My Christmas shift showed me the human connection behind medicine

My first medical on-call shift was on the evening of Christmas Day. Wary of what to expect, I joined my family for an early dinner with a cloud of trepidation hanging over it. The post-food cosy daze that everyone has after their traditional meal turned into the pre-work tetchy panic that every doctor has before a night shift.

I arrived at the hospital at 9pm to find remnants of Christmas cheer lingering on every ward. Boxes of half-eaten chocolates, needles starting to drop from Christmas trees, tinsel becoming unstuck and dangling from the walls, and families trickling away from the hospital after spending the day with their loved ones – it’s like you’ve arrived late at a party after everyone has left.

For the first few hours I was strangely enjoying my first medical on-call shift. It was a refreshing break from the daily grind of writing in patients’ notes what my consultant says on ward rounds and typing discharge summaries. I was reviewing and managing unwell patients, which is what I had been trained to do.

Fuelled by adrenaline, excitement, and those half-finished boxes of chocolates on the ward, I was in full flow. Please review this patient who is not producing enough urine: “urine problems – I remember the causes and treatment in a kidney lecture”. Please review this patient who’s got a temperature: “review patient, check the nursing observations, take some bloods, do I need to start some treatment straight away?”. Please review the ECG of this patient who’s developed chest pain: “reading ECGs – let’s decipher these squiggly lines step by step”.

I had just managed to clear the backlog of jobs when my bleeper barked into life: “Cardiac arrest, ward x. Cardiac arrest, ward x”. I immediately got off at the next floor and ran to the arrest call. By the time I got there, CPR had already started and my medical registrar arrived 20 seconds after I did. It was my first arrest call.

I took over doing compressions. Crack, one rib broken. Crack, another rib broken. At least I was doing good compressions. The consultant asked: “Can you get a blood gas from the patient?” Stab, the needle goes into the groin, nothing. Someone else has got it already. He continued: “Can you get the results please?” pH 6.9, lactate 11 – not good. I ran back to find the patient’s heart had successfully restarted.

At this point, a medical TV drama would cut to another scene. In reality, the patient’s heart was restarted but they were intubated and unconscious. The family later arrived and decided it would be in the patient’s best interests not to continue further care. I later certified death, feeling particularly poignant as it was Christmas, a time of celebration for a birth and new life. As I wrote the last entry in the medical notes, I saw the patient’s distraught family walk away from the ward, feeling their sadness as I signed my name and wrote the letters RIP.

With those swirling thoughts, I was no longer a doctor, but a ​person​ mourning the loss of another

Unyielding and relentless, I was bleeped again. My steps towards the next job got slower and slower as my brain swirled with thoughts of that arrest, that patient, and that family. The arrest call itself is a paradox – laid bare it is the most human act done in the most inhumane way. The act of trying to save someone’s life, of you pumping your fellow human’s heart, touches on the very essence of humanity’s common bond. The process, however, is as savage and barbaric as it is life-saving.

As part of the arrest call team, I was focused on my job of restarting the patient’s heart. That focus strips away the humanity of the patient, reducing life to lines on a screen and numbers on a chart. With each passing cycle, the focus intensifies until it changes into a mix of desperation and willpower – willing the tube to go in the lungs, the blood to flash back into the syringe, the pulse to return. And when it’s suddenly over, the humanity returns.

With those swirling thoughts, I was no longer a doctor, but a person mourning the loss of another. I stopped, turned around, sat in a quiet room and had a chat with one of the nurses who was also at the arrest call. We talked about anecdotes from the patient’s stay in hospital and our own lives. It felt refreshing to talk about the life that was lived in the face of the sadness of a life that was just lost.

Mentally and physically exhausted, I was glad to hand over the on-call bleeper at the end of my shift to the next bearer of that cross. As I walked out of the hospital, I reflected on every job I’d had during the night, still wondering how the family of the patient who died was coping and what the diagnosis would be of one patient I asked my registrar to review.

Nights are said to be one of the best learning experiences. At the end of my set of nights, I was comforted not only by the wealth of skills and knowledge I could take into the new year, but by the care I had given to my patients to make their Christmases that little bit better.

Everyone takes something different away from their medical on-call experience. I will always remember that behind every patient and medical diagnosis there lies a human connection that binds us all together.

