Recently, I went along for the first time to do voluntary work at my local hospital. This was an introductory session to tell me what I was going to be doing when I come in in the future. I was shown around the hospital (it's fairly small) and was told I would primarily be helping on the rehabilitation ward, where I will be talking to patients and helping generally on the ward e.g. meals.
During this first visit I spent half an hour talking to a patient on the ward. She had been moved from a large hospital to this smaller one and told me about how she'd found the whole experience. This gave me the valuable experience of seeing how a patient reacts to the care they are being given. Sometimes the patient can still feel lonely and wish for more - this is where volunteers can help. This is something I hope to do a lot more of in the coming months!
The matron also taught me how to take blood pressure, pulse, temperature and measure oxygen levels. Within 2 hours of arriving at the hospital I had taken these readings on a patient and was told that during busy times I may be asked by the nurses to do this. This was a very hands-on experience that I really enjoyed and hopefully will be able to do more of in the future!
I plan to go back to the hospital at least once a week and hope to do more of what I've done already!
Wednesday, 21 November 2012
BioChem Labs
Recently I had the opportunity to visit the Biochemistry labs at a large hospital nearby. I saw all the various machines used to analyse substances, such as urine and blood samples. Although most of the machinery I did not fully understand, there were some more low-tech methods that I know about from school, such as chromatography. I saw how haematologists can view individual red blood cells and from this diagnose cases such as sickle cell anaemia and how the hospital priotised blood tests on how urgent they were (generally the tests from the ICU in the hospital were more urgent than samples from nearby GP surgeries).
Perhaps the thing I found most interesting was the toxicology lab. Here they analysed urine samples from local sessions aimed to help addicts with drug dependancies. From analysing the urine it is possible to see whether it has been spiked by the patient in an attempt to significantly reduce the proportion of metabolites from drugs present. One example is how the patients would spike their sample with methadone to make the metabolites of the crack cocaine less obvious.
I found the whole experience interesting, especially as I saw an area of a hospital I had not previously experienced and saw the science that goes on behind the scenes.
Perhaps the thing I found most interesting was the toxicology lab. Here they analysed urine samples from local sessions aimed to help addicts with drug dependancies. From analysing the urine it is possible to see whether it has been spiked by the patient in an attempt to significantly reduce the proportion of metabolites from drugs present. One example is how the patients would spike their sample with methadone to make the metabolites of the crack cocaine less obvious.
I found the whole experience interesting, especially as I saw an area of a hospital I had not previously experienced and saw the science that goes on behind the scenes.
Thursday, 11 October 2012
First Aid Teaching
After spending most of the last month sorting out UCAS and my Personal Statement, I have now applied to university!
Over the last few months, I've attended a few Red Cross training sessions. We were taught CPR, bandaging, recovery position and also how to react and help in a few other situations. The point of the scheme was to eventually have us teaching younger years First Aid.
On Tuesday and today (Thursday) in our PD sessions, we taught the Year 12s basic First Aid - recovery position, CPR and bandaging. Both times, we had fairly large groups (30+!) and were in a noisy environment (with other groups in the sports hall). My team consisted of 3 of us and we had 20-25 minutes to teach our peers these 3 potentially life-saving skills. Obviously we had to be fairly quick, but also engage the audience! We planned our session and decided each of us would do a demonstration of one type of First Aid (I did CPR with breaths) to the whole group, then we would split the group into 3 smaller groups (10 or so) and get them to do it.
I found the whole experience new and exciting, if a little challenging! We had to convey a lot of important information in a very short space of time (and so used "Golden Rules" for each method of First Aid). We also had to engage the audience and compete with a noisy and distracting environment. Generally, I found our groups responded well and I felt they'd learned something. Volunteers got involved and did CPR correctly on a Little Anne. Hopefully, I'll be able to get involved in future peer mentoring schemes with the Red Cross - it's possible in the future we will teach First Aid to other years or run sessions about HIV on World AIDS Day - I look forward to getting involved in this!
In other news, I've managed to secure a placement in a Biochemistry Lab in a hospital. I'll be going there tomorrow and hope I'll learn a lot about research methods in hospitals. I'm also starting volunteering at my local hospital soon, which will involve seeing and talking to patients. I look forward to both of these exciting opportunities!
Over the last few months, I've attended a few Red Cross training sessions. We were taught CPR, bandaging, recovery position and also how to react and help in a few other situations. The point of the scheme was to eventually have us teaching younger years First Aid.
On Tuesday and today (Thursday) in our PD sessions, we taught the Year 12s basic First Aid - recovery position, CPR and bandaging. Both times, we had fairly large groups (30+!) and were in a noisy environment (with other groups in the sports hall). My team consisted of 3 of us and we had 20-25 minutes to teach our peers these 3 potentially life-saving skills. Obviously we had to be fairly quick, but also engage the audience! We planned our session and decided each of us would do a demonstration of one type of First Aid (I did CPR with breaths) to the whole group, then we would split the group into 3 smaller groups (10 or so) and get them to do it.
I found the whole experience new and exciting, if a little challenging! We had to convey a lot of important information in a very short space of time (and so used "Golden Rules" for each method of First Aid). We also had to engage the audience and compete with a noisy and distracting environment. Generally, I found our groups responded well and I felt they'd learned something. Volunteers got involved and did CPR correctly on a Little Anne. Hopefully, I'll be able to get involved in future peer mentoring schemes with the Red Cross - it's possible in the future we will teach First Aid to other years or run sessions about HIV on World AIDS Day - I look forward to getting involved in this!
In other news, I've managed to secure a placement in a Biochemistry Lab in a hospital. I'll be going there tomorrow and hope I'll learn a lot about research methods in hospitals. I'm also starting volunteering at my local hospital soon, which will involve seeing and talking to patients. I look forward to both of these exciting opportunities!
Monday, 3 September 2012
Medication
It's been a while since my last post. Since April I've had exams, gone back to school, started my new role as Head Boy, been starting UCAS applications and choosing universities and also had Biology Field Trips to Aberystwyth and the Galapagos! It's definitely been a busy Summer, so the blog was put on the backburner for a bit, but hopefully now I'll be able to make regular posts again!
I was thinking about all the various different things I could post about, and decided I'd look into the medications I have experience with and what they're used for. All of these I have used through my work with Mencap, so some are used to treat fairly similar conditions e.g. Epilepsy.
N.B. In each case, the medication I've dealt with is put with its brand name on the left and the generic name on the in italics.
Keppra - Levetiracetam
This is a medicine used to treat Epilepsy - either myoclonic, partial or generalised seizures. Levetiracetam helps control electrical activity in the brain and so helps reduce the chance of having seizures. Different doses of this medication are available and in some cases the doses increase over time.
Levetiracetam has numerous side effects, both affecting the body and mind. Some examples include eczema, vomiting, diarrhoea, mood changes and thoughts about suicide.
Imodium - Imodium
Imodium is used to treat diarrhoea. It works by slowing down the muscle movements in the gut, which increases the total time in the gut so more water is absorbed, meaning the stools are firmer and are passed less frequently.
Side effects range from common, including constipation and nausea, to uncommon and rare, which includes hypersensitivity reactions (e.g. anaphylactic shock) and coordination problems.
Phenytoin - Phenytoin
Phenytoin is used to treat a variety of different conditions, such as pain, neurotic pain and epilepsy. In my experience the medication has been used to treat epilepsy. Phenytoin is used to treat partial or generalised seizures by helping control the electrical activity in the brain, and so like Keppra helps control seizures and so is anticonvulsant. Like Keppra, the dosage of Phenytoin is gradually increased to control the condition.
Unlike the two medications above, Phenytoin does interact with alcohol and so cannot be taken with alcohol. There is a huge range of drugs that may interact with Phenytoin and so cannot be taken in conjunction, such as Vitamin D, warfarin, diazepam and doxycycline.
Phenytoin also has numerous side effects, some of which include dizziness, headaches, rashes, tremors and suicidal tendencies. Status epilepticus can also occur if this medication is stopped abruptly.
Lacosamide - Lacosamide
Lacosamide is used to treat partial epilepsy. Like most of the other medications it is available in tablet form or oral solution. Again the dosage may be increased over time. Interestingly, this medication may interact with Phenytoin and Midazolam, but can be used in conjunction if the prescriber thinks the benefits may outweigh the risks.
Again this medication has many side effects, which can include rashes, balance problems, double vision or rarely hallucinations.
Buccal Midazolam - Midazolam Hydrochloride
Midazolam can be used in a variety of ways including treating insomnia, convulsions and as a sedative. In my experience, Buccal Midazolam is used to stop convulsions in prolonged tonic clonic seizures or during status epilepticus. I've never actually had to administer Buccal Midazolam, although I am trained to. This medication interacts with grapefruit juice and so cannot be taken with this fruit juice as it increases the amount of midazolam in the blood. As midazolam should only be taken in the lowest amount to avoid dependence, this is not recommended.
Midazolam Hydrochloride can cause a range of side effects: aggression, rashes, vomiting, cardiac arrest and respiratory depression.
Rectal Diazepam - Diazepam
Diazepam is used in a variety of ways - for aggression, alcohol dependence and withdrawal, epilepsy, anxiety and more. My experience of Diazepam has been with rectal diazepam in order to stop prolonged tonic clonic seizures or status epilepticus. Again, although I have been trained to administer this drug, I have never actually had to. Alcohol and smoking, along with other drugs, such as Phenytoin, can interact with this drug, so taking these as well as Diazepam in not recommended.
Side effects of Diazepam are numerous and can include nausea, jaundice, gastrointestinal problems, tremors and even psychological problems and behavioural changes.
I was thinking about all the various different things I could post about, and decided I'd look into the medications I have experience with and what they're used for. All of these I have used through my work with Mencap, so some are used to treat fairly similar conditions e.g. Epilepsy.
N.B. In each case, the medication I've dealt with is put with its brand name on the left and the generic name on the in italics.
Keppra - Levetiracetam
This is a medicine used to treat Epilepsy - either myoclonic, partial or generalised seizures. Levetiracetam helps control electrical activity in the brain and so helps reduce the chance of having seizures. Different doses of this medication are available and in some cases the doses increase over time.
Levetiracetam has numerous side effects, both affecting the body and mind. Some examples include eczema, vomiting, diarrhoea, mood changes and thoughts about suicide.
Imodium - Imodium
Imodium is used to treat diarrhoea. It works by slowing down the muscle movements in the gut, which increases the total time in the gut so more water is absorbed, meaning the stools are firmer and are passed less frequently.
Side effects range from common, including constipation and nausea, to uncommon and rare, which includes hypersensitivity reactions (e.g. anaphylactic shock) and coordination problems.
