Osteoarthritis

Description: During placement I had the pleasure and privilege to meet MW, a 76 year old lady. She suffers from Osteoarthritis in both knees, and this was diagnosed by her GP. She presented with symptoms of joint pain and stiffness in both knees in her 50’s (she has been suffering for over 20 years) Her GP referred her to a consultant rheumatologist who did X-rays to confirm the same. As she had tenderness, discomfort and restricted movement in her knee joint she had a partial knee replacement in her left knee in August 2016. Since the operation and after undertaking physiotherapy she has full range of motion in the right knee. She has swelling and reports a dull ache in her unoperated right knee which is due for a partial knee replacement in February 2019. She is eagerly waiting for her operation to regain full mobility in her lower limbs.

She resides at her home with her husband, and her background is that of a home-maker. She lives in a two-storey house (and has lived there for over 50 years) which is located at the top of a very steep hill.  Her ability to climb up the stairs, drive and walk the dog up the steep hill has been impaired by her condition.

When taking her history and so as to find out if there had been excessive use of her joints, it transpired that four decades ago she used to drop off and pick up her four children from school every week day at the adjacent valley. The one-way journey was a 30 minute walk downhill at a gradient of 18% and she used to wear a basic plimsole/pump shoes which was all she could afford.

 

MW would also undertake a five mile journey on a daily basis in addition to the school run. Her mother was diagnosed with Alzheimer’s Disease which lead to Dementia and MW would drop off lunch and dinner for her mother. When MW was in her 50’s, she experienced pain in both knees and found activities of daily living progressively more challenging. As a Christian, she attends church every week and finds it difficult to walk in a straight line up the aisle to receive communion- this left her feeling upset with her state.

 

Feelings:  I wasn’t sure what to expect. Having volunteered with elderly people at a residential home during sixth form, I was used to interacting with elderly people. This was the first time I was making a home visit and taking on a more clinical role as a medical student rather than a volunteer. Some pre-conceptions I had were that she may be apprehensive and not willing to open up as I was a stranger to her. I was also scared that I may ask her questions that may offend her or discuss sensitive information with her that she may not wish to discuss further.

 

The GP that co-ordinates the care of MW calmed my nervousness and anxiousness by reassuring me that MW is such an open and kind lady. She has met several medical students and happily shared her story for the past 5 years. When I met MW, I was struck by her optimism. Her condition has not deterred her from leading an active family and social life. The couple was so friendly and kind when my partner and I first walked in. I noticed that the stairs that led to her bedroom were steep and that the furniture in the living room was scattered in a way that she would be able to lean on them when walking from one end to another. She answered each and every question that we had and I was surprised when I saw how many medications she has to take on a daily basis. I found it challenging to hear her difficulties and found it insightful when she told me had challenges with walking downhill by herself, being unable to reach the landline before it stops ringing and being unable to drive. She has pain walking up and down stairs and her unoperated knee would stiffen if she sat idle for too long.

 

Reflection:

We had studied the science behind Osteoarthritis in lectures yet meeting MW and interacting with helped me to view her day to day challenges in a practical and meaningful way. I learnt that in her left knee, the degeneration occurred in a lateral to medial fashion which is unusual as it is usually the other direction that it occurs.This was noticed by the consultant who operated on her in 2016. I was shocked when she told me how quickly she had recovered after her partial knee operation, having been operated on Monday morning and being discharged on Wednesday evening. Starting on a zimmer frame, she moved to crutches and then progressed to a walking stick within 4 weeks. She told me how useful she had found the Physiotherapist that attended to her in the hospital and I later learnt about their role in rehabilitation.

I found that as this was a home visit, MW was directing the conversation more towards the social aspect of her life rather than at the clinical, as she was much more open to answering questions and elaborating when asked about her life story. She was happy to tell me that she is the mother of four and grandmother to four grandchildren. When we took a Full Medical History some of her answers, I noticed were more closed off and she did not wish to expand. She retold her story in a mixed chronological order and would go off topic at times. I learnt that she did feel that her management ended up being long winded, especially with the hospital waiting list.

Her husband is highly supportive and drives her to the local park which has a much gentler slope where they are able to walk the dog and get fresh air in the mornings and evenings. She has adapted to her situation by to climbing up the stairs to her bedroom by using a sidestep motion. She also has a walking stick and furniture is carefully positioned in the house so she can use it as a hand support.

Conclusion:

I read an article by A. Shane Andersonand Richard F. Loeser(2009) which informed me that ‘osteoarthritis is the most common joint disorder in the world and one of the most common sources of pain and disability in the elderly’ so I learnt that increasing age is a high risk factor in osteoarthritis.

Before meeting MW I had not considered the physical implication of chronic illness, which promoted me to read an article by Di Chen. et al. (2017) which taught me that ‘Currently, apart from pain management and end stage surgical intervention, there are no effective therapeutic treatments for OA’ This prepared me to be more understanding to MW and her mental and social needs. Her condition was one which had altered her way of life in terms of engaging in activities of daily living as aforementioned.

 

MW did mention briefly that her mother had issue of walking in straight line as she got older yet I did not ask any follow up questions. When I read an article by Ananthila Anandacoomarasamy and Lyn March (2010), I learnt that a common risk factor for osteoarthritisis genetics. I feel that I should have been more confident in my history taking and asked more clinically relevant questions in this regard whilst taking the patient history.

