Centurians

Evening all,

Now, if you are reading this, you may be wondering why on earth I am writing my junior doctor blog about “Centurions”, the fierce Officers of the Roman armies after the Marian reforms of 107 B.C, who commanded over 80 men at a time. Am I going to talk about their physical prowess, the psychological traumas, the nutritional challenges of being at war, or the ravages of disease in an era without antibiotics or modern medicine? No.

centurion-dominic-west1

What I actually meant to write in the title was “Centenarian” – a person living beyond the age of a hundred. However, because it was such a silly mistake to make, I thought a little bit of public self-humiliation would do be good and keep me grounded.

Now I am 31 years old. I still consider myself young in mind, body and spirit, as does my mother who is well, only just slightly North of sixty. This pleases me immensely as I think a person’s approach to age can greatly dictate how they perceive their health and wellbeing. After-all, I have met 50 year olds on the ward who look 80 years, and very sadly some 30 year olds who look 50 years old (these are the decompensated alcoholic liver disease patients in intensive care who I have mentioned before and who tragically were never discharged…).

Besides, they do say that age is just a number. Well I have met a patient who is the very embodiment of this. They are 104 years old and just fantastic. This patient has a sharp mind, and well, ok, a not so sharp body – but it is all working – albeit slowly. I have seen them enjoy the World Cup Finals, BBC News, and visits from lots of relatives and staff.

I feel so privileged that I have been in a position to help look after someone who was 5 years old when World War One broke out, and a young man during World War Two. They have seen the world change beyond all recognition. They have seen nearly all of their friends come and go, technology overcome face to face social interaction, and the pace of life move from a comfortable 2nd gear to unmanageable 5th gear.

I continue to be part of the team that look after this 104 year old – and it is a sheer joy. Every day I try and ask them something different – and every day the answer fascinates me. We, as a society, should embrace Centenarians, talk to them, ask them questions about their lives because we will not have the privilege like this again to explore through conversation a world that is far beyond our current face paced, superficial, contentious and demanding world we have created.

Next week is my final blog entry as a Foundation Year One Doctor. Yes, it has really been 12 months. I will be reflecting on a year gone by and the highs, lows, and changes I have seen in myself both personally and professionally.

Have a great week!

Dr Nick

 

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The Penny Dropping

Hello all,

Now, I may have neglected to mention in my last blog entry that I am indeed on a lovely week off. Rather than opt to jet-off to some sunnier climate with the rest of the country or ‘find myself’ in some far flung corner of the world (I think I might be a little old to be ‘finding myself’ at 31 perhaps! If I do – I may need a GPS..), I decided to go back to my family home.

For many people (but very sadly, I appreciate, not all) the family home is a place to reconnect, recuperate and reflect on their life’s journey and take stock of what’s important. I am definitely at my most relaxed at home, I suppose in a way, safe from the pressures that I place upon myself and society backs up with a whacking great punch of expectation. I become Nick the 31 year old doctor – regressing back to 12 year old Nick, in my old bedroom, with all the dreams and aspirations that I had back then etched on the walls and photographs.

And it makes me smile.

It makes me smile because I realise that, despite being a little older (ok, fine, a lot), a little more grizzled and life hardened with the highs and the lows that have presented themselves, I still have those deep-routed dreams and aspirations – I still have belief.

I feel incredibly lucky to have these. I many lose them along life.

Which brings me onto the main point of today’s blog – as I sit here with a steaming cup of mum’s tea, having just done an hour of tedious (but necessary) revision questions for an exam in September – that I wanted to share with you. It is in a way, a mission statement. A Jerry Maguire-esque (but much shorter) entry…

I woke up this morning, as I always do back home, having had a wonderful night of sleep. I awoke calmly, body still paralysed from sleep, but as I opened my eyes and my brain started to get the first dusty, cerebral cog turning for the day, in that moment, I just knew what kind of doctor and more globally, health professional, I want to be, am meant to be, am positioned to be.

And it is a great feeing.

So let’s look at the “I want to be” part first. Quite simply I want to promote, help and support people to be as active, fit and perform to the best of their abilities that they wish to, both cognitively and physically. From the 45 year old running their first marathon, the 65 year old hoping to regain some more independence after an operation, to the 23 year old fitness addict – anyone.

Now what about the “am meant to be” part? ALL by fate and not design I should start by saying, in the past 12 years I have tripped my way across a degree in exercise and sports sciences, a PhD in performance nutrition, worked in health care consultancy, gained a medical degree, and helped numerous teams and individuals maximise their physical and mental performance to achieve whatever the goal – whether it be the 4 guys (and dear friends) who rowed across the Indian Ocean or my relative that wanted to loose weight and be more active. Now, I am getting also getting the opportunities to do some media work (and we will have to wait a couple of months to see how the Discovery TV show is received) and this yet provides me with another platform to share what I love – our body and all the highs and lows of performance that come with it.

And finally the “am position to be” part. I am very lucky to be a doctor as it means, in time, I will get the opportunity to specialise in my passion – Sports and Exercise Medicine – a means to understand to nth degree about how to optimise health, fitness and performance – for ANYONE. Now despite misconceptions this does not just mean for the elite athlete – in fact it is more about you or I (unless of course you are an elite athlete!), the average person who wants to get fitter or healthier so that they can play with their grandchildren for longer or walk the dog for an extra thirty minutes.

