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Health and Disease

Cushing’s Syndrome: Causes, Symptoms, and Treatment

What is Cushing’s Syndrome?

Cushing’s syndrome is a rare disease caused by the body having excess of the hormone, cortisol. Cortisol is the hormone that causes a stress response, increasing glucose concentration in the blood and allowing the brain to increase respiration to repair tissue and, similarly the adrenaline, temporarily stops non-essential bodily functions such as digestion. Cushing’s syndrome is the umbrella term for the effects caused by abnormally high cortisol levels, which can become more serious if left untreated over a long period of time. 

What causes Cushing’s Syndrome?

Due to the rare nature of the syndrome, the main cause of Cushing’s Syndrome is through taking steroids, in medication such as hydrocortisone skin cream, over too long a period of time, increasing cortisol in the bloodstream. In a select few cases, Cushing’s Syndrome can be caused by a tumour causing the excess secretion of cortisol. There are two different areas that a tumour could be that may cause increased cortisol secretion: the pituitary gland in the brain or a tumour in the adrenal glands, above the kidneys. The pituitary gland is vital as it controls the release of hormones from other glands, such as the thyroid gland and adrenal glands. Pituitary related tumours can cause effects ranging from low energy, feeling depressed, delay or advanced reproductive development and delayed or enhanced growth. The adrenal glands are where the hormones cortisol and aldosterone are produced and stress hormones such adrenaline. 

What are the risk factors of Cushing’s Syndrome?

Cushing’s Syndrome is more common in adolescent to young women than men and it can be induced through taking steroid medications over a long period of time or at too high a dosage. Those who already have pre-existing pituitary or adrenal tumours, or have a family history of benign or malignant tumours in these regions, are also more at risk of developing the syndrome.

What are the main symptoms of Cushing’s Syndrome?

According to the NHS website, symptoms of Cushing’s Syndrome can manifest suddenly or gradually over a longer period of time and intensify the longer that they are left untreated. A key initial symptom tends to be weight gain and a higher percentage of body fat. This weight accumulation may be more prominent on the chest and stomach, while the limbs do not noticeably change size. A defining feature of Cushing’s Syndrome is a “buffalo hump” on the back of the neck, which is a protruding deposit of fat and a “moon” face, which is a puffy or rounded appearance, is also a characterising feature. 

Other less noticeable symptoms may also be presented, such as skin sensitive to bruising, prominent stretch marks, weakness in the arms and thighs, low libido, difficulty conceiving and  frequent change in mood. Cushing’s Syndrome can also lead to other comorbidities such as high blood pressure, which needs treatment to prevent it from becoming more serious. 

At what point should you consider seeking medical advice for Cushing’s Syndrome?

In the UK, if you believe you are suffering from multiple symptoms of Cushing’s Syndrome, especially if you are most at risk due to taking steroids, seek the advice of a GP. Cushing’s Syndrome presents itself in a similar way to other diseases, with closely linked symptoms, therefore they may undertake investigations but find that Cushing’s Syndrome is not the cause. 

How is Cushing’s syndrome Diagnosed?

The amount of cortisol in your body can be determined through a 24 hour urine test, which may show any abnormalities. Saliva tests and blood tests are also, although less commonly, used and you may receive a referral to a specialist hormone doctor, an endocrinologist, if raised levels are detected. If Cushing’s Syndrome is diagnosed and you are not taking steroids, you may be referred for further examinations such as X-Ray or MRI scans to check the pituitary gland for tumours or ultrasounds to check the adrenal glands, which are situated above the kidneys. 

What is the treatment for Cushing’s Syndrome?

If steroid medication is found to be the cause of Cushing’s Syndrome, your consultant may gradually decrease your dosage or eventually remove you from the medication completely. If a tumour is detected, surgery may be used to remove the tumour or less invasive options such as radiotherapy can be used. If the tumour cannot be removed or destroyed, medications can be used to reduce the impact of cortisol in your body. 

Sophie Farr, Youth Medical Journal 2022

Bibliography

Categories
Health and Disease

Fibromyalgia: The Disease Which Causes Extreme Pain With No Definite Cause or Treatment

What is Fibromyalgia?

Fibromyalgia is a chronic condition that can cause pain across all areas of the body and often also causes extreme tiredness, sleep, memory, and mood problems. Although researchers are yet to discover a definite cause of fibromyalgia, it is suspected that the disease affects the chemicals in the central nervous system, causing non-painful and painful signals to be confused or amplified. 

How does Fibromyalgia Start and What are the Risk Factors?

Commonly, the onset of symptoms happens after a distinct event such as surgery, infection, physical trauma, or severe psychological stress. Despite this, not all patients have a certain event that may have triggered fibromyalgia; sometimes symptoms gradually worsen over time. Women are 7 times as likely to suffer from fibromyalgia than men and it is also more common in middle-aged 30-50-year-olds. People diagnosed with fibromyalgia may also suffer from headaches, irritable bowel syndrome, joint disorders, and mental health complaints such as anxiety and depression. A family history of a close relative having fibromyalgia increases the likelihood that you may develop it and other illnesses such as osteoarthritis, rheumatoid arthritis and lupus can mean you are more likely to suffer from fibromyalgia. 

What are the Symptoms of Fibromyalgia?