Action Plan:  If I were required to do anther home visit, I would be more thorough in my history taking. As I am a medical student and have not qualified, there are many things I am yet to learn, so I will not be as hesitant to ask as many questions.

I would have the basic structure written out and refer to my notepad more. I believe that practice is important in effective history taking, so I would speak to the Clinical Skills tutor in the Self-Directed Learning zone and get their guidance and practice my history taking technique to prepare me better.

I also believe that I need to adjust my approach my consultation towards chronic pain. I will do research into what causes OA, which would allow me to direct the conversation towards a more clinical direction. I would ask the advice of my personal mentor who is a GP and has 10 minute consultation slots. The articles mentioned pain management, I wish to read articles relating to the painkillers and NSAIDS that are commonly used to settle pain as a direct cause of OA.

I would also research mechanisms patients use to cope with their situation when surgery is not an option or is to be delayed for several years.

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References:

Shane Anderson, A and Richard F Loeser. “Why is osteoarthritis an age-related disease?”  Best practice & research. Clinical rheumatology vol. 24,1 (2010): 15-26.

 

Chen, Di et al. “Osteoarthritis: toward a comprehensive understanding of pathological mechanism”  Bone research vol. 5 16044. 17 Jan. 2017, doi:10.1038/boneres.2016.44

 

Anandacoomarasamy, Ananthila and Lyn March. “Current evidence for osteoarthritis treatments”  Therapeutic advances in musculoskeletal diseasevol. 2,1 (2010): 17-28.

 

 

 

‘Speaking to someone with Dementia isn’t hard for you, it’s hard for them.’

Due to vastly improved life expectancy, the UK has an ageing population which is on the rise and being a welfare state, the NHS takes care of the elderly in different ways depending on the status of their health. I have been regularly visiting one or the other elderly care homes on a weekly basis, devoting at least 1 hour of my time with the residents over the past two years                                 .      IMG_8121

Since September I have been volunteering at a Residential home with nearly all the residents suffering from Dementia or some other degenerative disease. During my initial visits I was emotionally jolted to see the conditions of the residents, this is not to say anything about the administration of the home, which was always good. As I got adjusted to their circumstances, my empathy towards them led me to understand their plight.

I learnt the importance of understanding individual circumstances of the residents which is necessary in making any move towards alleviating their predicament. Kindness and sympathy simply flew out of me and my urge to become a medical doctor got the better of me. For example, the need to be patient came to me when I was relating to a lady with Dementia and whilst reading her a book, she would often forget the previous content, often asking me to retell the story line.

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I realised that many residents were given to feelings of despair and openly say ‘Why am I here.’ What sustained me to continue my visits to them was the fact that whatever little I did for them had been highly meaningful for them which became clear to me by some remarks “I wonder if Robbie is coming today,  He’s such a nice boy and I hope he’s not too cold for him to visit ” Simply walking into the main activity room with my usual positivity and enthusiasm, the people’s faces and the atmosphere would light up! I was proud that I had that sort of connection with the residents there.

The residents face different challenges and these are only some of them:

A woman of 66 was scared of getting old and the idea of dying.

An ex-army war veteran who felt no one was interested in his war stories

Another woman felt that nobody cared about her and wanted to break free from the home so she could return back to her family.

And finally an elderly person who couldn’t get to grips with the demise of his wife.

In all their cases, one thing was common- that is the feeling that they have were only living to await their death. Therefore my act of taking their minds off from such a feeling  through small gestures such as sitting and listening to them, playing card and puzzle games, reading them books and stories, even singing Christmas Carols to them mattered a lot and was highly appreciated by the concerned individuals.

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As I know look back, I realise how much my personality has benefited from these visits and have helped me to affirm my journey towards a career in medicine. I really get a buzz from what I do in helping the residents and patient interaction is something I look forward to when I’m older. My communication skill has vastly developed- being able to converse with elderly residents in a manner where they ‘came out of their shells’, a task I found rather difficult at first. My experiences have given me a true insight into the challenges of ageing and the complications associated with it. I gained a good insight into the effects of memory loss which goes with degenerative brain diseases such as Dementia- involving loss of vision and hearing, thereby leading to a defect in the expression of feelings.

I shall conclude by reminding the readers of the challenges that emerges out of care for the elderly, particularly those who are in care homes. They are primarily that of empathy, the capacity to understand the emotional needs of the individuals and the capacity to relate to people and yet not become attached to them. In short, an attitude of being humane towards our elderly who in their own way have enriched our lives because of which many of us are what we are.

Reference:

https://www.parliament.uk/business/publications/research/key-issues-parliament-2015/social-change/ageing-population/

Dementia is currently the leading cause of death in the UK

This BBC News article grabbed my attention and it tied in with my first ever blog post about Alzheimer’s Disease. Weekly volunteering in a residential home and having family and friends with this degenerative disease, I have much interaction with these people and directly see the impact it has on their lives.

Every three minutes, somewhere in the UK, somebody develops dementia. Two-thirds of these people will develop Alzheimer’s disease, the most common form of dementia.

