Health Calendar: 24-30 January

Cervical Cancer Prevention Week

Cervical cancer is a type of cancer that develops in the cervix (the entrance to the womb from the vagina) of a woman. It is the most common cancer in women under 35 in the UK. Around 3,000 women are diagnosed with cervical cancer in the UK each year, that's around 8 women every day. However, the disease is largely preventable, thanks to cervical screening and the HPV vaccination programme. 

What causes cervical cancer?
The Human Papilloma Virus (HPV) is responsible for almost all cases of cervical cancer. The virus can be passed on through any type of sexual contact with a man or woman. There are more than 100 different types of HPV, most of which are harmless. At least 15 types of HPV, including types 16 and 18 are considered high-risk for cervical cancer. These types of HPV contain genetic material that can be passed into the cells of the cervix. This material causes a mutation in cell DNA, disrupting normal cell activity. These abnormal cells reproduce rapidly, leading to the growth of a cancerous tumor.

HPV infection is relatively common. Most sexually active women will come into contact with at least one type of HPV during their lifetime. However, not all women infected with HPV will develop cervical cancer. For most the virus causes no harm and is suppressed by the body's immune system.

Most types of HPV don't cause any symptoms so many men and women won't realise they have the infection.

What are the symptoms of cervical cancer?
There are usually no obvious symptoms with early stages of cervical cancer. This is why regular cervical screening is very important in detecting abnormalities of the cervix.

Vaginal bleeding is usually the first noticeable symptom of cervical cancer. If you experience bleeding at any time other than your expected monthly period, visit your GP for advice.

If the cancer spreads out of the cervix and into surrounding tissue and organs, you may experience further symptoms such as:
  • blood in your urine
  • urinary incontinence (unintentional passing of urine)
  • uncomfortable or irregular urination
  • swelling of one of your legs
  • pain in your side or back 

Preventing cervical cancer
  • Since 2008, the HPV vaccine has been offered to girls aged 12 to 13 as part of the NHS childhood vaccination programme
  • Protected sex (e.g. using a condom) can significantly reduce your risk of HPV infection
  • Regular cervical screening can help identify abnormal changes in the cells of the cervix at an early stage. The NHS offers a cervical screening programme to all women aged 25 or above. 
  • Removing or destroying abnormal cervical cells at an early stage can prevent cervical cancer
  • Avoid smoking - Smoking weakens the immune system, leaving you at greater risk of HPV infection

How is cervical cancer treated?
Treatment for cervical cancer usually depends on how far the cancer has spread.

Treatments for early cervical cancer include:
  • surgery to remove some or all of the womb
  • radiotherapy to destroy cancerous cells

Treatments for advanced cervical cancer include:
  • radiotherapy
  • chemotherapy
  • radical surgery (removing the womb and vagina as well as any part of the bladder, bowel or rectum the cancer has spread into) 

Medical Myths and Misconceptions: Week 4

This week's myth: We only use ten percent of our brain

There is no scientific evidence to suggest that we only use ten percent of our brain. However, this urban legend is often talked about, and popular culture has taken it as scientific fact. Media has often cited it, with the most recent being in the 2014 film Lucy. In this blog post we will be looking at why it is not true!

Where does the myth come from? Why does it continue?
It has been misattributed to many people, including Albert Einstein. William James in 1908 also said: 'We are making use of only a small part of our possible mental and physical resources'. After this, self-improvement 'experts' in the early 1900s may have used it to convince people that they had not yet reached their full potential. It has been suggested that a person may harness this unused potential and increase their intelligence.

Why is it not true?
We now know that we use almost every part of our brain, and that (most of) the brain is active all the time.  Evidence for this includes:
  • Brain damage: If the myth was true, damage to 90% of the brain would not impair performance, but it does.
  • Brain imaging/scanning (neuroimaging), e.g. magnetoencephalography (MEG): These have shown that all areas of the brain are active (some more than others though), apart from in brain damaged individuals. Metabolic studies of how brain cells process chemicals show no nonfunctioning areas.
  • Evolution: It is unlikely that large brains would have developed if it was not an advantage.
  • Conditions such as Parkinson's disease or stroke that damage relatively small areas of the brain may cause devastating disabilities.
How much of it do we use then?
The next time that you hear someone say that you only use ten percent of your brain, set them straight! We use 100 percent of our brain.

