A Full House

This week has certainly been an exciting one, and not only because of the preparation in the build up to my first interview at Glasgow next week. On Tuesday, I received an email inviting me to the selection centre at Warwick in March, which I had not really been expecting after finding out they were putting more weighting on the verbal reasoning section of the UKCAT. So I was thinking "time to give up on Birmingham, can't get 4 out of 4 interviews", but then on Wednesday I got an interview invite from them! Feeling extremely chuffed and literally cannot believe it! The main thing I need to concentrate on now is confidence and to try and learn from each one to improve for the next. 

Wish me luck!

Mother and baby let down by maternity hospital

A week ago (Tuesday 2nd), a mother and her 4-day-old baby went missing from St Michael's maternity hospital in my home city of Bristol. CCTV had shown Charlotte Bevan had left the hospital in hospital slippers and her daughter wrapped in just hospital blankets. On the Wednesday evening, Charlotte's body was found on the Avon Gorge and the body of baby Zaani was found the next day.

This is a moving and truly tragic story, but what is striking is how it was possible for Charlotte to leave the hospital. The CCTV footage shows Charlotte passing at least 4 members of staff whilst carrying her baby, but they did not even notice her. And where was security? After much criticism surrounding the care of Charlotte Bevan, University Hospitals Bristol Trust is launching a thorough review into the care of Charlotte and her daughter.

Image: BBC

Charlotte Bevan had a history of depression and schizophrenia, and was severely sleep deprived. Why was nobody monitoring her? The trust have said patients are free to come and go from the hospital, but nobody even questioned where she was going. At the newly built Brunel building at Southmead hospital this would not have happened as members of staff and security question anyone trying to leave the hospital. The hospital failed to identify a mother and baby at risk, and once again mental illness is overlooked as such as serious problem.

This tragedy happened just days before the firework display on Sunday to celebrate 150 years of the Suspension Bridge in Bristol. A minutes silence was held before the display to pay respect to Charlotte and Zaani, as well as the others who have taken their own life at this local landmark.

What a week!

So, last Friday I received an email from UCAS for track notification, which usually seems to mean a straight rejection if you hear from UCAS and not directly from the university. However, it was an interview from Glasgow for December! Then this week, I received an email from Edinburgh offering me an interview for January! Unbelievably happy and excited! This means now every day where I'm not working 12 and a half hour shifts at the hospital, I am doing preparation for these interviews. I'm still waiting to hear from Birmingham and Warwick, but no rejections so far! Wish me luck!

National Health Service Bill

Today, members of parliament are debating a bill that could undo some of the negative consequences of the 2012 Health and Social Care Act, brought in by the Health Secretary Andrew Lansley, which saw a huge reorganisation of the NHS towards privatisation. The National Health Service (Amended Duties and Powers) Bill 2014-2015, which is being brought forward by Labour MP Clive Efford, proposes to repeal parts of the NHS reform and halt privatisation.

The Bill consists of 14 clauses, which can be seen here. It includes removing hospitals' ability to earn 49% of their income from private patients, which has been reported to have risen 10% since 2010. It also exempts the NHS from the Transatlantic Trade and Investment Partnership (TTIP), which would have allowed transnationals to bid for government spending on heath, causing a number of negative consequences (for more information, see my previous post: Stop TTIP).

The Royal College of Nursing and the British Medical Association are in favour of the Bill, but are MPs likely to back it?

UPDATE (23/11/2014)

The result of the debate for the Bill found it was backed by 241 votes to 18 that opposed. Those in favour included two Conservative and seven Lib Dem MPs, as well as newly elected UKIP MP Mark Reckless. However, as a private member's bill, it has very little chance of becoming a law.

Week 3 and settling in

Just finished week 3 on the job and getting the hang of it now. Last week had been immensely tiring as it was a 4 day week of 12.5 hour shifts and all I'd wanted to do on my days off was stay in bed and do nothing! This week has been much better - feeling more independent and comfortable with my role and the routine of the day. Additionally, not feeling horrendously tired getting up at 5.45am!

Had a little scare this week when I was helping to feed a patient and had to pull the emergency bell, which causes all the members of staff to come running! It turned out he was having a seizure, but everything turned out fine. The situation reinforced the importance of acting fast when you see any change in behaviour.

First day on the job

Yesterday I had my first shift as a healthcare assistant on the Neurosurgery ward at Southmead, 7am-7.30pm! It wasn’t a particularly great day, but I guess that is only expected when starting a new job. As I don't have my manual handling course until later this week, there was a lot of things I am not allowed to do yet. This was really frustrating, as I felt completely useless when I was asked to help with such tasks. The two-week induction and training had not fully prepared me, as it is very different being shown a presentation on something and actually doing it in real life! It's a lot more about learning on the job. When I got home I was completely knackered, but I'm looking forward to when the job is second nature to me. 