  • Widespread pain: typically described as a non-stop, dull ache that lasts for at least 3 months. The pain must be occurring on both sides of the body and above and below your waist to be considered widespread.
  • Extreme Tiredness: tiredness that does not necessarily improve after sleeping, even after excessive sleep. Sufferers may find that their sleep is poor quality because of pain and some also report sleep conditions such as sleep apnea or restless legs syndrome
  • Mental Function: patients also suffer from impairment to their focus, attention span, and memory which may be referred to as “fibro-fog”, making it harder to concentrate on demanding tasks at work or school

What other conditions can Fibromyalgia Co-exist With?

Fibromyalgia is commonly paired with comorbidity (another disease) that can exacerbate symptoms and impair quality of life. Irritable bowel syndrome often happens alongside fibromyalgia and can cause digestive problems such as pain after eating and bloating. Chronic fatigue syndrome or ME is another disease that can coexist with fibromyalgia and it also has no certain cause although it presents symptoms of extreme tiredness that do not improve. Fibromyalgia patients may also suffer from migraines and other conditions such as cluster headaches but this can be hard to extract from the headaches reported as a symptom of fibromyalgia itself. An autonomic nervous system disease called postural orthostatic tachycardia syndrome (POTS) can also afflict fibromyalgia patients and this causes blood pressure and circulation-related issues as the body cannot adjust to the change from lying, sitting, and standing to regulate blood flow. Anxiety and depression are also common diagnoses that fibromyalgia patients receive as the disease can cause a huge impact on everyday life and prevent patients from continuing with their work, everyday routines, and social activities. 

How is Fibromyalgia Diagnosed?

If you suspect you may have fibromyalgia, you should contact a primary care team such as your GP. Although there is no diagnostic test for fibromyalgia itself, it can be confirmed through the absence of any other clear cause of the symptoms. Patients will often have blood tests, MRI scans, and other investigations to decipher whether there is any other condition causing the pain and, if not, they will likely receive a diagnosis of fibromyalgia.

How is fibromyalgia Treated?

Despite not having a cure for fibromyalgia, doctors are able to relieve certain symptoms to improve quality of life. Antidepressants and long-term pain medications can help to alleviate the pain and therapies such as cognitive-behavioral therapy, as well as counseling, can help to reduce anxiety-related symptoms that patients often exhibit. Lifestyle changes such as exercise have been proven to help to reduce pain, as well as relaxation techniques such as mindfulness. It is also vital that those with fibromyalgia seek medical advice for any other diagnosed conditions they also have so that they can receive treatment for any comorbidities. 

What other Support is there?

Receiving a diagnosis of fibromyalgia can sometimes be hard to accept and can impact patients’ daily lives enormously. Support groups can be a valuable tool to help patients to manage their symptoms and not feel alone in their struggles. Fibromyalgia Action UK offers information and support online and it also provides local support groups while UK Fibromyalgia is another national support group. 

Sophie Farr, Youth Medical Journal 2022

Bibliography

NHS England, “Fibromyalgia”, Accessed from: https://www.nhs.uk/conditions/fibromyalgia, August 2021

Mayo Clinic, “Fibromyalgia”, Accessed from: https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780, August 2021

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Health and Disease

Frontotemporal Dementia: The Causes, Symptoms and Management

By Sophie Farr

Published 10:08 EST, Mon November 30th, 2021

Overview

Dementia encompasses a range of diseases which, over time, cause changes to the brain and mostly impact the elderly populations. Unlike other types of dementia, most notably Alzheimer’s disease, frontotemporal dementia predominantly affects speech and behavioural management and has an earlier onset than other varieties. The disease is labelled as frontotemporal as it is characterised by damage to both the frontal lobe and temporal lobe regions of the brain which are at the front and sides. Social interaction and personality traits are key functions of the frontal lobe and these are drastically impacted in patients with frontotemporal dementia. 

Causes

The main cause of frontotemporal dementia is atrophy- shrinking- of these regions of the brain, resulting in changes to behaviour, language and social interactions, which they are responsible for. Although it is a rare form of dementia, frontotemporal lobe is often highly noticeable to friends and family of the patient and this results in early diagnoses, typically between the ages of 45 and 65 when the majority of dementia cases usually occur in over 65 year olds. Despite some genetic mutations having been linked to frontotemporal lobe dementia, roughly 50% of patients have no existing records of the disease in their families. Upcoming research has supposedly found connections between frontotemporal types of dementia specifically and a type of sclerosis, amyotrophic lateral sclerosis (ALS).

Symptoms

Frontotemporal dementia is most commonly noticed by loved ones first as the patient’s social manners and behaviour gradually seem more erratic or inappropriate for their setting. This can be difficult for healthcare professionals to detect without knowing the patient well, meaning observation from close family and friends is vital to an accurate diagnosis. Symptoms often worsen over a few years, and apathy towards previous interests, lack of empathy and changes to their behaviour can be obvious symptoms. Despite these being more uncommon, frontotemporal dementia can also cause symptoms more common to other types of the disease such as cognitive problems and lack of mobility. Frontotemporal dementia can occasionally be misinterpreted as aggression, discourtesy and even obsessive behaviours and patients may develop new routines or even lose interest in self care and begin to have disregard for the feelings of others. 

Language can also be severely impacted by this form of dementia, where patients lose their vocabularies, mistake objects, struggle to form sentences and even copy what someone else says in conversation. Sufferers also often lack the ability to organise themselves or see other perspectives, becoming distracted and agitated very quickly and unable to stick to plans. Combined with these mental changes, those with frontotemporal dementia may also become incontinent and struggle to be mobile without difficulties. Although memory and physical impairments can occur, this usually happens when the disease is more progressed and behavioural differences will be observed first. 