  • Magnetoencephalography: A neruroimaging device that measures magnetic fields produced by the brain's magnetic field.

Medical Myths and Misconceptions: Week 3

This week's myth: Shaved hair grows back faster, coarser and darker

It is often stated that shaving your unwanted hair will cause it to grow back at a faster rate, more thickly and even darker, however; this is simply not true! You can think of it this way, if shaving causes hair to grow back thicker, balding men would have been shaving their heads a long time ago...

Where does the myth come from? Why is it not true?
There are several reasons why this myth once, and continues to, flourish. It may just be that we are not very good observers! Human perception is limited so we often believe things that have no scientific basis. The myth may also have come about purely as an act of coincidence. For example, if a boy was to shave his moustache, it may come back thicker and darker. However, this is because the shaving may overlap with the timing of natural hormone fluctuations in his body that are developing his adult facial hair, not because of his hair removal. This myth is unlikely to be true for many reasons. One of them being that shaving removes the dead portion of the hair, not the living portion lying below the skin's surface, so it is unlikely to affect the rate or type of growth.

Fact: In 1928, a study involving four men compared hair growth in shaved patches to hair growth in unshaved patches. The hair that grew back was no darker or thicker, and did not grow faster. Further studies have confirmed this. In a more recent study (1970), five men agreed to explore how repeated shaving impacted on hair growth. Each volunteer shaved one leg weekly, whilst probably deciding to wear trousers during the study period! The study found no significant differences in the coarseness of the hair or its rate of growth.

Why does it appear this way then?
Shaving facial or body hair gives the hair a blunt tip (a human hair is like a pencil that is tapered at the end). The tip might feel coarse (or 'stubbly') for a period of time as the hair grows. This may also cause the hair to appear more noticeable, perhaps even thicker or darker - but it's not! Moreover, hair might appear darker because it has not been lightened by exposure to chemicals, pollutants and the sun.

So let's try to put this medical myth and misconception at rest - however; like our hair, it's likely to reemerge!

If you notice a sudden increase in facial or body hair, talk to your doctor. This could be a side effect of medication or a sign of an underlying medical condition.

St Giles Hospice

Recently, I started volunteering as a ward helper at St Giles Hospice. I am sure that it will be an extremely rewarding experience, and one that will confirm to me that I want to be a doctor. Below is a short summary of St Giles Hospice: who it cares for, its history, and how we can support its fantastic work.

St Giles Hospice is a registered charity providing specialist care in a variety of settings for local people suffering from cancer and other serious illnesses, as well as providing support for their families and helpers.The dedicated team offers individually tailored care either at the hospice or in patients' own homes across the region. St Giles Hospice has centres in Sutton Coldfield, Walsall and Whittington (between Lichfield and Tamworth).

St Giles Hospice began at the former vicarage of St Giles Church in Whittington in 1983. The vicar, Reverend Canon Paul Brothwell, became concerned at the care given to terminally-ill patients in local hospitals. Today, St Giles is a centre of excellence and one of the best known and most respected charities in the region, with over 400 staff, over 1,500 volunteers, 31 charity shops, one of the most successful hospice lotteries in the UK, and over £9 million spent on providing car every year.

The care is free of charge, irrespective of personal circumstances. Although St Giles Hospice receives some funding from the government, the charity relies heavily on donations and fundraising. You can support their work by donating here.

I hope that my year at St Giles Hospice will be challenging, heartwarming and unique.

Medical Myths and Misconceptions: Week 2

This week's myth: The blood in our veins is blue

Venous blood (the blood in our veins) is deoxygenated blood. There exists a common myth and misconception that deoxygenated blood is blue, and that blood only becomes red when it comes into contact with oxygen. However, this is not true! In this blog post, I will be looking at where the myth comes from and why it simply is not true.

