Work Experience at a General Practitioners

I truly love and enjoy reading about medicine and studying the complex world of science. However, my ultimate goal and dream is to become a doctor or consultant of some sort. So to have the opportunity to spend a week shadowing and following in the footsteps of real heroes and role models was one of the best experiences. This week gave me the chance to see and get involved- hands on- what doctors/GPs do on a daily basis and even apply my knowledge to complex situations and solve difficult problems. As a whole, I am ever more convinced that I do not want to be just a scientist and have expert knowledge, but I want to make a difference and work with people to change their life for the better.

Day 1

Before starting work experience, I had no idea whether I want to be a GP or whether I want to specialise and go into one of the many specialities medicine has to offer. Therefore, I did not only not know what to expect but I also began the first day with my eyes and options open. I admit I felt very nervous and shy so driving to the surgery was not the easiest. However, I stayed very positive and I knew I would love this because medicine runs through my blood.

On the first day, I was introduced to all the staff and some of the GPs I would be working with over the course of the week, and I was also given a tour of the surgery and told where everything was. This was the first of many challenges I experienced- learning all the names and remembering where all the rooms were (haha). Before I continue, I would like to say that I have never met a more lovely, kind and warming group of people before. The ladies in the office and reception were so so welcoming, explaining to me what they do, chatting to me about A-levels/school and life in general- the tea and biscuits too of course, who could forget about that! They made me feel calm and I felt so much less nervous about this experience.

The very first task I was given was to collect patient records, look through each of the files carefully (of which there were hundreds if not thousands) and go onto the profile of each patient on the system that all GPs use to look at when speaking to them, in order to know their entire past history/any previous medical problems etc. and sort all past medical problems into minor and major problems. I cannot begin to explain how complicated and almost enigmatic this software was. One of the ladies had to show me and demonstrate about 10 times how to operate the software and fill in the information. The patient records consisted of letters from consultants, surgeons and GPs, as well as test results like blood tests, cervical screenings and biopsies. It was extremely interesting and overwhelming going through all the patient records and seeing how doctors communicate with each other. In addition, I learnt so much new medical terminology, gained insight into the tremendous variety of diseases/conditions doctors deal with and had a moment to do some small research into the most intriguing illnesses.

After doing this, I had an extremely large pile of patient records, already on the system, to put in the file room in the correct alphabetical order. The file room seemed to carry on forever and the amount of patient records was never ending. Whilst carefully organising the records, I realised to what extent surgeries are struggling and what impact the increasing amount of new patients coming in is having on the NHS and surgeries. With certain cuts currently being made as well as many surgeries already closing down, I felt a bit worried and truly grasped the problems being faced by the Medical World.

Overall, throughout the first day I did mostly clerical and office work and at the end I was also showed what kind of paperwork GPs have to fill in. I was surprised to see that GPs spend a considerable amount of time writing reports, letters and overall do quite a bit of office work (bureaucratic). However, this “office work” consisted mostly of writing accounts on patients seen recently and referring them as well as problem solving.  Therefore, the first day was designed to introduce me to the paper work and ‘Office World’ of GPs.

Day 2

The next day, I came in just before 9:00am and was welcomed just like the first day. After making the first stressful set of cups of tea, I started off by ploughing through the remaining patient records and completing the notes on the system. At mid day, I was able to finally meet one of the GPs, who was also name & Senior partner, and shadow him for the rest of the day. First we spent a good half hour having a conversation about all things medicine. I had my list of questions ready and I learnt so much about university life (the GP I spoke to was an Oxford Graduate!), the NHS, how he deals with patients, his experiences,  things he would do differently, dealing with various situations, his work in general and I even got a mini masterclass in infectious disease and antibiotic resistance. I learnt so much I could go on for eternity. Afterwards, I attended a baby clinic and got to see how the GP examines newborn babies to see whether they are fit and healthy to have their first set of vaccinations at 8 weeks. Some of the tests were bizarre, but funnily enough they were well justified and when I asked later, the GP explained the reasons behind the different parts of examination very well. I even had the chance to use some of the devices and examine one of the babies myself! For instance I got to use the lens and hunt for any eye cataracts. Then, I saw one of the babies receive the four vaccines.                                                                                                                                                    Once the baby clinic finished, I sat with the GP for the rest of the day and met many very different patients with very different complaints and symptoms, and asked the GP more probing questions

Day 3 

Day 3 started off with me spending the entire morning with the lead nurse, and similarly to shadowing a GP, I had the opportunity to sit with her and listen to patients. I witnessed two blood tests, an INR (an INR is a meeting where patients on warfarin medication come in and the thickness of their blood is measured, to see whether their warfarin dosage needs to be increased or decreased. These patients have numerous cardiological problems which is why they are put on warfarin, for instance, those who find they have atrial fibrillation or clotting disorders), a spirometry test, asthma test and I also witnessed a man with prostate cancer come in for a zoladex injection.

On Wednesday’s the Surgery closes early at around 1:00pm because it is affiliated with another surgery elsewhere that is open longer, meaning they can finish early. The opposite happens on Fridays, where the surgery I spent the week works longer.