Diagnosis

It can be challenging to get a diagnosis of frontotemporal dementia as the patient may be unwilling to cooperate or even be aggressive and rude when prompted to seek medical advice. If the sufferer suspects they may have changes to their behaviour or physical health, they should consult a GP and a loved one could perhaps urge them to make an appointment and join them for support while they are there. Doctors are able to assess the symptoms and further investigations at a hospital may be required to check whether any noticeable abnormalities are present in the frontal or temporal lobes. Other comorbidities can also be ruled out and this can offer both the patient and their family peace of mind. 

Management

Receiving a diagnosis of frontotemporal dementia can be challenging for both the patient and their family. It is common for some to reject the diagnosis and even be offended by it, however it is important that the right support is provided so that their quality of life is preserved and their families are able to manage their symptoms. The multidisciplinary team is likely to advise that a care plan is established, including whether nursing support is required at home, to support carers of those suffering with frontotemporal dementia. Antidepressants are occasionally used to manage symptoms and occupational therapy, speech and language therapy and dementia friendly groups and activities can help patients to remain as comfortable and independent as possible as the disease progresses. Despite it being a rare occurrence, antipsychotics can be prescribed to lessen violence or aggression that may risk the carers’ safety and creating coping mechanisms for challenging behaviour is advisory. Financial support may also be offered to help create changes to the family home to make it as suitable and accessible as possible for the sufferer. 

Sophie Farr, Youth Medical Journal 2021

Bibliography

Mayo Clinic, “Frontotemporal Dementia”, Accessed July 2021 from: https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737

NHS England, “Frontotemporal Dementia”, Accessed July 2021 from: https://www.nhs.uk/conditions/frontotemporal-dementia/ 

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Health and Disease

Motor Neuron Disease: Symptoms, Causes, and Treatment

Motor neurone disease is the condition where messages from the motor neurones, which help carry electrical impulses from stimuli and sensory neurones, begin to stop reaching the muscles, preventing response. Stimuli include anything from sound, touch, smell, and even taste, which then allow an appropriate response, such as moving your hand away from a boiling object. In motor neurone disease (or MND), muscles, which are effectors in the stimuli-response cycle, meaning they put the response into action, begin to stiffen and waste away. Behavior and mental ability can also be affected. The disease is very uncommon, affecting roughly 5000 in the UK at any time, and can cause different symptoms in each patient.  

Causes

The causes of motor neurone disease are currently unknown. There is no clear hereditary link, although you are more likely to suffer from MND if a close relative has had the disease. MND is much more common in those over 50 and with other conditions, such as specific types of dementia. 

Symptoms

  • Weakness in the legs and ankles as well as trouble climbing stairs and more frequent trips and falls
  • Speech difficulty, including slurring as well as trouble swallowing and inability to express yourself through gestures and body language
  • Difficulty gripping items such as pens, opening jars, and often dropping things
  • Muscle cramps and tingling 
  • Weight loss due to muscle decay, which can cause thinning of arms and legs in particular
  • Inability to control laughter or tears in inappropriate situations
  • Changes to saliva consistency or volume
  • Weakened coughing, causing difficulty as unable to remove saliva
  • Difficulty breathing, leading to fatigue

Types

  1. Amyotrophic lateral sclerosis (ALS)- the most common form of MND that causes muscle wastage 
  2. Bulbar onset MND or Progressive bulbar palsy (PBP)- less common than ALS and affects the muscles in the face, throat, and speech, causing slurring and difficulty swallowing
  3. Progressive muscular atrophy (PMA)- affects a very minute proportion and causes problems with the hands and grip
  4. Primary lateral sclerosis (PLS)- highly uncommon and causes muscle stiffness and selected speech problems and is not usually life-shortening due to very slow progression

What can Motor Neurone Disease be Misdiagnosed as?

Motor Neurone Disease can sometimes present very similarly to Kennedy’s Disease or SBMA. Kennedy’s disease also affects the motor neurones and can cause muscle weakness and wastage, although additional hormonal problems may contribute. These two diseases are often confused at diagnosis, however, those with Kennedy’s disease usually live a normal lifespan. Problems with inflammation of the spinal cord, nerve damage, and muscle damage can also mimic MND, as well as strokes. It is vital to contact a GP as soon as symptoms of MND are observed for diagnostic tests

How is it Diagnosed?

  • Blood and urine tests can show rises in creatinine kinase, which is produced due to muscle wastage 
  • MRIs can prove that symptoms are not caused by another condition such as a stroke
  • Electromyography (EMG) and nerve conduction study (NCS) to show how electrical impulses and nerve function is working
  • Muscle biopsies to disprove other muscular conditions
  • Spinal taps and lumbar punctures can also rule out other conditions

Treatment

Although there is no way to treat the disease itself, there are ways that patients’ quality of life can be improved and day to day actions facilitated. Riluzole is a drug that has been proven to slightly slow down the progression of motor neurone disease, despite it still not being a cure. Specialized clinics with nurses and occupational therapists can help motor neurone disease sufferers. Regular physiotherapy can also help to combat muscle weakness, stiffness, and pain. In a more holistic approach, speech therapists and dieticians can also be involved in patient care to offer advice. 

Emotional support can also be vital for those with motor neurone disease and carers can be one way to allow sufferers to remain living independently. Joining groups and forums, such as the one run by the “Motor Neurone Disease Association”, can help to have advice and support from others who also have the disease. Organizations such as this can also offer financial support for those with motor neurone disease and advise as to where sufferers can seek professional help from hospitals who have expertise in motor neurone disease. 