Phenytoin - Phenytoin
Phenytoin is used to treat a variety of different conditions, such as pain, neurotic pain and epilepsy. In my experience the medication has been used to treat epilepsy. Phenytoin is used to treat partial or generalised seizures by helping control the electrical activity in the brain, and so like Keppra helps control seizures and so is anticonvulsant. Like Keppra, the dosage of Phenytoin is gradually increased to control the condition.
Unlike the two medications above, Phenytoin does interact with alcohol and so cannot be taken with alcohol. There is a huge range of drugs that may interact with Phenytoin and so cannot be taken in conjunction, such as Vitamin D, warfarin, diazepam and doxycycline.
Phenytoin also has numerous side effects, some of which include dizziness, headaches, rashes, tremors and suicidal tendencies. Status epilepticus can also occur if this medication is stopped abruptly.
Lacosamide - Lacosamide
Lacosamide is used to treat partial epilepsy. Like most of the other medications it is available in tablet form or oral solution. Again the dosage may be increased over time. Interestingly, this medication may interact with Phenytoin and Midazolam, but can be used in conjunction if the prescriber thinks the benefits may outweigh the risks.
Again this medication has many side effects, which can include rashes, balance problems, double vision or rarely hallucinations.
Buccal Midazolam - Midazolam Hydrochloride
Midazolam can be used in a variety of ways including treating insomnia, convulsions and as a sedative. In my experience, Buccal Midazolam is used to stop convulsions in prolonged tonic clonic seizures or during status epilepticus. I've never actually had to administer Buccal Midazolam, although I am trained to. This medication interacts with grapefruit juice and so cannot be taken with this fruit juice as it increases the amount of midazolam in the blood. As midazolam should only be taken in the lowest amount to avoid dependence, this is not recommended.
Midazolam Hydrochloride can cause a range of side effects: aggression, rashes, vomiting, cardiac arrest and respiratory depression.
Rectal Diazepam - Diazepam
Diazepam is used in a variety of ways - for aggression, alcohol dependence and withdrawal, epilepsy, anxiety and more. My experience of Diazepam has been with rectal diazepam in order to stop prolonged tonic clonic seizures or status epilepticus. Again, although I have been trained to administer this drug, I have never actually had to. Alcohol and smoking, along with other drugs, such as Phenytoin, can interact with this drug, so taking these as well as Diazepam in not recommended.
Side effects of Diazepam are numerous and can include nausea, jaundice, gastrointestinal problems, tremors and even psychological problems and behavioural changes.
Friday, 13 April 2012
Blood Tests and other things!
I recently had a blood test to test for any sign of infection after being bitten (thankfully there's no infection!). My GP referred me for a Full Blood Count and although I couldn't get a printout of my results, I thought it'd be interesting to find out what different types of blood test there are! So here goes:
Because of the substances in blood, blood tests can be used for a wide variety of things, such as assessing organs and checking for infections. Genetic screening for conditions, such as cystic fibrosis can be done with a blood test as well, as the blood is a source of DNA.
Full Blood Count
These are the most common type of blood test and while they cannot normally give a diagnosis on their own, they are useful in testing for certain conditions, a few of which are listed below:
These are mainly used for Diabetes to check the sugar levels of a patient. There are kits that can be used at home to check glucose levels say, before and after a meal, to ensure they are the right sort of values, so as to minimise the risk of any harm being caused due to hyper or hypoglycemia. Through my work with Mencap, I've been privileged enough to see this type of blood test multiple times. It involves taking a tiny pinprick of blood from the finger.
Gene Test
Samples of DNA can be assessed to look for gene mutations that cause conditions, such as haemophilia, where the blood doesn't clot properly and cystic fibrosis, where mucus is secreted into the lungs.
Chromosome Test
This is used when a professional suspects genetics may have caused an abnormality, but are unsure of which gene is involved. In a chromosome test, the professional can examine the chromosomes directly. By looking at the number of chromosomes (there should be 23 pairs) and their shape, it may be possible to detect the genetic abnormality causing the condition. For example, if you looked at the cells of someone with Down's Syndrome, instead of a pair of Chromosome 21s, you would find 3 (hence Trisomy 21). Chromosome testing is often used where patients (often children) have developmental problems with no apparent cause.
Genetic Screening
This is used when no symptoms are present, but is to check for the possibility of conditions, such as the screening during pregnancy for Down's Syndrome and sickle cell anaemia. Huntington's disease is a genetic disorder that often reveals itself in later life. If a family member has developed Huntington's, you may wish to find out if there's a risk of you developing the disease.
There's so much to look into in blood tests, and these are just a few. I hope to look into this further soon and maybe even into Blood Groups etc, but for now I think I'm going to call it a night! Too much revision and research is making my brain go numb!
In other news, I've recently done 1:1 caring for a client with Angelman's Syndrome. This involved me being paired with him in a club nearby. His parents drove us in the car and speaking to them and seeing the client at home showed me a new side of living with learning disabilities that I had not seen before. Speaking to his parents about the activities he likes, how he often communicates and how his condition was first diagnosed (what was initially thought of as febrile convulsions turned out to be Epilepsy and Angelman Syndrome) on his first birthday made me think about coping with conditions in a home setting, rather than just a work. It also made me think more about the cuts to the public sector, and services that many people locally use, such as Mencap.
Because of the substances in blood, blood tests can be used for a wide variety of things, such as assessing organs and checking for infections. Genetic screening for conditions, such as cystic fibrosis can be done with a blood test as well, as the blood is a source of DNA.
Full Blood Count
These are the most common type of blood test and while they cannot normally give a diagnosis on their own, they are useful in testing for certain conditions, a few of which are listed below:
- A low red blood cell count may be due to anaemia (iron deficiency)
- A high red blood cell count can indicate problems with the lung or kidney.
- A low white blood cell count can indicate problems with the bone marrow, such as leukaemia.
- A high white blood cell count can indicate some sort of infection in the body, as white blood cells are part of the immune response and so deal with infections.
These are mainly used for Diabetes to check the sugar levels of a patient. There are kits that can be used at home to check glucose levels say, before and after a meal, to ensure they are the right sort of values, so as to minimise the risk of any harm being caused due to hyper or hypoglycemia. Through my work with Mencap, I've been privileged enough to see this type of blood test multiple times. It involves taking a tiny pinprick of blood from the finger.
Gene Test
Samples of DNA can be assessed to look for gene mutations that cause conditions, such as haemophilia, where the blood doesn't clot properly and cystic fibrosis, where mucus is secreted into the lungs.
Chromosome Test
This is used when a professional suspects genetics may have caused an abnormality, but are unsure of which gene is involved. In a chromosome test, the professional can examine the chromosomes directly. By looking at the number of chromosomes (there should be 23 pairs) and their shape, it may be possible to detect the genetic abnormality causing the condition. For example, if you looked at the cells of someone with Down's Syndrome, instead of a pair of Chromosome 21s, you would find 3 (hence Trisomy 21). Chromosome testing is often used where patients (often children) have developmental problems with no apparent cause.
Genetic Screening
This is used when no symptoms are present, but is to check for the possibility of conditions, such as the screening during pregnancy for Down's Syndrome and sickle cell anaemia. Huntington's disease is a genetic disorder that often reveals itself in later life. If a family member has developed Huntington's, you may wish to find out if there's a risk of you developing the disease.
There's so much to look into in blood tests, and these are just a few. I hope to look into this further soon and maybe even into Blood Groups etc, but for now I think I'm going to call it a night! Too much revision and research is making my brain go numb!
In other news, I've recently done 1:1 caring for a client with Angelman's Syndrome. This involved me being paired with him in a club nearby. His parents drove us in the car and speaking to them and seeing the client at home showed me a new side of living with learning disabilities that I had not seen before. Speaking to his parents about the activities he likes, how he often communicates and how his condition was first diagnosed (what was initially thought of as febrile convulsions turned out to be Epilepsy and Angelman Syndrome) on his first birthday made me think about coping with conditions in a home setting, rather than just a work. It also made me think more about the cuts to the public sector, and services that many people locally use, such as Mencap.
Thursday, 29 March 2012
Epilepsy
I was in another training session for First Aid (with the Red Cross) today and we were discussing causes of unconsciousness and talked about Epilepsy. After a friend suggested to me and as I've had a fair bit of experience dealing with Epilepsy, I decided it would be my next post! As there's so much to say about Epilepsy, I'll focus on my experiences with epilepsy, but will provide basic information about other types.
Epilepsy is a complicated condition - once again one not fully understood. Sometimes damage to the brain is detected and this is believed to cause the seizures (or "fits"). This is Symptomatic epilepsy and an example would include a lady who had become epileptic after suffering head trauma (a patient who's consultation I sat in on while on Work Experience). However in other cases, epilepsy occurs with other conditions, such as learning disabilities (all my other experience dealing with epilepsy comes under this category). The learning disability hints there is some sort of brain damage, however no brain damage can be found. This is Cryptogenic epilepsy. In many cases, no obvious cause for the seizures can be found - that is, no brain damage. Seizures occur when neurones in the brain are disrupted, which causes the electrical impulses to cause the seizures.
There are many types of epilepsy. These are divided up into Partial and Generalised Seizures. The type of seizure depends on how much of the brain is affected. In Generalised Seizures, most or all of the brain is affected and, not surprisingly, in Partial seizures, only part of the brain is affected.
Partial Seizures
Partial seizures can be simple or complex. In simple partial seizures, the person will be conscious throughout the duration of the seizure, and so will remember it. In complex seizures, the person is unconscious for the seizure and can display unusual behaviours.
Generalised Seizures
There are 6 types of Generalised Seizures: Absences, Clonic, Atonic, Tonic Clonic, Myoclonic and Tonic. My experiences so far have involved Absences and Tonic Clonic seizures - so I'll focus on these in a minute. In Myoclonic jerks, the person experiences twitches as if being electrocuted. When these jerks persist and the person usually becomes unconscious, then they are experiencing a Clonic seizure. In a Tonic seizure, your muscles suddenly contract, which can cause you to fall over. In an Atonic seizure, the muscles relax, causing the person to fall to the ground.
Absences are very common and are seizures I have witnessed multiple times! During an absence, the person loses consciousness and appears to be daydreaming (which is why a lot of the time these seizures are missed). During a seizure, the person will not respond and will stare into space. Clients I work with who experience absences don't respond to name or any sort of visual stimulus (e.g. waving a hand in front of their eyes), have dilation of the pupils, cyanosis of the lips and can drop their head into their chest and blink rapidly. These seizures have also appeared to cause sudden changes in behaviours and the mood of the client, however do not always. When an absence occurs, the general approach is to quietly call their name until they come back round, especially as they can be disorientated after an absence.
