this), but not limiting the enjoyment one gets from such said pleasure. I know I like to play games on my laptop and on my Nintendo DS, but I know when I had too much. Overall, well played for keeping up with technology.

But, my argument is what they say next: “For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.”[1] That seems a bit too vague, kind of like YouTube’s ad revenue policies. To see someone being engulfed in gaming is within perspective. One doctor or psychologist might be able to see one person as a gaming addict while another might not see the same person as addicted to gaming. It is relatively new, because of the recent surge of gaming and so no-one can truly understand who a gaming addict is and who is not. While it may be seen in the near future, it is currently not possible and if it is possible, many may cause misdiagnosis. Dr. Vladimir Poznyak, a member of WHO’s Department of Mental Health and Substance Abuse, which proposed the new diagnosis to WHO’s decision-making body, the World Health Assembly states: “And let me emphasize that this is a clinical condition, and clinical diagnosis can be made only by health professionals which are properly trained to do that.”[2] Like I said previously, that is completely subjective. Also, it irritates me to not know what their training is. What is it? Like, would it not be obvious if someone has a gaming disorder? How would it work? Though there is some opposition from other professionals. For example, Dr. Richard Graham, lead technology addiction specialist at the Nightingale Hospital in London, said: “it is significant because it creates the opportunity for more specialised services. It puts it on the map as something to take seriously.” Though he argues that “it could lead to confused parents whose children are just enthusiastic gamers.”[3] highlighting the main issue when classifying this as an International classification of disease (ICD).

Also, you must consider some other factors. For example, has anyone is the WHO ever considered E-Sports at all when it came to this conclusion? E-Sports is professional gaming and there are stories out there which counter the point of having gaming disorder as a thing. Take example SKT Faker. SKT Faker, a professional League of Legends player, when he was only a teenager, he decided to drop out of high school to continue his love of gaming. He was scouted to be a part of SKT Telecom K and he played ever since for the organisation.[4] Guess what happened to him? He became known as one of the best players in League of Legends (LoL) as well as winning consecutive world titles in the game. The prize money is absurd when it comes to E-Sports. In 2016, the prize pool was $5,070,000 and last year’s being $4,946,969.[8] Faker, his team, and his organisation got both of those prize pool money because they won both years. E-Sports is not a joke. He threw away his education to win even more money than he would have if he continued his education – just by playing games that he was amazing at! While it is not implying people should leave school for a pursuit of professional gaming, if people see potential then they should go for it otherwise it would have been a wasted opportunity. Another example would be TSM Reginald, the owner of Team SoloMid. He placed his faith in LoL and focused on gaming rather than school or university and see him now.[7] Reginald owns one of the most successful franchises in E-Sports. Currently, TSM has investors such as Stephen Curry supporting his team.[9] Even actual athletes are recognising the potential in E-sports because it is as competitive as actual sports. 100 Thieves, a gaming organisation, has a partnership with the unstoppable NBA team Cleveland Cavaliers[6] and the Golden Guardians, another E-sports team, is supported by the Golden States Warriors.[5]

In my opinion, I think that gaming disorder as a classification should be reconsidered or at least put on hold for now. You must think of other factors, ones you don’t even know or think about, and while I commend WHO for trying to adapt to the new technological advances, I believe that they need further research. There are plenty of uprising professional gamers on the rise and the next thing we need is someone saying another person cannot pursue their career because of ‘gaming disorder’. While it is a good thing to consider, I believe personally, more research and proper training (in years, not months or days) should be done to properly assess this issue before they can officially press it as a disorder.

SOURCES:

[1] http://www.who.int/features/qa/gaming-disorder/en/

[2] https://edition.cnn.com/2018/06/18/health/video-game-disorder-who/index.html

[3] https://www.bbc.co.uk/news/technology-42541404

[4] https://www.youtube.com/watch?v=hNQC5GyumQ4 [The Story of SKT Faker]

[5] https://lol.gamepedia.com/Golden_Guardians

[6] https://www.100thieves.com/partners/

[7] https://www.youtube.com/watch?v=zbQsmHQh2gI [The Story of TSM Reginald]

[8] https://www.esportsearnings.com/leagues/190-lol-world-championship

[9] https://www.forbes.com/consent/?toURL=https://www.forbes.com/sites/mattperez/2018/07/24/tsm-raises-37-million-investors-include-stephen-curry-jerry-yang/#282742827f8a

By Joerel Gestopa

Cuts to NHS Procedures

To acknowledge its 70th birthday the NHS cut a total of 17 procedures from its service which have been deemed as unnecessary. Among this list of abolished or highly restricted procedures include snoring surgery, breast reduction, tonsillectomy, and hysterectomy for heavy menstrual bleeding.