Where does the myth come from?
The myth: 'The blood in our veins is blue,' could have arisen for a few different reasons, the simplest being that are our veins below the skin do in fact appear blue. Another reason could be the fact that many diagrams use colour when showing the difference between veins (usually shown in blue) and arteries (usually shown in red).

Why is it not true?
The blood in our veins appears blue due to a variety of reasons only weakly dependent on its color. The blood inside our veins is dark red and exhibits poor light reflection. This, along with the fact that light is diffused by the skin, causes us to perceive the blood in our veins as blue.

What color is it then?
The blood in our veins is actually dark red in colour. Oxygenated blood (the blood in our arteries) is bright red. Deoxygenated blood is darker due to the difference in colour of deoxyhemoglobin and oxyhemoglobin.

  • Vein: Any of the tubes forming part of the blood circulation system body which mainly carry deoxygenated blood towards the heart.
  • Artery: Any of the muscular-walled tubes forming part of the blood circulation system body which mainly carry oxygenated blood from the heart to all parts of the body.
  • Haemoglobin: A red protein responsible for transporting oxygen in the blood of vertebrates. Oxyhaemoglobin is formed when haemoglobin binds with oxygen. Deoxyhaemoglobin is the form of haemoglobin without oxygen.

Work Experience 101: What I have learned from two years volunteering in a residential home

This is an account of my experiences volunteering every Sunday for two hours (10am till 12pm) from February 2013 to March 2015 at my local residential home, *all surnames have been changed.
I will always remember my first day as a volunteer at my local care home; standing mentally trembling as a timid fourteen year old in the foyer. I had no experience of speaking to anyone older than the age of 60, other than my own grandparents and even that was a challenging task for me. This barrier was soon broken when a sweet petite old lady called ‘Nancy’ approached me, telling me how lovely I was and proceeded to kiss my hand. I think that my initial problem was finding something to talk to the residents, but I quickly overcame this and I ended up gaining an extensive knowledge on local history, childhood, school and parenting in the early 20th century, the music greats of past era’s and memories of World War II. Some of my best times during the years that I was there were around Halloween, Christmas and Easter when the whole home was decorated; I loved to entertain the residents by singing and dancing around the dinner tables- I also played to them a few times on the piano. I began to learn that the only true things that separated us were the dates that we were born and unfortunately, their illnesses.

There were occasions in which I had to comfort patients in times of sadness. I would sometimes watch them break down in front of me over the deaths of family or friends. They would also sometimes feel worthless or depressed and express their wishes to die. Staying professional, I took on a more personal caring role. I became the listener whilst care staff were busy with their duties. I would try my very best to lighten their mood, reminding them of all the things to be happy about, reminding them that their loved one would not wish to see them unhappy and by making them laugh. I dealt with them as I would comfort, or want to be comforted, by my own friends.

In the home, tensions sometimes were high between residents. Some were due to their medical conditions, or the drugs that they were taking, and some were not. For example, I once witnessed one resident bullying another. My first instinct was to alert the carer. I then helped to politely ask them to move apart from each other whilst the carer told ‘the bully’ that this behaviour was not acceptable. Another example, in which dementia played a part, was a woman who refused to eat her cornflakes despite asking for them. The woman was very aggressive towards the carer, shouting and swearing. As another carer was present, I chose to not be involved but I watched how the carer, knowing her condition, continued to act professionally and make the woman a different bowl of cereal. The woman soon relaxed and I can imagine that an incident report was filed. In the future, I know that I would deal with any similar situations in the same manner. It also alerted me further to the difficulties faced when caring for patients with dementia.

