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.
Saturday, 25 February 2012
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!!
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