Battling the Leader of Death

There are many illnesses, diseases and ailments in this world that we might all be subjected to. However, sometimes a treatment from your doctor isn’t the best way forward. Diseases and conditions are split into mainly 2 categories: communicable and non-communicable. A communicable disease is one which can be spread to another person through contact, for example, HIV/AIDS, polio, Tuberculosis, malaria, hepatitis and influenza. On the other hand, a non-communicable disease (NCD) is one which cannot be passed on from one person to another. It is non-infectious.  Currently, around the world today, NCDs are by far the leading cause of death in the world as roughly 63% of annual deaths are caused by them [1].

NCDs are split up into 4 categories: cardiovascular diseases (like heart attacks or strokes), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease) and diabetes [1]. If we think about it, while these conditions are very different, they still have one thing in common: for most people, these problems could be solved with simple lifestyle changes, which is where public health plays a role.

Public health is the area in medicine which focuses on public health in terms of maintaining hygiene, studying epidemiology and disease prevention. It considers a population rather than a single patient and focuses a lot on holistic care (focusing on the whole spectrum of well-being rather than just the condition that might be affecting someone) [2]

Public health aims to influence larger populations into living a healthier lifestyle, and I believe that the best way to summarise it is ‘prevention is better than cure’. When trying to raise awareness about the conditions, public health campaigns are very effective to emphasise the ‘prevention’. Some examples of public health campaigns include:

  • Stoptober: this is a public health campaign which aims to encourage smokers to make an attempt to quit smoking [3]. If we refer to the 4 main types of NCDs, this would improve the situation of almost all of them! You would be less likely to develop a cardiovascular disease because smoking damages the lining of your arteries, leading to a build-up in fatty material which narrows the artery: this could lead to angina, a heart attack or stroke [4]. You would be less likely to develop cancers such as lung cancer or mouth cancer. You would be less likely to develop COPD as smoking damages the lining of your lungs [5]. Lastly, you would be 30-40% less likely to develop Type 2 diabetes. [6]
  • Change 4 Life: this is a campaign which aims to tackle obesity and encourages families to ‘eat well, move more, live longer’. [7] Today, we have an obesity crisis, especially with children. In England during 2016/17, 1 in 5 children in year 6 and 1 in 10 children in reception were classified as obese. [8] This has been linked to the fact that now, nearly 7,000 young children and young adults have been diagnosed with Type 2 diabetes, which is almost 10 times the previously reported amount. [9] Having this campaign would significantly reduce someone’s risk of developing a cardiovascular disease. People who exercise regularly (‘move more’) have a significantly lower risk of having a heart attack, and the most physical people have a disease rate 50% lower than those who live a sedentary lifestyle. [10] Furthermore, having a healthy diet (‘eat well’) means that someone is more likely to have better control over their weight, thus reducing the chances of being negatively affected by the knock-on effects of being overweight.

There are many other things which aim to prevent conditions before cure is needed. For example, recently, the Mayor of London has called to ban fast food advertisements off the tube. Also, the labels of ‘smoking kills’ on cigarette packets are also put there with the aim to put people off an unhealthy lifestyle and push them towards a healthier standard of living.

It is up to us now to decide how effective we want to make public health

By Muskaan Jonathan

  1. http://www.who.int/features/factfiles/noncommunicable_diseases/en/
  2. http://www.euro.who.int/en/health-topics/Health-systems/public-health-services
  3. https://campaignresources.phe.gov.uk/resources/campaigns/6-stoptober
  4. https://www.bhf.org.uk/informationsupport/risk-factors/smoking
  5. https://medlineplus.gov/ency/patientinstructions/000696.htm
  6. https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html
  7. https://campaignresources.phe.gov.uk/resources/campaigns/17-change4life
  8. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2018
  9. https://www.bbc.co.uk/news/health-46290849
  10. https://www.healthline.com/health/heart-disease/exercise#2

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

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

The Little Girl Called Esme

I have recently obsessively begun watching the BBC Two Documentary, Hospital. In a recent episode, a 4-year-old little girl, Esme, was rushed to hospital with a case of sepsis. I watched her parents sit there, hand clasped tightly; nervous as their little child was put into an induced coma, her hands and feet turning a disconcerting purple/black colour. I could only imagine the fear that they would be going through.