It is estimated that this will stop approximately 100,000 operations, saving the NHS £200m. The medical director of NHS England, Steve Powis, insisted to the Times that ‘there is more to be done’ and this is just ‘the first stage’ of discontinuing unmerited and needless treatments.

Personally, I can definitely see reason for these cuts as the £200m saved could contribute towards offering more essential procedures. For example, I am a strong advocate for the introduction of brain scans for patients with migraines. I think that evaluating the effectiveness of each individual treatment provided is of paramount importance so it is ensured that taxpayers’ money is not wasted, but is spent only on evidence-based and necessary treatments.

Despite this, I can sympathise with those who will be affected by these cuts who will either have to turn to alternative or privatised treatments, or they will be forced to live (and potentially suffer with) the ailments for which they pursued a remedy. For example, women who have heavy menstruation will not be provided with hysterectomy (unless circumstances are extreme and fulfill certain restricted conditions). Hysterectomy is a surgical procedure where the cervix and womb are removed, hence stopping menstruation. This would restore confidence in women with heavy menstruation as they no longer have to worry about leakage, pain or feeling uncomfortable. An added bonus of this procedure is the eliminated risk of cervical cancer and hence the abolished necessity of cervical smears. However, this is a major surgery requiring general anaesthetic, so is associated with risks such as postoperative infection. Moreover, the procedure can cause premature menopause, cannot be reversed and may be less suitable than other treatments, for example, hormone therapy. Therefore, there is a strong argument to regard hysterectomy for heavy menstruation as an unnecessary risk with little benefit.

To conclude, I would propose that the cuts made were justified and that further cuts should be made in the future. Nevertheless, I maintain that each case should be considered deeply with an emphasis on ensuring patient care is of the highest possible standard.

By Sophie Maddock

World Hepatitis Day

Did you know last Saturday (28th July) marked World Hepatitis Day? So what is hepatitis? Hepatitis is a viral infection referring to the inflammatory condition of the liver. The liver is really important in carrying out vital functions in the body that affect metabolism, such as production of bile or filtration of toxins. Hepatitis can be fatal because when the liver can no longer functional properly it can lead to bleeding disorders, kidney failure or even death [1]

Although it is caused by a virus there are other possible causes such as certain medications and alcohol. There are five different types of viral hepatitis – A, B, C, D and E [1]

Hepatitis A – spread through contaminated food/ water

Hepatitis B – spread through bodily fluids such as blood or sharing razors

Hepatitis C – it is the most common blood-borne viral infection in the US

Hepatitis D – spread through direct contact with infected blood

Hepatitis E – it is a waterborne disease and found in places with inadequate sanitation

The disease develops slowly so symptoms such as loss of appetite and fatigue may be indistinct at first. [1]

The aim of world hepatitis day is to raise awareness of the 300 or so million people worldwide who are living with the viral hepatitis. That is nearly 4 and a half times the UK population. The problem here is that they are unaware which has a knock on effect. If these people are not given the appropriate care then this virus can spread rapidly from one person to another and continue to affect many more. By raising awareness, we will be helping so much by finding those ‘missing millions’. [2]

A few years ago, due to the lack of awareness and government intervention/ political commitment, the death toll had been continually rising – despite all the treatments and vaccines found. However, a lot has changed in the previous year. Meetings were held between the global hepatitis community to discuss ways of eliminating hepatitis and it was also recognised as being a global development priority. But this is not enough; the governments now want to fully eliminate viral hepatitis and the aim is to do it by 2030. [3]

A message from the WHO Regional Director for Africa, Dr Matshidiso Moeti : ‘I urge all Member States in the African Region to use the World Hepatitis Day campaign as a vital opportunity to step up national efforts on hepatitis and to spur action to implement the strategy on viral hepatitis. I appeal to the general public to seek information about viral hepatitis and services for prevention and treatment from the nearest health facility.’[3]

Around 1.3 million deaths are caused by hepatitis and it is also the cause of two in three liver cancer deaths per year. This makes hepatitis the seventh leading cause of death globally – that is bigger than HIV/AIDS and malaria. By ‘strengthening public awareness and prevention as well as ensuring that everyone living with viral hepatitis has access to safe, affordable and effective care and treatment services’ we can really come together and make a difference.[3] [2]

Remember prevention is better than cure!