‘Dementia, including Alzheimer’s disease, has overtaken heart disease as the leading cause of death in England and Wales’  Last year, more than 61,000 people died of dementia – 11.6% of all recorded deaths.

What are reasons for this:

England has an Ageing Population- This refers to an increasing proportion of people living to old age (60 and above)with the largest changes being to diet and lifestyle and medical advancements. 

People are living for longer and deaths from some other causes, including heart disease, have gone down. It could be argued that we have focused too much on heart disease and other  physical ailments in the past and all that seems to have happened is one ‘killer’ has been swapped out for another.

What is the difference between Alzheimer’s and Dementia:

Every three minutes, somewhere in the UK, somebody develops dementia. Two-thirds of these people will develop Alzheimer’s disease, the most common form of dementia.

The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. These changes are often small to start with, but for someone with dementia they have become severe enough to affect daily life. A person with dementia may also experience changes in their mood or behaviour.

Alzheimer’s disease, is a physical disease that affects the brain. There are more than 520,000 people in the UK with Alzheimer’s disease. Alzheimer’s naturally leads to Dementia.

During the course of the disease, proteins build up in the brain to form structures called ‘plaques’ and ‘tangles’. This leads to the loss of connections between nerve cells, and eventually to the death of nerve cells and loss of brain tissue.

Alzheimer’s is a progressive disease. This means that gradually, over time, more parts of the brain are damaged. As this happens, more symptoms develop and become more severe.

How does Dementia actually affect, and eventually kill people

Inital- Hippocampus is affected. This is the part of the brain which plays a central role in day to day activity. When this part of the brain is affected, it naturally leads to memory lapses.

Inital symptoms are that people forget about recent events and conversations.

They lose items such as their keys or mobile. Or they may be unable to think of the correct word in sentence and have a tendency to forget names.

End stages- Communication, Orientation and reasoning become more severe– people become more aggressive and agitated with their sleep pattern becoming irregular.

There are several factors which can eventually lead to the death of a person suffering from Dementia. As these people in their late stages require  round-the-clock care, they can lose their physical abilities including walking and sitting – and even swallowing, and they can becoming at increased risk of catching infections, especially pneumonia. They may also have difficulty with bladder and bowel functions.

Others may die as a result of complications related to loss of brain function and heart attack. People with dementia may also died due to dehydration, malnutrition and falls.

I will do more research in Alzheimer/ Dementia Diagnosis and Treatment and post it on here.

 

References:

http://www.bbc.co.uk/news/health-37972141

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=106

http://www.bbc.co.uk/guides/z33m4j6

https://www.tcd.ie/Neuroscience/assets/img/Advanced_Alzheimers_Brain.JPG

 

 

Paternity leave in the context of Gender Equality?

Paternity leave is “a period of absence from work granted to a father after or shortly before the birth of his child.” Generally, maternity leave is (what is the practice in many countries) where a mother is permitted to be absent from her job for a varying period of 3 to 12 months, depending upon the organisation, and this leave commences from just before the delivery of her child.

If a father is expected to take an active role in child care, with the current practice of 1-2 weeks, this period acts as mere tokenism. Examining this issue, there are several occasions where the woman (mother-to-be) is vulnerable and in need of physical proximity. The main example  is at the time of delivering a child, the mother is much comforted when the father is present. Again in the nursing period of the baby, the mother may need assistance and care with domestic chores within the household. Paternity leave offers the mother sufficient rest to build her emotional feelings to take care of their child.

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Bonding with the newborn, Image; The Telegraph

According to a study, dads in Britain who take time off at birth and engage in child care tasks were more likely to read books with their toddlers than those who hadn’t. Both parents are entitled to share in this intimate and critical point of family growth and when we take into account all these things, for paternity leave to be of any use, it will have to be for longer duration.

There are many other benefits also from paternity leave. This early interaction has longer- term benefits for a child’s learning abilities. The University of Oslo found that a longer than two week period with the father improved children’s performance at secondary school. Women’s career is affected by paternity leave in a positive way. When childcare responsibilities fall exclusively on the mother, the effect is to depress women’s wages. Time out of the labour force deprives them of experience and promotions. When men undertake more of the childcare burden, this effect is lessened.

 A father reading to his children

Equal maternity and paternity leave leads to better decisions about childcare since this encourages both the parents to develop the necessary skills to care for a child such as changing nappies preparing food, or bathing. This also enables the couples to be in a better position to make long term plans for the child’s care. Spending a longer period of time with the newborn, sustains the claim that both parents should care for the reborn child equally.

Dads should also be given the right to attend important health appointments and birth preparation activities and classes with full pay and allowances. One shouldn’t have to work twice as hard to be a good father, instead, able to afford the time to get to know one’s newborn baby better. To end, I believe that Paternity Leave should be extended to a more meaningful and beneficial period rather than acting as a mere tokenism.

nappy change

Euthanasia – A Good Death?!

It is generally accepted that Doctors and related medical personnel have to undertake the Hippocratic Oath before they enter medical practice, stating that they must “treat the ill to the best of (their) ability.” However is life worth prolonging under all circumstances? In this context Euthanasia or Physician Assisted Suicide (PAS) is a matter of great concern for the patients on one side and the community at large on the other side.