Volunteering at the home created my first experiences of dealing with people with forms of dementia and observing people living with long term health conditions. I learnt that patience is a virtue when Mrs Hilda Smith* is telling you how her mother always used to tell her “treat people as you want to be treated”; despite this being a very  useful phrase, it begins to loose meaning after the 10th time she has told you that story that day. I also learnt to never be alarmed as no action is too peculiar when dealing with dementia patients. One of the residents called 'Ken' repeated to use other residents cabinets as a toilet, despite having no recollection of it and never stopping even when the carers had told him several times. Through times of observing memory loss, mood swings and hallucinations- I began to realise the harsh realities of dementia and the effects on not just the individuals, but the family members and the carers. It was then when I began to take an interest in the disease, signing up for the Alzheimer’s Awareness magazine and raising money for the cause.

Dementia was not the only long term condition I witnessed whilst at the home. I also spent a long time with a resident called ‘Kath’ who had chosen to live apart from the other residents- she had recovered from bowel cancer, however; she was still living with some of the effects. She suffered from extreme pain almost every day, she struggled to go to the toilet and it was terribly painful for her to walk. I like to believe that I helped her a lot by visiting her room every week, making her bed, listening to her experiences, making her drinks and making sure that she got her dinner on time.

Whilst at the home, I also had to become more mature in order to deal with the deaths of the residents (something I had not previously experienced). The time that I was told that a resident had died, it upset me a lot. I can still remember shedding tears for them at home, but whilst volunteering I learnt to act professionally by not crying and being respectful and comforting to the residents affected by the death. Because I spent such a long time there, I began to get used to getting to know a resident and then seeing them deteriorate over a long period of time until one week I would arrive to be told that they are no longer with us. Despite these sad times, I feel these sad experiences have helped prepare me for life as a future medical student.

Throughout my volunteering I learnt a lot about what it would be like to work as a Health Care assistant (HCA). They have the responsibility of watching over a ‘unit’ of 6-8 residents, sometimes when no carers are present. Whilst I was there I was often left to fill in a small amount of paperwork,  such as the dinner menu, which involves recording what each resident would like to eat. I had to be aware of various dietary needs, for example; diabetes and food allergies. This was nowhere near the amount of paperwork that the HCA’s had to fill in, detailing every patient’s state every half an hour and I now appreciate the paperwork load that health care professionals face every day. Some of my other duties included feeding some of the patients and assisting them when moving around the room, both of which required an incredible amount of patience and self-awareness, but I enjoyed the feeling of responsibility.

Dignity. The word plastered across posters around the home stating: ‘How have you maintained my dignity?’ This may be a simple question for some, but for me this was the first time when I began to realise the true meaning of the word and from there, I began to put a real emphasis on maintaining it. If a woman’s underwear was on show whilst she was being hoisted, I made sure that it was pulled down. I made sure that residents had the opportunity to wear clothes protectors whilst eating. Making sure, when I was mistakenly left with a resident on the toilet (I was asked to do so by a carer), that I kept the door closed and checked on their progress only discreetly with the door only slightly ajar. Checking dignity became one of my most important rituals for residents left in my care.

All the experiences that I gained, good and bad, developed my skills as not only a person, but it furthered my certainty that I want to be a doctor. I carry the skills that I have learnt with me and I have applied them to further placements...but that’s another story!

The Science of getting drunk

Alcohol is classified as a suppressant drug however that does not fully explains its effects. People think that alcohol helps them cope with difficult situations and emotions, and that it reduces stress or relieves anxiety. But what does it really do to our body?

As alcohols enter  your body and makes their way to your brain, they starts to interact with brain cells and affect the neurotransmitters (brain chemicals that communicate information throughout the brain and body). There are two types of neurotransmitter- either excitatory (increase brain electrical activity), or inhibitory, (decrease brain electrical activity.)

1.       Alcohols can enhance the effects of the inhibitory neurotransmitter GABA in your brain which means your brain cell activities are slowed down and become less excited. And that’s what causes slow reaction, slurred speech and poor coordination and judgement. You will think very little but with great clarity.

2.       The feeling of pleasure when you are taking a drink is created by the increasing amount of the chemical dopamine in the brain's reward centre.