(Please visit this website to see how you can get invo

lved: http://www.worldhepatitisday.org/)

By Kashaf I

Bibliography:

[1] https://www.healthline.com/health/hepatitis

[2] http://www.worldhepatitisday.org/

[3] http://www.worldhepatitisday.org/wp-content/uploads/2018/03/WHD20201620Global20Summary20Report_11.pdf

[4] http://www.worldhepatitisday.org/wp-content/uploads/2018/03/WHD20Summary20Report1.pdf

The Journey Ongoing

You may remember how this blog page first began…

‘Medicine and Me’

‘Anatomy of Antonia’

‘The Making of a Medic’

The stories of each of us admins and why we decided that medicine is what we wanted to do. The decision may have been a lifelong wish for some, it may have been an epiphany for others, or it may even be an uncertain one still. There’s such a big difference between a child saying ‘I want to be a doctor!’ compared to ‘I want to do medicine!’ – it takes a certain spark and a certain energy to say ‘I want to do medicine’. Knowing you want to do medicine, is knowing what the course entails, the work you need to put yourself through to get there and knowing what a doctor actually does.

A-levels have been a struggle, not only for me but for everyone. There are many people who want to take medicine but are trying to think of other options to fall onto if they do not get into medicine. I believe that if medicine is your passion – if becoming a doctor is your passion – then do not feel disheartened, lift yourself up, and realise there are many ways to get into medicine.

Recently I went through work experience in my local hospital (Luton & Dunstable Hospital) with the orthopaedic department. I came with a feeling of uncertainty, yet I was excited at the same time. If you can remember my first blog, you’ll know that I am someone who was surrounded by the medical field, I was a weird child who was so interested in medicine that instead of normal online games a child would play, I ‘played’ the edheads surgery simulations! So it was hard for me when I started questioning my abilities and thinking: ‘Will I even get into medical school?’. That thought gives a horrible feeling to someone like me who has had the dream to be a doctor from a young age.

On my first day of work experience, I was surrounded by junior doctors in the wards. One word to summarise that experience: CHAOS. We walked, we ran, we were as fast as could be, rushing through patients, rushing through files, rushing through paperwork… It was a side of being a doctor I didn’t think about. I always saw being a doctor as something where everything you do fulfills you; everything you do makes you feel a sense of satisfaction; everything you do, in spite of all the hard work, pays you back. Not only did I see it as a job where you can help people and create an impact and difference in the world, I also saw it as a job where I could make my parents proud, I could be the child that parents tell everyone about, and not only that, but it’s a job that could make me money so I’m able to give back to my parents and live a good life. Seeing this side, and the stress the junior doctors were in, was a whole other side of being a doctor I had not thought of. Speaking to them almost brought my spirits down! They said that medical school was lovely, but the job itself is difficult. Some of them straight up said ‘DO NOT DO IT!’, some said that it was too hard and stressful, some believed that it just altogether wasn’t worth it. Other than that, there was also advice that I took close to me: being a doctor is something that you need to have true passion for – you can only do it if you really, truly love it; before you go into it, you just need to know that it is what you want for sure. One junior doctor even recommended taking a gap year.

After this hectic first day, I thought to myself: am I cut out to be a doctor? Is this endless stress really what I want? Is being a doctor actually what I thought it would be? I know for a fact that I want to be in the medical field – I want to make an impact on other people’s lives and help the world be a better place. But there are more ways of doing that than becoming a doctor. I contemplated and my mind ran away from medicine. I could be a nurse. I could be a dentist. There are many things out there which give the care-based work that I want to do. I decided, maybe this year, I’ll just apply for biomedical science and nursing, that way I won’t need to take medicine, and if I feel unfulfilled with what I am doing (which I was adamant I wouldn’t, especially that nurses have such a huge, vital role in the care of patients) I could take an accelerated course in medicine in the future. It was either that, or take a gap year to really experience what working in the medical field is like by applying to be a HCA (healthcare assistant) in my local hospital which would also build my personal statement as well as give me time to think and decide what I want to do for the rest of my life!

