Jess McLaughlin posted an update 4 days, 12 hours ago
Reflection on my Work Experience at The National Hospital
In April 2017 I spent 2 days at The National Hospital for Neurology and Neurosurgery observing Dr Simon Farmer, a consultant neurologist whose particular expertise is in general diagnostic neurology, movement disorders, neuro-ophthamology and spinal disorders.
During my time at The National Hospital I spent an afternoon in clinic with Dr Farmer observing his meetings with patients referred by their GP’s with various neurological complaints. The first woman we met had been trying to get pregnant. A blood sample had been taken that showed that she had three times too much of a certain hormone. This hormone may have affected her chances of pregnancy. When this hormone is overproduced there is a chance that this is due to tumour growth in the gland that produces it. However after some motor tests and optical tests it was clear that this was unlikely. I found this interesting because I didn’t know that tumours could cause an overproduction of certain hormones.
We also met an elderly woman who told us that she had sporadic optical disturbances lasting about 20 minutes where ‘c-shaped swirls’ crossed her vision. Dr Farmer checked her vision at the sides and, using an ophthalmoscope, made sure that there was no damage to the retina or optic nerve. She had perfect vision and there was no damage so it was unlikely that she had a tumour pressing on the nerve.
On the second day, I spent the morning in clinic with Dr Farmer where we met outpatients who had already been diagnosed with neurological disorders.
The first man I met was a French horn player who had bad muscle fatigue around his mouth that caused him to have trouble forming his embouchure, and therefore playing his instrument. I think that the muscle fatigue was caused by myasthenia gravis. It was very sad to hear how the disease affected his lifestyle as his livelihood depended on being able to play.
The next woman I met was in the civil service; she had been forced to take a break from her job as she had a splitting pain from her jaw. Before being told that the problem came from pressure on a nerve coming from the mouth, she had had several root canals to try and relieve the pain. She had an MRI to see what was causing the pressure, and found that there was a blood vessel pushing against the nerve. She is due to have surgery to gently move the blood vessel away from the nerve so that she can resume work. It was fascinating to talk to her about the difference that certain medications were making to the pain.
I also met a man who had Parkinson’s, but was also in a wheelchair after loosing most of his movement from his waist down due to a spinal cord injury. The loss of movement from his waist down caused many bowl problems. He also has an expanding aorta, which can cause the lining of the arterioles coming from the aorta to be stripped down. It was great to see how optimistic he was about moving forward with his mediation and carrying on with his life as normally as possible.
I then spent 45 minutes observing Mr. Bremner a Consultant Ophthalmic Surgeon, where I met a man with Multiple Sclerosis who complained that his left eye seemed to make things look like they were underwater. Mr. Bremner conducted some vision tests and, while the patient’s eyes were a bit shaky when following his finger, he had 20/20 vision. The patient’s eyes were then put under a laser scanner, which showed that there was no damage to the optic nerve, which can be common in people with MS. There was also no damage to the retina. Mr. Bremner explained to me that the eyes were an extension of the brain and that the retina was grey matter, and the optic nerve was white matter.
Dr. Farmer then took me to see a man whose brain scan had shown multiple hemorrhages. Before going to see the man we stopped off at the research center to have a look at his brain biopsy through the microscope. The biopsy showed that he had a small amount of myelin around his axons, causing axon firing to be damaged. However, after meeting the man, who had spent a couple of weeks on steroids, it was clear that, physically, he seemed to be getting better. He was able to walk well, and was even able to walk with one foot in front of the other, which he had not been able to do when previously examined. His memory was also improving as he could remember that he was going to have another scan the next day. I thought that this particular case was fascinating, as from his brain scan you could have assumed that the man would have been unable to walk or talk, but in reality was rather well, considering the circumstances.
One of the last patients I saw was a lady whose sensory neurons had been damaged; she was therefore unable to tell where her limbs were in space when she had her eyes closed. Dr. Farmer told us about one of his research patients, who had the same problem, but learnt how to carry on as normal without his sensory neurons. It took years of physiotherapy but the man came out of his wheelchair, and eventually you would not have been able to tell that there was anything different about him. I thought that this was an inspiring case and it hopefully encouraged the patient to strive for the same success.
Another interesting person I met while at the National Hospital was a PHD student, doing research on Parkinson’s. We discussed different treatments for the condition, including taking dopamine supplements in order to gain back control of the limbs, and Deep Brain Simulation where a wire is put into the back of the brain, and ,when turned on, can almost instantaneously stop the tremors caused by Parkinson’s.
The last person I met while at the National Hospital was an EEG expert, who was reading brain scans in order to try and diagnose whether a patient had epilepsy or not. This was especially interesting to me as I am currently doing a project on epilepsy at school. He told me how to tell if someone was having abnormal brain waves, such as a spike showing on the scan. Sleep deprivation is a very helpful thing when taking an EEG reading as it makes it easier to see an abnormality, as there is an increased risk of seizure. Hyperventilation also can bring out these abnormalities, especially in children with absence seizures. On the EEG scan this can show up as a spike and a wave shape. Flashing lights are also triggers of abnormal brain activities, and will cause a spike and wave shape on the EEG if abnormal brain waves are triggered.
I found it incredibly interesting to see the research side of medicine, and how the more general patient side of being a doctor can be paralleled with new research and technology. After reading Henry Marsh’s book Do No Harm, I found it fascinating to see the diagnosis and medication side of brain disorders, and how some of these cases can lead to brain surgery. It was very intriguing to see the difference between a general hospital (such as Queen Alexandra Hospital in Portsmouth where I previously had work experience) and a specialised research hospital such as The National. This visit has made me even more motivated to strive to become a medic as I have seen the pinnacle of what could be achieved in the profession. I found the research done here inspiring, and hope that I may achieve such things in the future.