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My Christmas shift showed me the human connection behind medicine

The Gut Microbiome-Mind Connection

We as human beings have many cellular processes that work in a collaborated effort to keep ourselves healthy and functional. You may have heard at certain times that mental health issues like autism, bipolar disorder, and depression are a chemical imbalance in the brain which is completely unfounded. This issue boggles my mind because of the constant puzzling “evidence, in general ” and I use that term loosely. Someone who works night shifts and extremely long, in general, will have a decline in their health. This is because of irregular circadian sleep rhythms, along with mental and physical stress accumulation. In addition, cardiovascular, gut, and thyroid problems rather than a deficiency or chemical imbalance in the brain. We need to remember that every system has their own micro biome and microbial process. In this case, the gut microbiome will be discussed.

I’m a psychology student investigating topics like schizophrenia, bipolar disorder, psychosis, and the professors only referred to methods of treatment like psychotherapy, and drug therapy. There has not been one lesson ever on the gut micro biome, or the chemistry of microbes. Microbes are one of the three foundations on which humans live on, including water and the periodic table. There was no medical or nutritional training in my entire schooling. Do professors not realize that the body is an interconnected system? The brain needs nutrition, a clean environment, and water, to perform its basic duties. To me, human chemistry and nutrition should be 95% of any psychology program.

In class, there was constant discussion of serotonin and its huge stand-alone role in mental disorders. Serotonin seeks to give the body the balance to restore homeostasis. My problem here is “How does one become deficient in serotonin or imbalanced in it?” I have yet to see a scan/chart of serotonin deficiency… I believe the body relies on the subsystems that interconnect our way to good health. Hence, psychosocial, nutritional, and behavioral factors all play a role in achieving optimal health. The medical profession for the most part has been bought out by corporations so the common advice is to prescribe anti-depressants, which not only disrupt serotonin neurotransmitters but cause withdrawal symptoms such as low libido, high insulin level spikes, and heart palpitations. Antidepressants like Thorazine and Prozac are symptom relievers at best which in turn create more symptoms.

The micro-biome consists of all our microorganisms like bacteria, viruses, fungi, yeast, parasites, etc. Most of our microbiome lives in the intestines. Such microorganisms work hard to digest food, create vitamins, manage hormone levels, detoxify the body from toxins and create chemicals to maintaining the lining of the gut. The gut promotes a secretion process for hormones, vitamins, enzymes supporting the movement of food through the GI tract. The digestive process taps into the different systems like the pancreas, gallbladder, nervous, and circulatory systems. Factors that disrupt gut function are nutrient malabsorption, Autoimmunity, Food intolerance, environmental toxins, Systematic inflammation, lack of vitamin D, gluten intolerance, etc. All of these factors will effect energy levels, mood, and cause conditions like autism, anxiety,etc. Harmful microbes and toxins enter Muscosal Membrane (gut) cells and causing tight junctions to widen and leave room for said toxins and microbes to enter. This causes the immune B and T cells to cause a reaction for the immune system to attack the body’s cells . This collateral damage is known as Autoimmunity.

This goes back to the issue at hand, how the key neurotransmitter can be imbalanced without any link to other hormones like dopamine, epinephrine, adenosine, etc. Our body will be only as functional and healthy, depending on the foods we nourish it with. This does not mean processed food which were raised with pesticides and antibiotics. Diets that have processed foods contribute to inflammation and dysfunction of the immune system which lies within your gut. One must consume a diet with naturally raised foods without anything added or removed. There are many diets out there, however plant based diet is the most scientifically proven method of nutrition known to keep us in optimal health. Diets that include animal and dairy foods are pro-inflammatory and can cause chronic inflammation if consumed to an excess. Spirulina and soil microbes contain adequate levels of B12, but our industrialized world helped strip the soil of microbes, minerals, and trace elements.

I introduced all these following points about nutrition, and lifestyle factors because it is the only way to manage your body’s system. Drugs are not the best form of treatment because they hinder the body’s systems particularly the thyroid, endocrine, and cardiovascular systems. Women often complain of their hormonal shifts and synthetic drug abuse since millions of American’s, particularly women, are using drugs to deal with their symptoms. Such drugs are not limited to GlaxoSmithKline for psychiatric disorders and/or even birth control pills which deplete the body of iodine, and selenium. Iodine is responsible for metabolic activity, protein synthesis, and thyroid hormonal production which would in turn disrupt cognition, emotions, hormone production and regulation, etc. Adequate nutrition is needed to retrieve iodine, selenium, and many other trace minerals to stabilize body function and structure.

