Horrible Hormones

I thoroughly enjoyed a lecture given by a senior lecturer at Newcastle University about common endocrine disorders and their biochemical causes. Of course I was already aware of how important hormones are to the body, but the way in which one tiny change can affect the body is truly extraordinary. 

The centre of this talk was obviously the pituitary gland and the way tumours associated with it affect the body. I learned that the pituitary gland is made of two sections with separate functions; the anterior and the posterior. A hormone produced in the anterior called prolactin is associated with the production of milk in mammals and also 'switches off' the menstrual cycle during this process to prevent further reproduction. Without considering this factor, the West decided to send bottled milk to Africa for children to be fed with rather than breast milk from mothers, which meant they no longer required milk which halted prolactin production and restarted the menstrual cycle. This effectively reversed mother nature's contraception and caused a population surge. This is a good example of when meddling with nature can have unexpected consequences, something which should always be considered in medicine. The posterior of the pituitary gland is associated with the production of ADH and oxytocin, but the main disorders discussed related to the anterior. 

The presentation of pituitary tumours seemed to be fairly generic at first, but could be anything from excess/deficiency in hormones to apoplexy in acute cases. They can also cause bitemporal hemianopia; a change in the field of vision due to pressure on the optic nerve or chiasm. Depending on where the gland is altered, there are varying physical effects. 

One disorder is acromegaly, which is an excess of growth hormones, caused by hypopituitarism. An example used by the lecturer was a man called Gary Tiplady who was 7ft3! Because these tumours are so slow growing, the tumours are often not noticed for years, by which time the patient often has many other problems related to pituitary adenomas. This includes Cushing's diseases, caused by an excess in secretion of ACTH and production of steroids by the adrenals glands and can result in conditions such as diabetes, osteoporosis and obesity if not recognised and treated. Another condition could be Addison's (which JFK had) which is often known as tuberculosis of the adrenal glands and presents as increased pigmentation and often also vitiligo, which contrasts massively on the skin. People may have an Addisonian crisis if they have a lack of steroids which is why people who take steroid medication will carry a card around with them stating this. 

We also looked at the thyroid as an area where problems often arise, thinking about both hypothyroidism and thyrotoxicosis. Hypothyroidism is often caused by an iron deficiency, but this cause is uncommon in the UK due to a good supply of iron in the diet. Thyrotoxicosis, however, is the opposite and can result in conditions such as Grave's disease, which is sometimes known as thyroid eye disease due to an antibody causing inflammation of the eye, meaning the patient often sees double. Grave's disease can also cause atrial fibrillation due to the overactive thyroid and this was exhibited in George Bush senior, when he collapsed on a golf course while in office as president as a symptom of his condition. This can be treated with inhibition of hormone synthesis orally or in extreme case with thyroid surgery. Alternatively, and more commonly in more current medicine, it can be treated with radioiodine, which is taken by the patient and ablates the thyroid. The patient is then given hormone replacement therapy to maintain the correct hormone balance usually controlled by the thyroid. 

In the most extreme cases, hormone deficiency can cause pituitary apoplexy, which can present as a subarachnoid haemorrhage, with symptoms such as a severe headache and visual loss. It is vital in these cases that the hormones are replaced as quickly as possible otherwise it is potentially fatal. 

Overall, the talk outlined to me that there are so many things that can go wrong with hormones in the body and it is so important that doctors are able to spot these disorders and treat them effectively. I was fascinated by the variety of conditions and the biochemistry that causes them. I continue to be amazed by the complexity of the human body, where there are so many opportunities for things to go wrong, yet the majority of us are lucky enough to be unaffected by these conditions. It seems almost unfair that most of us go through our lives completely blissfully unaware that these conditions exist and it's purely down to our genes and luck that we are not directly affected by them. It is in these situations where the vigilance and care of doctors, nurses and other medical professionals really come into their own and are able to provide life changing care and treatment. 

Work Experience

Last week I spent  4 days in my local hospital following several very busy doctors around! I was able to spend time in various departments of the hospital.