The next two days of work experience, we worked with on-call doctors, as well as a consultant. They were doing admin work, lots and lots of admin work. Then once they were called, they would head down to A&E and help out. I saw an NOF case (neck of femur). This means that the patient had fractured their neck of femur. We watched a team of paramedics administer a splint for pain relief. The doctor informed us about how the femur would be operated on to fix it, he also showed us the resuscitation forms which were forms to be signed and decide whether or not the patient would want to be resuscitated in case of cardiac arrest. It was an emotional conversation to have with the patient’s family member who was present. The doctor remained professional and understanding at the same time. NOF cases are considered urgent, yet when I was in trauma meetings every morning and doing ward rounds on my third day of work experience, they seemed very common in elderly patients. One of the things we were told by one doctor really stuck to me: ‘to you, it might be something you see every day – a small matter – but to them, it is the biggest, most important thing going on in their lives’. This applied to everything, from something like osteoarthritis (which was literally a case I’d see every day since I was working with the orthopaedic department) to an NOF case. The doctor I worked with on ward round on my third day of work experience explained to us the importance of patient experience. This side of being a doctor was the side that I was interested in: the whole care-based part of being a doctor – getting to know your patients, building a bond and helping to make a difference in their lives. I love to learn, I love the rush from the intensity of the job as a doctor, I would love to be able to use my knowledge, passion, and emotion to make a difference in the lives of many. This side of being a doctor was the sense of fulfillment I truly wanted to get into medicine for. Was I really going to throw away medicine, throw away being a doctor, throw away my biggest dream?

Medicine is a scary thing.

I find myself running back and forth. I’m going to be a doctor. I’m going to be a nurse. I’m going to be a psychologist. I’m going to be a doctor.

During work experience, I was able to really look at myself and ask myself if this was really what I wanted to do. Consultants would tell me that even after finishing medical school, you are constantly learning and learning – you have to keep going for years onwards before you can be a consultant. I thought to myself, ‘will it be worth it?’, ‘is being a doctor what I really want to do?’, ‘am I even capable of becoming a doctor?’.

L&D hospital is a source of inspiration for my biggest goals and aspirations since I was always surrounded by people in the medical field thanks to my mum. I can now proudly say that going through work experience in L&D hospital is also the very reason I know I do not want to give up on becoming a doctor. I will apply to medicine for university. Whether or not I get in is another story. I had the privilege of working with a passionate medical student, he himself went to the same sixth form that I do, and he was also rejected from medicine in the UK. He did not let that stop him. He knew that medicine was his passion. Being a doctor is what he wanted to do. He followed his dreams all the way to Bulgaria. Yes, he gets it all the time: ‘Bulgaria? Why Bulgaria?’. Well, there he was able to get into university to study medicine through an entrance exam. He said that if you are passionate about medicine and it what you want to do, then do it.

There are many routes into medicine, and if you feel like you are not capable, pick yourself up and tell yourself that you are. Medicine comes with hard work and dedication – all you need is your very best. If medicine is truly what you want to do, if being a doctor is truly what you want to do, then do it – reach for it. There are many ways around it. You can take a foundation year. You can take another degree and then an accelerated course in medicine. You can even take a gap year to really think about it!

I asked an orthopaedic registrar for advice on this whole topic, and here is what he said:

‘Hi Antonia

No probs, hope you are well and good luck with your application to medicine. In my A-Levels, although I got 3 As and a B, I wouldn’t worry at all. There are so many routes into medicine and in fact, some routes are exactly the same as getting into medicine right away.  Firstly The requirements are not 3 As. Secondly doing Biomedical sciences first then medicine is perfectly reasonable and in fact maybe better in the long run. Doing Biomedical sciences first will give you a chance to do research and publish which is desirable when it comes to applying for specialty training later on. It also gives you an added degree which also looks good on the CV. Many of my friends have done Biomed first and have done really well!

Extra-curricular things I did and would recommend are volunteering in a care home or nursing home and doing work experience in a hospital. I chose medicine genuinely because I would like to make a difference to people’s lives and because I enjoy the science behind it. It gives me a chance to do humanitarian work as well in poorer countries. Let me know if you need anything else and good luck!