Tonic Clonic seizures are what most people commonly associate with an "epileptic fit" and it is the most common type of seizure in people with epilepsy. Contractions and twitches cause the person to fall to the floor and jerk. This can involve banging their head, biting (it has been known for a person to bite their tongue very hard during a tonic clonic) and jerking their arms and legs. These normally last for up to 5 minutes, but vary depending on the person. In my experiences, they have lasted between 1 and 4 minutes. After a Tonic Clonic seizure, the person is normally fairly tired and will lay down for 10-45 minutes to recover. During a seizure, it is important to remove as many hazards as possible (without putting yourself in danger). Examples of this may include moving furniture to avoid the person causing injury to themselves or removing any objects that could cause injury. If possible, some people also put a soft object, such as a pillow, underneath the person experiencing the seizure's head in an attempt to prevent damage from repeatedly banging their head of the floor. Common drugs to be administered for Tonic Clonic include Diazepam (either rectally or through injection) and Buccal Midazolam (squirted onto the inside of the cheeks in the mouth). Thankfully, I've never had to administer either of these so far!
Status Epilepticus is where the person remains unconscious from a seizure for more than half an hour. This can be a single seizure or multiple (clusters). Medication is normally administered when this occurs or and ambulance is called as there is a risk of brain damage from a prolonged seizure.
While there is no cure for epilepsy, some people do seem to "grow out" of this condition. Most people learn to cope with it and the effects on their lives vary. For example, depending on your last seizure, you may or may not be eligible for a driving licence. AEDs (Anti-Epileptic Drugs) are prescribed to try to lessen the frequency of seizures.
There are multiple triggers, many of which are more common than the stereotypical "flashing lights" (photosensitive epilepsy), such as stress, blood sugar levels, dehydration and lack of sleep.
Epilepsy is a complicated condition - once again one not fully understood. Sometimes damage to the brain is detected and this is believed to cause the seizures (or "fits"). This is Symptomatic epilepsy and an example would include a lady who had become epileptic after suffering head trauma (a patient who's consultation I sat in on while on Work Experience). However in other cases, epilepsy occurs with other conditions, such as learning disabilities (all my other experience dealing with epilepsy comes under this category). The learning disability hints there is some sort of brain damage, however no brain damage can be found. This is Cryptogenic epilepsy. In many cases, no obvious cause for the seizures can be found - that is, no brain damage. Seizures occur when neurones in the brain are disrupted, which causes the electrical impulses to cause the seizures.
There are many types of epilepsy. These are divided up into Partial and Generalised Seizures. The type of seizure depends on how much of the brain is affected. In Generalised Seizures, most or all of the brain is affected and, not surprisingly, in Partial seizures, only part of the brain is affected.
Partial Seizures
Partial seizures can be simple or complex. In simple partial seizures, the person will be conscious throughout the duration of the seizure, and so will remember it. In complex seizures, the person is unconscious for the seizure and can display unusual behaviours.
Generalised Seizures
There are 6 types of Generalised Seizures: Absences, Clonic, Atonic, Tonic Clonic, Myoclonic and Tonic. My experiences so far have involved Absences and Tonic Clonic seizures - so I'll focus on these in a minute. In Myoclonic jerks, the person experiences twitches as if being electrocuted. When these jerks persist and the person usually becomes unconscious, then they are experiencing a Clonic seizure. In a Tonic seizure, your muscles suddenly contract, which can cause you to fall over. In an Atonic seizure, the muscles relax, causing the person to fall to the ground.
Absences are very common and are seizures I have witnessed multiple times! During an absence, the person loses consciousness and appears to be daydreaming (which is why a lot of the time these seizures are missed). During a seizure, the person will not respond and will stare into space. Clients I work with who experience absences don't respond to name or any sort of visual stimulus (e.g. waving a hand in front of their eyes), have dilation of the pupils, cyanosis of the lips and can drop their head into their chest and blink rapidly. These seizures have also appeared to cause sudden changes in behaviours and the mood of the client, however do not always. When an absence occurs, the general approach is to quietly call their name until they come back round, especially as they can be disorientated after an absence.
Tonic Clonic seizures are what most people commonly associate with an "epileptic fit" and it is the most common type of seizure in people with epilepsy. Contractions and twitches cause the person to fall to the floor and jerk. This can involve banging their head, biting (it has been known for a person to bite their tongue very hard during a tonic clonic) and jerking their arms and legs. These normally last for up to 5 minutes, but vary depending on the person. In my experiences, they have lasted between 1 and 4 minutes. After a Tonic Clonic seizure, the person is normally fairly tired and will lay down for 10-45 minutes to recover. During a seizure, it is important to remove as many hazards as possible (without putting yourself in danger). Examples of this may include moving furniture to avoid the person causing injury to themselves or removing any objects that could cause injury. If possible, some people also put a soft object, such as a pillow, underneath the person experiencing the seizure's head in an attempt to prevent damage from repeatedly banging their head of the floor. Common drugs to be administered for Tonic Clonic include Diazepam (either rectally or through injection) and Buccal Midazolam (squirted onto the inside of the cheeks in the mouth). Thankfully, I've never had to administer either of these so far!
Status Epilepticus is where the person remains unconscious from a seizure for more than half an hour. This can be a single seizure or multiple (clusters). Medication is normally administered when this occurs or and ambulance is called as there is a risk of brain damage from a prolonged seizure.
While there is no cure for epilepsy, some people do seem to "grow out" of this condition. Most people learn to cope with it and the effects on their lives vary. For example, depending on your last seizure, you may or may not be eligible for a driving licence. AEDs (Anti-Epileptic Drugs) are prescribed to try to lessen the frequency of seizures.
There are multiple triggers, many of which are more common than the stereotypical "flashing lights" (photosensitive epilepsy), such as stress, blood sugar levels, dehydration and lack of sleep.
Tuesday, 13 March 2012
Co-amoxiclav + other things!
This week I had an incident at work where a client showed extremely challenging behaviour and ended up biting me badly on my shoulder. I went to the minor injuries and was prescribed anti-biotics for a week to help prevent any infections. Since I hadn't heard of "Co-amoxiclav", I decided to look it up and see what I could find:
It's an anti-biotic in the Pencillin group and is used to treat many infections, including infections in the abdomen, kidneys, urinary tract, sinuses and more. It is a combination of Amoxicillin Trihydrate and Potassium Clavulinate. Like many anti-biotics, it works by interfering with the cell walls of bacteria, and causes holes to appear in the bacteria, causing them to die because they can't control the substances moving in and out of the cell (such as the cytoplasm). Like most medicines, there are side effects of Co-amoxiclav, such as diarrhoea, vomiting, dizziness and jaundice. Thankfully I haven't experienced any of these, but they can occur after finishing the course of anti-biotics!
Another thing that interested me this week was in Biology, where my teacher ended up getting side-tracked onto talking about high tension pneumothorax. This can be caused by several things, but he focused on small punctures of the lung, rather than the other types that can happen in the elderly and smokers or due to large punctures, such as a broken rib, stab wound or gunshot wound. His example was how some people's lungs can have a pinprick puncture when taking off in an aeroplane, due to the changes in pressure (where the volume of air increases/decreases depending on whether you're ascending or descending). This tiny puncture means that air from inspiration can enter the pleural space (chest), but is stopped from getting back into the lung. Essentially, the space outside the lungs fills up with air and can cause difficulties for breathing and circulation. My teacher also said how the windpipe is forced to the other side of the body by the air. It can become life-threatening and needs intervention immediately. This is done by essentially letting out the air from the pleural space with a valve-like mechanism.
I've also started reading another book called "Bad Science" by Ben Goldacre. It's really interesting so far and exposes all the fakes and frauds in big pharmaceutical companies and really emphasises how we can be made to believe anything through statistics.
It's an anti-biotic in the Pencillin group and is used to treat many infections, including infections in the abdomen, kidneys, urinary tract, sinuses and more. It is a combination of Amoxicillin Trihydrate and Potassium Clavulinate. Like many anti-biotics, it works by interfering with the cell walls of bacteria, and causes holes to appear in the bacteria, causing them to die because they can't control the substances moving in and out of the cell (such as the cytoplasm). Like most medicines, there are side effects of Co-amoxiclav, such as diarrhoea, vomiting, dizziness and jaundice. Thankfully I haven't experienced any of these, but they can occur after finishing the course of anti-biotics!
Another thing that interested me this week was in Biology, where my teacher ended up getting side-tracked onto talking about high tension pneumothorax. This can be caused by several things, but he focused on small punctures of the lung, rather than the other types that can happen in the elderly and smokers or due to large punctures, such as a broken rib, stab wound or gunshot wound. His example was how some people's lungs can have a pinprick puncture when taking off in an aeroplane, due to the changes in pressure (where the volume of air increases/decreases depending on whether you're ascending or descending). This tiny puncture means that air from inspiration can enter the pleural space (chest), but is stopped from getting back into the lung. Essentially, the space outside the lungs fills up with air and can cause difficulties for breathing and circulation. My teacher also said how the windpipe is forced to the other side of the body by the air. It can become life-threatening and needs intervention immediately. This is done by essentially letting out the air from the pleural space with a valve-like mechanism.
I've also started reading another book called "Bad Science" by Ben Goldacre. It's really interesting so far and exposes all the fakes and frauds in big pharmaceutical companies and really emphasises how we can be made to believe anything through statistics.
Friday, 2 March 2012
"Complications" by Atul Gawande
Recently I’ve been reading (something I don’t get the chance to do a lot of the time!) a book called “Complications” by Atul Gawande. I had Awards Evening vouchers (I won Key Stage 4 awards for Contribution to my House, getting good GSCE grades and Computing) that I had to buy a book with for my prize. This book was recommended on many sites for prospective medical students and so I bought it! It’s written by a surgical resident in the US and contains many key ideas to being a doctor, which are presented through his personal anecdotes. It’s a brilliant book – very well written by anyone’s standards – and especially good for people interested in medicine. I’d recommend it to anyone!
In this book, many interesting and complex conditions and medical treatments are discussed. These include blushing and how this can be prevented by a surgical operation, the feeling of nausea, how and why people feel pain, operations to force people to lose weight, biopsies and more. The book also focussed on aspects of being a doctor, other than the actual conditions, such as when “good doctors go bad” and the possible role of robots in future.
I’ll start with a few of the conditions I found particularly interesting:
Necrotizing Fasciitis
This is a condition I read about in the last chapter of the book (and is the freshest in my mind!), but I remember being especially fascinated by this lethal bacterial infection, partly because it’s so hard to diagnose and that we don’t know that much about it. This is caused by A Streptococcus, the bacterium that normally causes nothing more than a strep throat. However, some strains have evolved to become far more dangerous – such as this one. It is not known where exactly the bacteria come from, especially seeing as how cases of necrotizing fasciitis have developed from reported scratches (on any part of the body), after surgery, abrasions and even from punches on the arms. What I found most frightening is there are cases where no cause for infection has been found.