3.       Alcohols can also affect the brain’s memory storage area which known as hippocampus. People tend to forget what they did when they were drinking because in fact the memory at this point was never formed properly.

Hippocampus also controls your emotions. As a result you will find that you feel exaggerated emotions for example really happy:D or very depressed :(.

4.       It causes dehydration in your body as your kidney tries to eliminate them via urination. And this is why you need the toilet more.

5.       At intoxicating levels, alcohol causes blood vessels to relax and widen. At even higher levels, it can shrink the vessels and increase blood pressure, causes condition like migraine headaches.

6.      Your body will shut down when it gets overloaded with too much alcohol to metabolise, so your body is constantly digesting, but not getting any energy from the digestion of the alcohol. This results in passing out.

How is alcohol metabolised?

Once alcohol is in your system, your body makes metabolising it a priority because unlike carbohydrate and fat, there is nowhere for alcohol to be stored. Alcohol does not need to be digested like food therefore it can pass quickly and easily into the bloodstream. In general, 20% of the alcohol is absorbed in the stomach and the rest 80% is absorbed in the small intestine. You are more likely to get drunk with an empty stomach as there is nothing between the stomach wall and the alcohol- this increases the rate of alcohol absorption in your body. After the absorption, it dissolves in water and blood which then being carried throughout the rest of your body via blood circulation.

Factors that affects your alcohol tolerance
Gender- Muscle tissue contains more water than fat tissue. As alcohol get diluted in water, a female will reach a higher blood alcohol concentration than a male of the same weight after same amount of alcohol being ingested.

Genetic- Most individuals use a form of acetaldehyde dehydrogenase called ALD2 to metabolize the acetaldehyde which results from alcohol metabolism.
However some individual would produce another form of acetaldehyde dehydrogenase due to their genetic code. This is far less efficient at breaking down acetaldehyde than ALD2. The accumulation of acetaldehyde causes rosy cheeks, rapid heartbeat, headaches and vomiting.

Drinking history- Tolerance takes time to build. As a person’s drinking increases, the liver’s capacity of metabolising alcohol would also increase which means this person would be able to handle more drinks than you do.

Cell transplantation: The Cure to Everything?

After a horrific attack where he was stabbed repeatedly in the back with a knife in 2010, Darek Fidyka was paralysed from the chest downwards. However, after a two year struggle he has since regained the ability to walk with a frame due to a brand new treatment involving cell transplantation.

The most widely used forms of cell transplantation are the use of bone marrow and blood to treat conditions such as leukaemia. Cell transplantations are also used in the treatment of many cancers after intense chemotherapy. However, in the last decade many more uses of stem cells have arisen, and Mr Fidyka is now the first man to undergo a cell transplant for his spine.

There are two different types of transplant - allogenic and autologous. An allogenic cell transplant is where the stem cells used for a transplant come from a donor, usually taken from the blood or bone marrow. The major setback of this is that a close match needs to be found in order for the transplant to effectively work. The patient undergoing the transplant would also have to take immunosuppressant drugs to prevent the immune system from destroying the cells. Allogenic transplants are where the stem cells used are taken from the patient themselves. These can be taken from anywhere in the body that produce the cells required for the transplant, provided that the body is healthy. This was the case with Mr Fidyka.

The cells used in the transplant, called olfactory ensheathing cells (OECs), form part of the sense of smell. These are essential in the olfactory system as they enable nerve fibres to renew themselves. The OECs used in the transplant were taken directly from the nasal cavity and injected into the damaged spinal chord. This enabled the fibres above and below the injured sites to reconnect and eventually reform the spine.

Mr Fidyka's road to recovery has been a long and rigorous one, having undergone 25 hours of physiotherapy a week for two years. However, after the success of this treatment a further ten patients with similar spinal injuries are due to be treated in the next decade. Meanwhile the potential of cell transplantation continues to increase.