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The word “Euthanasia” comes from two Greek words “Eu” meaning good and “Thanatos” meaning death. In a literal sense, it means a “Good Death.”

Until the late 1990s, people had not thought of legalising same sex marriages. Again, adultery is now being decriminalised in Western Europe and the Americas. These aspects of human sexuality existed even before the modern thinking of Human Rights and have not registered any appreciable spurt after their acceptance in many societies. In a similar way, Euthanasia or “mercy killing” did exist in the past. Physicians did resort to this only in extreme cases and in a very discrete manner.
Euthanasia can be understood in different ways, Voluntary Euthanasia is when a patient seeks to end his/her own life but can’t do without external help whilst Involuntary is where the patient is in a physical or mental state unable to take a decision independently and other people decide that it would be better to take the life of the patient. Where deliberate action is taken to bring an end to a patient’s life in the form of administrating a lethal dose of medicine, also known as Active Euthanasia, is lawfully wrong in many countries.

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A Lethal injection, Image; Panam Post

This subject of mass interest evokes several different viewpoints, those opting against euthanasia are worried that this system, if introduced, would be misused resulting in a large surge of death and at times may be used to get rid of the people who some believe are not deserving or “fit” to live. However it is maintained that allowing a person the right to die with dignity is good. In a recent survey conducted in 15 countries worldwide by MORI on behalf of the Economist, the results revealed that there has been no spurt in the so called “mercy killings.”
It is important to understand the factors that go into a Patient’s decision to request for Physician Assisted Suicide. If the individual is suffering beyond the level of endurance in terms of physical, psychological, spiritual and practical, must the terminally ill patient be given a course of painful treatment to continue with their life even when they wish to terminate it? If so inclined, those determined to end their own life will find a way, even if it involves refusing to eat, overdosing on medication or other crude methods.
In order to remove any fear of wrongdoing on the part of the Doctor to a person requesting Physician Assisted Suicide, a six step protocol was recommended. This involves clarifying the request, determining and dealing with the root causes and educating the patient for control and comfort whilst seeking advice from trusted colleagues and advisors.

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Though there is wide disagreement on the issue of euthanasia among Medical Practitioners, Law Makers and the Leaders of different Religions, the ultimate authority of making the decision for assisted suicide is the well-informed patient. In the unfortunate event of a patient unable to make an informed decision due to being in a vegetative state, the deciding factor should be again in the interest of the patient and not for any extraneous reasons. Sufficing to say that Euthanasia or a “gentle death”; helping someone to die with dignity should be available to a patient as a matter of human rights.

Smokers have a higher risk of TB

A International study led by the University of Cambridge, revealed that the risk of becoming infected with TB is increased by exposure to smoke from cigarettes and burning fuel because smoke clogs up immune cells and weakens their ability to fight TB bacteria.

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Tuberculosis (TB) is an infection caused by th

e bacterium Mycobacterium tuberculosis. It can spread to any organ in the body, but it is most commonly found in the lungs. TB spreads from person to person through the air and can cause breathlessness and eventually, death. Treatments exist and typically last for about 6 months.

Macrophages/ Phagocytes are the immune system’s first line of defense against TB when it first enters the body. The immune cell engulfs the bacterial cell breaks it down with use of lysosomes. In most cases, this is successful – macrophages wipe out the TB bacteria and infection is avoided as memory cells are produced so that if a second infection were to occur, a more rapid and effective response would be more effective.

However, sometimes, the TB bacteria manage to avoid being broken down and  spread infection inside the body. Once it is established, TB then organizes the macrophages into tight clusters called tubercles, or granulomas.

For their study, the team used zebrafish to observe what happens inside macrophages when they encounter TB bacteria. Zebrafish are particularly useful for this kind of study because they are transparent.

zebrafish

Macrophages contain digestive enzymes called lysosomes which recycle old worn out cells as well as pathogens. The researchers found in the TB-susceptible zebrafish, mutant macrophages accumulated undigested material in their lysosomes.

The authors note that this accumulated undigested lysosomal material disrupts the macrophages’ ability to recycle and destroy, and it also “impairs their migration and engulfment of old, and dead cells.” With lysosomes being unable to recycle the debris, they become “bigger and fatter and less able to move around and clear up other material,”

macrophages

This can become a problem in TB because once the TB granuloma forms, the body will send more macrophages at a slow steady pace to help the already infected macrophages. But the enlarged macrophages cannot move into the TB granuloma. The result is that the macrophages that are already inside the structure burst and it is within this liquid that bacteria readily multiply and thereby cause infection.

Finally, the researchers examined macrophages from the lungs of people who smoke. They found their lysosomes were also clogged up, as they note in their conclusion:

“A majority of their alveolar macrophages exhibit lysosomal accumulations of tobacco smoke particulates and do not migrate to Mycobacterium tuberculosis. The incapacitation of highly microbicidal first-responding macrophages may contribute to smokers’ susceptibility to tuberculosis”

alveolar

 

The researchers suggest stopping smoking reduces the risk of developing TB because it allows the clogged-up, slower macrophages to undergo cell lysis (die off and gradually be replaced by new, healthy cells)

 

References:

http://www.medicalnewstoday.com/articles/

All About Autism- Autism Awareness

Currently it is Autism Awareness Week, therefore I wish to post regarding Autism, thus increasing its awareness.