Ebola - is a pandemic around the corner?

With an increasing number of cases and deaths of the Ebola virus in West Africa and the recent growing threat of spread to other countries, this post is long overdue. Here is what you need to know about Ebola, how and why it is spreading, and the future outlook for the virus.

What is the Ebola virus?

Signs & symptoms start 2 days – 3 weeks after contracting the virus. Early symptoms include a fever, sore throat, muscle pain and headaches, followed by vomiting, diarrhoea and rash, then decreased liver and kidney function. Internal and external bleeding may also occur. Death usually occurs around 6-16 days after symptoms begin, due to low blood pressure from fluid loss.

Image: Wikipedia

How is Ebola contracted?

The virus is spread by contact with blood and other bodily fluids of someone who is infected. This may also occur indirectly, by contact with a contaminated item.

How did the outbreak start?

The outbreak started in West Africa, with the first case being reported in March 2014 in Guinea. A week later, cases were reported in Liberia and Sierra Leone. In July, the first case was reported in Nigeria after a man travelled there from the Liberian capital. In August, the virus was then reported in Senegal. In the past, epidemics have not become a pandemic, as travel was less frequent. But now, there are around 6 million people travelling by plane everyday, meaning that the risk of a virus spreading around the world is much greater.

Image: BBC

Where has the virus spread?

In August, a Spanish priest died from Ebola in a hospital in Madrid, and in early October, a nurse who treated the priest contracted the virus and also died. In September, the Liberian Thomas Duncan flew to Dallas in Texas, via Brussels and Washington after trying to help women with Ebola in his home country. Days later, Duncan went to hospital reporting of fever and abdominal pain and was sent home despite telling the nurse he travelled from West Africa! After 2 days, he was admitted to hospital with the virus, and died on October 8^th. Since Duncan’s death, two nurses who treated him have tested positive for Ebola, despite precautionary measures. The day before the second nurse was diagnosed, she flew from Ohio to Texas through two international airports, despite having a fever.  Therefore, disease control specialists are being sent to Ohio to help monitor people she came into contact with. However, as the virus is not airborne, the risk to others on the flights is low but officials are trying to trace those on the flight.

How many have died?

The virus has killed nearly 4,500 people so far, with more cases and more deaths than all other outbreaks combined.

Image: CNN

What treatments are there for the virus?

There are no specific treatments available yet. Zmapp is an experimental drug that was effective on monkeys but tests on humans were less conclusive. The UK, US and Canada are currently trying to develop a vaccine, with the aim of 20,000 doses that could be used in West Africa in early 2015.

What is being done to prevent the spread of the virus?

According to an American group who is monitoring the spread of the disease, the UK is the third-most-likely country outside of Africa to “import” Ebola. Although there are no flights entering the UK directly from the worst affected areas of West Africa, there is still a risk. On October 14^th, London Heathrow airport began screening travellers from West Africa, and this will later be extended to Gatwick airport and the Eurostar. Passengers travelling from Sierra Leona, Guinea and Libreria will be referred to health workers to have their temperature taken and be questioned to establish whether they may have come into contact with anyone infected with Ebola. However, as the incubation period for symptoms is three weeks, it will be difficult to detect. The WHO say it may be more effective to screen people on exit from a country. America may take a more extreme approach, as some lawmakers are calling for a ban to travellers from West African countries hit hardest by Ebola. 

Image: The Guardian

What does the future look like for Ebola?

“I’ve just projected that about five weeks into the future and if current trends persist, we would be seeing not hundreds of cases per week, but thousands of cases per week and that is terribly disturbing” says Dr Dye of the World Health Organisation. The WHO are estimating 20,000 cases before the end, but this is described as optimistic by some scientists. The WHO are also saying it could be contained in six to nine months, but with 40% of deaths being over the last three weeks and cases increasing exponentially, just 20,000 cases seems unlikely.

Fear of waking up

A few weeks ago, I woke up from a nightmare to see the vivid white outline of the top half of a baby floating on the other side of the room. Naturally, I was absolutely petrified and thought I had seen a ghost. As it was the week before my UKCAT, I knew I needed to sleep, so I slept in another room. Since my test I have been sleeping at my Dad’s house whilst my Mum is on holiday in America. During my two weeks at my Dad’s, I have woken three times from bad dreams to see the face of the baby on the other side of the room. It was not as vivid as when I had seen it at my Mum’s house, so I thought it must just be my imagination projecting the image of this baby.