The doctor in that episode, Dr Patrick Davies, explained to the camera what was happening to Esme:

“There is a level of sepsis called septic shock and that is when the body starts to divert blood to the most important organs, I mean brain hearts, lungs, kidney that kind of thing. The organs that a body cares about least are fingers and toes and that is why with some patients with extreme septic shock, they will shut down their blood supply to the hands and their feet. So it’s almost a bit of self-sacrifice when the body is in that much trouble.”1

I had heard of sepsis before watching the episode but was never quite sure what it actually was, so the purpose of my article today is to find out more about sepsis.

Sepsis, as defined by The UK Sepsis Trust, is the reaction to an infection in which the body attacks its own organs and tissues.2 It is sometimes confused with blood poisoning or septicaemia—which is what I thought it was—but there is a difference.

With blood poisoning and septicaemia, bacteria (the nasty ones) make their way into our bloodstream, wreaking havoc as they get transported throughout our bodies. However, sepsis is different, as the bacterial infection (as well as albeit less commonly, viral and fungal infections) can cause harm to multiple organs in our body even without entering the bloodstream via septicaemia or blood poisoning.

There is a helpful mnemonic on The UK sepsis trust website, which is used to remember the symptoms of sepsis:

Slurred speech or confusion

Extreme shivering or muscle pain

Passing no urine in a day

Severe breathlessness

It feels like you are going to die

Skin mottled or discoloured 2

Esme’s hands and feet had gone that purple/blackish colour because as Dr Patrick had said, the body had stopped supplying blood to her hands and feet, as it does not care about those organs as much as the vital others such as the brain, lungs, heart, kidney etc. On our symptoms list above, this would be an extreme version of the last S: Skin mottled r discoloured.

There were two main concerns with Esme:

  1. No one knew if her brain would be in a good enough condition. Whilst in the induced coma, there was obviously no way to judge whether she would wake up to be the same girl as before. Her brain could have been starved of oxygen, in which case her neurones would suffer, causing a substantial amount of brain damage.
  2. Some of her digits (fingers or toes) may have had to be amputated due to the lack of blood supply as the body was pushing the blood to her vital organs instead of the fingers and toes.

Later on in the episode, the medical team stabilises Esme and take her life out of danger, fortunately without the need to amputate any digits, but they still didn’t know the condition of her brain. There is not a brain test yet that would have been able to tell the medical team whether Esme would wake up the same girl as before, so the only way they could get a good idea of how her brain was doing, was by waking her up out of her induced coma.

I sat at the edge of my sofa as Dr Patrick gently woke Esme up from her sleep. ‘Oh God, please let her be okay’ I thought to myself, my feelings probably somewhat mirroring those of her parents. If Esme could communicate well, she would be fine. If not, then she would have to spend more time in hospital, 80 miles away from home, as she and her parents would be loaded with information and the emotional rollercoasters of what to do next.

Esme was brought out of her induced coma, and when Dr Patrick asks her

“How are you?”, she answers: quietly but sturdily:

“Good”. A flood of relief washes over Esme’s parents’ faces, and I relax back into the cushiony sofa.

“Are you tired?” the doctor asks, to which she feebly yet affirmatively nods.

“Are you hungry or thirsty?” he asks again

“Thirsty” she replies

“Would you like some food?

“No, thank you… I’m thirsty”

“What would you like to drink?”