Autism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour.

It’s estimated that about 1 in every 100 people in the UK has ASD.  ‘Autism’ comes from the Greek word “autos,” meaning “self.” The term describes conditions in which a person is removed from social interaction – thus, an isolated self.

The cause of autism is unknown but it is considered that a combination of genetic and environmental factors account for the changes in brain development. Some researchers believe that an abnormality in the area of the brain called the amygdala may play a role in the deficits of ‘social intelligence’ of the disorder

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There’s no “cure” for ASD, but speech and language therapy, occupational therapy, educational support, plus a number of other interventions are available to help children and parents. Astonishingly 70% of adults on the spectrum are unable to live independently, of these individuals, 49% live with family members.

What is it like for a person with Autism?

As their brain process work differently to ours, communication with others can become very hard. Simple things like talking to other people, reading people’s body language and expressions can be difficult for people with autism.

Children and young people with autism often experience a range of cognitive, learning, emotional and behavioural problems, such as:

Behaviour:

  • Short attention span
  • Either overactive or very passive
  • Use of repetitive body movements, phrases and routines.
  • Tend to not partake in games or activities with other people as they find it hard to use their imagination or to be creative 

Social Interaction:

Children with ASD tend to have a lack of awareness and interest in other children. They’ll often either gravitate to older or younger children, rather than interacting with children of the same age. This results in them preferring to not get involved in interactive play, preferring to spend time alone and fail to show empathy especially when smiled at or made eye contact with.

Communication:

Some people with autism will be able to speak normally while others are developing their linguistic skills more slowly. As they can find it hard to understand other people’s emotions and feelings, and have difficulty starting conversations or taking part in them properly they usually cannot start or maintain a social conversation and repeat words or memorised phrases. They may appear uninterested in people and find it hard to make friends and meet new people, preferring to spend time on their own.

 There is a movie being released about a 10-year old boy who elaborates on his experiences of living with Autism. The link below will direct you to a short interview with him:

http://www.bbc.co.uk/newsround/35949807

 

References:

http://www.autism.org.uk/get-involved/world-autism-awareness-week.aspx

http://www.nhs.uk/conditions/Autistic-spectrum-disorder/Pages/Introduction.aspx

http://www.bbc.co.uk/newsround/35949807

3D Printing in Medical Theraphy

3D Printers May be able to make spare parts for flawed hearts:3-d-printer-heart_650x400_81456197930

In the cardiac operating room of the future, a surgeon may be able to repair a damaged heart with personalized parts made to fit the precise anatomy of an individual – bypassing donor lists and immune-suppressing drugs. This makes for patients, a rather reassuring and quicker means of recovery.

Medicine is advancing, as from my last post you may have read how doctors use 3-D-printed models of organs  to educate both patients and medical students. Researchers are also working to print out cells, blood vessels and other living tissues, and experimental studies have created, among other parts, knee cartilage, bones and an artificial ear.

“I really think the 3-D jet printer is transformative,” says Daniel Jones, Chief of minimally invasive surgical services at Harvard Medical School in Boston. “It’s going to change the way doctors talk to patients, how they plan surgeries and how they do surgeries. The sky is the limit in terms of applications.”

3D bioprinting of an artery at Carnegie Mellon University College of Engineering; experts predict that 3-D printers will become routine tools for heart care.

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In cardiology, 3-D models are, for now, proving most useful as educational tools. Like fingerprints, every person’s heart is unique, and every heart problem is individual therefore. With help from detailed replicas, surgeons can plan more accurately and reduce procedure times.

The technology of 3-D printing is so new that rigorous studies have not yet assessed how using it affects outcomes.  When Harvard Medical School cardiac anesthesiologist and echocardiographer Feroze Mahmood began printing full-size replicas of patients’ damaged mitral valves, he gained a new appreciation for the complexity of the structure, particularly a Pringle-shaped region called the annulus that was impossible to visualize with two-dimensional images. 

 

It is hoped that surgeons may even be able to print customized patches for repairing hearts damaged by heart attacks.  The challenge is to print high-quality that actually re-creates the function of real human heart muscle.  The use of 3D printing in medical treatment is in its infancy and who knows where 10 years of research could take us.

Reference:

http://www.ndtv.com/health/3-d-printers-1280236

Medical Training transformed by new 3D skeleton

Glasgow School of Art and the Royal College of Surgeons of Edinburgh have teamed together to help transform the way that medical students are trained.

The School of Art are designing a digital model of a human body which will allow students to practise surgical procedures as if they were dealing with a real patient.

Dr Paul Chapman, acting director of the digital design studio, Glasgow School of Art says work on the skeleton is complete and that the fully formed ‘3D Definitive Human’ project will be available to train medical students within the next two years

3D printed models allow surgeons to practice procedures before performing them on human patients. 

The model, which will allow medical students to practise medical interventions outwith the operating theatre, is based on medical scans of donor cadavers at Glasgow University.