So what can this terrifying bacterium do? Well the press have nicknamed it the “flesh-eating bacteria” and this isn’t untrue! It invades deep under the skin (unlike cellulitis, which necrotizing fasciitis is often misdiagnosed as) and consumes any tissue it finds at a rapid rate. This leaves the tissue grey, foul and gangrenous. Without early surgical intervention, fatalities are shockingly common! Thankfully, this is a rather rare condition; however that also means it is often misdiagnosed. When the diagnosis of necrotizing fasciitis is confirmed from a sample of the infected area, the patient is taken into surgery, where all the infected tissue must be removed. This often means that limbs have to be amputated. In the case in the book – the lady with the infection went into surgery and survived with only the muscle in her leg removed. She went back to work in an office eventually and after a while could walk as well.
Sudden Infant Death Syndrome (SIDS)
This condition was particularly interesting to me because it’s another mystery to medicine. SIDS is a condition where babies die with no apparent cause of death. In a similar way that types of autism can be diagnosed as “Pervasive Development Disorder – Not Otherwise Specified”, SIDS is another diagnosis essentially meaning “we don’t really know”. In a case in the book, eight babies from one mother were diagnosed with SIDS. It is described how the pathologists can find no cause of death and so put “Undetermined” in the report. It reminded me of a case I read about in the news a few years ago, where a healthy young man dropped dead suddenly – a condition that is very rare and seems to cause people to suddenly die. This mystery fascinates me, although eventually the woman in the book admitted to counts of first degree murder by smothering her children in their sleep. In this case, there was a logical, fairly simple answer, but how do we know this is always the case?
Moving more on to the experiences Gawande showed in the book: one that particularly caught my attention, and is also fairly disturbing, is how common Anxiety and Depression Disorders are among doctors. A frightening proportion of doctors (according to Gawande’s statistics) have disorders such as Depression and alcoholism. This of course could make them unsafe to treat patients and in “Complications”, Gawande tells of a doctor he knew who started off as a fantastic surgeon, but exhaustion and Depression ended up in him losing his licence.
Gawande also talks about diagnosis and the difficulties in diagnosing. The process is meant to be a purely factual one and he went on to say how the treatment for a patient should be decided by a mathematical process that determines the likelihoods of the possible outcomes of the diagnosis and of each treatment, however he said doctors have to make decisions in the heat of the moment, when a patient walks in, when something goes wrong in an operation or when a patient takes a sudden turn for the worse. They use their gut instinct; however Gawande also said how this can be influenced. For example, in the case of necrotizing fasciitis (see above), Gawande had experienced a case of this fatal bacterium merely weeks before. He described it as one of the worse cases he’s ever seen, the patient ended up dying after his organs started failing after they operated to remove the infected tissue that had consumed much of his tissue on the left side of his torso – the back and shoulder muscle, the abdomen, etc. This previous case had meant that the diagnosis was fresh in his mind and also something he didn’t want to see again. Had this previous patient not have been admitted, Gawande thinks he may have missed the correct diagnosis on the woman who eventually survived.
This book explores many issues of being a doctor and I would thoroughly recommend it to anyone, whether they’re interested in medicine or not!
In other news, today I attended my second training session with the Red Cross. We’ve covered how to lead sessions to peers and I’ve volunteered to train younger year groups in First Aid – I look forward to posting about this training and the sessions I end up running!
Saturday, 25 February 2012
Crohn's Disease
After meeting someone who lives with this condition (affecting the digestive system), and during work experience sitting in on a patient who also has Crohn's Disease, I decided to make it the topic of my next post:
Crohn's disease is a rare condition which causes inflammation of parts of the digestive system, most commonly the small intestine (ileum) or the colon. Because of the variety of places that can become inflamed (from the mouth to the anus), there can be a huge variety of symptoms. Symptoms can also be very mild or non-existent in times of remission, but then have a sudden flare-up of immense pain. Recurring diarrhoea is a common symptom of Crohn's, as is weight loss and abdominal pain. Weight loss can be caused by the fact that pain reduces appetite, or that the intestine doesn't absorb as much food due to the inflammation. Less common symptoms include fever and vomiting.
So what causes this rare, sometimes painful, sometimes unnoticeable condition? The truth is, it's still unknown. There is evidence to suggest, as with many other conditions, that smoking plays a role. Genetics also seem to play a factor, as does whether or not the individual has had a previous infection of the digestive system. Perhaps most interestingly however, is that Crohn's is a "disease of the rich". It's far more prevalent in modern, Western societies than in poorer countries. It's also become increasingly more common since the Second World War, which suggests the environment plays a part as well. There's also some evidence to suggest that the immune system causes Crohn's Disease. In Crohn's, a special antibody (TNF) is sent into the digestive system by the immune system to kill all bacteria, even the "friendly" bacteria that are beneficial to us. Supposedly, it is this killing of friendly bacteria that can cause Crohn's.
Crohn's Disease is a chronic condition and at present there isn't any cure. Treatment is focused on relieving the symptoms. Medication is normally given, such as steroids or hormones to reduce inflammation. Immunosuppressants can also be used to reduce inflammation, however this makes the patient more vulnerable to other infections and diseases. Controlling diet can also help (there's some evidence that suggests spicy foods cause flare-ups). For many people with Crohn's, surgery is needed to treat the symptoms and repair any lasting damage caused by the disease. Surgery is needed if an anal fistula, a common complication where a channel develops between the anal canal and the skin, occurs.
There is no specific method or test for diagnosing Crohn's, but there are tests that can rule out other conditions causing the symptoms, such as blood tests, stool samples and whether or not there is a history of Crohn's disease in the family.
Crohn's disease is an example of something in Medicine that is not fully understood - currently there is no cure and the cause is unknown. Due to the lack of a specific test, diagnosis is a long procedure and the condition can also cause no discomfort, then suddenly flare up. The fact that there's so much unknown about this condition makes it more interesting, but also highlights the fact that there's still so much more to learn about humans and the conditions that can affect them.
Crohn's disease is a rare condition which causes inflammation of parts of the digestive system, most commonly the small intestine (ileum) or the colon. Because of the variety of places that can become inflamed (from the mouth to the anus), there can be a huge variety of symptoms. Symptoms can also be very mild or non-existent in times of remission, but then have a sudden flare-up of immense pain. Recurring diarrhoea is a common symptom of Crohn's, as is weight loss and abdominal pain. Weight loss can be caused by the fact that pain reduces appetite, or that the intestine doesn't absorb as much food due to the inflammation. Less common symptoms include fever and vomiting.
So what causes this rare, sometimes painful, sometimes unnoticeable condition? The truth is, it's still unknown. There is evidence to suggest, as with many other conditions, that smoking plays a role. Genetics also seem to play a factor, as does whether or not the individual has had a previous infection of the digestive system. Perhaps most interestingly however, is that Crohn's is a "disease of the rich". It's far more prevalent in modern, Western societies than in poorer countries. It's also become increasingly more common since the Second World War, which suggests the environment plays a part as well. There's also some evidence to suggest that the immune system causes Crohn's Disease. In Crohn's, a special antibody (TNF) is sent into the digestive system by the immune system to kill all bacteria, even the "friendly" bacteria that are beneficial to us. Supposedly, it is this killing of friendly bacteria that can cause Crohn's.
Crohn's Disease is a chronic condition and at present there isn't any cure. Treatment is focused on relieving the symptoms. Medication is normally given, such as steroids or hormones to reduce inflammation. Immunosuppressants can also be used to reduce inflammation, however this makes the patient more vulnerable to other infections and diseases. Controlling diet can also help (there's some evidence that suggests spicy foods cause flare-ups). For many people with Crohn's, surgery is needed to treat the symptoms and repair any lasting damage caused by the disease. Surgery is needed if an anal fistula, a common complication where a channel develops between the anal canal and the skin, occurs.
There is no specific method or test for diagnosing Crohn's, but there are tests that can rule out other conditions causing the symptoms, such as blood tests, stool samples and whether or not there is a history of Crohn's disease in the family.
Crohn's disease is an example of something in Medicine that is not fully understood - currently there is no cure and the cause is unknown. Due to the lack of a specific test, diagnosis is a long procedure and the condition can also cause no discomfort, then suddenly flare up. The fact that there's so much unknown about this condition makes it more interesting, but also highlights the fact that there's still so much more to learn about humans and the conditions that can affect them.
Monday, 20 February 2012
Work Experience - GP Surgery #2!
I was lucky enough to get another placement at a different GP Surgery this week! It was only for one day (revising for mocks/a show meant I couldn't do much more), but certainly a long one (10 hours) and was well worthwhile! I saw lots of variation in patients and the conditions I met seemed to be completely different to the ones I saw at my other placement. I spent part of the day with one GP, another GP, the District Nurse and the Practice Nurse, so certainly saw a range of people!
GP - Dr Robins
I spent the morning with Dr Robins. He was really friendly and helpful towards me, giving me a quick briefing on patients just before they came in. Obviously as before, we had to ask their permission for me to sit in, and most said they were fine with it. In the morning, I mostly saw acute problems, which contrasted with the chronic problems, such as Depression, COPD and Heart Disease I saw at my other placement.
One of the first patients I saw was a mother concerned about her baby, who had had a nappy rash for 2 weeks, which had "angry spots" and hadn't gone away, despite the persistent application of Sudacrem. Dr Robins examined the baby's bottom and diagnosed a Thrush infection, caused by the bacteria called Candida. There are many other types of Thrush, such as oral and vaginal thrush, which are caused by the same bacteria.
Another patient was a boy called George, whose mother had noticed a lump on his back. Dr Robins examined the lump, firstly by looking and feeling it, then looking at with with a magnifying glass. He concluded it was a Sebaceous Cyst. Sebaceous Cysts are closed "sacs" beneath the skin which usually contain Sebum. Although mostly harmless, they tend to increase in size and can get infected. Dr Robins recommended that if George wanted to have it removed, or if the cyst became infected he should come back to the Surgery. Sebaceous Cysts can be removed in two main ways: Advanced Electrolysis, where a current is put through to the cyst to kill it before it's ingested naturally by the body, or by surgery. One type of surgery removes the cyst whole and results in scarring, but a more modern method drains the fluid from the cyst before removing the wall. This results in less scarring, and so for this reason many patients prefer this. Advanced Electrolysis results in virtually no scarring, however it can only be used on small cysts that have not been recurrently infected.
District Nurse - Susie Collins
After that, visits with the District Nurse. Firstly: an elderly woman who had been previously diagnosed with Hypertension. Susie checked her blood pressure, which wasn't at extreme levels and so we shortly left.
The next stop was less medical, but still very interesting and involved a patient, called Mrs Gale. Mrs Gale refused support from Social Services and denied needing it. However, her friend had been looking after her and her house for her, especially since she'd been ill with a chest infection. She was sometimes incontinent, incapable of washing her clothes, sheets and herself and also incapable of preparing food for herself. Susie spoke to Social Services to arrange 2 weeks of free care for Mrs Gale, who was ensured it was just to help her while she was ill. An assessment was arranged for that evening.