Image: Deviant Art

Tomorrow, I move back to my Mum’s house, which was slightly scaring me. So I decided to have a quick look on Google about hallucinations when waking, which I found were called hypnopompic hallucinations. These commonly occur when waking from a nightmare. They can also occur when falling asleep, which are called hyponagogic hallucinations. There seem to be lots of stories online of people seeing shapes and colours (see below), as well as spiders, dogs and also people. But when you see a person, how can you really know if it’s a ghost or a hallucination? As the experiences at my Dad’s house did not seem as real, it’s hard to know if these hallucinations are now just happening because of what I saw at my Mum’s house.

Image: No sleepless nights

Research suggests that these hallucinations are linked to sleep disorders, particularly insomnia. Since I came back from university 4 months ago, I haven’t been sleeping very well, but this had never happened before. It’s possible that I had been worried leading up to the UKCAT and submitting my UCAS application, so I had not sleeping as well. It appears that these types of hallucinations are part of everyday life for much of the population, with one third experiencing them at least twice a week. However, I hope this doesn’t become a regular occurrence for me. Next week I am starting the training for my HCA job and when I start work I will be doing 12 hour days starting at 7am – so hopefully I will be tired enough to sleep through the night without these disturbances!

Submitted!

So yesterday I finally came to the decision as to where I was going to apply for medicine, and submitted my UCAS form! In the end I went for Birmingham and Warwick graduate, and Edinburgh and Glasgow undergraduate. I had really wanted to apply for Kings graduate programme, and thought my UKCAT score might just be good enough to be selected for interview, but decided it was too risky. The UKCAT scores are released to universities at some point in November. After that comes the agonising months of waiting to hear back - wish me luck!

Getting ready to start!

Two months after having my interview at Southmead hospital and being offered the job of health care assistant in the neurosciences ward, things seem to be actually happening! For some reason references and paperwork took a while, but last week I was told that I would start my induction on October 13^th.

Today, I went in to meet my ward manager and have a look round the ward. I hadn’t been in the new Brunel building at Southmead and I was amazed at how big it is. The ward consists of 32 beds – two 4-bed bays, and 24 individual rooms. Due to the individual rooms, it means the ward is very big, which I was told makes the job a lot more difficult, with lots of walking around. I had been worried about footwear, but the ward manager informed me that since the move to the new building they had allowed all-black trainers.

I have now received the information for my induction that takes place over a couple of weeks. This includes: two days of corporate induction going over policies, safeguarding etc.; 3 days of clinical induction, which includes patient safety and clinical equipment training; 3 days of Foundation in care; adult basic life support; dementia level 2; and a manual handling training session.

This means I won’t actually start on the ward until near the end of October, but I am excited to get started with the training and hopefully it will make me feel more at ease about the job!

Stoptober

Tomorrow is October 1^st, which means the beginning of Stoptober – the 28-day stop smoking challenge. Nearly a quarter of a million people in England and Wales signed up last year and research has shown that stopping smoking for 28 days makes you 5 times more likely to stay smoke-free.

More than 79,000 deaths per year in England are due to smoking-related causes. 90% of lung cancer cases are due to smoking, and it can also cause cancer in other parts of the body. It also damages your heart and circulation, putting you at risk of coronary heart disease, heart attack, stroke and vascular diseases. Additionally, it puts your lungs at risk of chronic bronchitis, emphysema, pneumonia and chronic obstructive pulmonary disease (COPD). So your health is an obvious reason to give up smoking. 

The effect on your body after you stop smoking:

Stopping smoking does not only have a beneficial impact on your health. The average smoker has 13 cigarettes per day - 364 in 4 weeks. Therefore, Stoptober would save you £141 and a whole year without smoking saves you £1,696!

Stopping smoking is not only adding years onto your life, it's saving you money to spend in those years. To sign up, go to https://stoptober.smokefree.nhs.uk. 

The result...

After my last couple of UKCAT practices not going very well, especially in the quantitative section, I had started to panic slightly. But I attempted to remain positive, thinking "it will all come together on the day", and today was it! So here it is...

735 band 1

Verbal - 610

Quantitative - 790

Abstract - 760

Decision - 780

I had been hoping for around the 750 mark, but still very happy with my score. Massive improvement from last year for the verbal and quantitative sections - no idea how quantitative managed to be my highest scoring section! 

For the test statistics to date for this year's test cycle, this puts me in the top 10%! So hopefully there won't be loads of amazing people taking the test between now and the end of the test period!