Selenium is vital for producing the peptide glutathione which is key to protect the system from oxidative stress which occurs when free radicals outnumber antioxidants and causes irregular shifts to the body’s functions. It protects cells from damage but enhance the immune system as well. In my opinion, prescription drugs are not a great way to treat conditions. Drugs destroy the beneficial and harmful microbes in our body which can result in more depression, anxiety, and feelings of sickness. Beneficial microbes alone can weed out bad bacteria that is looking to interrupt vital bodily processes. Having a dysfunctional microbiome leads to a disruption through neural, endocrine, and immune pathways which influence physiology, brain and behavior. Most doctors are not trained to see an individual’s biochemistry, micro biome and gut flora. Gut health is key to determining mental health, since many people with eating disorders and hormonal disorders associated with leptin and ghrelin, in fact contribute to a dysfunctional gut.

People with these disorders usually have a physiological issue with their micro biome and general well-being rather than a neurotransmitter issue. The body is an amazing healing machine, and it is your top priority to maintain it. Our mental health is greatly determined by the condition of our gut microbiome which include good and bad bacteria. Good bacteria tries to optimize the function of the immune and endocrine systems. They help keep cortisol and adrenaline at bay so they don’t cause further problems when continually flowing. Bad bacteria helps to destroy the immune system and disregulate hormonal processes.

The book “Brain Maker” by David Perlmutter states in his introduction that scientists have identified about 10,000 species of microbes and each of these microbes contain it’s own DNA. This would translate to more than eight million genes. When I noticed this fact, I was reminded of so many amazing topics in science, such as that of Epigenetics. Epigenetics is the genetic expression to our environment, what it contains, it’s food produce, the level of optimism and pessimism surrounding us, etc. All of this contributes to our gene expression and how we feel on a daily basis. Our gut organ is a part of our immune system, and it should be cared for properly for our lifetime. Positive emotions will play a huge role in strengthening our immune system.“Research at the leading edge of medicine acknowledges that the state of the microbiome is pivotal to human health.”

Our cruel system is set out to not only burden us with harmful phenomena with food and environmental pollutants, cleaning products, food ingredients which contain many hard to pronounce chemicals and toxins. They have us beat since our educational system is skewed, bought technology, and advantages towards particular groups of people have given numerous incentives for depression. This is in fact not subjective since, this has been proven to be the reality we are living in, due to blatant malfunction as a society, but a malfunction to our hearts and souls interfering with our personal aspirations. The Human system is very sensitive to toxins in our environment, especially our thyroid, therefore detoxification is absolutely necessary for good health.

Final Words

We live in a fast paced world, in which it is hard to make great health choices, having reduced stress, and live in a functional society. I firmly believe that psychological issues are a dysfunction of many interconnected physiological systems in the body. Another tip I would recommend is to order food sensitivity tests from a conventional lab with your doctor to detect issues plaguing your gut. It is crucial to see different doctors to get differing options and assessments to fit your specific condition. I would like to say that you, the reader can empower yourself, too many people live in hopes, doubts fears. All it takes, is simple dietary changes, incorporation of vitamin D and certain supplements, and a positive attitude to get you through the day. Persist in these changes and you will find that you will achieve great results.

Citations

Yarandi SS, Peterson DA, Treisman GJ, Moran TH, Pasricha &J, 2016, “Modulatory Effects of Gut Microbiota on the Central Nervous System: How Gut Could Play a Role in Neuropsychiatric Health and Diseases.” Journal of Neurogastroenterology Motility, 22:201-212.

Axe, J. (2016). Eat dirt: Why leaky gut may be the root cause of your health problems and 5 surprising steps to cure it. New York, NY: Harper Wave, an imprint of HarperCollins.

Brogan, Kelly, Loberg Kristin, 2016. “A Mind of your Own” New York, NY, Harper Collins Publishing. Print

Cryan JF, Dinan TG, 2012. “Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour.” National Library of Medicine, Oct;13(10):701-12. Print

Marchesi, Julian R et al. “The Gut Microbiota and Host Health: A New Clinical Frontier.” Gut 65.2 (2016): 330–339. PMC. Web. 2 Dec. 2016.