Being with the District Nurse was an entirely different scenario to sitting in or even accompanying GPs on visits. It seemed less science-based and included more social and care issues than being a GP. Susie repeatedly told me that the sole purpose of the District Nurses, who are employed by the Health Authority, not the surgery, was to keep patients out of hospital. They never see patients in the surgery.
Practice Nurse - Megan Johnson
I spent the next few hours with the Practice Nurse. Once again, this was less scientific than when I sat in with the GP. The Practice Nurse dealt with a range of patients, but another key difference was that patients booked appointments with the Nurse and stated what for - the Practice Nurse knows what she has to do before the patient comes through the door. The first patient I saw was travelling to South Africa and Zambia and wanted to ensure she was up to date with all her jabs, which due to her interest in travelling abroad, she was. To name a few of the vaccines required for the travelling the patient wished to do: Yellow Fever, Hepatitis A and Hepatitis B.
The next patient had been routinely coming to the Practice Nurse for about 6 years. He had severe leg ulcers, which had been exacerbated by obesity and hypertension. The ulcers had become infected multiple times, which had resulted in very slow healing. Megan dressed the ulcers with compression bandages, which aim to control the blood pressure in the leg.
GP - Dr Carter
Dr Carter saw acute and chronic problems. These mostly took the form of injuries, such as sprains (acute) and various aches (chronic), usually arisen from activities such as going to the gym and weightlifting, running and cycling. For most of these, Dr Carter recommended rest and in some cases swimming to help alleviate the pain (this was for more chronic pains though).
I really enjoyed my placement - being with the Practice and District Nurses was definitely another worthwhile experience and being with more GPs was also extremely valuable! Dr Robins said he often performed minor surgery on Thursdays, however when I went unfortunately it was cancelled. I'd love to go back (if I can fit it in with my school timetable!) one Thursday afternoon to see this! It sounded really interesting!
GP - Dr Robins
I spent the morning with Dr Robins. He was really friendly and helpful towards me, giving me a quick briefing on patients just before they came in. Obviously as before, we had to ask their permission for me to sit in, and most said they were fine with it. In the morning, I mostly saw acute problems, which contrasted with the chronic problems, such as Depression, COPD and Heart Disease I saw at my other placement.
One of the first patients I saw was a mother concerned about her baby, who had had a nappy rash for 2 weeks, which had "angry spots" and hadn't gone away, despite the persistent application of Sudacrem. Dr Robins examined the baby's bottom and diagnosed a Thrush infection, caused by the bacteria called Candida. There are many other types of Thrush, such as oral and vaginal thrush, which are caused by the same bacteria.
Another patient was a boy called George, whose mother had noticed a lump on his back. Dr Robins examined the lump, firstly by looking and feeling it, then looking at with with a magnifying glass. He concluded it was a Sebaceous Cyst. Sebaceous Cysts are closed "sacs" beneath the skin which usually contain Sebum. Although mostly harmless, they tend to increase in size and can get infected. Dr Robins recommended that if George wanted to have it removed, or if the cyst became infected he should come back to the Surgery. Sebaceous Cysts can be removed in two main ways: Advanced Electrolysis, where a current is put through to the cyst to kill it before it's ingested naturally by the body, or by surgery. One type of surgery removes the cyst whole and results in scarring, but a more modern method drains the fluid from the cyst before removing the wall. This results in less scarring, and so for this reason many patients prefer this. Advanced Electrolysis results in virtually no scarring, however it can only be used on small cysts that have not been recurrently infected.
District Nurse - Susie Collins
After that, visits with the District Nurse. Firstly: an elderly woman who had been previously diagnosed with Hypertension. Susie checked her blood pressure, which wasn't at extreme levels and so we shortly left.
The next stop was less medical, but still very interesting and involved a patient, called Mrs Gale. Mrs Gale refused support from Social Services and denied needing it. However, her friend had been looking after her and her house for her, especially since she'd been ill with a chest infection. She was sometimes incontinent, incapable of washing her clothes, sheets and herself and also incapable of preparing food for herself. Susie spoke to Social Services to arrange 2 weeks of free care for Mrs Gale, who was ensured it was just to help her while she was ill. An assessment was arranged for that evening.
Being with the District Nurse was an entirely different scenario to sitting in or even accompanying GPs on visits. It seemed less science-based and included more social and care issues than being a GP. Susie repeatedly told me that the sole purpose of the District Nurses, who are employed by the Health Authority, not the surgery, was to keep patients out of hospital. They never see patients in the surgery.
Practice Nurse - Megan Johnson
I spent the next few hours with the Practice Nurse. Once again, this was less scientific than when I sat in with the GP. The Practice Nurse dealt with a range of patients, but another key difference was that patients booked appointments with the Nurse and stated what for - the Practice Nurse knows what she has to do before the patient comes through the door. The first patient I saw was travelling to South Africa and Zambia and wanted to ensure she was up to date with all her jabs, which due to her interest in travelling abroad, she was. To name a few of the vaccines required for the travelling the patient wished to do: Yellow Fever, Hepatitis A and Hepatitis B.
The next patient had been routinely coming to the Practice Nurse for about 6 years. He had severe leg ulcers, which had been exacerbated by obesity and hypertension. The ulcers had become infected multiple times, which had resulted in very slow healing. Megan dressed the ulcers with compression bandages, which aim to control the blood pressure in the leg.
GP - Dr Carter
Dr Carter saw acute and chronic problems. These mostly took the form of injuries, such as sprains (acute) and various aches (chronic), usually arisen from activities such as going to the gym and weightlifting, running and cycling. For most of these, Dr Carter recommended rest and in some cases swimming to help alleviate the pain (this was for more chronic pains though).
I really enjoyed my placement - being with the Practice and District Nurses was definitely another worthwhile experience and being with more GPs was also extremely valuable! Dr Robins said he often performed minor surgery on Thursdays, however when I went unfortunately it was cancelled. I'd love to go back (if I can fit it in with my school timetable!) one Thursday afternoon to see this! It sounded really interesting!
Sunday, 12 February 2012
House Plays
It's been a couple of weeks since I've posted! This is more of an excuse for that rather than one that's factual/account/both! The last 2 weeks have been insane! I was involved with House Plays - a competition at school where Year 12s are given a budget of £50 and are told to make a play with only Year 10 members.
As I'm Year 12, I was co-director and we were doing Beauty & The Beast. I worked with lots of Year 12s and 10s and had a brilliant time (and our performance on the night was brilliant as well!). It definitely put a lot of of pressure on me - I had to make sure I organised my time in order to keep up with all of my schoolwork/work etc. Having said that, I absolutely loved it!
In other news, I've got Work Experience lined up at another GP Surgery in the next week - so I look forward to posting about that soon!!
As I'm Year 12, I was co-director and we were doing Beauty & The Beast. I worked with lots of Year 12s and 10s and had a brilliant time (and our performance on the night was brilliant as well!). It definitely put a lot of of pressure on me - I had to make sure I organised my time in order to keep up with all of my schoolwork/work etc. Having said that, I absolutely loved it!
In other news, I've got Work Experience lined up at another GP Surgery in the next week - so I look forward to posting about that soon!!
Sunday, 29 January 2012
When Doctors Prescribe Too Much - My Experience with Phenytoin
The last few weeks have been interesting at work. Most of the time, I've been working with a client who was born with Hydrocephalus and is also epileptic. He has tonic clonic seizures about every week or so, of which I've witnessed a few. He also has trouble with his bowels and so has been on Imodium and Phenytoin (for the seizures) since I started working with him in the Summer.
However, a few weeks ago, his dosage of Phenytoin was increased. While on shift, I noticed he'd become extremely unstable on his feet. He would fall back down after standing up and fall over occasionally - a sign that normally meant he was about to have a seizure. Looking through his communication book, it appeared everyone had noticed the same thing because each day the words "Michael has been very wobbly today" were written. Each time I came on shift and saw him wobbly, I thought he might have a seizure yet he never did. It had also been noticed that Michael hadn't been eating very well.
However, the definitive moment (and one that I'll never forget!) came one night when I was working with him. We were walking down the stairs and Michael dropped something. He attempted to pick it up but, due to his unsteadiness, rolled down the stairs. This deeply embarrassed Michael and so he started showing challenging behaviour (hitting etc). After he'd calmed down however, I checked him for any signs of injury and other than a few scratches he appeared alright. I wrote about the accident several times (in the many different books) and informed night staff and on call, who were to keep an eye on him just to make sure there were no serious injuries.
Over the next few days, similar things happened to Michael, albeit not on the stairs, and he seemed to be losing his appetite. He was taken for a blood test at the hospital and when the results came back the next morning, the levels of Phenytoin were found to be too high and so his dosage was dropped again. Since then, Michael has had further blood tests to ensure the dosage now is now the correct one and hasn't been showing any of the symptoms of the dosage being too high.
Phenytoin is an anti-convulsant, used to treat tonic clonic seizures in epileptic patients by slowing down the impulses in the brain. It can come in tablet, both chewable and non-chewable form and also in suspension (as a liquid). There are many side effects to Phenytoin - some more serious than others. Depression and thoughts of suicide can occur as well as the loss of balance, co-ordination and appetite that Michael displayed, especially when the dosage is too high.
This whole case really brought it home to me the importance of pooling knowledge. Friends and family, or in this case support workers and Michael's key worker, need to monitor medication carefully and let doctors know of anything that seems out of the ordinary.
However, a few weeks ago, his dosage of Phenytoin was increased. While on shift, I noticed he'd become extremely unstable on his feet. He would fall back down after standing up and fall over occasionally - a sign that normally meant he was about to have a seizure. Looking through his communication book, it appeared everyone had noticed the same thing because each day the words "Michael has been very wobbly today" were written. Each time I came on shift and saw him wobbly, I thought he might have a seizure yet he never did. It had also been noticed that Michael hadn't been eating very well.
However, the definitive moment (and one that I'll never forget!) came one night when I was working with him. We were walking down the stairs and Michael dropped something. He attempted to pick it up but, due to his unsteadiness, rolled down the stairs. This deeply embarrassed Michael and so he started showing challenging behaviour (hitting etc). After he'd calmed down however, I checked him for any signs of injury and other than a few scratches he appeared alright. I wrote about the accident several times (in the many different books) and informed night staff and on call, who were to keep an eye on him just to make sure there were no serious injuries.
Over the next few days, similar things happened to Michael, albeit not on the stairs, and he seemed to be losing his appetite. He was taken for a blood test at the hospital and when the results came back the next morning, the levels of Phenytoin were found to be too high and so his dosage was dropped again. Since then, Michael has had further blood tests to ensure the dosage now is now the correct one and hasn't been showing any of the symptoms of the dosage being too high.
