"Are you well?"

A rhetorical question when asked by your GP.  Unless you are there for a ‘well man check’ (WMC).  I went for my WMC back in February; I was beaten in to it by my wife who was extracting revenge for me having pestered her in to having her cervical smear and bi-annual mammogram.  As I noted the appointment in my diary, I can honestly say I had never felt healthier.

It was all very civil, we discussed such pithy items as the frequency of my night-time bathroom visits, weight, exercise regime, my low blood pressure and the childrens’ schools.  A quick blood test and I was on my way or so I thought.  A week later I got the  call from the Practice Nurse (when do they become competent?) saying my cholesterol was high and that I had ‘glucose intolerance’.  Another, fasting (ie. nil by mouth for 12 hours previous), blood test involving the drinking of a foul fizzy pop like substance, 2 hour wait and then another bruise in my arm from a further blood sample.  Another week passed before a slightly garbled message on my cell phone saying that all was good and I had nothing to worry about…….but I wasn’t anyway.

Three months passed when out of the blue came an impersonal ‘billet doux’ in the post advising me that I was due my 3 monthly blood test.  I queried this but wasn’t able to get a great deal of sense from anyone so went along for another fasting blood test complete with even bigger bruise on my arm.  Another 10 days passed before a breathless message from one of the secretaries at the GPs Practice saying that it was still bad (I presumed they meant the cholesterol) and that if I was confident I had done all I could with my diet then I would have to go on a course of statins.  Suspecting that ‘a hare was off and running’, I tried to call my GP; just like in any country this wasn’t possible for a whole host of reasons.  I set about some research on the web; I spent a happy afternoon dredging in to the merits or otherwise of LVLs, HVLs, side effects etc etc.  Meanwhile a prescription arrived and somewhat lemming like I trotted down to the Pharmacy and got my pills.  Suspiciously there was no ‘patient info’ leaflet enclosed but I was assured by the Pharmacist that they were ‘just like vitamins’.  Ho hum.  Having failed to establish voice contact with my GP I fell back on that other naval stand-by, the letter.

Time passed.  Mindful of the fate that befell a long-term friend (high LVL cholesterol test followed by major heart attack a short time later), I started the course of tablets.  As I was now in possession of the actual brand name, I was able to download a patient info sheet form the company web site.  The side effects made particularly frightening reading until you stop and consider they all do; after all I was now a walking cardiac time bomb wasn’t I?

Whilst being in good health, I do need optical assistance for many day-to-day tasks.  In late July I went for a routine check up at the Opticians.  All was well but like so many health care providers, they had a new toy: a visual field (VF) checker.  I have never been subjected to one of these before but happily went along with the test.  Apart from telling me that I was wearing my contact lens too much, thereby causing wear / deterioration of my cornea, I was asked to come back for a repeat VF test in a couple of weeks time as there were some anomalies.  Later that afternoon, I received a call from the optometrist , whilst watching my daughter receive her dance medals, asking that I contact my GP for an urgent referral to an eye surgeon as there was a definite pattern to my failed VF tests that might indicate pressure on my optic nerves.  Duly I rang the surgery and got an appointment for the end of the week and attended.

My GP discussed at length my letter of some 9 weeks previous and convinced me to keep taking the pills, have another blood test after finishing the initial 3 months supply and have a cardiac risk assessment with the Practice Nurse.  This took place a couple of weeks later and revealed that on the strength of my ‘high cholesterol’ blood test my cardiac risk was a 6% chance of ‘a cardiac event’ in the next 5 years.  This did not strike me as startling odds and certainly I shouldn’t be selling tickets for the impending event.

Then 3 things happened: firstly I finished the initial course of statins, had my blood test and rejoiced in the fact that my LVL was half the figure in July and my cardiac risk assessment was now a paltry 3%; better keep taking pills and forget about my cardiac event.  Secondly I received an appointment to see the eye specialist who because it was so urgent was referring me to his locum.  Thirdly I received an appointment from the hospital for an MRI scan of my brain and pituitary although who had actually ordered it was something of a mystery; the GP and eye surgeon all denied any knowledge.