HPV vaccine for boys?

Since 2008, a vaccine against the human papilloma virus (HPV) has been routinely offered to girls age 12 and 13 as part of the NHS childhood vaccination programme. However, it has been criticised that it is not offered routinely for boys. Currently, if parents want their sons vaccinated, they have to pay £450.

There are more the 100 different types of HPV, and the virus is easily spread by sexual activity. It can cause the common STI genital warts, cervical cancer, as well as cancer of the vagina, anus, penis and mouth. The vaccine Garsidil protects against two types of HPV, which cause more the 70% of cervical cancer cases in the UK.

At the moment, there are regional variations of girls being vaccinated, with 96% in some areas, compared to just 62% in others. Researchers at GSK found that the national uptake of the vaccine is 86%. Experts have said that if 96% of girls across the UK had the vaccine, then 198 cervical cancer cases and 87 deaths could be prevented every year. With 14% of girls not being vaccinated, herd immunity cannot be achieved, which puts many girls and boys at risk.

As boys are not offered the vaccine, this puts them at risk when having sex with the 14% who have not been vaccinated in the UK. Additionally, men are at risk if they are sexually active with men, or with those from countries where the vaccine is not available. More than 2,000 cases of cancer in men are caused by HPV each year. Extending the vaccination programme to boys would outweigh the costs of treating HPV-related diseases.

Scientific experts are meeting to discuss whether boys should also be offered the vaccination against HPV. However, they are investigating whether to extend to it boys, or men who have sex with men, or both. This is absurd as vaccinating only gay men seems extremely unfair to heterosexual men and also women who were over the age to be routinely offered the HPV vaccination. The fairest solution would be to introduce the HPV vaccination to adolescent boys.

First stages

As the medicine UCAS deadline of October 15^th looms closer, the various components of the application are slowly coming together. Yesterday I started my UCAS application, which is a very lengthy process to go through every exam result from GCSE, through A level modules and then my degree! And today, after about 7 drafts and trying to be within the limit, I may have finally finished my personal statement. I now have just 3 days left until I take the UKCAT, so these will be spent doing the last practice tests I have to hopefully prepare me for it! Once I have my UKCAT result, I will then be able to decide which universities are best to apply for – so fingers crossed!

Resisting Alzheimer's

Alzheimer’s disease has a prevalence of 850 per 100,000 people and is the most common form of dementia. Dementia causes deficits in memory, cognitive function and language (for more information on dementia, see my previous post - http://my-medical-musings.blogspot.co.uk/2014/09/dementia-in-news.html).

Image: Upright Health

Alzheimer’s disease is caused by a loss of neurons in the brain, but it is not completely understood why this happens. The dominant theory is the “amyloid hypothesis”, which suggests that proteins misfold, causing fibrous aggregates known as plaques. Pathophysiology may also include oligomers, which are formed in the production of the amyloid plaques. The oligomers are thought to cause toxicity by disrupting cell membranes, causing them to die. Additionally, tau deposits are also thought to contribute. These neurofibrillary tangles interrupt signal transmission between neurons, leading to cell death.

Image: Brain Athlete

There are few drug current treatments for Alzheimer’s that target neurotransmitters, but their efficacy is not great. Therefore, researchers are looking at targeting processes that cause pathophysiology. A recent article in Nature Neuroscience reveals how researchers at the University of California may be in the early stages of understanding how the brain may be able to fight early damage.

The study involved 71 adults with no signs of mental decline memorising a series of pictures in detail and later recalling them whilst their brain activity was recorded. Results found that of those with amyloid deposits, better recall correlated with increased brain activity. The researchers suggested that their brains were able to adapt to compensate for early damage caused by the protein. Whilst this is a significant finding, more research is needed for further understanding of how people react to amyloid differently and the next stage will be to test those with Alzheimer’s disease.  

One researcher suggested “people who spend a lifetime involved in cognitively stimulating activity have brains that are better able to adapt to potential damage”. So keep doing that sudoku, no matter how long it takes you – just keep the brain active!

MISSING: Cerebellum!

A woman, age 24, was admitted to hospital in China after complaining of dizziness and nausea, only to find she had part of her brain missing. Her mother reported she had not walked until age 7 and she had not been able to walk steadily her whole life. A CAT scan revealed that she had no cerebellum and that the space was instead filled with cerebrospinal fluid.

Top image: Normal brain showing cerebellum (http://myweb.tiscali.co.uk/ataxia.pages/)

Bottom image: Brain missing cerebellum (Feng Yu et al.)