Phenytoin is an anti-convulsant, used to treat tonic clonic seizures in epileptic patients by slowing down the impulses in the brain. It can come in tablet, both chewable and non-chewable form and also in suspension (as a liquid). There are many side effects to Phenytoin - some more serious than others. Depression and thoughts of suicide can occur as well as the loss of balance, co-ordination and appetite that Michael displayed, especially when the dosage is too high.
This whole case really brought it home to me the importance of pooling knowledge. Friends and family, or in this case support workers and Michael's key worker, need to monitor medication carefully and let doctors know of anything that seems out of the ordinary.
Hepatitis B - Need to get that jab!
While working this week, I was bitten on the cheek (not my best experience of work I must say!). The skin was slightly broken and I've been left with a small mark for the rest of the week, but the whole thing reminded me I need to organise my Hep B (Hepatitis B) jab, one that I'm recommended to have seeing as how I work in a house where clients with disabilities live. I decided I'd look into what I was actually being vaccinated against and here's what I found:
Hepatitis B is an infection of the liver (Hepa being Liver, itis meaning inflammation or disease) and is one of multiple strains of the virus that can infect the liver - hence A, B, C etc. Someone becomes infected with the virus when they come into contact with it through someone else's blood or bodily fluids and has not been vaccinated. Because of how it's spread, the virus is predominantly thought to be caught through unprotected sex, but can also be caught by sharing toothbrushes, razors and other objects that are contaminated with blood. Hepatitis is also more common in certain parts of the world, so medical treatment with unsterilised instruments abroad can also result in infection.
So how come I'm recommended to have the vaccination? Well because I work with people with learning disabilities, including in a supported living home, I run the risk of being bitten and scratched at work - which as I said previously I have! Because of this contact, there is a risk of my contracting the virus.
Symptoms of Hepatitis B won't emerge till at least 40 days after exposure to the virus, although a lot of people don't show any symptoms while they have the virus. However, until their body has fought it off, they can still pass it on. The main symptoms include nausea, general flu-like symptoms, jaundice and aches, especially in the upper right side of the body and appetite and weight loss. Normally symptoms don't last longer than a few months, but the infection is said to be chronic if symptoms last longer than 6 months.
So how is it treated? Well those who display symptoms can take PRN medication, such as Ibuprofen or Paracetamol. Codeine may be prescribed by a doctor if the pain is more severe and nausea is generally treated with metoclopramide. Regular blood tests and physical checkups will be required while the patient is displaying symptoms and afterwards to ensure the infection is gone and they don't develop Chronic Hepatitis B. Medication is normally only required for Chronic Hepatitis B to prevent damage to the liver, however not all sufferers of Chronic Hepatitis B need this medication. Chronic Hepatitis can go on to cause liver cancer, fulminant hepatitis B (where the immune system attacks the liver) and cirrhosis (scarring).
For full protection, I'll need 3 jabs in the next 4-6 months - thankfully I'm not scared of needles! My immunity will then be tested a month after the third dose to ensure the vaccination has worked.
Hepatitis B is an infection of the liver (Hepa being Liver, itis meaning inflammation or disease) and is one of multiple strains of the virus that can infect the liver - hence A, B, C etc. Someone becomes infected with the virus when they come into contact with it through someone else's blood or bodily fluids and has not been vaccinated. Because of how it's spread, the virus is predominantly thought to be caught through unprotected sex, but can also be caught by sharing toothbrushes, razors and other objects that are contaminated with blood. Hepatitis is also more common in certain parts of the world, so medical treatment with unsterilised instruments abroad can also result in infection.
So how come I'm recommended to have the vaccination? Well because I work with people with learning disabilities, including in a supported living home, I run the risk of being bitten and scratched at work - which as I said previously I have! Because of this contact, there is a risk of my contracting the virus.
Symptoms of Hepatitis B won't emerge till at least 40 days after exposure to the virus, although a lot of people don't show any symptoms while they have the virus. However, until their body has fought it off, they can still pass it on. The main symptoms include nausea, general flu-like symptoms, jaundice and aches, especially in the upper right side of the body and appetite and weight loss. Normally symptoms don't last longer than a few months, but the infection is said to be chronic if symptoms last longer than 6 months.
So how is it treated? Well those who display symptoms can take PRN medication, such as Ibuprofen or Paracetamol. Codeine may be prescribed by a doctor if the pain is more severe and nausea is generally treated with metoclopramide. Regular blood tests and physical checkups will be required while the patient is displaying symptoms and afterwards to ensure the infection is gone and they don't develop Chronic Hepatitis B. Medication is normally only required for Chronic Hepatitis B to prevent damage to the liver, however not all sufferers of Chronic Hepatitis B need this medication. Chronic Hepatitis can go on to cause liver cancer, fulminant hepatitis B (where the immune system attacks the liver) and cirrhosis (scarring).
For full protection, I'll need 3 jabs in the next 4-6 months - thankfully I'm not scared of needles! My immunity will then be tested a month after the third dose to ensure the vaccination has worked.
Sunday, 22 January 2012
Work Experience - GP Surgery - Dr Harrison
Fortunately, I have been privileged enough to get some valuable work experience in a GP Surgery! I'd arranged to spend a few days in the school holidays shadowing a GP both in clinic and on visits. I had to agree to confidentiality, something which I'm used to in my work with Mencap. We also had to ask patients' permission for me to sit in on their appointments and many of them were happy to have me there, with quite a few of them telling me about their condition and how it affects their day to day life. During my time there, I saw many cases of COPD, Heart Disease, Eczema, colds and Depression, some of which are discussed below:
On the Monday I arrived at the surgery and immediately began shadowing Dr Harrison, who handed me a copy of the "GP Handbook", so I could look up conditions as we saw them. I saw lots of different conditions, ranging from Depression to sports injuries. One patient we saw came in complaining of an aching elbow. He had a history of tendonitis in his elbow, due to weight lifting. It had been recommended that he stop weight training to prevent further damage, but he'd continued. This caused a repetitive strain injury with inflammation around the elbow called medial epicondylitis, also known as "Golfer's Elbow". It was strongly advised that he give up weight lifting for a time to prevent even further damage.
There was one patient who really stood out as a particularly interesting one to me however. We also saw this patient on the Monday and perhaps what first drew my attention to her was the fact she had epilepsy - a condition I'm very used to. It had been caused by a head trauma in childhood, however this was not why she was here. She agreed to have me in the room and her partner spoke to Dr Harrison.
The patient, Mrs Kite, had been suffering from Depression on and off throughout her life, the most recent case being after an incident that occurred at her work where she was attacked and had since been off work. Her partner said she was having trouble motivating herself to do basic tasks, such as get out of bed, prepare food and even eat. She seemed to spend most of her time in bed, simply not doing anything. Mrs Kite said she simply did not feel motivated enough to get up each morning or to look after herself. She was extremely skinny and had suffered severe weight loss recently and had developed a tremor, especially on her left side. This was exaggerated when she elevated her arm or tried to pick objects up. Mrs Kite's partner had also noticed what seemed to be a slight loss of memory, although the patient didn't agree. The patient was prescribed a further course of anti-depressants, which she was recommended to take and see how she felt. It was agreed the patient would then be reviewed in the next few weeks again. However, before the next appointment Mrs Kite was hospitalised due to a sudden deterioration and it was suspected that Mrs Kite had Creutzfeldt-Jakob Disease - known commonly as "Mad Cow Disease" - a fatal condition that's very rare in humans and causes damage to the brain, which can lead to Depression & anxiety disorders, tremors and an inability to speak or look after one's self.
As well as neurological disorders and illnesses, patients came in with infections. One patient had had a C-section to deliver a baby a few weeks before and also has Diabetes and suffered from obesity. Where the stitch in body folds was, an infection and rash had occurred: Intertrigo. A topical antifungal was prescribed by Dr Harrison and all seemed fairly straight forward, if a good example of some of the not-so-appealing parts of medicine!
I accompanied the doctor on visits, one of which was to an old people's home. The patient was in a very vulnerable state and could not talk, move or fulfil basic personal needs such as eating without support. It was known the patient was going to die soon - she was very old and very frail - but as the GP, Dr Harrison had to visit her every 2 weeks, so that if she died, there would be no coroner's report. This gave me a brief insight and opened my eyes to the legalities doctors face.
While shadowing Dr Harrison, I saw some very interesting cases and learnt a lot! As it was my first actual experience in a medical workplace, I wanted to make sure I really wanted to do this for the rest of my life... and I really enjoyed it! Dr Harrison said one of the highlights of being a GP was that you look after the same patients for years - in some cases even 3 generations of the same family! You get to see them grow, something which is tremendously rewarding!
On the Monday I arrived at the surgery and immediately began shadowing Dr Harrison, who handed me a copy of the "GP Handbook", so I could look up conditions as we saw them. I saw lots of different conditions, ranging from Depression to sports injuries. One patient we saw came in complaining of an aching elbow. He had a history of tendonitis in his elbow, due to weight lifting. It had been recommended that he stop weight training to prevent further damage, but he'd continued. This caused a repetitive strain injury with inflammation around the elbow called medial epicondylitis, also known as "Golfer's Elbow". It was strongly advised that he give up weight lifting for a time to prevent even further damage.
There was one patient who really stood out as a particularly interesting one to me however. We also saw this patient on the Monday and perhaps what first drew my attention to her was the fact she had epilepsy - a condition I'm very used to. It had been caused by a head trauma in childhood, however this was not why she was here. She agreed to have me in the room and her partner spoke to Dr Harrison.
The patient, Mrs Kite, had been suffering from Depression on and off throughout her life, the most recent case being after an incident that occurred at her work where she was attacked and had since been off work. Her partner said she was having trouble motivating herself to do basic tasks, such as get out of bed, prepare food and even eat. She seemed to spend most of her time in bed, simply not doing anything. Mrs Kite said she simply did not feel motivated enough to get up each morning or to look after herself. She was extremely skinny and had suffered severe weight loss recently and had developed a tremor, especially on her left side. This was exaggerated when she elevated her arm or tried to pick objects up. Mrs Kite's partner had also noticed what seemed to be a slight loss of memory, although the patient didn't agree. The patient was prescribed a further course of anti-depressants, which she was recommended to take and see how she felt. It was agreed the patient would then be reviewed in the next few weeks again. However, before the next appointment Mrs Kite was hospitalised due to a sudden deterioration and it was suspected that Mrs Kite had Creutzfeldt-Jakob Disease - known commonly as "Mad Cow Disease" - a fatal condition that's very rare in humans and causes damage to the brain, which can lead to Depression & anxiety disorders, tremors and an inability to speak or look after one's self.