It all went ‘pear shaped’ on Taranto Night (11 Nov) when an hour after retiring I was awoken by the most excruciating pains in all my joints.  Now, like many of the male form, I am no hero when it comes to pain but this was awful.  My medical professional wife announced that she was not going to do anything until morning and ordered that I make less noise or I might wake the children.  When day finally broke I staggered in to the shower, made a half-hearted attempt at washing and then had to be assisted with dressing.  Eventually made it downstairs to be greeted with two worried little faces and another edict from the medical profession that I could only have water in case the hospital wanted to do anything more with me.

We arrived at ED just before 09:00 to a deserted waiting room.  I was whisked away shortly after the ‘warm’ welcome from the receptionist (do they do a course to be so rude and uninterested?) and after answering seemingly interminable questions, the young doctor announced that he was pretty sure it was an allergic reaction to the statins.  A blood test followed (not much of a bruise this time) and, 2¾hours later after the lab processed it, he was back confirming that was the reason, oh and by the way Mr Sutton your liver function is a bit off.  I was discharged with a wad of painkillers and told to make an appointment with my GP.

My GP had the sense to look concerned and after discussing my ceasing taking the statins any more (would you?) I was bundled next door for another blood test (biggest bruise of the lot) and then in to the Physiotherapy clinic which just happens to be collocated there – I was still having trouble getting my limbs to do every day tasks like pegging up the washing.  Eventually, 4 days later, my GP phoned to say that my blood test was back and whilst my liver function was better, it still wasn’t where they would like it to be and would I like to have another in a weeks time?  What the hell?  My arm was shot now anyway so what’s one more bruise?

Meanwhile I saw the eye surgeon; delightful chap with an excellent ‘bedside manner’ and a thoroughly charming assistant (his wife).  No he couldn’t see what all the fuss was about and whilst my VF wasn’t great it was OK.  A few days later I had my MRI (it had been ordered by the Outpatients dept at the local hospital after a referral from my GP).  My wife’s boss did it and pronounced it all perfectly normal indeed for someone my age (and who in younger years abused his body with alcohol at various mess dinners including Taranto nights) it was in remarkably good condition.

Another blood test before having a therapeutic shoulder massage at the local health spa and that afternoon a Practise Nurse called to say all was normal.

So now here I am $320 poorer and but feeling fine! In fact isn’t it time for your annual WMC dear?

[Via http://xpinger.wordpress.com]

Newly Discovered Fat Molecule: An Undersea Killer With An Upside

A photomicrograph of an Emiliania huxleyi cell. The black spots within the cell are the virus, which contains a previously unknown lipid that is killing phytoplankton in the North Atlantic. (Credit: V. Starovoytov and A. Vardi, Rutgers University)

A chemical culprit responsible for the rapid, mysterious death of phytoplankton in the North Atlantic Ocean has been found by collaborating scientists at Rutgers University and the Woods Hole Oceanographic Institution (WHOI). This same chemical may hold unexpected promise in cancer research.

The team discovered a previously unknown lipid, or fatty compound, in a virus that has been attacking and killing Emiliania huxleyi, a phytoplankton that plays a major role in the global carbon cycle.

“Emiliania huxleyi is the rock star of phytoplankton,” explains Kay Bidle, Rutgers assistant professor of marine science in the Institute of Marine and Coastal Sciences. “It blooms all over the oceans, and we can easily see it by satellite. We know that these blooms are frequently infected with viruses, and this virus is specific to this phytoplankton.”

“The lipids are the key ingredient in the virus that causes the phytoplankton to die,” says WHOI scientist Benjamin Van Mooy. “We have a completely different lipid molecule that, as far as we know, is unknown to science.”

E. huxleyi grows rapidly in the North Atlantic, “in these big blooms that you can actually see from outer space,” Van Mooy says.

“But,” adds Van Mooy, “they die just almost as quickly as they start out, and we’re not sure why. They die after a few days.”

Bidle and Assaf Vardi, a postdoctoral investigator in his laboratory and the study’s lead author, had been examining the interaction between the virus and the dying phytoplankton and had developed ideas for how this process works. After Vardi heard lipid expert Van Mooy give a talk in Santa Fe, N.M., he suggested the collaboration between WHOI and Rutgers.

“I saw Ben’s talk on marine microbes and lipids…[and] I ran after him,” said Vardi. “We told him about our ideas” involving the virus’s effect on the phytoplankton.

“They studied the viruses and I study lipids,” Van Mooy said. “It seemed like a good mix.”