Ayd, Frank J. “EMOTIONAL PROBLEMS IN CHILDREN—The Uses of Drugs in Therapeutic Management.” California Medicine 87.2 (1957): 75–78. Print.\

McLachlan, Sandra M., and Basil Rapoport. “Breaking Tolerance to Thyroid Antigens: Changing Concepts in Thyroid Autoimmunity.” Endocrine Reviews 35.1 (2014): 59–105. PMC. Web. 2 Dec. 2016.

The Gut Microbiome-Mind Connection

Dementia Danger And Vitamin D Ranges: Is There A Connection?

A deficiency of vitamin D in older persons could double the danger of developing dementia and Alzheimer’s ailment, according to benefits of a new examine.

Dementia is broadly characterized by a decline in pondering and memory. Alzheimer’s ailment, which impacts about five million men and women in the US, is the most common type of dementia linked with aging. And with the aging infant boomer population, the amount of folks residing with Alzheimer’s is anticipated to improve virtually three fold by 2050.

The research was published online in the Journal Neurology, August 6, 2014.

Researchers evaluated levels of vitamin D in the bloodstream, reflected by dietary consumption of vitamin D, sun exposure, as well as use of dietary supplements. Vitamin D  is contained in eggs, milk and cheese, as effectively as in fatty fish this kind of as tuna, mackerel, and salmon.

“We anticipated to locate an association among lower Vitamin D ranges and the danger of dementia and Alzheimer’s disease, but the outcomes were surprising—we really located that the association was twice as robust as we anticipated,” explained examine writer David J. Llewellyn, PhD, of the University of Exeter Medical College in England.

The research evaluated vitamin D levels in 1,658 wholesome people age 65 and older with out dementia.  Six years later, 171 persons in the study created dementia and 102 had Alzheimer’s condition.

According to the benefits of the research, individuals with lower amounts of vitamin D had a 53-percent improved danger of creating dementia. Persons who had a far more significant deficiency had a 125 % improved threat  of establishing dementia compared to participants with typical ranges of vitamin D.

Those individuals with reduce amounts of vitamin D were almost 70 percent more likely to build Alzheimer’s disease and people who had extreme deficiency have been in excess of 120 percent a lot more most likely to create Alzheimer’s disease.

The outcomes were unchanged after researchers adjusted for elements that could influence threat of dementia, this kind of as smoking, alcohol use, as effectively as education.

“Clinical trials are now essential to create whether or not consuming food items such as oily fish or taking vitamin D dietary supplements can delay or even prevent the onset of Alzheimer’s ailment and dementia,” explained Llewellyn.

Even so, Llewellyn was mindful about the implications concerning the findings of this study.

“We need to have to be cautious at this early stage and our most recent results do not show that lower vitamin D levels trigger dementia. That said, our findings are very encouraging, and even if a small amount of folks could benefit, this would have massive public wellness implications provided the devastating and pricey nature of dementia.”

Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in New York City specializing in memory problems believes that a multifaceted technique to Alzheimer’s  disease and dementia is vital to effect a broader comprehending of the condition.

“Alzheimer’s illness, which occurs later in life, is an sickness caused by a multitude of variables including diet, lifestyle, as properly as genetics,” explained Devi.

“This research points to the relevance of great levels of vitamin D in helping to prevent onset of Alzheimer’s ailment in late daily life, the most typical variety of Alzheimer’s,” said Devi.  “Vitamin D helps to prevent the accumulation of the toxic amyloid plaque that is current in Alzheimer’s illness and prevents vascular brain condition.”

Dementia Danger And Vitamin D Ranges: Is There A Connection?

Blame Wakefield For Missed Autism-Gut Connection

This Pediatrics assessment of autism and gut ailments discovered greater costs of constipation, diarrhea, and stomach pain amongst autistic individuals. But the authors do not once mention nervousness.

That in spite of the reality that anxiousness is a essential characteristic of autism and that research suggests that autism and anxiety are without a doubt linked.  And that gut circumstances like diarrhea and constipation and gut soreness are frequently connected to nervousness.

When young children are not autistic and they have stomach ache or constipation or diarrhea, the regular conclusion is that anxiety and anxiety are the cause and predictive of anxiety in adulthood. Without a doubt, with that small nervous method parked there in our gut, it is no wonder that factors get a small seized up and out of rhythm when the rest of us does.