Day 4

The week was slowly coming to an end, and I couldn’t help but feel a little sad coming in on the fourth day. Spending time at the GP surgery made me realise and think about why I want to do what I want to do. I see GPs and they are so happy and enjoy their job so much, which inspires and motivates me to study hard.

I spent most of the day once again, shadowing a GP and later for an hour or so at a health clinic listening to the nurse talking to patients and discussing their symptoms. This time, I managed to have a conversation with the GP about a few ethical topics and the current NHS situation. The nurses role at the health clinic was to see patients to examine them and decide whether their complaints were serious/an emergency and whether they should go to the GP. This saves a lot of time for the GPs and it also means doctors can see more patients (patients in a worse condition) during the day. Finally, I did a big pile of photocopying for the ladies in the office, which are in charge of the day to day running of the surgery.

Day 5 

On the last day, I had the chance to get involved and help the GP with performing some tests and procedures. For example, I carried out an ECG on a lady all by myself with some assistance and to my surprise everything went quite alright-apart from originally mixing up the exact locations where the sticky tabs were meant to be put. After the patient received their ECG result, the GP later gave me a mini masterclass on electrocardiograms, the cardiac cycle and how the heart beat is brought about overall. Following that, I had the opportunity to attend a minor operation- one of the GPs and leading nurses was removing an infected toe nail. I admit that in the beginning I felt a little uneasy and the view was something I wasn’t used to, however, as the operation proceeded I felt much more comfortable and had a better look at what was going on.

Finally, I got to meet a patient who has diabetes and attended the surgery to get the wound on his foot cleaned. Speaking to the patient and gaining an insight into their life as a diabetic made me feel empathy and compassion. Although they did not control their condition well in the beginning, after being diagnosed, their struggles later on made me feel slightly helpless. This feeling made me also feel somewhat bad and angry at myself… when I become a doctor, I don’t want to feel that way all the time and I would like to improve peoples lives by diagnosing, treating, developing science and pointing them in the right direction. OF COURSE, I am aware that to be a physician isn’t so positive all the time and that there will be difficult periods where the future might not seem the brightest and I will face tough situations. BUT you have to battle through it and using your love for people and medicine do everything in your power to save the day.

Leaving and saying goodbye to everyone at the surgery was a little bit hard, because during this week I felt like I had become a part of a family. A family that shared one exact same passion, same mission, and same goals plus determination. The surgery felt like home, and I was able to build some fun, challenging but everlasting memories. The list of things I learnt is immense.

I am still unsure whether General Practice is the way forward for me after medical school, however, I am most definitely not crossing it out after this week. Who knows!? I think this is because I enjoy the rush and spontaneity of hospitals and having the chance to directly treat fascinating diseases. Being a GP and being a Consultant are both amazing, so I’m hoping medical school can help me become even more inspired and give me the knowledge I need to be a fantastic doctor! This week was another huge leap and step towards becoming a medic and I want to gain even more experience, more insight and more skill.

Overall, I have become a more confident speaker and developed qualities I hope to hold forever. Thank you to those who made this experience so amazing.

 

The Biggest Killer you may not know- Septicaemia

I recently stumbled across an article/case study in The Independent, describing how a women named Savita Halappanavar was admitted to A&E with a condition that was presumed to have been an obstetric emergency.                                                                                                            It was reported that she had been told she started to miscarry, as her waters broke and she was quite heavily bleeding. However, the important question here is, despite it appearing to be an obstetric emergency at first sight, was it really? Not long after, Ms Halappanavar unfortunately died of a severe blood infection called septicaemia which can arise from something small like a toenail infection or from something much more complex like a complication during pregnancy.                                                                                                       In this patients case, if her membranes ruptured early that could have allowed bacteria to ascend into her uterus resulting in an infection, developing into septicaemia. Or, the other possibility is that septicaemia may have originated from another, different infection such as appendicitis or a kidney infection (she complained of back pain previously). Although the latter reason is much less likely. Overall, the exact cause of septicaemia in this case was not fully established.

I wanted to begin this post with an overview of this case because it introduces the issue of sepsis very well. I have previously heard of many other cases similar to this one, but never really thought of them much because my understanding of disease was very limited.                                                                                                             Sepsis (or Septicaemia) is a condition that kills, on average, more people in the UK each year than bowel, breast and prostate cancer combined. Patrick Kane, a victim, was only nine months old when he suddenly became very ill, droopy and unresponsive, and was told by a family GP that all he needed was some Calpol. Only a few hours after falling ill, Patrick had multiple organ failure and was rushed to St Mary’s hospital in London where he spent three and a half months. In the end, he lost his right leg (below the knee), left arm and fingers on his right hand.

So what is Sepsis?                                                                                                         Septicaemia is blood poisoning that arises as a result of the body’s immune response (first triggered by a bacterial, viral or fungi infection) going into ‘overdrive’ and attacking the body’s own tissues and organs. Common locations for the primary infection include the lungs (pneumonia), brain, abdominal organs (appendicitis), skin (cellulitis) and urinary tract (urinary infections).