Their paper is published in the Nov. 6 issue of Science., E. huxleyi performs photosynthesis — “just like plants,” says Van Mooy. “They suck up carbon dioxide.” In doing so, they reduce the amount of CO2 released into the atmosphere. They form a calcium carbonate shell, also helping to regulate the carbon cycle.

If viruses are killing off phytoplankton, this can increase greenhouse emissions, Van Mooy suggests. “That’s important because if viruses infect a whole bunch of cells, then they can’t perform photosynthesis, they can’t take up carbon dioxide.”

In April 2008, Van Mooy’s team visited the sites of E. huxleyi blooms during a research cruise between Woods Hole and Bermuda and collected samples for lipid analysis back in the laboratory.

They immediately recognized lipids that were just like those in virally infected E. huxleyi cells grown by the Rutgers team. Helen Fredricks, a research associate with Van Mooy, carried out the lipid analyses at WHOI. “Seeing this viral lipid appear during the course of infection was amazing, and then we found it in the ocean too. We were celebrating in the lab that day.”

Adds Vardi: “Viruses are really important players in regulating phytoplankton blooms. We zoom into the bloom and try to understand the interaction between the viruses and host, which is this really important, cosmopolitan, bloom-forming species.”

After isolating the viral lipids, the team found that the lipids alone were able to bring about the symptoms of viral infection in the phytoplankton. “The lipids themselves act just like the virus,” says Van Mooy. “We can cause the phytoplankton to die by just giving the lipids.”

This alone was enough to excite the team. “Now we have a biological marker that we can go out on a ship and look for and identify where this [infection of phytoplankton] is happening and learn how to study it better,” Van Mooy says.

But there may be other, even farther-reaching implications. Both the virus and the newly found lipid deal their deadly blow by causing the upper-ocean plants to commit cellular suicide. As a major focus of their research at Rutgers, Bidle’s lab has found that “programmed cell death” is an important process in the fate of marine phytoplankton and in the demise of blooms in the oceans. Bidle’s group had previously found that successful infection of E. huxleyi induced, and actually required, the programmed cell death pathway.

But programmed cell death is not unique to phytoplankton. It is a common and healthy process in all kinds of cells, including human cells.

According to Vardi, “These lipids can induce programmed cell death in many organisms, including animals and plants. They also enrich in plasma membrane, and they are the port of the cell, where pathogens get in and out of the cell. This is important in viral diseases.”

There is also a potential connection with cancer. If a healthy cell is stressed or damaged, usually it will kill itself with programmed cell death. But cancer cells have a defect: “They don’t kill themselves,” says Bidle.

“It’s a critical aspect of cancer research, because cancer cells have figured out a way to turn off the programmed cell death pathway,” he says. “In cancer studies, they try to figure out ways to reactivate those pathways.”

The lipid may help shed light on why cancer cells are unable to commit suicide. Someday, the researchers say, it might suggest ways to correct that defect. Right now, the lipid is only known to be effective in algae, but in the future, the team is hoping to test the effectiveness of their molecule in experiments with cancer cells.

“There’s a long way to go between here and curing cancer,” Van Mooy says, “but the potential exists that this molecule could have therapeutic applications in the treatment of human disease, including cancer. Hopefully this paper will pique the interest of other investigators.”

More immediately, scientists hope to learn more about the central role phytoplankton — and viruses — play in regulating climate. Bidle says this is a particularly interesting virus. “It appears that the virus has…borrowed, copied actually, the genes for this lipid from the host,” he says. “Similar genes are still on the host, but the virus has figured out a way to take those genes and put them into its own genome, and alter them enough to make them more toxic.”

“We find the biosynthetic pathway for this unique lipid encoded in the virus genome, not only in the host, and this has never been described before in any other virus,” Vardi says. “We knew that [lipids] were important, but we were really intrigued about why the virus contained these genes. And what is the role of the pathway in the co-evolution of programmed cell death in the host and virus.”

Van Mooy sees it as a struggle between two mighty forces. “The phytoplankton are at one end of the boxing ring and they’re taking up carbon dioxide, and the viruses are at the other end, and they’re out to kill them. And how that works out controls how much carbon dioxide is taken up.