“Blackcurrant juice”

The doctor leaves the family in peace, and the nurse comes in, gently lifting Esme and placing her in her mother’s arms, who cradles her like a new-born baby. The small family sit there, tears in their eyes; Esme resting peacefully with her eyes closed. I can only imagine what they might have been imagining. What they went through must have been a horrible experience.

But, it reminds me to be grateful for the wonderful organisation that is the NHS. In another episode of Hospital, a lady describes the NHS as ‘a privilege, not a right’, after her operation is cancelled for the second time, and that made me think: no matter how much we may scrutinise the NHS, they are absolutely incredible. We are lucky to have them.

Watching Hospital has allowed me the honour of witnessing the highs of being a doctor, but it has also shown me a glimpse of the stressful reality that lies ahead of me. To be completely honest, when I think that one day, I will have to make a decision which could change someone’s life (whilst running on sleep deprivation, lack of food and underfunding), it terrifies me, and I want to run in the opposite direction from medicine. But then I see that doctor getting a huge smile from their patient, or that child getting a huge hug from their parent, and I am reminded that yes, it will be tough, but it will all be worth it in the end.

After all, ‘diamonds are formed under pressure, but they are not formed overnight’.

By Muskaan Jonathan

References:

  1. https://www.nuh.nhs.uk/latest-news/four-year-old-esme-fights-sepsis-in-hospital-2637
  2. https://sepsistrust.org/what-is-sepsis/

Other sources:

  • https://www.nhs.uk/conditions/septic-shock/
  • https://www.nhs.uk/conditions/sepsis/
  • You can find out more about the documentary via this link: https://www.bbc.co.uk/programmes/b09xt5yv

 

10 Questions: Someone with Alopecia Areata

Some time ago, my lovely (but annoying) 11-year-old sister, Khushbu, started rapidly losing hair from the top of her head. We were all pretty worried and went to the GP multiple times, but they just said every time that ‘it will grow back’—even though we were doubtful as the hair would not stop falling.

Anyway, it turns out that we finally found out that she has alopecia areata. After consulting Dr Google yet again, I found out that this is when ‘Hair is lost because it is affected by inflammation. The cause of this inflammation is unknown but it is thought that the immune system, the natural defence which normally protects the body from infections and other diseases, may attack the growing hair.’

Medical treatments and a multitude of home remedies given to us by friends in the UK failed to make any significant impact on the regrowth. When on holiday in India, we decided to try our luck by consulting our family GP, who also turns out to be a homoeopathic doctor, and she prescribed some homoeopathic tablets. These had some temporary effect in that the hair was re-growing, but it was falling out after a couple of weeks again.

Khushbu is now stuck in this frustrating cycle, where the hair re-grows, but then falls again at the same rate it is re-growing. Meanwhile, I am stuck in the frustrating position where I have to meticulously vacuum all the fallen hair which gets trapped in the carpet.

I thought it would be a nice idea if I could talk to Khushbu and find out how having alopecia truly makes her feel, so I interviewed her (while she was high on Lucozade so it seems). Here are 10 questions: someone with alopecia areata:

Q: What is alopecia?

A: I don’t know actually. Is it something in your immune system that affects your head? I’m not sure.

Q: How has having alopecia changed you?

A: I’m not sure really.  I guess It has made me feel more conscious about the way I look.

Q: How do you feel having alopecia?

A: I feel different to the others [at school] because I have shorter hair than others on the top of my head. It makes me feel worried when I see my hair falling out so much. I miss my old hair sometimes, but other times, I don’t bother about it. it frustrates me when my hair grows back then starts falling all out again.

Q: Have you ever been bullied for the way you look?

A: No, I haven’t. People in my school usually support me and are really supportive towards me. Sometimes though, I hear about people who have been talking about my hair behind my back, which makes me feel quite upset, but I have my friends who always make me feel better.

Q: What’s the best thing that’s happened to you because of your alopecia?