However, it may also arise from the simplest and trivial of injuries like a minor cut/wound on the hand. Initially, the body’s immune system produces white blood cells, and along with platelets, they travel to the place where the cut is situated to form clots in the surrounding tissues. The inflammation of the wound can then spread through the body affecting healthy tissues and organs as a result of the immune system essentially ‘over-reacting’.

It is difficult to say who is most at risk of developing septicaemia, because everyone has the potential. Although, more vulnerable are newborns, young children and the elderly as they have weaker immune systems. In addition, those battling with AIDS, kidney or liver disease are also slightly more at risk, as well as pregnant women who have suffered any burns or physical injuries.

Signs and Symptoms of Septicaemia                                                                              Below are some of the common signs and symptoms of sepsis:

  • weakness
  • loss of appetite
  • fever and chills
  • thirst
  • difficult or rapid breathing
  • rapid heart rate
  • low blood pressure
  • low urine output
  • low body temperature
  • edema

Even though the symptoms above are the most common of sepsis, most of these signs do not immediately mean you have blood poisoning. However, it is advised that you still see your local GP as there may be other underlying reasons for those symptoms.

Treatment and Prevention                                                                                                           In severe cases of septicaemia, your body needs increased amounts of fluid to prevent dehydration and kidney failure.                                                                                      Fluids would be given intravenously during the first 24 to 48 hours after admission and it is very important that the doctors know how much urine your kidneys are making, so they can spot signs of kidney failure                                             As well as this, antibiotics would also be given intravenously (quicker effect). Ideally, antibiotic treatment (broad spectrum antibiotics) should start within an hour of diagnosis to reduce the risk of serious complications or death. After two to four days of intravenous antibiotics they are usually replaced by tablets.

In terms of preventing septicaemia, the only logical way is to attempt to prevent the primary infections that develop into sepsis, from being introduced in the first place. This can be done through vaccinating children and the elderly- or anyone for that matter, who may be at risk or susceptible to the disease.               Furthermore, antibiotics should be used with care and their use restricted. Antibiotic resistance is becoming a worldwide concern, and recently excessive use of drugs has led to a sharp increase in the number of bacteria that have mutated and developed to resist the antibiotics.                                                                 In order to prevent common and typically minor infections from becoming deadly, it is essential that antibiotics are only used when absolutely necessary, the right type of antibiotic is prescribed to tackle the right infection and that the course is finished and not stopped early.

Lastly, poor hygiene increases the chance of picking up infections, as you touch and do everything with your hands. Therefore, promotion of good personal hygiene, spreading the importance of hand washing and ensuring clean water is more widely available have the potential to save millions of lives, by drastically lowering the risk of sepsis- as is seen in some parts of East Africa.

Role of the NHS and what is currently being done… 

The NHS is definitely doing more to combat sepsis than they used to, however, many are doubting that this is not enough. We don’t really hear much about sepsis on the news and the problems doctors are facing. A report in 2015 stated that “four in ten patients being admitted to A&E emergency units were not being reviewed quickly enough and uncovered delays in giving antibiotics in nearly a third of cases”.

Due to the inconsistencies in how patient’s symptoms are assessed, the National Institute for Health and Care Excellence is constructing a few new laws regarding medical practice. More will be done to provide rapid treatment if a patient is suspected to have sepsis, and doctors/healthcare staff must treat sepsis with the same urgency as a suspected heart attack.

Despite this, I believe we will not see much (if any) progress in this battle against sepsis any time soon, given the difficulties the NHS is trying to overcome already. Funding is low, which means research will be slow. Nevertheless, medicine is improving without a shadow of a doubt, and discoveries in fields across medicine only lead to more discoveries.

Hearing and reading about the story of Patrick Kane who survived after having sepsis is truly disheartening, but at the same time it gives you hope. If someone can confront and come out even stronger after facing an agonising battle with sepsis, what is to stop scientists, doctors and us from going out into the world and developing countries to not only win against sepsis but to extinguish and erase the fear from everyone’s minds.

New treatment for a deadly form of brain cancer?

mri_gbm2

I am currently completing a project and carrying out some research into one of the most deadly forms of brain cancer known to man- Glioblastoma multiforme. This brain cancer arises from star shaped glial cells (astrocytes and oligodendrocytes) that support the health of the nerve cells within the brain. It grows and spreads ever so rapidly to nearby brain tissue, which is what makes this cancer pretty impossible to control. So far the only treatments available for glioblastoma are surgery/removal followed by chemotherapy (involving the use of temozolomide) and radiotherapy. Sounds promising? Well, you would be surprised to hear that the median survival is only 14.6 months and two-year survival is 30%…                                                                                                                                                                               In fact, due to the blood-brain barrier (a protective sheath separating brain tissue from its blood vessels) the cancer is very well protected from drug and radiation based therapies and surgery most of the time is relatively ineffective, as even the tiniest remnants can spawn into new and equally as large tumours.