“We’re very interested in understanding what controls these phytoplankton,” he says. “I didn’t know that much about viruses until I started working on this project and the Rutgers researchers didn’t know that much about lipids. So now we’re both really onto something here. We’re continuing to collaborate. “We have found other interesting lipids from these viruses,” says Van Mooy.

“There are probably more out there. And who knows what kind of activities they may be involved with. They may hold a cure for a human disease or they may play unknown role in…phytoplankton.

“I’d like to think [the work] is going to have a continued impact.”

Story Source:

Adapted from materials provided by Woods Hole Oceanographic Institution.

http://www.sciencedaily.com/releases/2009/11/091109121207.htm

[Via http://thewere42.wordpress.com]

Science & Soul: Cellular Automata

Science News in Brief

Turns out that the Iron Curtain helped isolate Eastern Europe from more than the Western world.  It also blocked the import of alien bird species.  Restrictions on the movement of people and trade in Soviet bloc countries prevented invasive birds being imported, a problem which has plagued much of Western Europe.

There is a difference: An introduced, alien, exotic, non-indigenous, or non-native species is one found outside its native range, having been brought their by humans through deliberate or accidental means.  Invasive species are introduced, but also have a detrimental effect on the environment.

The Intergovernmental Panel on Climate Change (IPCC) released a statement that the emails hacked from scientists’ computers did not contain information which indicated that human created greenhouse gases were not a factor in global warming.

Quirky Quote: “There is an anti-change group. There is an anti-reform group. There is an anti-science group, there is a flat Earth group, if I may say so, over the scientific evidence for climate change.” –Gordon Brown

Researchers have released a study showing that there are large variations in the amount of carbon being absorbed in the North Atlantic: as much as 10%.   They are still doing research to understand what causes these differences.  Currently, the ocean absorbs about half of carbon emissions from human activities.

Apocalypse Scenario: Here’s a nice positive feedback loop for ya: as the climate warms, the ability of liquids to absorb gases decreases (think pop cold vs pop warm), increasing global temperatures, decreasing the ability of the ocean to absorb carbon dioxide…crap.

Cool Creature: Superb Fairywren

Cute Superb Fairywren

The Superb Fairywren, Malurus cyaneus,  is a a small bird found across south-eastern Australia.  The male of the species has a bright blue head, back and tail, with a dark mask, and buff belly.  The female, however are a dull brown colour.  This example of sexual dimorphism is fairly common in the bird world.  The bird is known for its strange mating behavior.  The male wren will pluck yellow flower petals and display them to females.  Although it is socially monogamous, in that they will form fairly regular pairings, but one male will father many chicks with multiple females.  And, he will help raise most, if not all of them.  This causes a rather complex social dynamic.

Feature Story: Cellular Automata

So this is my first post where I talk about what I do as a bioengineer.  People often tell me, “So you mess with genes and stuff, right?”  First, nobody is “messing” with anything.  Second, not really.  I specifically enjoy working with complex ecological systems.  I work to better understand the causes and effects of environmental changes due to natural and human-caused events. Bioengineering allows me to have a holistic look at ecological systems.  Emergent behaviors result from nonlinear interactions between individuals in these ecological systems.  Eventually, I plan to do field research as well as computer modelling to help change the many problems our environment faces.   One of my tools as a bioengineer is cellullar automata.  Have no fear: this is not going to be a trip down molecular biology lane.  Not necessarily anyway.

Networks are built when individuals interact with their local neighborhood, their surroundings.  Thus, range and links are important in a network.  If a system is a complex system with multiple networks, nonlinear interactions among individuals can spontaneously create patterns from an initially random or uniform area. A grid model made up of many individuals represented by cells, or automata (us engineers like to make things complicated sounding), whose possible states are finite and distinct can be updated based on a function which refers to the state of each automata’s neighbors.

Perhaps a good way to explain this is to delve right into an example.  Image a 100 x 100 grid.  This represents a theater.  Each grid space represents a person in the theater.  We want to test the effects of fire on the movie goers.  Let’s say that if 4  people or more around an individual is scared, the middle person is scared.  Otherwise, the cell’s status is normal.  By using a computer program, we can quickly perform multiple iterations of these tests on each of the 10,000 individuals in the test to see if there is any emergent behavior.  Emergent behavior is such that results from nonlinear interactions between autonomous agents in a complex system. That is, it is neither completely random nor completely structured.