Os’

I know I am not the only one who has had these mixed emotions with medicine. It is a course you have to be sure about, and rightly so! So, it would be unfair for me to be the only one who poured my heart out for the blog page! I asked our other two admins (Bernice Mangundu and Muskaan Jonathan) to say what they had to say about their journey to medicine…

‘The journey to medicine has not been easy. I have had doubts about whether this has been the right path for me. It is. 

There is no other profession quite like medicine. The ability to help save the life of others is a powerful thing. It will not be easy to go into medicine. The job is difficult and the hours are long, however, the positive impact I will make on other people’s lives will be worth the effort. It is a scary thought that the life of others may literally be in my hands but I know I will do everything in my power to ensure that they will be safe hands.  

To be a part of the NHS family will be an honour. I am willing to fight for the NHS. For 70 years they have been helping to save and improve the lives of millions of people. They are a group of hardworking, caring people and I would be proud to a part of them. To lose it would be a tragedy for this country.  

Bernice Mangundu’

‘It has been a difficult journey for me to decide to do medicine. I know how much work it is, but don’t know how it feels to go through that grueling process, so fear of the unknown has made me very conflicted. One minute I want to do medicine, but the next, it scares me so much that I go running in the opposite direction. But if not medicine, then what? I have looked for experience in so many different areas, and none of them have inspired me, moved me and satisfied me as much as medicine. There are days when I ask myself if I am crazy to be signing myself up for such a lifestyle, but then I remember the hope that I will be spreading and the comfort that I might provide for someone who is feeling vulnerable.

Why do you want to do medicine? It is a difficult question to answer: I have so much to say but at the same time, I have nothing to say—it just feels right. Obviously, I can’t say that in my interviews for medical school or in my personal statement. That is when I have too much to say. I just finished writing a first draft of my personal statement, and the process was torturous. I had to cut at least 7 paragraphs which say why medicine is suited to me (trust me, it was like taking a knife to the soul). But no matter how exhausting the process is, all I can do is have faith in myself that in the future, I will make a good enough doctor to make a small, or big difference to someone’s life and make them a happier person.

Muskaan Jonathan’

Well.

This was a LONG post! But it had a whole journey and a half! I still have a long way to go, and who knows! My mind might change again! I doubt it will now, however; taking medicine, being a doctor, making a difference in the world has been my dream from such a young age. I’m not willing to throw it away now, and I am determined to do everything I can so that one day I will be a doctor.

Antonia Marie Jayme

Questioning Confidentiality

Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.’- Hippocratic Oath

Doctor-patient confidentiality is arguably one of the most important policies enforced in modern medicine. Doctors in the UK may not disclose information about their patients unless extenuating circumstances would put the patient more at risk than if the information was not disclosed.

However, complex issues arise from this policy.

Consider the following:

Mrs. A is pregnant, with what is supposedly Mr. A’s child. Mrs. A and Mr. A arrive at the clinic to test for a specific gene that causes a rare disease, of which it is known that Mr. A is a carrier of. Upon inspecting the genealogical data collected from the foetus, it comes to light that the child is not M.r A’s.

What should the doctor do?

I am going to pose three arguments to answer this question.

Argument 1

The doctor has no right to disclose the information to Mr. A as it is not the doctor’s place to do so. The couple has come to the clinic to test for the rare gene, not to test for the paternity information. Besides, it would be in the child’s and the family’s best interest not to disclose the information as this could lead to a broken home.

Argument 2

The doctor should disclose the information to Mrs. and Mr. A, as it is both of their information. It is likely that Mr. A would want to know and to withhold the information would be dishonest.

Argument 3

The doctor should tell Mrs. A but not Mr. A. The information belongs to Mrs A only as she is the carrier of the baby. It would most likely be in the best interest of Mrs. A and the child not to tell Mr. A as this could lead to a broken home.

Personally, I would agree with argument 1 as the doctor is being called on to identify the presence of the rare disease gene so it is not their place to step in. However, the two concepts of non-maleficence (do not harm) and beneficence (only do good) can be called in to question.

Would it be more harmful to tell the couple, than not to tell them? Who would it harm?