Strain (Photograph credit: kevin dooley)

So why is it that no a single attends to this clear (to me) website link when it come to autistic children? Properly, the Pediatrics assessment by McElhanon et al. happens to cite that cause a number of times:  Wakefield’s MMR/autism/gut red herring and the subsequent noxious cloud that his fraud left more than any study examining autism and the gut. So we do not know something about the real underlying causes of these digestive troubles among autistic young children. The Pediatrics authors state it unequivocally:

It is clear that greater clinical and analysis scrutiny is necessary to boost awareness on this subject and therefore assistance improvement of the very best specifications of care. Previous controversy surrounding the MMR vaccine and proposed causal link among ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population even though fostering uncertainty in the ASD neighborhood regarding the validity of this line of inquiry.

Another point for which to thank Andrew Wakefield, a self-described “academic gastroenterologist.” A person with that specialization would have been the ideal particular person to make this connection in between nervousness in autistic individuals and gut discomfort. One particular more amongst so several opportunities for comprehending and intervention missed, even as public health in general and the overall health of autistic kids especially continue to endure.

Possibly now, with this Pediatrics review disconnecting Wakefield from the picture altogether and encouraging real investigation, researchers will really feel more justified in pursuing this question with valid, testable hypotheses and scientific studies that may possibly lead to successful interventions for GI distress between autistic individuals.

Blame Wakefield For Missed Autism-Gut Connection

The Surprising Connection Amongst Enjoying Video Video games And A Thicker Brain

For all the unfavorable news about the alleged downsides of taking part in video video games, it is always surprising to come across investigation that shows a probably large upside. A new examine fills the bill by showing that heavy video game perform is related with better “cortical thickness” – a neuroscience term that means higher density in certain brain locations.

Researchers studied the brains of 152 adolescents, each male and female, who averaged about 12.6 hours of video gaming a week. As one particular may possibly guess, the males, on typical, played far more than the females, but all of the participants invested a significant volume of time with a gaming console. The research team wished to know if much more time invested gaming correlated with differences in participants’ brains.

What they located is that the brains of adolescents that invested the most time enjoying video video games showed higher cortical thickness in two brain places: the left dorsolateral prefrontal cortex (DLPFC) and the left frontal eye area (FEF).

The prefrontal cortex is frequently referred to as our brain’s command and manage center. It is exactly where increased order contemplating will take place, like determination-producing and self-handle.  Pervious research has proven that the DLPFC plays a large component in how we process complex selections, notably those that involve weighing choices that contain achieving brief-phrase objectives with prolonged-term implications. It is also exactly where we make use of our brain’s working memory sources – the information we hold “top of mind” for fast access when generating a choice.

The FEF is a brain spot central to how we procedure visual-motor information and make judgments about how to take care of external stimuli. It is also crucial in choice-creating due to the fact it enables us to efficiently figure out what type of reaction ideal fits what’s happening around us. The term “hand-eye coordination” is component of this procedure.

Collectively, the DLPFC and FEF are crucial gamers in our brain’s executive determination-producing system. Greater “thickness” in these brain places (in other phrases, a lot more connections amongst brain cells) signifies a better capability to juggle a number of variables, no matter whether those variables have immediate or prolonged-phrase implications, or each.

Whilst this review doesn’t quite demonstrate that playing hrs of movies games every single week brings about these brain locations to increase thicker, the correlation is robust – robust enough to consider the chance that gaming is type of like bodyweight lifting for the brain.

And that, even far more than the video-game connection, is what makes this review genuinely exciting. It suggests that the well-known terms “brain training” and “brain fitness” are more than advertising ploys to sell specialized software program. If it’s true that enjoying video video games is not not like exercising that beefs up our brain’s choice-producing brawn, then it logically follows that we can not only perceptually, but physically improve our brains with practices developed for the goal. Long term investigation will continue exploring exactly that chance.

The research was published in the on the web journal PLoS 1.

You can find David DiSalvo on Twitter @neuronarrative and at his site, The Every day Brain. His most current book is Brain Changer: How Harnessing Your Brain’s Power To Adapt Can Adjust Your Life.

Associated on Forbes…

The Surprising Connection Amongst Enjoying Video Video games And A Thicker Brain