Just when things could not get any more dark and hopeless, there was a very small but bright light at the end of the tunnel.                                                                                                                                                              Scientists and biomedical engineers at Duke University embraced a slight different path of thinking and noted- What if the only way to develop a cure or treatment for a deadly disease, was to take advantage of another deadly disease and manipulate it so that it attacks the cancer.                                                                                                                                            Taking this idea on board, researchers chose and worked on a strain of Salmonella typhimurium. This bacteria which causes food poisoning was genetically altered to not attack the human gastrointestinal tract, but instead the glioblastoma tumour. This was the first DNA sequence modification.                                                                                                          Knowing that tumours are naturally rich in the protein purine, scientists reconstructed the bacterium further, this time with the aim of making it deficient in this exact amino acid. This was done so that when injected, the bacterium would essentially use the tumour as a food source (the purine in the tumour attracting it like bees to honey), settling and reproducing inside the mass. However, the work does not stop here. Of course, the aim of this pursuit is to eradicate the cancer, so the team also instructed the bacteria’s genetics to produce two substances- Azurian and p53, both of which order cells to self destruct. In addition, these compounds are only activated in oxygen-low environments- Convenient and Perfect as the interior of tumours is exactly that. As a result, both the tumour and the bacteria are destroyed in the end.

Outcomes

Trials on rats were initially performed to test the effectiveness of this new method of treatment. 20% of rats lasted over 100 days, which is equivalent to 10 human years, with the tumours going into complete remission. Although the remaining 80% of patients showed no significant improvement/increase in survival rate, researchers explained that there may have been a few limiting factors and vital reasons why this occurred. Firstly, there were no signs of resistance to any of the substances, meaning ineffectiveness was likely due to inconsistencies in the bacteria’s penetration, and/or to the tumour growth outpacing the bacteria action. Nevertheless, every rat showed initial signs of improvement.                                                                                                                                                             So what more needs to be done?                                                                                                                       As Dr. Jonathan G.Lyon himself stated “It might just be a case of needing to monitor the treatment’s progression and provide more doses at crucial points in the cancer’s development…still, more experiments are needed to know for sure.” So far, only animal trials have been performed, and at times you cannot guarantee that the effects this therapy has on rats will be the same for humans. Therefore, human trials will play an important role in establishing whether this new therapy will work.

My thoughts-GMO Project 

In my opinion, finding a cure for brain cancer is almost like attempting to come up with one unified equation explaining everything in the universe= there is simply hundreds of thousands of concepts (or in this case variations) that need to be explored first. One may think that this would be a lengthy but straightforward process. However, even though we are living in the 21st Century does not mean we have everything in the world right by our feet. I had thought and planned, until I reached an interesting idea. What if there was a way that you could combat the vague or unknown boundaries of the glioblastoma and make removal by surgery 90% successful or even 100% successful?

Hopefully, the idea I have produced can be started and turned into reality soon, and I am very excited to finally share it with you-                                                                                                       Due to the unknown boundaries and edges of this form of brain cancer, Glioblastoma, surgery holds a very gloomy future to patients as (like stated before), remnants can spawn into big tumours again and cause maybe even more damage.                                                                                                                                  THE IDEA: A bioluminescent genetically modified organism could be designed by inserting into it specific genes, proteins and receptors that very accurately and precisely bind to the tumour cells resulting in this cancer. This cautious and safe process could aid the identification and pinpoint the exact boundaries/location of tumour cells. Having done this, doctors could very easily see whether they have removed all the tumour cells during surgery, and not after the surgery, as we all know brain surgery is a very dangerous and potentially fatal procedure.                                                                                                         This brief idea, is I hope only the beginning and hopefully my small team and I will be able to develop this idea beyond it just helping with treatment.

BUT we have to remember one thing; any change, no matter how tiny,  means an immense deal. Just because there has been 1% or even 80% of uncertainty, by absolute no means suggests that what we have started and produced should be forgotten and given up completely. And this is one of the many reasons I decided to complete the extended project qualification on brain cancer. The more research that is admitted, the more hope there will be for those troubled and affected by this traumatic illness.

More information on my GMO project to come very soon!

 

 

 

References                                                                                                                                  http://www.abta.org/brain-tumor-information/types-of-tumors/glioblastoma.htm   https://pratt.duke.edu/about/news/tumor-seeking-salmonella-treats-brain-tumors https://www.sciencedaily.com/releases/2017/01/170111102942.htm

MRI vs Biopsy: Huge leap in prostate cancer testing

The mighty MRI proves it could potentially save your life yet again!                                                   In Britain, prostate cancer is the most common form of cancer in men. If high levels of serum prostate specific antigen (PSA) are detected in the bloodstream, men will usually undergo transrectal ultrasound-guided prostate biopsy (TRUS-biopsy). This involves twelve needles which take random samples from the whole prostate which can then be tested. Although not obvious at first, this technique has some very clear flaws and limitations. For instance, it can miss the cancer that is there as not the entire prostate is tested, and even if a fragment of the cancerous tissue is extracted, the biopsy may fail to spot whether it is in any way, shape or form aggressive. Including this, the TRUS-biopsy can cause side-effects including bleeding, pain, and infection. So overall, this biopsy is blind to the location of cancer in the prostate, leading to many men without clinically important cancers undergoing unnecessary biopsy, over diagnosis of clinically unimportant disease, and under-diagnosis of clinically important cancers.prostate-cancer-s20-photo-of-prostate-cancer-cells

Therefore, to see whether there are other methods that can reduce the performance of unnecessary biopsies and improve diagnostic accuracy, a trial was performed in 11 hospitals in the UK. This trial involved the use of a multi-parametric MRI on men with high PSA levels, to see whether this device, having been around for some time, can produce some positive outcomes- and they were amazing. 93% of aggressive cancers were detected by using the MRI scan compared with just 48% when the biopsy was done at random. The MR-MRI produced the most precise and intricate images, providing information on tissue anatomy, as well as valuable data on tissue characteristics such as prostate volume, cellularity, and vascularity. There is also some more evidence that suggests this MRI can detect higher-risk disease and overlook low-risk disease.