As well as neurological disorders and illnesses, patients came in with infections. One patient had had a C-section to deliver a baby a few weeks before and also has Diabetes and suffered from obesity. Where the stitch in body folds was, an infection and rash had occurred: Intertrigo. A topical antifungal was prescribed by Dr Harrison and all seemed fairly straight forward, if a good example of some of the not-so-appealing parts of medicine!
I accompanied the doctor on visits, one of which was to an old people's home. The patient was in a very vulnerable state and could not talk, move or fulfil basic personal needs such as eating without support. It was known the patient was going to die soon - she was very old and very frail - but as the GP, Dr Harrison had to visit her every 2 weeks, so that if she died, there would be no coroner's report. This gave me a brief insight and opened my eyes to the legalities doctors face.
While shadowing Dr Harrison, I saw some very interesting cases and learnt a lot! As it was my first actual experience in a medical workplace, I wanted to make sure I really wanted to do this for the rest of my life... and I really enjoyed it! Dr Harrison said one of the highlights of being a GP was that you look after the same patients for years - in some cases even 3 generations of the same family! You get to see them grow, something which is tremendously rewarding!
Sunday, 15 January 2012
Glue Ear And Eustachian Tube Dysfunction - My Childhood Years!
Yesterday I went to the outpatients clinic for my yearly check-up on my hearing due to a condition I had when I was a lot younger. After 10 years I've been discharged and thought it would be good to find out what actually went on with my right ear when I was younger!
When I was 5, my parents were concerned with my hearing. They'd noticed I seemed to have the TV unusually loud all the time and often had difficulty hearing them calling me/in conversation. After many ear infections, I was referred to an ENT specialist, was diagnosed with Glue Ear in my right ear and have been a regular visitor to the outpatient clinic since!
The eustachian tube is what's responsible for draining mucus and fluid away from your ear and also providing air to your eardrum to equalise pressure in the middle ear. Since mine was faulty, neither of these things could happen. This meant my middle ear filled up with fluid, which was watery at first, but then became thick (hence the name "Glue Ear"). This fluid muffled my hearing, as it stopped the eardrum and the surrounding bones that are necessary for hearing from vibrating. Since my eustachian tube was blocked, the pressure inside my middle ear was less than outside, which sucked my eardrum in. Again, this stopped the eardrum from vibrating, muffling my hearing, and also stretching the eardrum.
Whereas most cases of Glue Ear are caused by a cold and so disappear naturally in a few months, my hearing was persistently muffled. It was decided necessary for surgical intervention, and so in late 2002 , I had a grommet inserted. Grommets are small tubes inserted through the eardrum designed to drain any fluid and also allow air to pass into the middle ear. They are put in under general anaesthetic in an operation that only takes about 15 minutes, which meant I could leave hospital that day. Although normally the grommet falls out naturally due to the eardrum healing in about a year, mine stayed in for nearly 3!
This grommet solved the problem of Glue Ear and fluid build-up, but my Eustachian Tube was still dysfunctional. The remaining problem was the problem of ear pressure. My eardrum was still being sucked into my ear, causing muffled hearing and stretching of the eardrum. This created a pocket, which they wanted to monitor. Ear infections were less common, but still occurred. I was to have 2 appointments a year to outpatients, one of which would also involve a hearing test to monitor my hearing. I was also given the treatment of autoinflation, which involves blowing up a special balloon by your nose in an attempt to push the eardrum out. After a while, this was discontinued and I was told to pop my ears a few times a day.
When I was 10, I had a cold and was in/out of school for about 2 weeks. After 2 weeks of feeling ill/feeling better, I went into school on the Friday, but developed a severe ear ache. After 2 long, extremely painful hours, I was taken home, where I lay in bed screaming. All of a sudden the pain was gone and there was fluid coming out of my ear. I was taken to the GP surgery and was told my eardrum has burst due to the excessive build up of fluid caused by the cold. This obviously meant I couldn't hear in my right ear.
After a few months it healed and I went back to outpatients for my appointment. My eardrum was still being sucked in due to the faulty Eustachian Tube. I still had a pocket that they wanted to monitor, even though I never had another ear infection after that. It looked as though my hearing wasn't going to deteriorate, so my appointments became yearly at the age of 12.
Yesterday, at the age of 16, I saw the original consultant I saw those 10 years ago (appropriate ending!) and after looking at my eardrum and my hearing test results, he concluded that my eustachian tube was now working, as my eardrum was no longer being sucked in. Due to this, he discharged me! However, he advised me there was still a pocket in my eardrum caused by all those years of being sucked into the middle ear that was vulnerable to infection and could mean a deterioration in my hearing.I was told to pop my ears multiple times a day to try to push out the pocket, and that if I was ever to have an ear infection or get concerned with my hearing, I had to come back.
When I was 5, my parents were concerned with my hearing. They'd noticed I seemed to have the TV unusually loud all the time and often had difficulty hearing them calling me/in conversation. After many ear infections, I was referred to an ENT specialist, was diagnosed with Glue Ear in my right ear and have been a regular visitor to the outpatient clinic since!
The eustachian tube is what's responsible for draining mucus and fluid away from your ear and also providing air to your eardrum to equalise pressure in the middle ear. Since mine was faulty, neither of these things could happen. This meant my middle ear filled up with fluid, which was watery at first, but then became thick (hence the name "Glue Ear"). This fluid muffled my hearing, as it stopped the eardrum and the surrounding bones that are necessary for hearing from vibrating. Since my eustachian tube was blocked, the pressure inside my middle ear was less than outside, which sucked my eardrum in. Again, this stopped the eardrum from vibrating, muffling my hearing, and also stretching the eardrum.
Whereas most cases of Glue Ear are caused by a cold and so disappear naturally in a few months, my hearing was persistently muffled. It was decided necessary for surgical intervention, and so in late 2002 , I had a grommet inserted. Grommets are small tubes inserted through the eardrum designed to drain any fluid and also allow air to pass into the middle ear. They are put in under general anaesthetic in an operation that only takes about 15 minutes, which meant I could leave hospital that day. Although normally the grommet falls out naturally due to the eardrum healing in about a year, mine stayed in for nearly 3!
This grommet solved the problem of Glue Ear and fluid build-up, but my Eustachian Tube was still dysfunctional. The remaining problem was the problem of ear pressure. My eardrum was still being sucked into my ear, causing muffled hearing and stretching of the eardrum. This created a pocket, which they wanted to monitor. Ear infections were less common, but still occurred. I was to have 2 appointments a year to outpatients, one of which would also involve a hearing test to monitor my hearing. I was also given the treatment of autoinflation, which involves blowing up a special balloon by your nose in an attempt to push the eardrum out. After a while, this was discontinued and I was told to pop my ears a few times a day.
When I was 10, I had a cold and was in/out of school for about 2 weeks. After 2 weeks of feeling ill/feeling better, I went into school on the Friday, but developed a severe ear ache. After 2 long, extremely painful hours, I was taken home, where I lay in bed screaming. All of a sudden the pain was gone and there was fluid coming out of my ear. I was taken to the GP surgery and was told my eardrum has burst due to the excessive build up of fluid caused by the cold. This obviously meant I couldn't hear in my right ear.
After a few months it healed and I went back to outpatients for my appointment. My eardrum was still being sucked in due to the faulty Eustachian Tube. I still had a pocket that they wanted to monitor, even though I never had another ear infection after that. It looked as though my hearing wasn't going to deteriorate, so my appointments became yearly at the age of 12.
Yesterday, at the age of 16, I saw the original consultant I saw those 10 years ago (appropriate ending!) and after looking at my eardrum and my hearing test results, he concluded that my eustachian tube was now working, as my eardrum was no longer being sucked in. Due to this, he discharged me! However, he advised me there was still a pocket in my eardrum caused by all those years of being sucked into the middle ear that was vulnerable to infection and could mean a deterioration in my hearing.I was told to pop my ears multiple times a day to try to push out the pocket, and that if I was ever to have an ear infection or get concerned with my hearing, I had to come back.
Tuesday, 10 January 2012
Training Courses
Working as a member of staff at West Berkshire Mencap, I have to attend training sessions regularly. Below are a brief summary of the training sessions I have attended and a few things they've taught me.
Buccal Midazolam/Rectal Diazepam & Epilepsy Awareness
In this training sessions we learned when and how to administer these 2 drugs and also basic knowledge about Epilepsy, which is a neurological disorder that causes various types of seizures, such as tonic clonic, myoclonic and absences. Buccal Midazolam and Rectal Diazepam are used to stop convulsions of a seizures, which if prolonged can cause brain damage and severe muscle damage. The people I work with use Buccal Midazolam after 5 minutes of a tonic clonic seizure. So far I've never had to administer either medication.
Medication Theory
This is a training course where after the theory part, you are assessed in your practical skills in administering medicine to clients. In the theory part, we discussed the laws surrounding medication in supported living. The main things I took away from this training were that gloves MUST be worn when handling any medication, even tablets and that we cannot administer any medication, even non-prescribed, PRN (administer when necessary) drugs, such as E45 cream, without written consent from the client's GP, no matter whether the parents have given permission or not.
Something we discussed that had never occurred to me, but I took particular interest in was the issue of chewing tablet medication. Each tablet/capsule has a certain coating, such as enteric or film coated, which affects when the coating is broken down and thus when the medication absorbed into the bloodstream. For example, if a tablet has an enteric coating, which is designed to dissolve in the non-acid conditions in the intestine, it will be broken down in the intestine and absorbed into the body only then. However, if the tablet is chewed or crushed, this leaves a surface of the drug without the coating, meaning it will be absorbed into the body before reaching the intestine, which would affect the medication's effectiveness and duration.
This course gave me direct insight into how medicines must be administered and also how they are designed, such as the coating, in order to fit their purpose.
Safeguarding Children
This was a course I had to do to work with children. It ran through the procedure of reporting suspected child abuse and how to identify it. We looked at famous case studies of child abuse where the result was death of a child, such as "Baby P".
Buccal Midazolam/Rectal Diazepam & Epilepsy Awareness
In this training sessions we learned when and how to administer these 2 drugs and also basic knowledge about Epilepsy, which is a neurological disorder that causes various types of seizures, such as tonic clonic, myoclonic and absences. Buccal Midazolam and Rectal Diazepam are used to stop convulsions of a seizures, which if prolonged can cause brain damage and severe muscle damage. The people I work with use Buccal Midazolam after 5 minutes of a tonic clonic seizure. So far I've never had to administer either medication.
Medication Theory
This is a training course where after the theory part, you are assessed in your practical skills in administering medicine to clients. In the theory part, we discussed the laws surrounding medication in supported living. The main things I took away from this training were that gloves MUST be worn when handling any medication, even tablets and that we cannot administer any medication, even non-prescribed, PRN (administer when necessary) drugs, such as E45 cream, without written consent from the client's GP, no matter whether the parents have given permission or not.