A: People want to talk to me more to find out more about alopecia or why my hair is like this. They are more interested in talking to me about it. Also, I am very grateful to my friend. She makes me feel happy about the way I look. She is also really funny, so we have a lot of fun with each other. My hairdresser is also really nice. She made me feel really happy—recommending more products and telling me that my hair is still beautiful.

Q: What’s the worst/most annoying thing that’s happened to you because of your alopecia?

A: People keep on thinking it’s a weird haircut and think that I wanted it to look like this on purpose.

Q: Do you miss the way you used to look?

A: I miss the way I used to look a lot, but not that much at the same time because I know my hair is going to grow back. If it doesn’t grow back, then I would change my whole hair [instead of only the top] to make me feel happier with the way I look. I really miss my old hair when I remember how silky it used to be and because it was all even out. Also, people never really bothered me that much i.e. they didn’t think that I was trying to do some strange styles with my hair.

Q: Do you feel that you receive enough help for your alopecia?

A: In the UK I got hair cream from the doctors and shampoo. When we went on holiday to India, I got a homoeopathic medicine from there.

Did any of them work? Not really.

Q: any friends give you advice?

A: Yeah. I received a lot of different home remedies from a lot of friends (and their parents). I found it very helpful and felt very supported, but none of them really worked. I appreciated it though.

Q: What’s something you would say to someone who is suffering from alopecia the way you are?

A: Think on the positive side. People that you didn’t really talk to would maybe be more supportive. Stay happy and comfortable with the way you are.

As you can see, Khushbu has been affected by alopecia in many ways, but she is very lucky to have quite minimal hair loss: only on the top of her hair. There are people out there who suffer from alopecia totalis, which is when there is a complete loss of hair on the scalp. Unfortunately, there is no cure as of yet, and if a lot of hair is lost initially, then even treatments that are available offer only a 1 in 10 chance of full recovery.

Khushbu’s story with alopecia areata has made me realise that even the seemingly smallest complications, like losing parts of your hair, can change one’s life in ways that we could never expect.

I would just like to take this opportunity to thank all of those who spread positivity to people with alopecia—and any other body issues that cause low self-esteem. It is so important for us to remind each other that we are beautiful as we are!

By Muskaan Jonathan

Sources:

http://www.bad.org.uk/shared/get-file.ashx?id=68&itemtype=document

https://rarediseases.info.nih.gov/diseases/613/alopecia-totalis

http://www.bad.org.uk/for-the-public/patient-information-leaflets/alopecia-areata/?showmore=1#.WspXXojwZP

It was a Happy Birthday indeed!

Saturday 24th March was a very special day for me! Firstly, it was my birthday, and I am now officially 17. I can learn how to drive (although I probably shouldn’t be trusted with a car). However, that is not the point of this article.

What was really special about Saturday, was that I was given the opportunity to present at Medic Mentor’s national Insight into Medicine conference! It is the very place that I decided I wanted to do medicine, and I felt so privileged and honoured to be able to inspire some people!

I was really excited to give the presentation, until the actual day, as I realised the large scale of the conference! Having never spoken in front of 100+ people at one time, believe me when I say that my legs were jelly. I thought I would mess it up completely, but the very encouraging mentors and even some the parents and their children assured me that it was apparently a very good presentation.

I really enjoyed helping to co-ordinate the conference too. I saw things from ‘the other side’ I guess. I met up with some of my fellow school ambassadors, Chloe and Ellie, and we had a great time together! We sat through a lot of the talks, laughing with each other when the (wonderful) speakers went over time and completely ignored the time notices we were waving around in front of their faces.

But I was reminded of why I want to do medicine yet again. I left inspired and uplifted, yet again; excited for the future instead of fearful of the unknown. I would be satisfied to know if I inspired even 1 person to think about doing medicine as a career and will remain thankful to the wonderful organisation that is Medic Mentor, for allowing me to make use of such a humbling opportunity, and for just being all-round amazing, genuine people!