3D allows the reproduction of human anatomy so that students can feel what the tissue feels like and can actually dissect those models. Even patients with complicated problems will be able to be replicated meaning that medical training will be heightened with more clinical experience.

According to Medical Students, understanding complex human anatomy can be very difficult. To be able to deal with the 3D anatomy is a much more intuitive way of learning.

It also can help in consultations and better explain the situation to the patient using these tools where they can see the situation. From my personal expereince, it can help ease a patient’s mind when they also have a better understanding of what’s going on inside them.

 

References:

BBC News- Medical

https://www.asme.org/engineering-topics/articles/bioengineering/medical-training-with-3d-printing

Pigeons identify breast cancer ‘as well as doctors’

Pigeons are often seen as dirty and an urban nuisance, but they are just the latest in a long line of animals that have been found to have abilities to help humans. Despite having a brain no bigger than the tip of your index finger, pigeons have an impressive visual memory.

pigeons

Recently it was shown that they could be trained to be as accurate as humans at detecting breast cancer in pictures. Pigeons, with training, did just as well as humans in a study testing their ability to distinguish cancerous from healthy breast tissue samples.

The pigeons were able to generalise what they learned, correctly spotting tumours in unseen microscope images.

example of cancerous and benign images

The pigeons’ ability could help improve new image-based diagnosis technologies:

“Pigeons can distinguish identities and emotional expressions on human faces, letters of the alphabet, misshapen pharmaceutical capsules, and even paintings by Monet vs Picasso,” said Prof Edward Wasserman from the University of Iowa, a co-author of the study.

“Their visual memory capacity is equally impressive, with a proven recall of more than 1,800 images.”

Each bird was taught to distinguish microscope images of cancerous and non-cancerous tissue, by being rewarded only when a correct answer was provided. The birds learned to recognise tumours at a range of magnifications and image compression levels, as well as in the absence of colour.

“The birds were remarkably adept at discriminating between benign and malignant breast cancer slides,” said lead author Prof Richard Levenson, from the University of California, Davis.

The researchers also tried a “flock-sourcing” approach. This involved pooling the decisions from a group of four birds, and led to an impressive 99% accuracy in diagnosis.

The birds might be able to assist researchers and engineers in developing imaging-based cancer diagnostic tools.

Such tools have to be validated by trained clinicians, to ensure quality and reliability. This is a tedious and expensive process – which the common pigeon may be able to help with in the future.

 

REFERENCE:

http://www.bbc.co.uk/news/science-environment-34878151

 

Cirrhosis of the Liver

Cirrhosis is an abnormal liver condition in which there is irreversible scarring of the liver.

It is what Phil Mitchell is diagnosed with in Eastenders.

For cirrhosis to develop long-term, continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and replaced by scar tissue the condition becomes serious, as it can start blocking the flow of blood through the liver.

Cirrhosis is a progressive disease, developing slowly over many years, until eventually it can stop liver function (liver failure).

The liver

The liver is an important organ, which carries out several essential functions, including the detoxification of harmful substances in the body. It also purifies the blood and manufactures vital nutrients. As well as this it:

  • stores glycogen (a carbohydrate that produces short-term energy)
  • makes bile, which helps to digest fats
  • makes substances that clot the blood

There are usually few symptoms in the early stages of cirrhosis. However, as the liver loses its ability to function properly, usual symptoms are a loss of appetite, nausea and itchy skin.

In the later stages, symptoms can include jaundice (yellowing of the skin, eyes and tongue), vomiting blood, dark, tarry-looking stools, and a build-up of fluid in the legs (oedema)

In the UK, the most common causes of cirrhosis are:

  • drinking too much alcohol over many years
  • being infected with the hepatitis C virus
  • a condition called non-alcoholic steatohepatitis (NASH) that causes excess fat to build up in the liver

NASH is on the rise in the UK, due to increasing levels of obesity and reduced physical activity. It’s likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis.

Preventing cirrhosis

Not exceeding the recommended limits for alcohol consumption is the best way of preventing alcohol-related cirrhosis.

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Treating cirrhosis

There’s currently no cure for cirrhosis. However, it’s possible to manage the symptoms and any complications, and slow its progression.

Treating underlying conditions that may be the cause, such as using anti-viral medication to treat a hepatitis C infection, can also stop cirrhosis getting worse.

In its more advanced stages, the scarring caused by cirrhosis can make your liver stop functioning. In this case, a liver transplant is the only treatment option.

 

References:

http://www.medicalnewstoday.com/articles/172295.php

http://www.nhs.uk/conditions/cirrhosis/Pages/Introduction.aspx

Breakthrough treatment for MS Patient

UK Doctors say that patients with Multiple Sclerosis are showing remarkable improvements after receiving a treatment usually associated with cancer.

Steven Storey was diagnosed with MS in 2013 and went from being an athlete to needing a wheelchair whilst losing sensation in parts of his body.

‘Panorama: Can you stop my Multiple Sclerosis?’ aired on Monday 11th January, 8:30pm, BBC One and covered the rest of the story.

The Treatment:

Around 20 patients at Sheffields Royal Hallamshire Hospital recieved bone marrow transplants using their own stem cells. Some patients who were once paralyzed have been able to walk again.