Surgery

I watched several operations both laparoscopically and open, all of which were extremely interesting. I particularly enjoyed a mini stomach bypass on an obese man. I was amazed by the innovative equipment the surgeons had access to and was fascinated by the intricate manoeuvres they could perform. The bypass was performed in about an hour, with no complications. More than the actual procedures, however, I was watching the interactions between the doctors and scrub nurses. It was interesting to see the team of people working together on the one operation and it really confirmed to me that being a doctor is definitely a job for a team player. I took opportunities to ask the doctors about their lives and their training and one thing that stuck in my mind was when a surgeon told me that if I wanted to make money and be praised then I shouldn't be a doctor, but went on to say that if I wanted to make a difference to people and have good job satisfaction then I was making the right decision. I think I am. I asked him what the worst part about being a doctor was, and he told me it was most definitely the family life (or lack of, for that matter). This is something I'm sure I cannot fully understand, given that I am only 17, and have lived away from my family since I was 14 at boarding school. However, I know it is fully possible to have a family life in the medical profession, it just may not be completely conventional, but that being said, I don't think I would enjoy a conventional life. I think I will enjoy the challenge, being constantly stretched. I also attended a lunchtime meeting with the consultants where they discussed all of the new cancer patients they would be dealing with and the direction they thought their treatment should go in. One of the consultants told me that the reason for this meeting was to get as many opinions as possible and ensure the patient was receiving the best care possible, yet another example of doctors acting in a team.
A&E
I absolutely loved my morning in A&E again! I followed a lovely nurse, who showed me everything there was to see! There were some difficult cases and of course dealing with sudden loss is a major issue in A&E. Something that stood out hugely in A&E was the importance of good nurses and good bedside manner. A lot of the people who came in were distressed and their relatives and loved ones were upset and worried, requiring friendly faces and chatty nurses to take their minds off the hard time they were going through. I enjoyed talking to the patients and laughing with them as they had bloods taken and obs done because I felt as though I was helping them slightly. I was really stretched in A&E where the consultant asked me what I wanted to gain from my morning in her department and I told her I wanted to gain insight, experience and an idea of what it's like to be an A&E doctor, but also to be challenged. She rose to that straight away and handed me a case of a man who had been referred to A&E by MIU for them to then refer him to the specific department he needed. She asked me how efficient I thought this was and if I could think of a better pathway to go through. Well… It was 9am on a Tuesday morning and I had definitely been thrown in in the deep end but I loved it. I told her I thought it was very inefficient given that A&E had nothing to do with this particular patient until they were given his file by MIU, which seemed an unnecessary link if only
Cardiology
The cardiology department was probably my most challenging stint (stent ;) haha) in my work experience because it required a good level of understanding about all of the areas of the heart and the blood vessels around it. Luckily, this was my favourite chapter of the biology course, so I looked more into it! Thank goodness! I watched the procedure performed with catheters to investigate a stenosis in a lady's coronary artery and discussed with the doctor the procedure to insert a stent to widen the artery to prevent an MI. The doctor then took me to an audit meeting about a new blood thinning drug. He explained that this drug was better than Warfarin because with Warfarin, the blood needs to be tested regularly whereas with this drug, testing is much less frequent. This is positive because it means the drug has less of an impact on the patients life.
Interventional Radiology
Nowadays, surgery itself is much less invasive because of the fantastic advances in technology, and this includes certain operations which now don't even need to be operated on as such. They can be performed with ultrasound or X-Ray assistance. I watched a procedure where a lady had a gall stone stuck in her bile duct which was causing blockages and infection, but the woman was old and the risk of removing the gall stone, along with the stress it would cause her to have to undergo surgery, was deemed to not be worth it. So instead, the doctor used ultrasound to direct him to her liver, gave her a local anaesthetic, and used a needle to go through her liver to find the stone. He used dye which could be seen on a screen to be filling her bile duct, and the stone was so obvious. He then used the needle to guide a wire, over which he could pass a tube, to act as a bypass around the stone. This would prevent it from causing anymore blockages and less infections. The procedure took no more than 20 minutes! The personal side of this was more difficult than most of the others I watched, because the lady had dementia, and was very upset, asking why we had done that to her. She was crying and would beg me to let her go home and make her stop, reaching her hands out to me. I must admit, I wasn't overly sure how to approach this situation, given that I knew she couldn't go home just yet and was in no position to help her. I found it so hard to see her in pain the way she was, both emotional and physical. However, I was so touched by the way the other professionals in the room dealt with her and reassured her and calmed her down. They were so kind, patient and compassionate with her, which is exactly the type of doctor I hope to be one day.
Neurology
The final department I visited was a ward in neurology where I saw a lumbar puncture! I noticed on the ward how attentive the nurses were to the needs of the patients but also, how much administration the doctors had to! There was a lot of paper work and less patient contact that I expected. The doctors spent  quite a lot of time looking at scans and discussing treatment plans as opposed to seeing patients. I still enjoyed this though, because I was able to see lots of scans.