The cerebellum modifies motor commands in order to maintain balance and posture, coordinate voluntary movements, and it plays a part in motor learning and cognitive functions. Although it represents 10% of the brain’s total volume, it contains 50% of its neurons.

Only a few are known to have lived without the entire cerebellum, but it usually causes severe mental impairment, motor disorders or epilepsy. However, this woman only had a moderate motor deficiency, and despite her speech only becoming understandable at age 7, she only had mild speech problems.

The doctors suggest that normal cerebellar function may have been taken over by the cortex, showing how plastic the brain is, being able to compensate for such an important part.

Dementia in the news

Dementia is becoming an increasingly common topic amongst news stories on health and a poll has revealed that nearly 60% of over 50s in the UK are more scared of developing dementia than cancer. The ageing population means more people are being diagnosed as they are living longer. However, a health study reported this week that twice as many people in the UK are developing dementia before the age of 65. The research showed that there are thousands of early-onset dementia sufferers in their 40s, as well as more than 700 in their 30s!

Dementia is a term used to describe a set of symptoms that are caused by brain conditions, the most common form being Alzheimer’s disease. Such diseases do not only affect the elderly, and therefore, need to be recognised in younger generations. Early symptoms of dementia include: lack of initiative/interest, changes in personality/mood, misplacing things, problems with keeping track of things, poor judgement, distortion of time or place, language problems, difficulty performing familiar tasks (e.g. dressing), and the most obvious symptom – memory loss. However, younger people with these symptoms may be reluctant to report such symptoms to the doctor, as they may be afraid of the stigma surrounding dementia. Therefore, they may fear that they will be discriminated against, especially in the workplace.

It was also reported this week by researchers from the Alzheimer’s Society that patients with dementia are effectively paying a “dementia tax”. They found that on average £32,242 was spent a year on care for a patient with dementia, but only around one third came from the NHS or council funds. The other two-thirds came from private care services or in the form of unpaid care. Those with cancer or heart problems get all their care for paid by the NHS, which seems unfair. However, the cost of caring for those with dementia is increasing due to the ageing population, so it would be extremely costly to the NHS to pay the full cost of care.

Dementia has also been in the news this week for being linked to use of anxiety and sleeping pills. This was found in a study of 2,000 people aged over 66 with Alzheimer’s disease in Quebec, Canada, compared with 7,000 healthy individuals of the same age. They found that the use of benzodiazepines for longer than the recommended 12 weeks was linked to a 51% increased risk of dementia. However, they did not find an underlying reason behind the link and suggested a limitation of the study was that anxiety and sleep disturbance are early symptoms of Alzheimer’s disease.

New rules on the pitch

The lack of immediate medical treatment for players who suffered head clashes at this year’s FIFA World Cup has sparked a lawsuit, brought about by a group of players and parents in the US. The group are asking for the rules of football to be changed to allow better prevention and management of head injuries and concussion. It is thought that three bouts of concussion could cause permanent brain damage and heading the ball repeatedly may reduce cognitive function.

The Premier League has introduced new rules on how to deal with head injuries, starting in the 2014-15 season. The policy states that a player suffering a head injury must now leave the pitch and the club doctor must decide whether the player is able to continue, not the team management. If there is a confirmed or a suspected loss of consciousness, the player will not be allowed to return to play. Home teams must also have a third “tunnel” doctor to support the doctor of each side. Furthermore, a campaign is to be launched to make players and managers aware of the dangers of head injuries and players must undergo baseline neurological assessments as part of their annual medical check-up.

England players help to promote the FA head injury campaign

However, this does not fully the tackle the risks associated with head-to-ball contact. In 2002, Jeff Astle, the former West Bromwich Albion player and England striker, died at age 59 due to chronic traumatic encephalopathy. This degenerative brain condition is usually associated with boxers, but in this case, it is thought that it was caused by heading footballs. After a long-running campaign, Astle’s family met with FA chairman Greg Dyke in August and the Football Association has agreed to research into head injuries in the sport. Although footballs are much lighter than those used in the 1960s when Astle was playing, footballs can travel up to around 60mph in a professional match. Therefore, these blows to the head can still have a serious impact on the brain, even though they are not severe enough to cause concussion. Not only is it thought to cause cognitive impairment; it is also likely to have an effect on memory. Studies have shown that those heading the ball more often performed worse on memory tasks and tests of their attention span. Furthermore, those who were frequent “headers” showed obvious signs of mild traumatic brain injury on scans.