This is all due to  a new stem cell treatment for MS, known as Autologous Haematopoietic Stem Cell Transplantation (AHSCT or HSCT). This is a relatively new treatment, currently in trials in the UK.

Dr Emma Gray,  Head of Clinical Trials, said: “Ongoing research suggests stem cell treatments such as HSCT could offer hope and it’s clear in the cases highlighted by Panorama they’ve had a life-changing impact. However, trials have found while HSCT may be able to stabilise or improve disability in some people with MS it may not be effective for all types of the condition.

About Multiple Sclerosis:

Multiple sclerosis (MS) affects the nerves in the brain and spinal cord, causing a wide range of symptoms including problems with movement, balance and vision.

MS is an autoimmune condition. This is where something goes wrong with the immune system and it mistakenly attacks a healthy part of the body.

In MS, the immune system attacks the layer that surrounds and protects the nerves called the myelin sheath. This damages and scars the sheath, meaning that messages travelling along the nerves become disrupted.

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors are involved.

More than 100,000 people in the UK have MS. Symptoms usually start around he ages of 20-30 and it affects almost three times as many women as men.

The main symptoms include:

  • extreme tiredness (fatigue)
  • vision problems, such as double vision in one eye
  • numbness or tingling in different parts of your body
  • muscle spasms, stiffness and weakness
  • problems with balance and co-ordination
  • problems with thinking, speaking and concertating

The Treatment:

Autologous Haematopoietic Stem Cell Transplantation (AHSCT) is being investigated as a treatment for severe immune-mediated diseases, such as MS.  Haematopoietic refers to the type of stem cells  used in the treatment which are found in the  bone marrow and blood. Autologous means ‘from the same place’ as the stem cells used in the procedure are the person’s own.

AHSCT homepage 560 x340

The aim of AHSCT is to ‘reset’ the immune system to stop it from attacking the central nervous system.  Haematopoietic stem cells are not the type of stem cells that would be expected to change into or regenerate permanently damaged nerves or other parts of the brain and spinal cord.

The treatment uses high doses of chemotherapy and antibody treatments, and therefore is more intensive and higher risk than most other MS treatments and involves a number of steps:

  1. Collection or ‘harvesting’ of stem cells from the bone marrow or blood of the person receiving treatment
  2. Purification and freezing of the harvested stem cells in liquid Nitrogen until they are required.
  3. Administration of chemotherapy combined with growth hormones to flush out an individual’s white blood cells
  4. Indusion of the thawed stem cells to help ‘reset’ the immune system

Risks:

AHSCT is an aggressive therapy involving intensive chemotherapy and its short term risks are higher than other MS therapies.It has a higher risk than current MS therapies, carrying a 1.3% mortality rate. This means one to two people die from the treatment for every 100 people who receive it.

Typically, the person receiving a transplant will be closely observed for about a month in an isolation room in order to prevent infection.

whilst receiving antibiotics and transfusions to support them through the procedure in

Effectiveness:

For many MS sufferers, standard drugs and blood treatment whereas this new treatment has been effective. The best results so far have been seen in people with highly active forms of relapsing MS but so far it doesn’t look to be effective for progressive MS as it cant repair damage already done, so there are limits to the recovery. 

This new treatment looks promising but more research is needed.

References:

BBC News- Health

http://www.nhs.uk/conditions/multiple-sclerosis/Pages/Introduction.aspx

https://www.mssociety.org.uk/ms-news/2016/01/ms-treatment-feature-panorama

 

Can a virus give you cervical cancer?

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I had the privilege of shadowing a consultant gynaecologist who informed me about medical advancements revealing that the virus (HPV) can cause cervical cancer.  During a consultation I met a young  woman who was discussing the results of her cervical screening test which revealed that the pre-cancerous lesions progressed onto invasive cervical cancer.

What is HPV:

Human papillomavirus (HPV) is an extremely common virus.  Worldwide, HPV is the most widespread of all sexually transmitted viruses; four out of five of the world’s population will contract some type of the virus once in their life. In the majority of cases the body’s immune system will clear or get rid of the virus without the need for further treatment.

There are over 100 identified types of HPV and each different type has been assigned a specific number. HPV infects the skin and mucosa (any moist membrane, such as the lining of the mouth and throat, the cervix and the anus).  Around 40 of the HPV types affect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), anus, and the linings of the vagina, cervix and rectum.

Around 20 of these types are thought to be associated with the development of cancer. The World Health Organization (WHO) International Association for Research on Cancer (IARC) defines 13 of these 20 types as oncogenic (cancer causing). This means there is direct evidence that they are associated with the development of cervical cancer and are considered high risk

HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity.

Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection don’t have any symptoms, so many women won’t realise they have the infection.

Signs and Symptoms:

The majority of HPV infections do not cause symptoms or disease and resolve spontaneously. However, persistent infection with specific types of HPV (most frequently types 16 and 18) may lead to pre-cancerous lesions. If untreated, these lesions may progress to cervical cancer.

Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage and may include:

  • irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse;
  • back, leg or pelvic pain;
  • fatigue, weight loss, loss of appetite;
  • vaginal discomfort or odourous discharge;
  • a single swollen leg.

Using condoms during sex offers some protection against HPV, but it can’t always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area.