References

“About MND.” StackPath, http://www.mndassociation.org/about-mnd/.

“Motor Neuron Disease: Types, Symptoms, Causes, and Treatments.” Medical News Today, MediLexicon International, http://www.medicalnewstoday.com/articles/164342#treatment.

“Motor Neurone Disease.” NHS Choices, NHS, http://www.nhs.uk/conditions/motor-neurone-disease/. 

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Health and Disease

A Brief History of Organ Transplantation: The Past, Present, and Future

By Sophie Farr

Published 6:46 PM EST, Thurs June 10, 2021

History

Transplantation began with the basic principle of the Carrel Patch which proved that a vein could be reattached and still support a functioning blood flow. This technique was employed by the Ukranian surgeon Voronoy Kiev and allowed him to accomplish the feat of being the first person to successfully transplant a kidney in a cadaver. 

After this promising start to transplantation, medical advancements were catalysed during the Second World War of 1939-1945 and transplantation especially had major breakthroughs. The war meant that severe injuries were more common and novel treatments could be tested as a last resort. Skin grafts were first used to heal airmen’s burns and this prompted the realisation that the immune system may reject transplants, a problem which has continued throughout the surgery’s development. 

David Hume, an American doctor, was the first to attempt a kidney transplant in a living patient, albeit in the arm instead of in the normal position in the thorax. The implanted kidney was removed After two days and natural function then resumed and the patient miraculously survived. This is still seen in the NHS today with the “Bridge to Transplant System” which uses ventricular assist devices for prospective heart surgery patients that are then removed and if the relief has assisted function, full transplantation may not be necessary. 

In 1951, a doctor in Paris performed the first ever renal transplant, using the kidney of an executed criminal, into a patient in renal failure. Although the surgery failed, the kidney was transplanted into the groin and bladder which forms the basis of the modern technique. Still in Paris, the first ever successful live kidney donor, Mrs Renard, gave her organ to her son Marius in 1952. Mrs Renard’s kidney functioned in Marius for 21 days but then it ceased but this was most likely due to rejection.

Finally, the first successful transplantation was achieved in Boston in 1954, having been done on a set of identical twins. One twin was experiencing kidney failure and the other donated a kidney which was transplanted without rejection because of their identicalness. After renal transplants had been accomplished, liver transplants followed in the 1960s and the first successful heart transplant happened in 1967. This heart transplant was undertaken by Christian Barnard in Cape Town on a female car crash victim and marked the greatest achievement in transplantation, now allowing full heart and lung transplants. 

Present

Since the amazing triumph of successful transplants, the world has been focused on decreasing the likelihood of complications. Immunosuppressants have been widely used to reduce the chance of rejection and 6MP and azathioprine are the most commonly used after the immunosuppressive effect was demonstrated in a rabbit by Schwarz and Dameshek and on a dog in 1959 by Roy Calne, who later performed the first European liver graft in 1968 in Cambridge. 

Preservation has also been a pressing issue as chance of function is reduced with poor preservation. In the past, kidneys were simply stored in ice, preservation fluid and a plastic ice to remain sterile but this arrangement was less successful with livers so the University of Westconsin Preservation fluid was developed by Jamieson for normal liver function. This fluid, combined with improved anaesthetic and the ability to keep patients warm during surgery to prevent clotting, increased transplantation success rates by the 1980s and further advancements are still improving chances of success today.

The opt-out system of organ donation that the NHS moved to in March of 2020, where all adults are assumed to be donors unless they actively specify against, has mitigated against the issue of how few organ donations the NHS had. This, combined with the risk of reduced function due to storage, means that transplantations have long waiting lists and it is contentious as to who receives them. Currently, storing organs for more than 12 hours in ice means that efficacy decreases by 25% every 6 hours. 

Future

In the future, the main developments are likely to surround storage and preservation. Cold storage can cause tissue injury and immediate graft function is roughly 65% effective, compared to the delayed function that is only 35% effective. In order to combat these worrying statistics, ex vivo normothermic machine perfusion, a new technique that restores kidney function out of the body before it is transplanted to remove the issue of cold storage, is being tested as a way to repair kidneys and allow more organs to be successfully transplanted.

Write up based on “Horrible History of Organ Transplantation and its Future” at the Cambridge Festival 

Sophie Farr, Youth Medical Journal 2021

Categories
Health and Disease

Management for Heart Attacks: Angioplasty and Bypasses

By Sophie Farr

Published 7:21 PM EST, Wed April 21, 2021

What Is A Heart Attack?

Throughout our lives, deposits of saturated fats called plaques can build up in the arteries of our hearts because of high cholesterol levels. Over time, this can lead to the restriction of blood flow due to vessel narrowing. These fatty deposits can lead to a complete blockage of an artery because of formed blood clots. If this occurs in the coronary artery, oxygenated blood may be prevented from reaching the heart muscle tissue. Without this vital oxygen, which is needed for aerobic respiration and normal cell function, the heart muscle can begin to die. The longer the blockage continues, the more damage can be done to the heart;this effect is known as a heart attack. In the worst case scenario, if the clot is dislodged and becomes mobile, it may travel to different areas of the body and, when it reaches the brain, could cause a stroke. 

What Are The Risk Factors For Heart Attacks?

Your risk of having a heart attack is increased by both hereditary and lifestyle factors. Firstly, a diet full of saturated fats, such as butter, cakes and bacon, increases the LDL (low-density lipoprotein) cholesterol in your blood, leading to more fat deposits. Furthermore, a sedentary lifestyle means that deposits build up more readily; smoking can also cause this effect. Another key risk factor is genetics. Men are more likely to suffer from a heart attack than women. Stress hormones, such as cortisol, can increase your heart rate which, in turn, causes more fat deposits in arteries. 