Some researchers argue that head trauma is usually due to the head clashes when players are going to head to ball, rather than the contact with the ball. Nevertheless, these studies show that head injuries in football can have very serious consequences. The research the FA has agreed to is likely to reveal more information into the dangers of heading the ball. However, long-term studies are needed to assess the lasting effects. It has been suggested that young footballers should be limited on how often they can head the ball. Will there be a time in the future where there are restrictions on the number of times professional players are allowed to head the ball?

Ashya King - neglect?

On Saturday it was reported that parents took their 5-year-old son suffering from a brain tumour from hospital, against medical advice. After medical staff from Southampton General Hospital informed the police that Ashya King was in “grave danger”, an international search was launched and Hampshire Constabulary obtained a European arrest warrant. Additionally, Ashya was made ward of court, which means he is appointed a guardian by the court.

The family were found in the city of Malaga in Spain on Saturday evening, where they have an apartment. The parents were arrested the same day and taken to a prison just outside Madrid, whilst 5-year-old Ashya was taken to a hospital in Malaga.

The European arrest warrant was granted on the grounds of neglect as the parents had been advised that Ashya’s condition would become critical if he was removed from hospital. One major concern was that the battery in his feeding device would run out. However, Ashya’s older brother posted a video on YouTube explaining that they were charging the device in the car on the journey to Spain and they had the same resources available as in the hospital, as they were able to order them online. He also explained that they had travelled to Spain to sell their property in order to fund a treatment provided in the Czech Republic, called Proton Beam Therapy. This is a form of radiation therapy that uses beams of protons directed more precisely at the tumour than other conventional treatments. The beams stop once they hit the target, which supposedly causes less damage to the surrounding tissue.

Ashya’s parents refused consent to their extradition to the UK, and are remaining in custody for 72 hours while the High Court Judge considers granting bail. Ashya’s six siblings were unable to visit their brother as he was under police guard. This meant the 5-year-old was alone, and unable to speak or understand any Spanish. However, yesterday afternoon Ashya’s eldest brother was allowed to visit him.

The family and the public have criticised the police’s approach to finding Ashya and his parents, saying it was a “ridiculous chase” and “cruel” that the parents are being “treated like fugitives”. However, the intention of seeking alternative treatment was not known during the search for the family on Saturday, and the police were just going by what they were told by Southampton General Hospital.

It is understandable that it was instinct for the parents to try and do what is best for their child. Ashya’s parents made it clear they are willing to do whatever is necessary for their son’s health, as they consented to blood transfusions during an operation two months ago, which in the end was not needed. However, removing Ashya from hospital against medical advice was irresponsible. Not only would travelling by car from the UK to Spain be tiring and stressful for Ashya, but also his family were unable to properly monitor his condition, which could have put him at great risk. Ashya’s parents attempted to discuss the use to proton beam therapy with the doctors at Southampton General Hospital, but ignored their judgement that the treatment was unsuitable for their son. Nevertheless, they could have informed the hospital that the clinic in the Czech Repeublic had agreed to assess whether Ashya was eligible so that arrangements could have been made for Ashya to be safely transported from the UK.

Despite what may be interpreted as neglect, it is critical that the situation resolves. Ashya will be scared, confused and missing his parents. The family needs to be reunited and it is vital that communication is made between the family, Southampton General Hospital and the proton beam therapy centre in the Czech Republic in order to agree on the best course of treatment for Ashya.

UPDATE (03/09/2014)
After publishing this post on Tuesday, the same day the Crown Prosecution Service withdrew the European arrest warrant, saying "there is insufficient evidence for a realistic prospect of conviction for any criminal offence". Since being released on Tuesday, the parents were reunited with Ashya at the hospital in Malaga today.

My ALS ice bucket challenge!

I wrote about the benefits of the ALS ice bucket challenge over a week and have been waiting to be nominated. Yesterday, I was finally nominated by my sister, Izzie.

So here it is!

Stop TTIP

What is TTIP?

TTIP stands for the Transatlantic Trade and Investment Partnership. This is being negotiated between the EU and the USA, and will involve Free Trade Agreements (FTAs). The aim of FTAs is to encourage the trading of goods by removing restrictions, making it easier for private companies to trade. The supposed benefits of FTAs are increased jobs and economic growth. However, the FTAs also pose some threats.

But isn’t the NHS a public service, and therefore, is not included in TTIP?

The NHS was a public service until the 2012 Health and Social Care Act. This reorganisation of the NHS allowed for private providers to take over NHS services. This fragmentation turned the NHS into a market, causing competition between private companies for NHS funding for patient services. Turning the NHS into a commercial activity means it can now be included in FTAs.

What does this mean for NHS?