Something we discussed that had never occurred to me, but I took particular interest in was the issue of chewing tablet medication. Each tablet/capsule has a certain coating, such as enteric or film coated, which affects when the coating is broken down and thus when the medication absorbed into the bloodstream. For example, if a tablet has an enteric coating, which is designed to dissolve in the non-acid conditions in the intestine, it will be broken down in the intestine and absorbed into the body only then. However, if the tablet is chewed or crushed, this leaves a surface of the drug without the coating, meaning it will be absorbed into the body before reaching the intestine, which would affect the medication's effectiveness and duration.
This course gave me direct insight into how medicines must be administered and also how they are designed, such as the coating, in order to fit their purpose.
Safeguarding Children
This was a course I had to do to work with children. It ran through the procedure of reporting suspected child abuse and how to identify it. We looked at famous case studies of child abuse where the result was death of a child, such as "Baby P".
West Berkshire Mencap
Since July 2009, I've been volunteering at West Berkshire Mencap for Children's Services. I've regularly attended After School Club, Holiday Playschemes and organised entertainment for Youth Club and Gateway (a club for adults with learning disabilities). The After School Club and Holiday Playscheme sessions involve me being paired 1 to 1 with a child who attends that session. It's my job to make sure that child enjoys themselves! During my time with Children's Services I have had experience with many different conditions, mainly Autism and Down's Syndrome, but also Angelman Syndrome, Cerebral Palsy, Asperger's and also comorbid conditions, such as Autism and William's Syndrome (a genetic development disorder that often causes learning disorders and is strongly characterised by specific facial features) and developmental delays with severe allergies. A few of the conditions I have had experience with are discussed in separate blogs.
In June 2011, I successfully applied for a job at West Berkshire Mencap. This involved paid work with adults and children and more responsibilities, such as handling medication. The most unfamiliar part of the job was providing 1 to 1 care for adults with learning disabilities in supported living, which includes administering medication and assisting with personal care. Many of the clients I support also regularly displayed challenging behaviours.
My work with West Berkshire Mencap has been immensely rewarding! Although extremely challenging at times, my involvement has been one of the best choices I've made. It's given me a huge experience of disabilities, conditions and interaction with people that I definitely didn't have before. I've always been told that Medicine is an extremely rewarding career, but is also very challenging and hard-going at times, which I feel is a parallel to my work with people with learning disabilities. There are times when things aren't so good, but specific positive moments make up for all the negative ones!
In November, my House Head nominated me for the "West Berkshire Junior Citizen of the Year Award" for my contribution to West Berkshire Mencap. I was amazed when he handed me a letter congratulating me on winning the overall award, mainly due to the fact I wasn't even aware that this award existed, let alone that I'd been nominated!
In June 2011, I successfully applied for a job at West Berkshire Mencap. This involved paid work with adults and children and more responsibilities, such as handling medication. The most unfamiliar part of the job was providing 1 to 1 care for adults with learning disabilities in supported living, which includes administering medication and assisting with personal care. Many of the clients I support also regularly displayed challenging behaviours.
My work with West Berkshire Mencap has been immensely rewarding! Although extremely challenging at times, my involvement has been one of the best choices I've made. It's given me a huge experience of disabilities, conditions and interaction with people that I definitely didn't have before. I've always been told that Medicine is an extremely rewarding career, but is also very challenging and hard-going at times, which I feel is a parallel to my work with people with learning disabilities. There are times when things aren't so good, but specific positive moments make up for all the negative ones!
In November, my House Head nominated me for the "West Berkshire Junior Citizen of the Year Award" for my contribution to West Berkshire Mencap. I was amazed when he handed me a letter congratulating me on winning the overall award, mainly due to the fact I wasn't even aware that this award existed, let alone that I'd been nominated!
Monday, 9 January 2012
Angelman Syndrome
After volunteering at West Berkshire Mencap for some time, I've met a variety of conditions that cause learning disabilities, one of which, is Angelman Syndrome:
There's a boy who regularly attends the After School Club and the Holiday Playschemes, called James, who has Angelman Syndrome, a condition which causes severe learning disabilities. Angelman is most commonly caused by a deletion of Chromosome 15, when the deleted gene comes from the in mother. Angelman Syndrome is paired with Prada-Willi Syndrome, which occurs when this deletion is inherited paternally. The gene defect that causes Angelman Syndrome is on UBE3A and can also cause Angelman Syndrome through translocation, as well as deletion/inactivation of this gene.
Angelman was discovered by Dr Harry Angelman. It was previously called "Puppet Syndrome", which came about after Dr Angelman saw an Italian picture of a smiling boy holding a drawing. He believed this also described the jerky, hand-flapping movements many people with Angleman Syndrome display. People with Angelman Syndrome are sometimes referred to as "angels", partly due to the name of the condition, but also partly to do with how they appear much younger than "mainstream" students or adults without Angelman Syndrome.
There are many symptoms of Angelman Syndrome, many of which I have noticed in James. He has severe learning difficulties and has no speech, other than stringing together the 3 noises of "ba", "ga" and "ma". Mental retardation common in Angelman Syndrome, with many people with this condition being able to learn only a few words at best. However, many find other ways of non-verbal communication, such as Makaton an/or PECs. James only communicates by pointing to things, such as at snack time, where he will point to what he wants (often choosing Skips!). James also has an unsteady gait, another common symptom of Angelman Syndrome. James was very late learning to walk and due to this and his lack of balance, he has a buggy which he is often strapped into to go long distances, such as when we went to Thorpe Park. James also appears to be in a very good mood most of the time, which is another common occurence in people with Angelman Syndrome. James' apparent happy demeanour means that he laughs and smiles a lot and also gives lots of people hugs. James also has an obsession with water. This occured to me when we had a day trip out of TVAP, an adventure playground specifically designed for children and adults with learning disabilities. We spent the whole day (5 hours) playing with the water jets, which he appeared to absolutely love. He was giggling and laughing the whole time! this fascination with water is also common in people with Angelman Syndrome, although there is no obvious cause of this.
James also has epilepsy. He takes regular medication for this. He has absences multiple times everyday and these occur more frequently when under certain conditions, such as if he's too hot or cold or hasn't had enough food or drink. An absence is where the person temporarily loses consciousness. They are unaware of this and these types of seizures only last a few seconds normally. Many absences are mistaken for daydreaming, as they have no response while in this seizure. For James, absences are common and result in his head dropping suddenly and his eyelids fluttering. When these seizures happen, we gently stroke James' arm and quietly call his name until we have a response, such as a smile or when he lifts his head. We do things gently to minimise confusion for him when he comes out of the absence. James also suffers rare tonic clonic seizures, and due mainly to this he wears a padded helmet (other than in bed and when in a padded play area) to protect his head in case he has a tonic clonic seizure and falls. Tonic clonic seizures are the ones most commonly associated with epilepsy, and are also called "drop fits" as the person loses control and has full body convulsions. This can often result in injury from falling, or from the convulsions, such as biting their tongue, and sometimes incontinence. Although I have never witnessed James have a tonic clonic seizure, I have witnessed many of his absences.
Working with James has been something that I have immensely enjoyed! It's been extremely rewarding and due to his generally happy demeanour, James is lots of fun to work with! After working with him many times, he's started giving me hugs when he sees me, whether I'm working with him that session or not! It's made me see how rewarding helping people is - something which I wish to continue by studying Medicine.
There's a boy who regularly attends the After School Club and the Holiday Playschemes, called James, who has Angelman Syndrome, a condition which causes severe learning disabilities. Angelman is most commonly caused by a deletion of Chromosome 15, when the deleted gene comes from the in mother. Angelman Syndrome is paired with Prada-Willi Syndrome, which occurs when this deletion is inherited paternally. The gene defect that causes Angelman Syndrome is on UBE3A and can also cause Angelman Syndrome through translocation, as well as deletion/inactivation of this gene.
Angelman was discovered by Dr Harry Angelman. It was previously called "Puppet Syndrome", which came about after Dr Angelman saw an Italian picture of a smiling boy holding a drawing. He believed this also described the jerky, hand-flapping movements many people with Angleman Syndrome display. People with Angelman Syndrome are sometimes referred to as "angels", partly due to the name of the condition, but also partly to do with how they appear much younger than "mainstream" students or adults without Angelman Syndrome.
There are many symptoms of Angelman Syndrome, many of which I have noticed in James. He has severe learning difficulties and has no speech, other than stringing together the 3 noises of "ba", "ga" and "ma". Mental retardation common in Angelman Syndrome, with many people with this condition being able to learn only a few words at best. However, many find other ways of non-verbal communication, such as Makaton an/or PECs. James only communicates by pointing to things, such as at snack time, where he will point to what he wants (often choosing Skips!). James also has an unsteady gait, another common symptom of Angelman Syndrome. James was very late learning to walk and due to this and his lack of balance, he has a buggy which he is often strapped into to go long distances, such as when we went to Thorpe Park. James also appears to be in a very good mood most of the time, which is another common occurence in people with Angelman Syndrome. James' apparent happy demeanour means that he laughs and smiles a lot and also gives lots of people hugs. James also has an obsession with water. This occured to me when we had a day trip out of TVAP, an adventure playground specifically designed for children and adults with learning disabilities. We spent the whole day (5 hours) playing with the water jets, which he appeared to absolutely love. He was giggling and laughing the whole time! this fascination with water is also common in people with Angelman Syndrome, although there is no obvious cause of this.
James also has epilepsy. He takes regular medication for this. He has absences multiple times everyday and these occur more frequently when under certain conditions, such as if he's too hot or cold or hasn't had enough food or drink. An absence is where the person temporarily loses consciousness. They are unaware of this and these types of seizures only last a few seconds normally. Many absences are mistaken for daydreaming, as they have no response while in this seizure. For James, absences are common and result in his head dropping suddenly and his eyelids fluttering. When these seizures happen, we gently stroke James' arm and quietly call his name until we have a response, such as a smile or when he lifts his head. We do things gently to minimise confusion for him when he comes out of the absence. James also suffers rare tonic clonic seizures, and due mainly to this he wears a padded helmet (other than in bed and when in a padded play area) to protect his head in case he has a tonic clonic seizure and falls. Tonic clonic seizures are the ones most commonly associated with epilepsy, and are also called "drop fits" as the person loses control and has full body convulsions. This can often result in injury from falling, or from the convulsions, such as biting their tongue, and sometimes incontinence. Although I have never witnessed James have a tonic clonic seizure, I have witnessed many of his absences.
Working with James has been something that I have immensely enjoyed! It's been extremely rewarding and due to his generally happy demeanour, James is lots of fun to work with! After working with him many times, he's started giving me hugs when he sees me, whether I'm working with him that session or not! It's made me see how rewarding helping people is - something which I wish to continue by studying Medicine.
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