What Are The Symptoms Of A Heart Attack?

The main symptom of a heart attack is severe chest pain which may radiate across the left arm, shoulder or even abdomen. Sufferers describe this pain to be “crushing” and “vice-like”, which can cause patients to collapse and be unable to perform daily activities. Despite some cases having extreme and visible symptoms, women and the elderly are more likely to experience lesser symptoms such as mild discomfort, agitation, lethargy and weakness. 

What Is The Immediate Response In Case Of A Heart Attack?

Treating heart attacks is a key part of most first aid qualifications. If you encounter a suspected heart attack, the crucial thing is to call emergency services as soon as possible to ensure the patient receives required treatment quickly. While you wait for further assistance, the pain of a heart attack can be partially relieved by sitting the patient in the “W” position. This refers to sitting on the floor, against a wall, and bringing your knees upwards to create a “W” shape. If there is access to medication, the patient should chew a 325mg aspirin, which works to thin their blood. This would allow potential blood flow through a blockage. 

Coronary Angioplasty

Coronary angioplasty is a medical technique that attempts to relieve the blockage by expanding the artery. Not all hospitals have access to the resources required to undertake this complicated procedure. Therefore, ambulances always attempt to take patients with suspected heart attacks to advanced cardiology units such as the Royal Papworth. Coronary angioplasties are usually done through a large vessel in the groin (the femoral artery) or the arm. A catheter, with a deflated balloon attached, is threaded through to the potential site of the blockage. Once the afflicted area is reached, the balloon can be inflated which expands the artery and relieves the blockage, allowing oxygenated blood to reach the heart. Commonly, a stent is also placed in the affected artery to hold it open to prevent further damage from deposits. These are typically made of a flexible metal and aid disease management into the future. 

Coronary Bypass

A coronary bypass involves taking a blood vessel from either the arms (radial arteries), chest (internal mammary arteries), or legs (greater saphenous veins) and reattaching it to the heart. This redirects blood flow to ensure oxygenated blood reaches the heart. The blood vessel created is referred to as a graft, and the whole procedure is done in 3-6 hours under general anesthetic. If there is a risk of a patient experiencing further damage to the heart in the same area, or another heart attack, this graft can help to lower the risk.

Sophie Farr, Youth Medical Journal 2021

References

NHS England, “Treatments for Heart Attacks”, Accessed March 2021 from: https://www.nhs.uk/conditions/heart-attack/treatment/#:~:text=Primary%20percutaneous%20coronary%20intervention%20(PCI),-Primary%20percutaneous%20coronary&text=It’s%20a%20procedure%20to%20widen,such%20as%20low%2Ddose%20aspirin.

NHS England, “Coronary Artery Bypass”, Accessed March 2021 from:

https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/

Mayo Clinic, “Cardiac Catheterization” Accessed March 2021 from: 

https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695

Categories
Biomedical Research

Asphyxiation and Westaby Tubing

By Sophie Farr

Published 5:49 PM EST, Sun March 7, 2021

Introduction

The world renowned cardiothoracic surgeon, Professor Stephen Westaby, details tragic cases of asphyxiation during his career in his memoir, “Fragile Lives,” and his innovation, which revolutionised treatment. Asphyxia is a broad term which refers to when the body does not have sufficient oxygen, resulting in unconsciousness and  suffocation. Although they may all result in asphyxia, there are a plethora of different causes of the critical state which include choking, severe burns, seizures, carbon monoxide poisoning and contact with other harmful chemicals. This allows the condition to be separated into two causes: physical or chemical asphyxia. This article will focus on physical asphyxia but also touch on carbon monoxide poisoning as the most common cause of chemical asphyxia. 

Physical Asphyxiation

Physical asphyxia is typically due to obstruction or mechanical force which prevents your cells from receiving sufficient oxygen through breathing. For example, choking is an obstruction which results in asphyxiation due to it preventing you from taking deep enough breaths to supply the body with adequate oxygen levels. In cases such as these, as well as similar causes such as aspiration which is where food or water travels down an incorrect pipe, treatment is urgently required to remove the blockage. Many people will be familiar with the Heimlich maneuver and abdominal thrusts to resolve choking and CPR. Furthermore, mouth to mouth resuscitation is also commonly used to save the victims of drowning (a type of aspiration). But what happens when parts of your own body are causing this fatal obstruction?

Seizures are another more common cause of physical asphyxiation due to epileptic seizures sometimes causing apnea or a sudden break from breathing. If this occurs, oxygen saturation can plummet to fatal levels and require immediate treatment. Epileptic seizures can also cause asphyxia through force as the airway can occasionally become obstructed by objects such as pillows when convulsing. 

As Professor Stephen Westaby narrates in his book, many cases of asphyxia are the result of trauma such as severe burns. He tells the harrowing story of a young boy Cape Town, Olim, who had been the victim of an explosion in his house, inhaling toxic gases,  likely due to a stove or gas cooker. In cases such as this, the body’s own process of recovery, through inflammation of the affected tissue and scabbing to allow healing, can cause asphyxiation. These patients are likely to already be in critical conditions, unable to breath unsupported by a tracheostomy: a surgery where incisions are made in the trachea to allow air to be ventilated through tubing through the neck. However, treatment such as this can be dangerous due to the risk of infection around the exposed tubing and not always accessible, especially in crisis hospitals where this young boy was treated. 