The Health and Social Care Act has already been criticised of causing increased costs, reduced quality of care, and increased health inequalities. This is likely to only get worse with TTIP. TTIP will give transnationals the right to bid for all government spending on health, but there will be restrictions on the ability of the UK government to control costs and regulate transnational companies that provide healthcare services. Furthermore, it will give transnational companies the right to claim compensation if the government introduces initiatives that may reduce their profits. TTIP also makes it impossible for the UK government to reverse the privatisation of the NHS that resulted from the 2012 Health and Social Care Act.

How will this affect me?

TTIP will ultimately lower our standards of health. As transnationals can sue if new health measures affect their future profit, this means that safer or more effective treatments could not be put into practice. Furthermore, food standards and health regulations could be changed to match those of the USA, who uses a “safe until proved otherwise” principle, opposed to the EU’s precautionary principle that means tests must prove substances are not harmful. Therefore, we could see the return of banned food products like chlorine bleached chicken and growth hormones in beef. Additionally, the UK could be forced to reverse its ban on asbestos (used for insulation), which has been linked to lung cancer.

What can we do?

David Cameron needs to make the NHS exempt from TTIP.  However, the problem with TTIP, is that it is all being done in secret and many people do not know it is going on. Therefore, public awareness is vital. Please show your support by signing this petition (http://action.sumofus.org/a/stop-ttip/?sub=taf%3C/blockquote%3E) and sharing the link to it.

Suicide tourism

It was reported last week that 1 Briton a fortnight goes to Switzerland for assisted suicide. Euthanasia and assisted suicide is illegal in the UK, but perhaps this needs to be changed, as Brits account for a fifth of foreigners going the Swiss assisted-suicide or “right-to-die” clinics.

The non-profit organisation Dignitas is the only Swiss clinic to open its doors to foreigners. There are strict criteria of prerequisites that need to be met in order to access the service. First, the patient must be of sound judgement and possess a minimum level of physical ability to enable self-administration of the drug. Secondly, they must have a terminal illness (a disease that will lead to death), an unendurable disability or unbearable and uncontrollable pain. For an accompanied suicide, the patient must submit a formal request comprising a personal signed letter to Dignitas, a biographical CV describing personal background and family circumstances for the doctors to assess, and medical reports.

The course of accompanied suicide is taking an anti-emtic (drug against nausea and vomiting) followed by a fatal dose of pentobarbital, normally administered dissolved in water. Within a few minutes the patient falls asleep, slipping into a deep coma and death occurs via paralysis of the respiratory centre leading to the patient being unable to breathe.

The issue of assisted dying was recently debated in the House of Lords. Lord Falconer presented an Assisted Dying Bill offering assisted suicide to terminally ill patients deemed mentally capable and within 6 months of death. A YouGov survey found 73% of adults in England and Wales support the proposals in the Bill. However, it has only received its second reading in the House of Lords and there is a long process ahead (you can track the progress of the bill at http://services.parliament.uk/bills/2014-15/assisteddying.html).

It is argued that legalisation of assisted dying would not mean more deaths, but less suffering. However, this Bill is still limited. Only 43% of the British public agree that a doctor should be allowed to end the life of someone who is not in much pain or danger of dying, but is completely dependent on relatives, like Daniel James.  At 23, he became the youngest to go to Dignitas after a rugby accident that left him suffering with tetragplegia (paralysis from the chest down). Therefore, disability should be considered when discussing the Assisted Dying Bill. It is also important to deliberate assisted dying for those in the position who do not meet the prerequisite of being able to self-administer the drug. Will there be point in a future where once you are over the age of 18 you must put in writing what should happen to you in the unlikely event?

However, the introduction of disability and inability to self-administer the drug causes more safeguarding concerns. However, if Britain does not address these issues surrounding assisted suicide, this forces an already increasing number of people to travel to Switzerland. 

Below is documentary called Choosing To Die by Terry Pratchett, which features a 71-year-old suffering with motor neurone disease going to Dignitas. 

Let's talk about it

Image: Pauline Hughes Ceramics

Robin Williams was a beloved actor and comedian, who played many inspiring roles and his suicide was shock to the public. It is sad that such a tragedy has been the source of the recent talk about mental illness, but maybe it is what was needed for people to realise the seriousness of mental illness.

Due to the stigma surrounding mental illness, its victims are shamed into hiding their disorders and not talking about them. There is currently no definitive biological cause for mental illnesses, which leads people to believe that they are not as serious as diseases such as cancer and Alzheimer’s disease. However, just because we don’t fully understand it, does not mean it is not real. Mental illness is very much all around us. Everyone knows someone affected by cancer, but you probably know a lot more people affected by mental illness. You just don’t know it. According to WHO (World Health Organisation), in 2012 there were 14.1 million cancer cases worldwide, but there are approximately 450 million people worldwide suffering from a mental disease.