Alternatively, would it be more beneficial and who would it benefit?

In conclusion, the principle of doctor-patient confidentiality is a complex and ambiguous one. I think that there is an argument for more strict and precise guidelines for doctor’s to follow. However, I believe that the solution should be left for the individual discretion of the doctor, who is very likely to act in what they think is the best interests of all parties involved.

By Sophie Maddock

Happy 70th to the NHS!!!

Last week, our NHS turned 70 years old! This is a huge reason for big celebrations, and we decided to do a little tribute along with the rest of the country. Some of the writers at Medicine on my Mind have written a small piece about what the NHS means to us. We hope you will enjoy reading our messages of gratitude to the NHS, and hope that this serves as a reminder of how privileged we are to have such a noble service available.

What the NHS means to me

Today is the 70th birthday of the NHS. 70 years ago, Beveridge described the National Health Service as providing care “from the cradle to the grave”. Though a simple phrase, the dedication, hard work and billions of lives saved within those lines are astonishing. From grandparent to parent to child, generation to generation, the NHS has provided an amazing gift to all of us. The gift of security in our healthcare, knowing that no matter what happens to any one of us, anything will be done to save our lives, as care is based on the clinical need of a patient, not the ability to pay. What makes the NHS so unique from any other nations health service, is the powerful values that underpin it. Values of inclusivity, compassion and the highest standard of care. Happy birthday, here’s to the next 70 years.

Jenna Philpott, Guest blogger for Medicine on my Mind

Parent

Until before I wanted to become a doctor, I never really gave much proper thought into how much the NHS does. It was just something that I knew was there when anyone needed it. But that is precisely what makes it so special. The NHS is there for whoever needs it, whenever they need it. They are always there—a bit like a parent. They tell us what to do just like a parent might: ‘smoke less’; ‘drink less’; ‘exercise to reduce your risk of cardiovascular inefficiency’. We try to pick fights and find faults in them, question them just like we may do with our parents sometimes: ‘The NHS is a victim of its own success’ or ‘the NHS is failing to meet targets’ or ‘Is the NHS still the “envy of the world”?’. But, they accept us no matter our background or circumstance, just like a parent does. And their hearts only wish the goodwill for us—just like a parent’s. At the end of the day, no matter what we may say, the NHS is an absolute privilege to have access to. Thank you so much to all the staff who make it so special and selflessly give so much of themselves to benefit the rest of us.

Muskaan Jonathan, Admin for Medicine on my Mind

Happy Birthday NHS!

In the 70-year course that this organisation has worked through, I must admit, it is doing well so far.

Now, I was not born in England – I was born in the Philippines and was brought to England around 2006. There are a few things I want to say about my experience with the NHS. I think that it is the light at the end of the tunnel. I believe many of us in the UK truly underestimate or do not appreciate the fact that the NHS provides free (to an extent) services for both adults and children. The NHS is something that I always thought just made sense? You know? Free healthcare?

Seeing other countries and their massively expensive bills for a consultation and surgery, (I’m looking at you America) it pains me to know that there are others who cannot actively seek help to improve themselves, to improve their conditions physically and mentally because of the fees and costs.

The NHS has helped me out so much in the ten years I have been here. I love the free dental care and the service they give, I would not have been able to get my glasses without them and they are improving by now focusing on mental health, which people undermine these days. The people who work there are selfless people who work around the clock to save lives, to comfort others and put their patients above themselves. We should not take these things lightly but rather help to improve.

The NHS is something wonderful and we should appreciate it because I do not know about you readers, but I would much rather get free health care than having to pay for one if the NHS is privatised.

Clement Attlee was the prime minister who helped establish the NHS, and his legacy and ideals give on in the NHS. He knew that change was needed so he delivered. We should support our National Health Service, and not lose this organisation that benefits not just one person, but everyone in the UK.

May the NHS and everyone who works there live on and prosper for many more years to come!

Joerel Gestopa, guest blogger for Medicine on My Mind

NHS Appreciation

NHS has been a vital part of many people’s lives, including mine. Some may even have had NHS since birth! That fact truly calls for a celebration. Imagine you, your child or your mum, anyone, playing a friendly game of football. One thing leads to another and suddenly – SNAP – a broken knee. A bit gruesome to imagine I suppose – but fear not: NHS comes to the rescue! The knee has been fixed, and at what cost? Nothing! Did you know that a surgery for a broken knee/leg can cost the NHS around £5,120? And you get it for free!