By Muskaan Jonathan

The Silent Beast that makes all the Noise

The 20th of March marks the international day of happiness. All around the world, many people work together to try and ‘make the world a happier place’. This year, the theme is sharing happiness with others.

In a recent RE lesson, we were watching a documentary about the Amish. A group of British teenagers had travelled to America to spend 4 weeks or so with different Amish families and see their way of life. In one episode, a British teenager asks the father of the Armish family: ‘How many bad days would you say you have?’. The Amish man replies ‘in a year, I’d say around 10 days’.

10 bad days in a year. Imagine that! How many bad days do you have? Perhaps you may have to think of an answer per week? The British teenager said that he had two bad days a week. If we calculate that, then he has roughly 104 bad days in a year—just over 10 times more than the Amish man.

According to this article in The Independent https://www.independent.co.uk/news/uk/home-news/british-people-depression-west-mental-health-uk-oecd-europe-scandinavia-women-more-men-a7945321.html, British people rank amongst the most depressed in the Western World—and the statistics don’t include people below the age of 25, which I believe is a range of ages where emotion and stress levels can be running high enough to cause many other mental health issues. By no means am I confirming a common misconception that depression only means being sad all the time, but depression, the chemical imbalance in the brain, definitely affects peoples’ happiness.

I am fortunate enough to be one of the people who can say that I have never (yet) had depression, or any similar mental health problem which may affect my happiness—at least I don’t think so. I often wonder—why do we hear so much about depression so frequently? It seems like the term ‘mental health issues’ has blown up all of a sudden. Is it because of the technology we are surrounded with? Most of the more traditional Amish do not have mobile phones, but one family did leave the Amish church and their children were now allowed to have mobile phones. They said that it definitely sped up their lives. Maybe that’s what it is. Do you ever get that feeling that life is going too fast for you to keep up with? Or it could be the depressing stories we see on the news. Brexit, terrorist attacks, lack of funding, murders etc. etc. And of course, last but definitely not least everyone has their own personal issues. Whether it be bereavement, financial issues, all of these things may affect our happiness and even push us into the dark, endless abyss which is depression.

So, what is depression?

I found this question tough to answer. It is long periods of sadness, feeling down or fed up etc., but it is so much more than that. I guess only a person with depression would be able to give us a true perspective of what depression is. However, medically speaking, it is ‘An illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things’. It is easier to say what depression is not. It is not a trivial matter that you can just ‘get over’ or ‘snap out of’. Let me use the infamous ‘broken leg analogy’. If you had broken your leg, you wouldn’t be told to just ‘walk it off’. You would be given proper treatment; time to recover. Similarly, depression requires these things. Time, patience, and teams of dedicated healthcare professionals who work hard for the best of their patient. I imagine depression to be like a beast in our minds. On the surface it is silent; invisible. But beneath the surface it is causing a ruckus. Pulling our minds: pulling us deeper and deeper until all we can hear now is chaos, and nothing else—leaving behind a sort of empty shell. Over time, our ears become numb to all the silence, then to all the chaos.

No matter what the cause of one’s depression may be, we must learn to recognise when to get help—whether that help may be for ourselves or for others. It starts by talking. Talking to someone who you feel might understand, even a little bit. Whether you are depressed or not, I feel that the worst thing anyone could do for themselves is to keep their feelings bottled up inside. I must admit, even I am guilty of this, but for someone else who already may be depressed, I can only imagine doing so would eat away at them from inside.

GPs can help too of course. Often, patients are referred to other allied healthcare professionals such as psychologists, counsellors, therapists. Sometimes, patients may even be prescribed antidepressants.

There is a multitude of ways in which we can help ourselves, but it starts with us helping each other. Just for a minute, let us adopt the mindset of a public health doctor. They are concerned with populations and focus on health promotion and illness prevention.