In 2011, 159,178 people died from cancer in the UK. In 2012, there were 5981 deaths from suicide. Obviously this is just a fraction of the deaths from cancer, but this is just the number of successful suicide attempts. But what is most important is that these deaths could have been prevented. Suicide is not the only serious consequence of mental illness. It is estimated that 400/100,000 people self-harm. It can also be the reason behind many crimes; it is thought that as many as 9/10 prisoners suffer from a mental illness. Additionally, it often leads to substance abuse and addiction. Addiction, like mental illness, is a biological disorder; it is not just something that happens to some people. Yes, there is the initial choice to take substance, but some have a difference in their genetic make-up that makes them more susceptible to addiction via changes to the reward pathway in their brain – the mesolimbic system. Mental illness is an illness, not a deficiency of character.

Celebrities speaking out about mental illness helps to break the taboo that surrounds the subject. Catherine Zeta Jones and Stephen Fry have spoken openly about suffering from bipolar disorder, where one has mood swings between mania and depression, making it particularly difficult to treat. Actors such as Emma Thompson, Jim Carey and Zach Braff have admitted to suffering from depression. Michael Phelps, a professional swimmer and the most decorated Olympian, suffers from ADHD – which many do not take seriously as a mental illness. Both Elton John and Tom Fletcher (lead singer of McFly) have suffered from eating disorders, which are not often associated with males but are very common.

It is extremely important to recognise that males suffer from mental illnesses too. According to reports, twice as many women suffer from depression. However, men are three times more likely to commit suicide. Therefore, it is not that more women suffer from depression; they are just more likely to report it and seek help. Suicide is the main cause of death in men under age 35. We need to allow males to communicate and feel it is ok to talk about their problems – it is not weak.

This year, 1 in 4 will experience a mental illness, 8-12% of the UK population will experience depression, and nearly 5,000 young people in the UK will commit suicide this year with depression being the primary cause. Less than 50% respond to current treatments, emphasising the multifactorial cause of mental illnesses, and the need for more effective pharmacotherapies.

Help to eliminate the negativity surrounding mental illness and if you can, please donate to Mind, a UK mental health charity, at http://www.mind.org.uk/get-involved/support-us/donate. Let’s allow the world to be a place where people can stand up and ask for help.

Image: LA Screenwriter

#ALSicebucketchallenge

So you all must be aware of the ice bucket challenge that is going around on social media. However, whilst it’s great watching celebrities get their kit off for the challenge, it’s important to understand the cause behind it.

The challenge has been going on for a while, but only went viral after college baseball player Pete Frates, who was diagnosed with ALS 2 years ago, decided to start his own campaign. ALS (amyotrophic lateral sclerosis) is the most common form of motor neurone disease, which causes muscle weakness and loss of voluntary movement due to the degeneration of upper and lower motoneurons (neurons that control movement). It has a prevalence of 5/100,000 people, with an average onset of around age 55, and death usually occurring a few years later due to respiratory failure. So the idea of the ice bucket challenge is that pouring freezing cold water over yourself gives a numbing sensation and you are not able to move or breathe for a few seconds – mimicking the symptoms of ALS. It is a rare and seriously debilitating disease with no clear cause or effective treatment. However, charities for ALS are seriously underfunded, but this global internet sensation has prompted donations reaching $50 million to the ALS association (www.alsa.org). People may criticise the ice bucket challenge for being an excuse to look altruistic or show off your wet body, but there is no denying that it has helped to raise a lot of money for the charity, as well as awareness for the disease.

However, Macmillan started using the hashtag, and consequently, people in the UK are donating to them instead. Although the #nomakeupselfie had no relevance to cancer, it does not make it ok that Macmillan cancer charity has been using the craze to encourage donations when the point of the challenge is to give an insight into ALS. Cancer is a hugely funded charity, understandably, as everyone knows someone who has had cancer or has been effected by cancer. Donating to any charity is a wonderful thing to do, but Macmillan has taken away the importance and spread of awareness for other diseases such as ALS.

This video is what the #ALSicebucketchallenge is really all about.

And now my top 5 celebrity videos:

5. Lady Gaga - ....what?

4. Justin Timberlake

3. David Beckham

2. George Bush

1. Eddie Redmayne - this is particularly relevant as he is playing Stephen Hawking the biopic The Theory of Everything, which will be released later this year. Stephen Hawking was diagnosed with ALS at age 21!

(And there's the added bonus of Jamie Dornan)