So how does this relate to the environment you ask.  Well, I recently completed a project to model ecological succession from bare soil.  Each individual tree species is predisposed to a certain environment.  In turn, each tree affects the environment.  For example, most climax trees are shade tolerant, that is, they grow well in light deficient conditions.  This allows them to grow where there are already a number of pioneer (fast-growing, light-loving) trees.  They in turn create more shade, helping climax trees compete against pioneer trees.  In developing my model, I decided to focus on three main variables which determine plant growth: the soil’s water content, the soil’s pH, and the amount of light in the area.  I also chose the most common trees in an Eastern deciduous forest as my possible states.  To account for the possible variables in the environment, I calculated the amount of trees surrounding a given cell.  The higher the number of trees, the higher the amount of shade, and the less sunlight will reach the trees. I also totaled the number of trees surrounding each cell to calculate water usage.  The more trees there were (as opposed to blank spaces), the less water there was for that area of land.  There are no units for the variables per se, but they can be interpreted as described above.  I then developed a function which would analyze the current state of a cell and compute what the future state of the cell will be.  So, if the current state in the cell is bare soil, then it will either continue to be bare soil or a tree will grow there.  The simulation began with a white field (all blank) as would a piece of land after a disaster leaving bare ground.  In the next time step, pioneer trees came on the scene.  Following this, a few climax trees appeared, and more pioneer trees grew, removing many more of the plots of bare ground.  In the subsequent time steps, more climax trees grew and ultimately dominated the field in the simulation.  By the tenth time step, there was some flux, but most of the trees were of the climax varieties.  There would always be some pioneer trees.  When a tree “died” and resulted in open ground, the first trees to fill the gap would often be pioneer trees, but these are quickly weeded out.  Thus, I used cellular automata to model a biological phenomenon involving emergent behavior.

Secondary Succession: A Cellular Automata Application

Cosmic Perspective

What am I, as a bioengineer, doing with this information?  In my example, I modeled secondary succession, an already understood process.  However, there are other applications.  I know individuals who have used this technique to model forest fires based on forest density.  I have seen the effects of the surroundings on a cell’s (living cell, that is) processes modeled to test new drugs.  The future is truly limitless, but we must understand that we must also ask ourselves whether or not our methods are being applied in such a way to help, rather than harm, the world.  Science is useless without ethics.

[Via http://scienceguy288.wordpress.com]

Year 10 - Leeds Trip

Year 10 have the opportunity to visit the Thackray Medical Museum as part of their GCSE studies on Medicine Through Time. We are visiting the museum on Friday 8th May, and Saturday 9th May returning to the island on Sunday 10th. There are also social excursions to the cinema, bowling and shopping. See Mr Dargan for a letter, or more details.

[Via http://manxhistory.wordpress.com]

The Placebo EffecStudies Reveal How Fake Medicine Actually Reduces Pain.

Proof that mind controls the body.;shows that mind controls the brain(which is different from Brain according to Indian Philosophy).
Story:
New medical research is finding that the pain relief induced by placebos may come from releasing the body’s own chemical pain relievers.
A team of researchers smears a cream said to contain a powerful anesthetic on the skin of your forearm. Then, in their mad-scientist way, they apply an electric heating pad that can be dialed up to painfully hot levels.

Imagine being pleasantly surprised to find that the cream works — the heat seems quite bearable. The researchers even run a brain scan to document just how well this cream works.

But picture your dismay at learning that the cream was actually inert and contained no anesthetic. Nada.

Guileless lab rat that you are, you have been punked. By a placebo.

Scenes like this are playing out in U.S. and European laboratories as neuroscientists try to figure out how our brains can be tricked by sham treatments into producing potent pain-blocking effects that rival (and may sometimes enhance) the effects of real drugs.

The details of the emerging picture are still being sketched in, but it seems that our expectations — whether shaped through conditioning or a simple verbal instruction — can trigger our native pain-control networks, some of which extend from higher cognitive regions deep into the brain stem and spinal cord.

In recent papers published in Science and Neuron, a team of scientists led by Falk Eippert and Ulrike Bingel at University Medical Center Hamburg-Eppendorf in Germany explored how placebos activate the brain’s “descending pain control system,” which involves structures in the brain stem. It’s a complex process that relies on opioids — naturally produced substances that chemically resemble opium and block the transmission of pain signals.