Having said that, after performing a MR-MRI on a patient, a biopsy afterwards may still be required for further testing, but this time with much much more accuracy because the exact location and characteristics of the cancerous tissue has been established.

With every new advancement in technology, there will always be that small obstacle stopping the idea from getting incorporated into the system… so despite this new revolutionary study, performing a MR-MRI on every patient may put some strain on the NHS in terms of cost and funding…

Each scan costs between £350 and £450 per patient. Thinking about it, if all patients across the UK with high levels of serum prostate specific antigen were to receive a MR-MRI scan, the NHS would receive a bill of around £40m through their letter box. Now, this is not such happy news for the NHS taking into consideration the current state and the complications it is experiencing with strikes and the already-struggle with cost and funding. BUT, weigh the cost of this scan with a biopsy, and the figure is pretty much the same so will it really make that much of a difference? I’ll let the board decide that, however I know that:

  • Catching aggressive cancers earlier not only can potentially save the patient but also deliver savings, as patients with very low-risk cancers will not be receiving unnecessary ‘heavy’ and distressing treatments.
  • This new leap in diagnosing prostate cancer should not & will not be limited to just diagnosing and treating prostate cancer. Prof Ros Eeles, from the institute of Cancer Research in London, said this “study and data was very important” and scientists are already working at linking and making connections to try adapt this new idea to other forms of cancer as well as other diseases, and develop more efficient diagnostics. Therefore, this may be very beneficial in the long-term.

So far, I have produced a few of my very own posts on this blog about some events that have happened this year, and I am truly surprised by the topics I have written about (this being a good surprise). It is because before beginning, I thought “yeah, I will just be writing about different diseases each week”. However, I am also writing about current affairs that broaden my own perspective and open my eyes to the world of medicine more and more throughout every post. In a way, I am not only giving you a message but also learning something about myself as well as learning a complete different dimension of medicine. I treat every bit of research into every post like a mini step towards med school, so although not directly, you are actually experiencing my journey to University-which is why I am writing this blog- It is increasing my passion for medicine and resilience every single day!

The Mesentery- Meet the organ you never knew was there!

Recently, The Lancet Journal released some ground-breaking news. J Calvin Coffey and his colleagues at the University of Limerick in Ireland have reported that from the images they produced, showing a complete new anatomical view of the mesentery, the mesentery should be considered the human body’s 79th organ.

Previously, the mesentery was thought to be made of fragmented, separate structures. However, from further research and detailed observations, it was found that the mesentery is actually a continuous set of tissues which is formed by the double fold of peritoneum (smooth tissue membrane forming the lining of the abdominal cavity/coelom) that attaches the intestines to the wall of the abdomen and the area of the backbone.  Its most obvious purpose is to keep our guts from slipping and sliding around, and collapsing into the pelvis, so that when you stand up the intestines are in a fixed conformation. But, the Irish researchers, J Calvin Coffey and D Peter O’Leary (University of Limerick), suggest that the new organ may also have other roles, including shuttling white blood cells around the intestines (due to evidence provided that the mesentery takes environmental signals from intestine and orchestrating immune responses) and carrying blood and lympathic fluid between the intestine and rest of the body.

Although it is accepted that the mesentery plays a vital role in the intestinal, vascular, endocrine, cardiovascular and immunological systems,  it’s absolute function is not entirely known yet. However, as Coffey stated, if you manage to establish the correct anatomy and structure, you can then establish and identify abnormalities leading you to disease and therefore the importance and function of the organ. That is why this new revelation is so significant, as the newly discovered organ “the mesentery” may be the hidden mystery to some of the very debilitating diseases like Crohn’s and colorectal cancer.

While it’s unclear if mesenteric research will interest or catch on with others in the medical community, the mesentery will most definitely be payed more attention, regardless. In the latest issue of one of the most paramount, revolutionary and famous medical textbooks, the 41st edition of Gray’s Anatomy, the mesentery’s description has already been updated to note that it is indeed one continuous structure, and any small additional detail included too.

The day that this news was revealed, I woke up and was truly astonished by what I was hearing, feeling amazed, inspired but also quite shocked and scared at the same time. I am guessing that this was because I had maybe installed an idea in my head before, where I thought that everything about the anatomy of the human body was known. Nevertheless, this event has made me somewhat more driven and passionate, because this situation shows that we in fact don’t know how much we know, and there is still so much we can find out about the human body. You never know, but with this new discovery taking place now, me or you, a potentially aspiring medic/scientist reading this, could be a part of a future discovery that might change the understanding/treatment of disease or even how medicine is practiced.