We could start by educating ourselves. Have a read of the NHS symptoms section for clinical depression. If you recognise any of the signs in a person, put them in contact with someone who might help. Talk to them. Don’t let them be alone. Prevent their depression from escalating.

https://www.nhs.uk/conditions/clinical-depression/symptoms/

Next, promotion! Promote happiness everywhere you can! In your children, in your school, on your social media, in your local community—the list is endless and the need is limitless! Sign up to be a part of the International Day of Happiness here to start spreading joy:

http://www.dayofhappiness.net/#join

We need to work together to defeat this beast and make it silent…truly silent.

By Muskaan Jonathan

Sources I used:

http://www.dayofhappiness.net/#join

https://www.medicinenet.com/script/main/art.asp?articlekey=2947

https://www.nhs.uk/conditions/clinical-depression/

http://www.channel4.com/info/press/programme-information/living-with-the-amish

 

The Meningitis Monster nearly got us

On the 16th of January, my aunty and uncle in India blessed us with yet another beautiful baby girl. It was a really exciting time because our family group chat was absolutely flooded with pictures of this radiant little angel that had entered our lives. But the excitement ended very abruptly.

One Sunday, my parents and sister, all of us engrossed in our own busy lives, had a moment to spare to look at each other’s’ faces and hear each other speak. We had just finished watching a movie, and were on our way to step back in our chaotic lives when we got a phone call from India. Now bear in mind, that at this time, it was around 9 pm in the UK, which means it was roughly 2:30 am in India. We don’t usually get phone calls that late from them. We all sat down, a sort of eerie silence settling around us, and my dad answered the phone.

My grandmother was weeping. She was bawling her eyes out on the other end of the phone. Apparently, the little baby had fallen unconscious. Her eyes rolled back in her head, she was unresponsive and had a bad nose block. It was difficult to understand her through her sobbing. Wanting to get more information, my dad just told her not to worry and pray lots and lots. On calling my uncle, we found out all that had happened. The little baby wasn’t eating, wasn’t feeling well, had something which looked like a convulsion/seizure, and seemed very stiff.

Immediately, I consulted Dr Google. What could be wrong with her? I came across epilepsy. Nope. Wrong symptoms. A seizure? Nope. Not enough information to deduce that. This went on for about 30 minutes—my mum asking me every 2 minutes: did you find anything? When my uncle called us back, I found out more information. The baby had taken a feed before this episode and hadn’t fed again or woken up. My mind immediately went back to when my own sister was little and she used to bring up her milk. Maybe this baby was having an acid reflux? Maybe she nearly choked on her own vomit due to lying down? I wasn’t sure. The only thing I could think of was ‘when I become a doctor, I might not feel so helpless’.

A couple of days later, after the situation had calmed down a bit more and we knew some of the symptoms better, the doctors in India had told my family that the baby has an infection in the brain. My mum looked at me worriedly and mouthed ‘meningitis’. She had had a lumbar puncture, and her poor little hands were being invaded by needles sucking away at her blood.

I looked it up and was terrified at what I saw. I really hope this baby doesn’t have meningitis. Here’s what I found out that scared me so much:

The first line on the NHS website read like this: Most people make a full recovery from meningitis, but it can sometimes cause serious, long-term problems and can be life-threatening. My fearful mind only read the last few words. What were these life-threatening complications?

  • Partial or total hearing loss
  • Epilepsy
  • Memory and concentration issues
  • Co-ordination and movement problems
  • Learning difficulties and behaviour issues
  • Total or partial vision loss
  • Loss of limbs via amputation to stop the spreading of the infection
  • Bone and joint problems
  • Kidney problems

The thought that anyone, particularly a baby and their family may have to deal with this stuff, scared me immensely. Luckily, in our case, the little baby’s symptoms were recognised at a very early stage, so everything is fine now, but my heart goes out to those who are suffering the consequences of this monster, for want of a better word. The consequences really are life-changing. There is only limited treatment, such as counselling, prosthetic limbs and cochlear implants, and I hope that one day, medicine can progress far enough to find ways to reduce the risk of meningitis. Something as simple as reducing the time taken to detect meningitis (which you can read more about here: https://www.irishtimes.com/news/scientists-developing-hour-test-for-meningitis-1.682985) could have enormous advantages to a lot of people.