The scientists induced the placebo effect in their 48 test subjects by falsely telling them they were applying a cream containing lidocaine, a topical anesthetic. But some subjects also received naloxone, a drug that blocks the effects of opioids (the rest got an inert injection of saline solution).

Next, the scientists studied their subjects’ brains with a functional magnetic resonance imaging scanner and asked them to subjectively rate the pain intensity.

The subjects who received naloxone (which blocked opioid activity in the dorsolateral prefrontal cortex and midbrain structures like the rostral anterior cingulate cortex, amygdala, hypothalamus, the periaqueductal gray and the rostral ventromedial medulla) saw markedly lower pain relief than those who had received saline, the team reported.

“Until now it was believed that placebo was just a psychological phenomenon that has no neurobiological basis, but that’s really not the case,” Eippert said. He noted that naloxone did not completely erase the pain-relief effect, suggesting that placebo treatment may also engage other less-studied brain networks.

The placebo effect is probably at work even when proven opiates are administered for pain relief, Eippert said. Experiments have shown that patients experience some pain relief when they are given opiates without their knowledge, which is no surprise. “However, when you give this drug and tell the patient, the pain relief is going to be much, much stronger,” he said. “The interesting thing is if you give naloxone at the same time, then this additional effect of telling the patient is completely canceled. There’s a placebo component in treatment as well.”

http://www.alternet.org/story/144327/the_placebo_effect:_studies_reveal_how_fake_medicine_actually_reduces_pain

[Via http://ramanan50.wordpress.com]

Late cancer diagnosis kills 10,000 a year-Guardian UK.

Have all tests done immediately and do not postpone.
Story.
Up to 10,000 people die needlessly of cancer every year because their condition is diagnosed too late, according to research by the government’s director of cancer services. The figure is twice the previous estimate for preventable deaths.

Earlier detection of symptoms could save between 5,000 and 10,000 lives in England a year, Prof Mike Richards will reveal this week. The higher figure is nearly twice his previous calculation, which put the figure at about 5,000.

Richards has revised up his estimate after studying the three deadliest forms of the disease ‑ lung, bowel and breast cancer ‑ which together kill almost 63,000 people a year.

“These delays in patients presenting with symptoms and cancer being diagnosed at a late stage inevitably cost lives. The situation is unacceptable,” Richards told the Guardian.

New efforts are planned to educate the public about the signs of cancer, tackle the widespread reluctance to tell their GP if they develop symptoms, and improve family doctors’ ability to spot signs of the disease earlier, he added.

Britain is poor by international standards at diagnosing cancer. Richards’s findings will add urgency to the NHS’s efforts to improve early diagnosis.

They also raise further questions about how often family doctors fail to recognise telltale signs.

Experts say early diagnosis can be the difference between a patient living for a short or long time or deciding whether they need surgery, such as a mastectomy, or not because quick access to surgery, drugs or radiotherapy greatly improves chances of survival.

In an article in the forthcoming British Journal of Cancer, which is published by Cancer Research UK, Richards will say: “Efforts now need to be directed at promoting early diagnosis for the very large number (over 90%) of cancer patients who are diagnosed as a result of their symptoms, rather than by screening.

“The National Awareness and Early Diagnosis Initiative [NAEDI] has been established to co-ordinate and drive efforts in this area. The size of the prize is large – potentially 5,000 to 10,000 deaths that occur within five years of diagnosis could be avoided every year.”

Richards reached his conclusions after analysing one-year survival rates for the three cancers in England and comparing them with those in other European countries in the late 1990s. Previously he had looked at the number of patients who were still alive five years after diagnosis.

One-year survival is now thought to be a much better indicator of whether diagnosis was early or late.

The study focused on Britain’s three biggest cancer killers: lung, which killed 34,589 people in 2007; colon (16,087); and breast (12,082). They account for 40% of the 155,484 cancer deaths in the UK in 2007 and, Richards found, about half of all the deaths that could have been avoided if diagnosis was as good as the best- performing European countries.

Richards found that “late diagnosis was almost certainly a major contributor to poor survival in England for all three cancers”, but also identified low rates of surgical intervention being received by cancer patients as another key reason for poor survival rates.