Mini Alzheimer’s Masterclass

Following on from the previous post on a recent study on Statins and their effect on Alzheimer’s, I thought why not talk to you a bit more about my passion for neurology and go right back to the beginning where we can explore the origins of this disease…alzheimer

Alzheimer’s disease is a chronic neurodegenerative disease, meaning it is an irreversible, progressive brain disorder that very slowly destroys memory and thinking skills, eventually leading to the loss of any ability to carry out simple every-day life tasks. Alzheimer’s disease is also known to be the main cause of dementia today.                                                                                                             Statistics show that in 2015 there was a shocking 48 million people worldwide with Alzheimer’s disease and this number will most definitely increase to millions more people over the years. Alzheimer’s disease develops over a long period of time and symptoms only start to show in most people over the age of 60. However, it has increasingly become the case that some people may experience symptoms in their early 50s.

In 1901, Alois Alzheimer met the 46 year old Auguste Deter, a patient in Frankfurt, Germany. Alois Alzheimer studied the behaviour and followed the progress of this patient for five years until she died. Auguste grew ever more confused, she was unable to identify objects and soon could not remember at all what they were even after just being explained what they were. In the final stages, she was incontinent, bedridden and unable to speak but still able to show emotional response. Due to this, the patient eventually died (aged just 55) as muscles begin to waste as a result of inactivity leading to infection. After her death, Alois Alzheimer performed histological studies on Auguste Deter’s brain tissue. In the process, he discovered two clear abnormalities: Large abnormal clumps had formed between neurons, and ropelike tangles had formed inside neurons. Calling these abnormalities “a peculiar disease of the cortex,” Alzheimer presented his findings at a 1906 psychiatric conference in Germany, marking the first documented case of what is now known as Alzheimer’s diseasealois_auguste

“She was unable to write her name, saying she had lost herself completely.” 

Despite it being a considerably long time since Alois Alzheimer first diagnosed a patient with Alzheimer’s disease and carried out his own research, and despite so many advances in neurology ever since, scientists and physicians do not known exactly what the cause of this disease is. However, many reasonable and very likely causes have developed over the years. For instance, it is believed that this disease has a strong genetic component, like a genetic mutation, as there is no clear evidence of any infection that may have caused the disease.

Environmental and lifestyle factors could also very much be a contributing factor (nutritious diet, physical activity, mentally stimulating pursuits etc), although the precise onset of this condition will vary from person to person.                                                                Some hypotheses that have developed over one hundred years:

  • Cholinergic Hypothesis- This is probably the oldest theory on the possible cause of Alzheimer’s disease and is the basis for most of the current drug therapies. This hypothesis proposes that Alzheimer’s is caused by reduced synthesis of the neurotransmitter acetylcholine (acetylcholine is an organic chemical that functions as a neurotransmitter). Not many medications intended to treat this acetylcholine deficiency have proven very effective, so the idea has been developed and changed slightly and one of the ideas is that initiation of large-scale aggregation of amyloid leads to general neuroinflammation.
  • Amyloid Hypothesis- This theory, developed in 1991, proposed that extracellular amyloid beta deposits are the fundamental causes of the disease. Substances called apolipoproteins enhance the breakdown of this beta amyloid, however, a specific isoform of apolipoprotein is not very effective at this task and therefore leads to excess amyloid build-up in the brain. This in fact was developed further and altered slightly, again, and researchers have been lead to suspect that non-plaque amyloid beta oligomers bind to receptors on neurons and change the structure of the synapse, thereby disrupting neuronal function- possibly leading to Alzheimer’s disease. NOW, it is believed that a close relative of the beta-amyloid protein is the culprit and causes neuronal withering and depressing synaptic function, potentially leading to a risk of developing Alzheimer’s. Amyloid accumulations can also themselves trigger the formation of neurofibrillary tangles…
  • Tau Hypothesis= Tau protein abnormalities initiate the disease cascade. When tau pair with other threads of tau, tangles called neurofibrillary tangles inside nerve cell bodies form. The microtubules disintegrate and the destruction of the cell’s cytoskeleton, collapses the neurones transport system. Overall result of this is a malfunction in biochemical communication between neutrons leading to cell death.

Most people with Down syndrome develop Alzheimer’s. It is thought that this occurs because people with Down syndrome  have an extra copy of chromosome 21, which contains the gene that generates harmful amyloid.brain_slices

Nonetheless, scientists are carefully and tirelessly studying every little nanometre of the human brain to learn about the various plaques, tangles and biological features of Alzheimer’s in order to lead to an explanation and possible treatment.                                                                                                                     Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. In addition to this, scientists are also exploring the very earliest steps in the disease process by observing changes in the brain and body fluids that can be detected years before Alzheimer’s symptoms actually appear.