Westaby Tubing

Professor Westaby was personally affected by the traumatic complications as his own grandmother had experienced asphyxiation in the final weeks of her struggle against thyroid cancer. This connection to the horror patients’ experience inspired him to not only become a doctor due to wanting to prevent other people suffering through that level of pain and fear, but also made him determined to treat the young boy. Having previously treated a construction worker, Mario, who had suffered extensive burns in an accident, Westaby had made great scientific progress by pioneering a new technique for asphyxiation. He employed the help of a company which produced medical tubing and requested them to produce a Y-shaped piece which could be fed down the bronchi, through the damaged tissue, until it reaches a healthy lung to aid breathing and relieve asphyxiation. This procedure, although novel and potentially risky, alleviated the patient’s suffering and allowed for easier management of an otherwise horrifically painful illness. Westaby received the honor of having the new medical tubing named after him and it is now branded as “Westaby Y-Tubing”.

Despite being presented with an even more complex case, due to it being on a child who was malnourished and had a significantly smaller respiratory system, Westaby adapted his treatment to a child’s body. His adaptability and confidence are key skills any doctor requires; although there were risks to the surgery, Olim’s injuries were likely to be fatal therefore it was worth attempting treatment to improve his quality of life. The operation was successful but, tragically, Olim passed away a year and a half later with no obvious cause. 

Chemical Asphyxiation

The most common cause of chemical asphyxiation is carbon monoxide poisoning. The colourless, odourless, toxic gas binds with haemoglobin in red blood cells to form carboxyhemoglobin. This results in a reduced capacity for the red blood cells to carry oxygen and, in turn, the effects of asphyxia due to insufficient oxygen levels. Therefore, the symptoms of carbon monoxide poisoning, such as fainting, are the same as the broader disease. In order to prevent poisoning, house owners should purchase a CO monitor to detect the gas in case of emergency.

Although asphyxia has a multitude of different causes, professionals such as Professor Stephen Westaby offer us hope that medical advancements are offering innovative advancements as time progresses. His career acts as an example for aspiring doctors who can learn from these transferable skills of problem solving, pragmatic thinking, and creativity.

Sophie Farr, Youth Medical Journal 2021

References

“What is Asphyxia?” Web MD, Accessed February 2021 from: https://www.webmd.com/first-aid/asphyxia-overview#1 

“Fragile Lives” Professor Stephen Westaby

“Asphyxiation” Medical News Today, Louise Morales-Brown, September 2020; Accessed February 2021 from: https://www.medicalnewstoday.com/articles/asphyxiation 

Geevasinga, Nimeshan et al. “Choking, asphyxiation and the insular seizure.” Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia vol. 21,4 (2014): 688-9. doi:10.1016/j.jocn.2013.05.012 

Categories
Health and Disease

Hypothyroidism: Possible Cause of Fatigue, Weight Gain, and Constant Coldness?

Introduction

Approximately 5 in 100 people in the US, over the age of 12, suffer from hypothyroidism. This condition, more commonly known as an under-active thyroid, can cause unpleasant symptoms such as chronic fatigue which can make the daily lives of those affected significantly harder. Luckily, the disease can be easily treated but needs constant monitoring throughout one’s life to ensure that they have the correct dosage of medication

Symptoms

  • Excessive tiredness
  • Weight gain
  • Low mood
  • Constipation
  • Sensitivity to cold
  • Dry and scaly scalp
  • Brittle hair and nails
  • Slow movements and thoughts
  • Muscle aches and weaknesses

What is Hypothyroidism?

The thyroid gland is a butterfly-shaped organ in front of the trachea which controls the release of vital hormones. Your metabolism is controlled by this small organ and the hormones it releases allow the regulation of energy gained from food. The main hormones the thyroid is responsible for are triiodothyronine (T3) and thyroxine (T4) and fluctuations in these levels can cause symptoms of either hypothyroidism or hyperthyroidism (known as an overactive thyroid). If the thyroid gland doesn’t produce enough T3 or T4, you begin to experience the symptoms of an underactive thyroid which can result in constant tiredness, gain in weight, and a lower mood if not treated properly. 

Causes

An underactive thyroid can be present from birth, this is called congenital hypothyroidism, and all newborns in hospitals will be tested through the blood spot test at roughly 5 days old. Sometimes the immune system randomly attacks the thyroid gland, causing you to develop an underactive thyroid, and this common cause is known as Hashimoto’s disease. This disease causes hypothyroidism as a result of an autoimmune disorder, rather than direct damage to the gland, as it causes inflammation which prevents normal hormone function. 

Other causes of hypothyroidism can include damage to the thyroid during radiation treatment or surgery for a severely overactive thyroid, goiter, or thyroid cancer. During these procedures, excessive damage may be caused due to radiation attacking healthy cells as well as cancerous ones or a surgeon having to remove the whole organ as a result of other conditions. The treatment for hypothyroidism due to these causes is the same as that of Hashimoto’s and the symptoms can usually be easily treated using the right dose of hormone replacement. 

Finally, one other cause of hypothyroidism, albeit less common, is thyroiditis. Thyroiditis is a broad term that encapsulates any inflammation of the thyroid. Initially, thyroiditis can cause secretion of increased T3 and T4, leading to symptoms of overactive thyroid, which can last for the first 3 months after developing the condition. After this period, the thyroid may become underactive, which is usually temporary and only lasts a year- a year and a half, but occasionally is permanent. Thyroiditis can come on after childbirth (postpartum thyroiditis), due to a bacterial or viral infection (subacute thyroiditis), or painless, asymptomatic thyroiditis (“silent” thyroiditis). 