Research by academics at Durham University led by Prof Greg Rubin has identified five types of delay in NHS cancer care: “patient delay”, “doctor delay”, “delay in primary care [at GPs' surgeries]“, “system delay” and “delay in secondary care [at hospitals]“.

The new initiative is intended to “fix this problem”, helping the UK’s 53,000 GPs improve their ability to identify patients who may have cancer, said Richards.

With smoking in decline “early diagnosis is our next big challenge in cancer and will be crucial in bringing our survival rates up to the best in Europe”, he added. Prof Steve Field, chairman of the Royal College of GPs, said: “Mike Richards’s latest findings on cancer diagnosis are really important information and reinforce the need for GPs to put a lot of effort into ensuring that patients present [their symptoms] and have access to GPs, and that we pick up the symptoms early on, and also reflect if we can do things even better in this crucial area of healthcare, which we can.

“It’s wrong to blame GPs for all these deaths, as there are many factors involved, including patients not recognising symptoms of cancer and not talking to their GP about them, especially middle-aged men. But I’m sure that we could all at times be more alert to symptoms and investigate and refer patients quicker,” he added.

Sara Hiom, director of health information at Cancer Research UK, said GPs faced a difficult task in spotting cancer: “Despite cancer being a common disease, the average GP will only see one case of each of the four biggest cancers each year.

“Many of the symptoms that could be cancer turn out to be something less serious, but it’s best to get things like unusual lumps, changes to moles, unusual bleeding or changes to bowel motions checked by a GP.”
Do not ignore symptoms.Have a thorough examination and necessary tests done.Read the story.
Story.
Early diagnosis usually means that treatment is more effective and milder for the patient, added Hiom.

Katherine Murphy, director of the Patients’ Association, said: “Some patients are diagnosed with cancer when they have presented with the same symptoms six months earlier.

“Patients will sometimes tell us that they had been going to see their GP for six to nine months with, say, a pain in their stomach and were told to go to the pharmacy and buy an over the counter medicine [and later are found to have cancer].”
http://www.guardian.co.uk/society/2009/nov/29/late-cancer-diagnosis-kills-thousands

[Via http://ramanan50.wordpress.com]

In Hospice, Care and Comfort as Life Wanes

This article is the beginning of a series I want to post about the impact and effects nurses can have in different settings.  This particular article is about the hospice nurse and how hospice nursing can give a patient and the family a way to end life with dignity and peace. Nurses work in all types of settings, not just in hospitals, but I’m not sure the general population is aware of this.  There are nurses who counsel, who educate, who practice holistic practices, who listen and comfort, as well as the stereotypical nurse who takes your blood pressure and temperature at the doctor’s office. I hope to be able to find articles to showcase nurses in non-standard practices over the next few months.  I hope you enjoy these looks at nursing outside of the box. _____________________________________________________________________________________________ Personal Health By JANE E. BRODY Published: November 30, 2009

I spent a day last month shadowing hospice workers from the Visiting Nurse Service of New York. With each visit to the homes of four patients whose lives were ebbing, the caring, patience, attention and expertise I observed left me wondering why all medicine is not like this — focused on the whole person, not just a disease.

Hospice workers never know what they may find when they enter the homes of people whose doctors expect them to die within six months. But they are prepared to handle almost anything and have a team of specialists to call upon when needed: doctor, nurse, social worker, spiritual care counselor, bereavement counselor. The home hospice service is but a phone call away 24 hours a day, 7 days a week. The needs of patients and families are met within hours, if not sooner; moreover, the cost is usually covered by Medicare or Medicaid.

With hospice, death assumes a more natural trajectory, unencumbered by frightening machines and sometimes grotesque interventions of modern medicine that do little, if anything, to prolong life and often make dying more painful for patients and families, as well as costlier for society.

Indeed, studies have shown that, all other things being equal, patients receiving the comfort care provided by hospice tend to live longer and die more peacefully than those who continue to get intensive care for their disease when treatment has ceased to help.

Resolving Crises

At age 80, Ellen Gladden learned she had multiple myeloma, a cancer of plasma cells in the blood. Four years later, this once elegant and dynamic woman, now a shadow of her former self, lay dying in a hospital bed installed in her bedroom, attended by one or more of her three daughters and hospice workers from the Visiting Nurse Service.