The NHS comes with much controversy, especially with the threat of privatisation – but today, let’s really think of all the positives and all of the things we brush off and disregard; things we are ungrateful for.

I admit, I myself have been guilty of debating about whether or not the NHS should be privatised. Yet the honest truth is, if NHS never existed, we may not even be alive! Just look back at UK’S history and why the NHS began! I believe that the NHS is one of the most unique, essential part, not only of UK’S history, but of its people. The wonderful service provided and the hard work being put in is something we truly cannot repay and wherever NHS goes from here, it will always be a part of us.

Antonia Jayme, Admin for Medicine on My Mind

Happy Birthday to our much-loved NHS!

By the writers of Medicine on My Mind

A drink to save my life?! Milk-shaking up the medical world

If you remember, the last post I did was all about sepsis. Well, this week, I happened to stumble upon a very interesting article about a ‘vitamin cocktail that can treat sepsis’! How strange, a simple vitamin cocktail to treat a deadly condition like sepsis, surely there must be more to it?

[1] At the Eastern Virginia Medical School, Paul Marik gave a mix of Vitamin C, Vitamin B1 and a steroid to 47 sepsis patients in 2017. Before using the treatment, 19 of those 47 sepsis patients dies, whereas out of the 47 who got the treatment, all but 4 survived! Unfortunately, this would not qualify as enough evidence to determine that the cocktail is successful.

However, now the time has come to put the cocktail up to bigger tests. The way in which researchers are aiming to do this is by randomly selecting between 500-2000 patients at multiple hospitals, and giving some of them the cocktails, while others are given a placebo for about a year and a half. The researchers will want to answer questions about what the vitamin mixture does to speed up recovery in sepsis patients on life support. If any improvements in mortality are seen, it is likely that the study may be extended.

The main hope with this vitamin cocktail is that it will minimise any injury caused to the vital organs due to sepsis. Therefore, the researchers will be evaluating how well it prevents organ damage as well as how well it reduces death rates. Furthermore, what is so good about the cocktail is the limited risk of side effects. There can be some side effects of having too much Vitamin C. It can throw off measurements of blood sugar, which would mostly be concerning for those in patients who are getting extra glucose in the hospital. Furthermore, people who take a lot of Vitamin C are more likely to develop kidney stones.

However, there are a lot of benefits of getting that extra vitamin C and B1. Vitamin C lowers oxidative stress and inflammation (oxidative stress is an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants [2], which can trigger inflammation leading to many chronic diseases such as Cancer, Cardiovascular disease and other neurodegenerative diseases like Alzheimer’s and Parkinson’s disease[3]). Vitamin C also helps blood vessels from dilating (widening or expanding) which can help maintain blood pressure. People who suffer from sepsis are usually deficient in vitamins C and B1, so when combined with the steroid hydrocortisone, the effects seem to be boosted. Vitamin C can also improve blood flow to tissues, which is exactly what sepsis patients need so that their cells can be supplied with enough nutrients and oxygen to prevent organ failure.

A vitamin cocktail is not the only thing that seems to be showing some degree of promising results for treating diseases. There was a nutrient milkshake being sold online in the UK which claimed to be able to slow the effects of Alzheimer’s, however, experts said that there was not enough evidence to support these claims. [4]

The milkshake, called Souvenaid, comes in strawberry or vanilla flavour. It contains a combination of fatty acids, vitamins and other nutrients. The milkshake should be taken once daily and the boost of nutrients is supposed to slow down the effects of Alzheimer’s in people with the earliest signs of this type of dementia.

Unfortunately, clinical trials do not show the results to be positive. 311 patients with very early Alzheimer’s or mild cognitive impairment were given a daily drink, but only half of them were given Souvenaid while the other half were given a placebo—a drink with no added nutrients. After two years, the patients were reassessed, but no advantage from the treatment was found. However, the patients who received Souvenaid did have slightly less brain shrinkage on brain scans, which offers some level of promise because it is brain shrinkage in the memory-controlling regions of the brain which is often seen with worsening dementia.

Whether the drinks are successful or not, the concepts have certainly milk-shaken up the medical world!

By Muskaan