The little baby in India is doing fine now. It seems that there was no major problem, but it was just one of those scary and random moments that seemingly have no explanation. She is happy and healthy now, but still doesn’t have a name. There has been a huge family debate going on for the last 3 weeks and we are choosing between Adeera and Maira. Hopefully, this strong little girl doesn’t have to be nameless anymore!

By Muskaan Jonathan

Sources I used:

https://www.nhs.uk/conditions/meningitis/complications/#treatment-and-support

https://www.meningitisnow.org/meningitis-explained/signs-and-symptoms/signs-and-symptoms-babies-and-toddlers/

Baby Adeera/Maira (?) hanging out with her older sister Dilara, who seems to have found a new toy

These are some common symptoms of meningitis that I came across when doing research

‘That’ Blood Test you may have read about

Sunday marked World cancer day, and the internet was filled with things to do with it! We had people showing off their unity bands, while others were sharing their uplifting stories of recovery. It was an important day, to raise awareness, to admire the fighters and to salute the survivors. While it is important to celebrate how far we have come, we must still remember those who have lost the fight. In solemn moments like those, the loss can seem overwhelming, but the pace at which new treatments are being developed is something very exciting!

I am sure we can all appreciate the importance of diagnosing and treating cancer in its early stages, as this greatly increases the chances of treatment being successful. In my endeavours to do ‘wider reading’ for medicine, I stumbled upon a headline about a ‘Blood test that can detect 8 different types of cancer’. In the moment, I didn’t get time to read it (as I was in the study area and was actually supposed to be studying), but I bookmarked it for later. When I got time (which as an A-level student, is rare) I went back to do more research, and this is what I found out:

How does the test work, and how was the research carried out?

The blood test, called CancerSEEK, works by searching for mutations (changes in the sequence of DNA) in 16 genes that commonly arise in cancer and in 8 proteins that are often released. The test recognises mutations in ctDNA (circulating tumour DNA) and protein biomarkers, which can be found in the blood. These biomarkers are ‘naturally occurring molecules, genes or characteristics by which a particular condition/disease etc. can be identified’. CancerSEEK was tested on 1005 patients with stage 1 to 3 cancers. The eight cancers it was tested on were: Ovary, liver, oesophagus, pancreas, stomach, colorectum, lung and breast. 812 healthy individuals (with no cancer) were used as a control population, to compare the results to. A patient’s result was classified as positive if the mutation in one of the 16 genes or the levels in one of the eight proteins was greatly elevated as compared to the healthy control population.

The Success of CancerSEEK

In summary, the median overall ability to find cancer was 70% for those 8 common cancers. Furthermore, sensitivity of the test to liver cancer in stage 1, was 100%, however, overall, the median sensitivity to stage 1 cancer was a low 43%.

CancerSEEK has been described as ‘promising’, although there is a lot more research to be done into it, mainly because one of the major limitations of the study was that all of the patients already had known cancers.

My thoughts on CancerSEEK

I think that this whole study is extremely exciting! If we can identify these 8 most common cancers, then the cases of cancer globally would be reduced immensely. This non-invasive test, in my opinion, once developed, will be much preferred over other, invasive means of diagnosing cancer, such as colonoscopy. On the other hand, CancerSEEK has a 1% false rate, which may cause concern for many people as they could be told that they have cancer, when in fact, they do not, so while CancerSEEK may help the situation, we may still require the invasive procedures to confirm whether a person has cancer or not. I absolutely agree with the main conclusions of most articles, that this test is promising, but requires a lot more development and research.