Vaccination:

Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13  as part of the NHS childhood vaccination programme.

According to Cancer Research UK, cervical cancer is the second most common cancer in women under the age of 35. In the UK, 2,900 women a year are diagnosed with cervical cancer, that’s around eight women every day.

Around 970 women died from cervical cancer in 2011 in the UK. It’s estimated that about 400 lives could be saved every year in the UK as a result of vaccinating girls before they are infected with HPV.

Why is it given at such a young age:

The HPV virus is very common and is easily spread by sexual activity.

As much as half the population will be infected at some time in their life. In most cases, the virus doesn’t do any harm because your immune system gets rid of the infection. But in some cases, the infection persists and can lead to health problems.

Although most girls don’t start having sex until after they’re 16 years of age, it’s important that they are protected against HPV infection early enough and a good time is in the early teenage years. Getting the vaccine as early as possible will protect them in the future.

 

Refereneces:

  1. Koutsky L, 1997. Epidemiology of genital human papillomavirus infection. The American Journal of Medicine 102 (5A), 3–8.
  2. Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine 24 (3), S3/35–41.
  3. http://www.jostrust.org.uk/about-cervical-cancer/hpv
  4. http://www.nhs.uk/conditions/vaccinations/pages/hpv-human-papillomavirus-vaccine.aspx

Alzheimer’s Disease

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Over the Festive Period, my father and I took at trip to Warmister, Wiltshire to visit a dear family friend- Rev Grose (He is my father’s Godparent). We have known both Rev and Mrs Grose for many years and are in regular contact with them. We make it a point to visit them in Warmister at least 2 times a year.

 

 

Rev Grose is in his early 90’s and is suffering from the early stages of Dementia. He has suffered from some Memory Loss and this is evident as often he struggles to find the right word to use in the conversation, at times forgets the names of others as well as loses items-(such as his mobile) and is at times unable to recollect recent conversations or events. In order to help, we have helped him develop a routine to combat the memory problems he faces.

Thankfully he is still very fit and active and visits his wife on a daily basis at the residential home she where is located- a 10 minute car journey from his Care Centre- Ashwood.

Whilst at Ashwood, I picked up an information booklet about Alzheimers which was given by the Alzheimers Society- a research and support charity leading the fight against dementia.

After reading the booklet, I learned more about Alzheimers and Dementia and I wish to share with you some of this information. Most of the reference material can be found on their website alzheimers.org.uk

What is Alzheimers Disease:

It is a disease which is the most common cause of Dementia

Dementia- The word itself descripes symptoms such as:

  • Memory Loss
  • Difficulty with thinking,problem-solving and language

Alzheimer’s disease was named after the Doctor- Alois Alzheimer.

It is a physical disease which affects the brain and affects more than 520,000 people in the UK.

As the disease progresses, proteins build up in the brain forming structures called ‘Plaques’ This can lead to the loss of connections between nerve cells which eventually leads to the death of nerve cells as well as brain tissue.  The disease is progressive, meaning that over time more parts of the brain get damaged leading to more symptoms and the severity increases.

During the the Later stages, people suffering from Alzheimer’s can develop behaviours unusual to them or out of character. These can include agitation-restlessness,calling out words. This may mean that the individual requires separate treatment and management.

Who gets the Disease?

Most people develop the disease after the age of 65 but it is possible for people under this age to develop it. Currently in the UK there are over 40,000 people under 65 with dementia.

  • Age is the greatest factor. Above 65 years, a person’s risk of developing Alzheimer’s doubles every 5 years.
  • Gender. There are about twice as many women as men over the age of 65 with Alzheimer’s disease. There are no clear reasons for this, yet it is suggested that it could be due to the lack of Oestrogen after menopause.
  • Inherited. For someone with a close relative (parent or sibling) who was diagnosed with Alzheimer’s disease when above 65, their own risk of developing the disease increases. People with Down Syndrome also are at a particular risk of developing Alzheimer’s disease.
  • Health/Lifestyle- Conditions such as Diabetes, Stroke, Heart Problems as well as High Blood Pressure, Cholestrol and Obestity in mid-life are all known to increase the chance of Alzheimer’s disease.

So people who adapt a healthy lifestyle are less likely to delevelop Alzheimer’s disease!

Treatment and Support

As of yet there is no cure for Alzheimer’s disease, however, drug and non-drug care, support and activities can enable someone to live well with the condition.

People suffering from Alzheimer’s disease find that speaking to a professional about their diagnosis helps them.

Talking Therapies (such as cognitive behavioural therapy), Anti-depressants and Councilling can help the individual adjust to the diagnosis.

There are drug treatments which alleviate some of the symptoms or slow down progression of the Disease . The common brands of these drugs- Aricept, Exelon, Reminyl and Exbia

Many people also benefit from partaking in activities that they enjoy such as reading or puzzles.

 

SUMMARISED FROM ALZHEIMER’S DISEASE INFORMATION PACK- The Alzheimer’s Society

 

 

 

The Blog

My main aim for this blog is to POST AND SHARE New Medical Treatments and Articles related to Health and Medicine for people from all backgrounds and ages.

Contact: If you wish to contact me please feel free to- robbieanand@yahoo.co.uk

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