Mrs. Gladden’s hospice nurse, Vanessa Boyce, and Dr. Alfred Hartman, who supports the hospice team caring for her, had explained to the family that the end was near. Mrs. Gladden was turning inward, detaching from life, but although she could no longer speak, she could still hear. The family was encouraged to continue to speak to her, but cautioned against saying anything in her presence they would not want her to hear.

That included the daughters’ argument over the medications Mrs. Gladden was receiving to relieve her pain and reduce her agitation and anxiety, common symptoms as death approaches. Two daughters agreed that the drugs were necessary to keep their mother comfortable, but the third thought her mother was being overmedicated, making her unable to communicate and hastening her demise.

With patience and caring, Ms. Boyce and Dr. Hartman explained yet again why the drugs were being used. Seeing that the one daughter remained unconvinced, they offered a compromise: reduce the medication by half. If Mrs. Gladden remains comfortable, fine. If not, they can increase the dose.

Another crisis resolved in the lives of two hospice workers who typically visit four or more patients a day.

Extending a Life

Mercedes Perazzo, 87, a former ambulance technician for New York City whose life force now waxes and wanes because of congestive heart failure and diabetes, attributes her longevity to the care administered by her hospice team for the last 16 months. Her doctor thought she would die in a few months, but her spiritual care counselor, Henry Schoenfield, said she had rallied under the comfort care she received.

“I was very ill,” Ms. Perazzo told me. “But the care I got through hospice helped me live much longer than anyone expected.

“The entire team — all are excellent. They really care for people. The nurse, Eileen, takes my blood pressure, checks my whole body, arranges my medicines, gives me the supplies I need, calls the doctor if there’s a problem. Sometimes I feel very depressed, but she and Henry make me feel better.

“I had been in and out of the hospital, and they finally told me not to come back. But when I got with this agency, I didn’t have to go to the hospital no more.”

A ‘Reassuring’ Presence

Desiree Harris, a mentally challenged 40-year-old with advanced breast cancer, does not really understand what is happening to her. But her mother, Marie Harris, who has cared for Ms. Harris her entire life, understands that the end is approaching.

“The future doesn’t look too bright from a medical point of view,” Mrs. Harris said. “I know death is a part of life. I discussed hospice with her oncologist, who put everything in place. I want Desiree to be as comfortable as possible. I don’t want her to suffer needlessly.

“The hospice team has been so wonderful, very caring, very informative. I can contact them at any time. It’s so reassuring.”

Stephania Cajuste, the social worker on Ms. Harris’s team, emphasized the value of the team approach. “It can take so many ears to hear what you have to say,” Ms. Cajuste explained. “The patient or family member may say something to the nurse that doesn’t register. If they say it to me, I can go back to the nurse and tell her what I heard and what needs to be done.

“We all listen to each other, because it’s not about us. It’s about the patient and family.”

Mrs. Harris agreed. “The team came on Friday and stayed for well over an hour,” she said. “It felt like family time. Everyone explained their roles and made sure I understood everything. The nurse told me that if I think of anything I wanted to know, I should just call. It was so reassuring.”

Helped After a Spiral Down

Michael Cordovana (“I’m only 80”) had traveled all over the world playing the piano for professional singers. “Then,” Mr. Cordovana said, “all of a sudden my health took a downward spiral.”

Four years ago he had a heart attack and underwent a quintuple bypass. He has since had a stroke and now has an inoperable aneurysm, diabetes and congestive heart failure.

Yet during a visit by his hospice nurse, Dahlia Nichols, he remarked: “You can’t believe the care I get. I don’t think I’ll ever die.” He said his home health aide, Tony Williams, was “the greatest gift — he gives me my shower, takes care of my laundry, helps me with my exercises, makes me delicious juices.”

After a check of his blood pressure, temperature, legs and feet, and questions about pain and shortness of breath, Ms. Nichols told him: “You look pretty good. I’m a really happy camper.”

“I feel wonderful,” Mr. Cordovana replied. “It’s such a compliment to the nurses. I’m so taken care of.”

In addition to contacting local Visiting Nurse Services, hospice care can be found through the National Hospice and Palliative Care Organization. Go online to www.nhpco.org and click on Find a Provider, or call (703) 837-1500.

The original article can be found here

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