Diagnosis

If you suspect you may be suffering from an underactive thyroid, it is important to speak to a family doctor so they can either perform diagnostic tests or refer you to a hospital’s endocrinology department if your case appears to be severe. Typically, the initial diagnosis of hypothyroidism can be made through a thyroid function test which is performed similarly to a classic blood test. This can show your medical team whether you have high levels of TSH (thyroid secreting hormone) and your T4 function. Once this test is performed, you can usually be treated by your local family doctor or GP but you may be referred to a specialist hormonal department (endocrinology) at a hospital if you are under 16, pregnant, or have underlying health issues that may affect treatment. 

Treatment

Usually, an underactive thyroid is treated using oral hormone replacement tablets of levothyroxine. Most patients will have their TSH and T4 levels monitored at regular 3-month intervals to ensure you have the right dosage to effectively replace the lacking T3 and T4 hormones. Initially, you may be started on a low dosage (for example 25 micrograms) but if symptoms do not improve this can be adjusted, usually by going up by 25 micrograms or potentially 12.5 micrograms in children for a less dramatic increase. Once the correct dose is found, patients usually report an improvement in symptoms and only require monitoring on a yearly basis. However, it is important that if, after a while, your symptoms worsen to contact your doctor as this may indicate that your dosage is incorrect. 

Complications

Rarely, hypothyroidism can cause complications such as heart disease, goiter, pregnancy complications, and in extremely severe cases myxoedema coma. These complications typically only occur if a patient has suffered from a severely under-active thyroid, without treatment, over a long period of time. It is vital to contact a medical professional if you appear to be suffering from any of these complications and are experiencing classic symptoms of an under-active thyroid. 

Sophie Farr, Youth Medical Journal 2021

References

NHS England, “Underactive thyroid”, Accessed January 2021 from: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/ 

US Department of Health and Human Science, “Hypothyroidism”, Accessed January 2021 from: https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism#causes

Endocrine Web, “Thyroid gland overview”, Accessed January 2021 from: https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland-controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi#:~:text=The%20thyroid%20gland%20is%20a,way%20your%20body%20uses%20energy.

Categories
Health and Disease

Retinal Detachment: About the Disease, Symptoms and Treatment

Introduction

Retinal detachment is the term that means the retina (the thin coating at the back of your eye) becomes loose. This disease must be treated urgently to preserve sight, typically through surgery.

Causes

The most common cause of retinal detachment is PVD or posterior vitreous detachment. Posterior vitreous detachment is a condition increasingly likely with age and is caused by variations in the vitreous gel which is a clear gel-like substance that fills the space between the lens and retina in the eyeball. This cause of retinal detachment does not present with pain and rarely causes sight loss; PVD commonly causes symptoms of black “floaters” obstructing vision and what patients have described as flashing lights. Over time, the brain adapts to the symptoms caused by PVD, learning to ignore them, and sight returns to the same condition as before the disease manifested. It is paramount that anyone who experiences symptoms of PVD consults an ophthalmologist or optometrist as 1 in 10 cases of the disease will result in a retinal tear and could trigger retinal detachment which requires emergency surgery.

Although most cases of PVD can be left to resolve themselves, and most do not result in retinal detachment, you are more likely to experience complications if:

  • You are short-sighted
  • Have had eye surgery before
  • Have experienced eye trauma
  • Have a family history of detachment

Tests

  • Retinal Examination: An optometrist or ophthalmologist can inspect the back of the eyeball, including the retina, by using a bright light and a variety of special lenses which allows for a detailed view of the whole eye, showing any tears of the detachment of the retina
  • Ultrasound: medics can also perform an ultrasound test on the eye to check for tears or possible detachment if the vision of the retina is otherwise blocked by bleeding.

If no tear or detachment is diagnosed on the first examinations, the doctor may ask for you to return a short time later to check for delayed tears due to the vitreous separation. It is common for both eyes to be examined even if the patient is only symptomatic in one.

Treatments for Retinal Tears

As retinal tears are usually a precursor for complete detachment, doctors may try to treat the occurring tear to prevent it from progressing and preserve sight. There are two mains ways this can be done:

  • Laser Surgery (Photocoagulation): A laser beam is concentrated at a point in the eye through the pupil. The surgeon can burn around the tear using the laser, prompting the retina to rejoin or “weld” to the scarred tissue.
  • Freezing (Cryopexy): Surgeons can use a freezing probe on the outer surface of the eye, under local anesthetic, and directly over any tears. Similar to laser surgery, this causes scarring which allows the retina to be reattached to the eye’s wall.

Both treatments for retinal tears can be done within one day at an outpatient clinic with minimal recovery time. The surgeon would likely advise you to avoid anything which could jar the retina (such as jumping, sudden movements, or sports) for a few weeks to allow the tear to weld.

Treatments for Retinal Detachment

Retinal detachment must be treated in only days after diagnosis to allow for eyesight to be preserved. The type of treatment depends on the severity of the detachment and 3 main surgeries can be performed:

  • Pneumatic Retinopexy: an air bubble or bubble of gas is inserted into the vitreous cavity and, if it is in the correct positioning, it can push the area containing holes against the wall of the eye, preventing the flow of liquids behind the retina. Any fluid collected under the retina is absorbed by itself, allowing the retina to attach to the wall. You will be required to keep your head in the same position for a couple of days after surgery to allow the bubble to stay in the right position.
  • Scleral Buckling: silicone material can be sutured to the sclera surrounding the area containing the holes. This causes an indent in the eye’s wall, relieving the effects of the force provoked by the vitreous pulling on the retina. If the detachment is severe, or many tears and holes have occurred, a scleral belt can be placed around your eye which will remain in position permanently but not obstruct vision.
  • Vitrectomy: The vitreous and any tissue pulling on the retina can be removed by a surgeon and then air, gas, or silicone-based oil can be injected to flatten the surface of the retina. Eventually, the substance injected is absorbed and the vitreous space can be filled again with body fluid. This procedure is often paired with scleral buckling in severe cases of detachment.