Diagnosis:                                                                                                                                                                     To determine whether a patient has Alzheimer’s disease, a doctor will use several techniques and methods. The Doctor may do the following-

  • Gather the patient’s medical history, by asking the person and/or family members about overall health, any past medical health problems, and recent changes in behaviour or personality.
  • Memory tests, problem solving activities, attention, counting and language tasks may also be conducted to assess cognitive activity.
  • Standard medical tests such as blood tests and urine tests to identify other possible  underlying causes of the problem.
  • Perform, CT (computed tomography) brain scans, Magnetic resonance imaging (MRI) or portion emission tomography (PET), to rule out or identify other possible causes for the symptoms.

Although, for the most definite diagnosis, scientists use postmortem analysis of brain tissue.

Signs and Symptoms:

Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s disease. Some people with memory problems have a condition called mild cognitive impairment (MCI). In MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do. Some may even go back to normal cognition.

The first symptoms of Alzheimer’s vary from person to person. For many, decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may signal the very early stages of Alzheimer’s disease. Researchers are studying biomarkers (biological signs of disease found in brain images, cerebrospinal fluid, and blood) to see if they can detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimer’s. Studies indicate that such early detection may be possible, but more research is needed before these techniques can be relied upon to diagnose Alzheimer’s disease in everyday medical practice.

Treatment of Alzheimer’s disease is a whole different story. Without possessing a solid explanation in relation to the cause of Alzheimer’s, little can be done to come up with effective treatments for this condition. Scientific research and clinical trials are carried out day and night to find drug therapies and develop an immunisation therapy to overcome this problem. There are some methods that have been developed to help those affected by this condition to live and manage, to some degree, their lifestyle, and control their behavioural symptoms, but to limited extent.

Alzheimer’s disease has been discussed quite a fair bit in the news lately and certainly a lot of attention has been focused on this topic for the last couple of years, as a result of the difficulties and struggles it is posing and the rising amount of people diagnosed with Alzheimer’s.

In my opinion, Alzheimer’s is becoming somewhat similar to cancer. By similar I mean that it is so common in this time that it’s impossible to not pass a stranger in the street and for that stranger not to have any connection, whether direct or through a family member, with Alzheimer’s. It is a fact and people still attempt to deny it and live on. My point is, if no-one does nothing now then no-one never will. So by spreading awareness and by mentioning just a short sharp fact you can be a person that DOES do something and if you do, everyone will simply follow.

Alzheimer’s Disease- Do statins really work?

Neurology. Everything about neurology- the complexity, the unknown, the importance for life and beauty- is striking and, as well as others, it is an area of medicine that truly makes me ponder and question the different diseases, conditions, treatments and theories.  Therefore, when I stumbled across an article about Alzheimer’s and the effect of statins on the development of the condition, I thought that this was a perfect study/finding to share with you and an opportunity to convey to you what I mean by neurology being ‘striking’.

statins

Statins (lovastatin, pravastatin, simvastatin, and others) are powerful cholesterol lowering agents of proven benefit in cardiovascular disease, and are often prescribed to lower levels of low density lipoprotein (“bad” cholesterol). Published in JAMA neurology, studies have shown that high cholesterol levels may be associated with the build up of beta-amyloid plaques in the brain, which are considered a hallmark of Alzheimer’s disease. Therefore statins may have the potential to lower the risk of Alzheimer’s disease, and a strong relationship between high statin use and lower risk of Alzheimer’s disease was identified.

400,000 patients were observed and reviewed, and it was established that those who took the tablets had reduced the chance of developing Alzheimer’s by 12% to 15%. In addition to this, a surprising observation was made during the investigation as scientists found that the link between high statin use an lower Alzheimer’s risk was dependent on ethnicity, gender and type of statin used. For instance, the research teams examined the potential roles of different types of statin and found that:                                                                                      1. Pravastatin and rosuvastatin were particularly associated with a reduced risk of Alzheimer’s in white women.                                                                                                                                2. High atorvastin exposure was linked to reduced alzheimer’s risk for white and black women, as well as Hispanic men and women                                                                                                3. White, Hispanic, and black women had Alzheimer’s risk with high use of simvastatin, as did white and Hispanic men.                                                                                                                                 4. As for black men, the research team identified no significant reduction in Alzheimer’s risk with the use of any statin.

This study has produced some mixed findings and is purely observational, so the data will have to be checked and investigated further in clinical trials, as this observation alone does not provide concrete evidence that statins definitely do lower your chance of developing this neurodegenerative disease. For example, after drug giant Eli Lilly announced that their promising drug candidate solanezuman had failed to reduce cognitive decline in a phase III trial of patients with the disease, proving clinical trials are essential when proving/establishing the effectiveness of a certain drug. However, despite this revelation not being exactly “solid”, researchers believe their findings indicate that certain statins could be a feasible strategy to combat Alzheimer’s disease:

“Our study identified the associations between Alzheimer’s incidence and statin use by statin type, gender and ethnicity. This suggests that certain patients, facing multiple, otherwise equal statin alternatives for hyperlipidemia treatment, may reduce Alzheimer’s risk by using a particular statin.                                                                                                                                                          The right statin type for the right person at the right time may provide a relatively inexpensive means to lessen the burden of Alzheimer’s disease”

In my opinion, no matter how big or small a development or finding it should be talked about and discussed, because how can medical professionals move forward and make discoveries if they do not consider and act upon the whole picture? In relation to this, I believe statins are a great drug to begin with in this race for a prevention/treatment/cure.