By Muskaan Jonathan

If you would like to find out more about CancerSEEK, here are the links to the articles I used:

https://www.medscape.com/viewarticle/891491#vp_5

http://www.telegraph.co.uk/news/2018/01/19/promising-blood-test-detects-eight-different-kinds-cancer-spread/

https://www.pancan.org/news/6-things-know-cancerseek-test-early-detection/

https://www.hopkinsmedicine.org/kimmel_cancer_center/cancerseek_faqs.html

Medicine and Me

My name is Muskaan. I am currently 16, and am battling with this oh- so-daunting question that everyone seems to be bombarding me with nowadays: What do you want to be when you are older? I am from India, where many young people like me are ‘manufactured’ into doctors, by their parents, relatives and the unreasonably high and stress-inducing standards they (and sadly, sometimes society) force themselves to keep.  I am lucky enough to have parents that have embraced my (very indecisive) career changes: from a ‘fairy princess’, to a fashion designer, then a psychologist, but finally, I inexplicably find myself drawn to the wonders and variation of medicine.

There was a time in my life where I hated science. When I miserably failed a science test, I vowed to myself that I would never ever even consider becoming a doctor, as my mum and I had had some vague conversations about this strange concept of the ‘future’ before. Doctors were boring. They did the same thing every day: all science, no fun. Just talking and writing scribbling repetitively.

Miraculously, in year 10, when we started doing real GCSE science (rather than just pretending to be the particles in a solids liquids and gases), I suddenly started to look forward to my science lessons! I absolutely loved it, but still didn’t want to be a doctor. Why? Even I don’t quite know the answer to that.

Then rolls along Year 11. It was a hot, summer Friday afternoon. I had just eaten a very large and satisfying lunch of fish and chips- which I really appreciate as a speciality of my school- and was suffering from a serious case of lethargy. I had finished all the coursework I needed to do in that Health and Social lesson with 45 minutes to spare, so I decided to check my emails. I had received one from our careers advisor about a programme run by Medic Mentor. It was about psychology, which is what I was interested in at the time. When I clicked on the link, however, for reasons unknown to me, I was drawn to the Medicine part of the page. It looked good! I emailed my parents the link, hoping they would agree to book a place.

Then I researched a lot about doctors. What do they do? What CAN they do? How much do they get paid? (those results made me shamelessly happy) Then I came upon the entry requirements and competition for places. I have always set my bar high, but for the first time, I felt that the bar was too high, unreachable, on another dimension of existence. There was a lot to look forward to, but the immense amount of work needed to get to the pot of gold on the other side (of the rainbow?) intimidated me.

I almost forwarded the psychology link on Medic Mentor’s website to my parents saying that I had accidentally sent them the wrong one to medicine before, but then I thought to myself: I love science. I love that warm, fuzzy (a little bit cheesy) feeling you get inside after helping someone. Some people have told me I am a ‘born doctor’. Should I really just shun the idea without taking a good look at it? I sent them the psychology link, but I said that I would like to attend the medicine one. This action surprised me momentarily, but I didn’t think too much of it because I just felt like it would just be another fun day out in London for me to make the final decision that medicine was not for me.

I could not be more wrong! The best things in life happen unexpectedly. During that weekend with Medic Mentor, I realised that this saying is 100% true! I went and I came back a changed girl. Excited by medicine. Inspired by medicine. Ready for medicine. All I came back asking myself was why did I ever NOT want to be a doctor? The competition, the stress, the requirements and the work were still intimidating, and still are (very much so sometimes), but I know deep down that it is all worth it even though it might not seem so at the time.

I still struggle today with fear of the work, doubts on my own ability to cope. I often question if it is still what I am intent on doing. Sometimes the answer is no! Run in the other direction! Save yourself! But when the answer is yes (which thankfully, it is most of the time) I remember that I can’t wait to help people. I can’t wait to make a difference. I can’t wait to change their lives with medicine, and I can’t wait for my own life to be changed with medicine!

By Muskaan Jonathan