Although surgery can be successful, some people will require multiple procedures before their detachment has been fully repaired. Detachment can be a recurring problem so it is vital that, if you redevelop symptoms, you consult an ophthalmologist or optometrist. In some cases, vision cannot be fully restored but most treatment plans and combinations can help preserve a large proportion of vision.

Sophie Farr, Youth Medical Journal 2021

References

NHS England, Retrieved 16/12/20 “Detached Retina” https://www.nhs.uk/conditions/detached-retina-retinal-detachment/

Mayo Clinic, Retrieved 16/12/20 “Retinal Detachment”
https://www.mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348





Categories
Health and Disease

Glaucoma: Causes, Treatment, and Diagnosis

What is Glaucoma?

Glaucoma is an eye condition categorized by damage to the optic nerve. The optic nerve transmits light detected by the eye as electrical signals to the brain so it can decipher an image. When the optic nerve suffers damage, such as in glaucoma cases, it can lead to sight loss if not treated promptly. Typically, glaucoma is genetic, and the common disease affects 1 in 50 Europeans over 40. 

Symptoms

Glaucoma is usually slow progressing and in most cases, the patient will have been suffering from the disease, asymptomatic, before they first seek advice from an ophthalmologist. Initial warning signs of glaucoma are changes to your peripheral (outer edge) vision, blurred vision, or seeing rainbow circles. Glaucoma is often discovered during a routine eye health check-up and treatment can progress from there. Occasionally, acute cases of glaucoma can come on rapidly, causing intense eye pain, nausea, red eyes, tenderness, seeing rings around lights, and blurred vision. It is imperative to seek medical attention, such as an emergency eye clinic or A&E care if you think you may be suffering from glaucoma; the sooner a glaucoma patient can be diagnosed, the sooner they can get treatment, potentially saving their sight. 

Types

Most glaucoma cases are primary open-angle glaucoma. This type of disease usually progresses slowly over years and is typically caused by drainage channels in the eye becoming clogged over time. There is also acute open-angle glaucoma: where the drainage channels suddenly become clogged, causing sudden and immense pressure build-up. Acute glaucoma is uncommon, but it is vital that you know where your nearest A&E or emergency eye clinic is in case you ever suffer from the disease. Secondary glaucoma is a different variation of the disease caused by a separate, underlying, eye condition. For example, inflammation of the eye (uveitis) can lead to secondary glaucoma. Congenital glaucoma is an extremely uncommon type of glaucoma, occurring in young children, which is caused by an abnormality of the eye. 

Causes

Currently, opticians are unsure of anything you can do to reduce your risk of glaucoma. However, your chances of developing the condition are increased for these reasons: you have a family member with glaucoma; you are of African, Caribbean, or Asian descent; you suffer from long-sightedness, short-sightedness, or diabetes; you are of an older age. It is crucial to let your optician know if you have symptoms of glaucoma, especially acute glaucoma if you fall into any of these categories. It is also important to follow your optician’s advice and to regularly go to eye appointments to test for glaucoma and a multitude of other diseases. 

Tests

The most common test for glaucoma is the non-contact tonometry test or the NCT. This involves an optician releasing a puff of air into your eye. A machine can then measure your eye’s resistance to the air, without needing any contact. This procedure is painless and non-invasive and can be performed in a regular opticians appointment. Opticians also have machines that can measure the pressure in your eye, another investigative method for diagnosing glaucoma. 

Treatments

Unfortunately, opticians are unable to solve vision loss which happened before a glaucoma diagnosis; their main aims will be to alleviate symptoms and to prevent further damage to the optic nerve. Treatment options for glaucoma depend on the severity, and type, of the case. Most patients suffering from primary open angle glaucoma will be prescribed eye drops-reducing pressure. Other treatment plans, typically for more severe cases, include laser eye treatment to release blocked drains and to reduce how much fluid your eyes produce; surgery to improve the drainage channels, allowing more fluid to be released, reducing pressure; more regular appointments with an optician or ophthalmologist to assess your glaucoma. 

Link between Diabetes and Glaucoma

Those who suffer from diabetic retinopathy are more likely to develop glaucoma. Retinopathy can lead to abnormal blood vessel growth which can cause the natural drainage of the eye to become blocked. Because of this link between certain types of diabetes and glaucoma, it is important that you communicate with your endocrinologist (specialist hormone doctor) and ophthalmologist to ask whether regular screening needs to happen. 

Sophie Farr, Youth Medical Journal 2020

References

Diabetes.co.uk, 15th Jan 2019; https://www.diabetes.co.uk/diabetes-complications/glaucoma.html

NHS UK, 15th Feb 2018; https://www.nhs.uk/conditions/glaucoma/#:~:text=Glaucoma%20is%20a%20common%20eye,not%20diagnosed%20and%20treated%20early.

Glaucoma UK; https://glaucoma.uk/

Specsavers UK; https://www.specsavers.co.uk/eye-health/glaucoma