Research is currently being conducted into the use of cell transplantation to help strengthen the immune system of those suffering from HIV and AIDS. Corneal cells have successfully been transplanted into damaged eyes to cure blindness, and cochlea hair cells have been grown from embryonic stem cells as part of research to cure deafness. 

While the possibilities appear to be endless, many of these are merely hypotheses and have yet to be trialed. This is partially to do with the controversy surrounding the use of embryonic stem cells, as these would play a crucial role in the development of many of these potential cures. However, the success of Mr Fidyka's cell transplantation may lead to further research into the use of healthy specialised cells instead of stem cells, and these potential cures may eventually become reality.

For more information about Darek Fidyka's story, here is the link to the BBC News article.

Could intestinal bacteria help catch criminals?

Earlier this year I was given the opportunity to observe at an embalmers. Whilst there I was surprised to find that many of the bodies had green abdomens and chests. This is as a result of the 'friendly' bacteria in our intestines.

There are more than 100 trillion bacterial cells within our intestines. They have a constant supply of food, but also aid in the breakdown of food as it passes through our digestive systems, and help to keep pathogens at bay by outcompeting them.

When we die, however, the muscles within the intestines relax and the bacteria is released. It colonises tissues, starting with the large and small intestines, and feed off of carbohydrates, amino acids and lipids secreted from dying cells. This can take anywhere between 24 hours and a week, but eventually gives the cadavers their gorey green colour.

The structure of a bacterial cell
However, a recent article in New Scientist divulged the results of an investigation into intestinal bacteria, or thanatomicrobiome, and how they behave after death. It was discovered that, since there is a lot of variation in thanatomicrobiome between individuals, this could be used in forensic sciences as a new form of identification.

Intestinal bacteria can be analysed and matched to bacteria found on the clothing of missing persons, for example. Furthermore, analysis could prove vital for murder trials; if bacteria surrounding a victim does not match their thanatomicrobiome it could be indicative that the body was moved.

While the investigation into thanatomicrobiome is ongoing, it has already made new breakthroughs. 'The microbiome of a cadaver is an unknown data set in biology' according to scientist Sibyl Bucheli and, even if no medical or forensic uses are proven, the investigation will allow for thousands of new species of bacteria to be catalogued and studied. I think that this is going to become an important new forensic technique and could yield many more new scientific discoveries in the future.

The Brain: Neurons and Glial Cells

The Brain is composed primarily of two different types of cell: The Neuron, which acts as a cable through which electrical impulses travel through the brain and the entire body, and Glial Cells, which perform many functions to support the neurons. 
Above is a diagram of a basic neuron and it's components. A neuron has many basic cell components such as mitochondria, endoplasmic reticulum and others that you may know about if you study AS Biology. Besides from these, neurons also have many unique organelles which I will now describe:

Dendrites - dendrites carry nerve impulses to the cell body.

Axon - an axon is the long fibre that makes up most of the length of a neuron. Electrical impulses travel away from the cell body and down the Axon to the terminal endings.

Myelin Sheath - this is, in essence, an extremely extended plasma membrane that is wrapped around the Axon. The Myelin Sheath electrically insulates the axon.

Nodes of Ranvier - The nodes of ranvier are gaps in the myelin sheath. Gaps are usually between two and three micrometers and occur ever one to three millimeters.

Terminal Endings - Terminal Endings (or Axon terminals) are where the electrical impulse leaves a neuron in a chemical form, which travels across a synapse and then to another neuron.

There are three main types of neuron:
- Sensory, transmits nerve signals from a receptor to a motor neurone.
- Motor, transmits signals from a sensory neurone to an effector such as a muscle.
-Immediate, transmit impulses between neurones.

Glial Cells
For a long time, glial cells were believed to be of not much use, but it is now believed that they perform quite a few important functions. The glial cells generally work to keep the brain in a good shape, which they do in a number of ways:
- Removing dead neurons
- Removing dead pathogens
- Supply neurons with vitals such as nutrients and oxygen
-Supporting the structure of the brains by keeping neurons in the correct place.