Finally, going back, this topic explains my first point very well. The amount that is unknown about the brain, such as Alzheimer’s, as well as the complexity of it is what makes neurology and medicine as a whole so beautiful. It makes it beautiful because it shows that we, scientists, doctors- HUMANS are still capable of achieving and discovering far more in this field than we already have, as so much is yet unknown. It shows that your passion of medicine can take you and the world beyond the stars. With your passion, you can take over the Universe.

 

Astonishing Ebola Vaccine gives 100% Protection.

In March 2014, countries in West Africa experienced not only the largest but the most devastating ebola outbreak in history. The World Health Organisation, American Government Agencies and other partners around the world deployed mass numbers of public health experts from across the globe to battle the virus that was killing thousands. The devastating legacy ebola left in countries across west Africa fuelled scientists and doctors to develop a drug or treatment or even a cure, if possible, to stop this disease from devastating thousands more lives.

The Vaccine                                                                                                                                                      

Just over a year after the outbreak of Ebola in Guinea, Liberia and Sierra Leone, there was new hope and a promising vaccine was developed.

The strategy used to vaccinate and administer the weakened virus was similar to that used to eradicate smallpox. The aim of the strategy proposed was to administer the vaccine to so called “clusters” (groups of people who had been in contact with others with reported cases of Ebola). This would result in an almost “protective ring” stopping the virus from spreading further, for instance, from one family member to another.

In 2015 the experimental vaccine was given to people in Guinea who had recently been in contact with patients who had confirmed cases of Ebola. The outcome was astonishing and only a few months after the trials, the World Health Organisation announced that the preliminary results were already an “extremely promising development”.  More than 11,000 people were involved in the trial and this small step towards a treatment/cure was in fact a huge leap.

Patients were either vaccinated immediately (immediate vaccination) or after three weeks (delayed vaccination). The three-week groups served as the control in the cluster, as they didn’t actually get the vaccine until it was clear that they were not infected. After immunisation, researchers and scientists then followed up on the volunteers on days 3, 14, 21, 42, 63 and 84, and collected data on their stability. When analysing the results, people who got sick within 10 days were not counted as it was believed that they were already infected before the administration of the vaccine. 

In total, 5,837 of the volunteers were given the actual rVSV-ZEBOV vaccine, and the study showed that none of these volunteers/clusters had a recorded case of Ebola after 10 days or longer. In the clusters, vaccination protected both those who were vaccinated and those who were not at all. However, of some of those who were not given the rVSV-ZEBOV vaccine, 23 cases of Ebola were recorded (11 clusters). Of course after vaccination, some patients had reported headaches, fatigue, muscle pain and some minor allergic reactions, however this was expected as with any vaccination. It was concluded that vaccine efficacy was 100%.

As with multiple other viruses, there are multiple strains of the Ebola virus and this vaccine covers what is known as the Zaire group. This means that this vaccine provides protection for all the similar strains in the group and not the virus as a whole. Although there are numerous other strains of the Ebola virus, this particular advancement shows that it is possible to identify the remaining variations, like the lethal Marburg virus.

The Ebola vaccine was developed in Canada and manufactured further in the U.S, however, without the help, technology and knowledge of other organisations and countries around the World, this advancement would  not have been at all possible. Teamwork and the immense success we have already had, proves that we will not be defenceless if future outbreaks occur. This has truly been a David Vs Goliath battle, but despite such immense advancements already, scientists are determined to continue and will not stop until every soul on this planet is 100% protected.

 

 

Welcome!

My name is Julia Lenkiewicz, I am 16 years old and currently studying Biology, Chemistry and Maths at A-Level, where I am also completing the AQA Extended Project Qualification (which is worth an AS) at sixth form. As well as an aspiring medic, I am a true sports fanatic competing at County, Regional and National level in Swimming.

On the 17th and 18th December this year, I attended the Medlink Residential/Conference at Nottingham University which was designed to give aspiring medics/sixth formers a taster of what life as a medic truly is. As well as this, we were provided with tips and secrets on how to ace you personal statement, MMI & interview and the essential chemistry a-level. Before I attended this two-day residential, I did not know what to expect and at one point I was scared that this experience would put me off pursuing a career in medicine. However, this conference managed to do the polar opposite and I left Nottingham University inspired, motivated, excited and most importantly ever-more passionate and in love with medicine. It felt like something dormant and trapped inside me was finally set free and fireworks full of ideas filled my mind, which brings me here to this blog.

Through this blog I aim to share with you my journey towards Medical School, information about the research and extra projects I am undertaking, thoughts and feelings and current affairs/news surrounding the dazzling world of Medicine. Also, be sure to look out for extra and exclusive practical activities (which will be posted on this blog) and experience first hand what a doctor really does! Such as using a stethoscope!

I cannot explain to all of you reading how excited I feel about beginning this blog and the medical journey I am about to undertake.

For now, stay safe, stay healthy and Happy New Year!

Julia Lenkiewicz