And I think the timing is right. People are becoming increasingly aware of the value of health and fitness. It is the currency for life. What you run out of it, chances are you are sadly running out of time. Society is, as well increasingly aware, with the rapid ascension of social diseases such as obesity, type 2 diabetes and ischaemic heart disease. There is a reason, after-all, that the World Health Organisation have stated that physical INACTIVITY is the 4th global cause of death. ‘Lifestyle’ too, I would argue, is becoming more of a ‘sport’ almost with people focusing on levels of physical activity, stress, sleep, nutrition and so on to optimise who they are and what they can do in work, at home and in life. I want to embrace that all as it is, for me a pleasure to talk and learn from and help people who are driven to help themselves. And when people aren’t driven, I want to help them find it. They say that knowledge is power. Maybe I am lucky that as a doctor I have a growing bank of knowledge that I can use to empower, educate and drive others. Who knows.

Now I am going to stop here, as I have 30 magazines that I wish to write to and see if they have any writing slots for me AND I also want to enjoy some of this British sunshine! So let me sum up what this, likely yes, over gushy and from the heart, blog epiphany is about today:

Performance of the body and mind is my distilled, summarised passion.

I like to call it “PERFORMANCE FOR LIVING”…

I’m going to follow it now fully, with excitement, drive and the self belief that I still have since I was 12 years old.

Have a great week everyone,

Dr Nick

Just don’t hold your breath: Life Under Water

Good morning all,

Now firstly I have to apologise. I believe it has been an unforgivable two weeks since I last published a blog entry. I am going to place the blame squarely on my on-call medical rota and two weekends worth of open water scuba diving courses! Of course, I am joking – the responsibility rests with me, doesn’t it, as with most of the actions we take in life. But I am back!

I have also genuinely missed writing this over the past two weeks – it’s a reminder how much I really enjoy sharing with you what I have been up to – as long as it’s interesting for you that is. So let’s begin shall we…

A patient’s ability to breathe is key to supporting life. This rather obviously fact is what I am going to focus on first. We are, in fact, not even going to talk about the heart or blood or once. For when you assess somebody in an emergency situation (or any patient for that matter really), you follow ‘ABC’, otherwise known fully as ‘airway, breathing, and circulation’. They are written that way as that is indeed the likely order in which they will kill you the fastest.

Without an airway i.e. the tube (your ‘trachea’) connecting your mouth to your lungs, the 21% of oxygen within the sea-level air we breathe cannot get in. You die. If that works, then comes the next possible problem are – the breathing part of the acronym. For without being able to breathe, because of say, a collapsed lung or muscular paralysis from a rare infection – OR perhaps being able to breathe but having nothing to actually breathe, will kill you next fastest. We see these situations often in patients not so much in the extremes of those (although within intensive care we do), but more along a spectrum of breathlessness from the mild in people with well-controlled asthma to those with very severe chronic obstructive pulmonary disease (COPD) with a superimposed chest infection (known as an ‘infective exacerbation of COPD’) that requires machines known as non-invasive ventilators (NIV) to force air in against their failing lungs. COPD is a result of smoking. Please don’t become one of the people I see who struggle for breath daily because of something you did in your earlier years. It makes me so sad. That’s the only plug you’ll ever see me write.

Now, we digress! Yes, so airway and breathing – both very important to life.

So I decided I wanted to try exploring an environment that was not, without assistance, compatible with an airway or breathing – under water! Now, you will see, from the photograph below, that from an early age, I have always been a bit of a water lover…..

swimming

….and so 5 years after this photograph (ok, ok, maybe more like 20 years!) I decided to take the plunge again and go scuba diving in the most romantic, picturesque, majestical diving mecca I could find – a swimming pool in Tooting Bec in London, and then a man-made silt-lined murky lake in Wraysbury, 40 minutes outside of London. The blue hole, Belize, The Great Barrier Reef…..I’ll be seeing you soon!

wraysbury

The course for achieving the qualification of Open Water Diver, was just absolutely brilliant! Although, true to my passion for health and medicine, I found myself very sadly becoming more excited and enthralled with the physiology of how people become survive under water and also fall ill under water when I really should have been listening about the ‘how not to drown under water’ part of the lectures! Plus the kit you get is fantastic – who doesn’t love gadgets! The bulk of my breathing apparatus while scuba diving comprised the following:

1. An Air tank (10-15L) of 200 bar pressure – the big tanks divers lug around

2. A Buoyancy Control Device (or BCD) – those flashy looking vests

3. A Regulator which has the 1st stage which attaches to the tank and the 2nd stages which are where you breathe from (I say second stage’s’ as you have one primary and one back up) – the bit you put in your mouth and all the tubes popping off the tank

4. Submersible pressure gauge (SPG) so you know how much you air you have – just a gauge!

5. All the other fashionable accessories like: mask and snorkel, dins, compass, and dry suit (looks like a ridiculous oversized boiler suit out of water, I know) when in open water (because diving in the UK can be very cold even just 8m underwater despite the surface water temperature deceptively that of a warm bath!

And when you are all kitted up you end up looking something like this…

Pool diving

 

dry suit

Breathing underwater is simply magical. If you have had the honour of doing it then you will know what I am describing. For those of you who haven’t, if you have the time and are willing to pay (I forfeited going on holiday to do this course) then I really encourage it – or at least try out some snorkelling on holiday or your local swimming pool. It was for me an incredibly relaxing place to be and you are just in your own little, mask tinted world, with the sound of your own breath as the melodic backdrop to this underworld existence. Unsurprisingly I didn’t see any tropical fish or sharks in Wraysbury – I saw one crayfish and a bus that they had deliberately sunk in the lake to give us SOMETHING to look at! The first breath you take in when you go underwater is one of trust by the way…and a VERY surreal experience.

What I want to finish is by telling you about something a bit ‘sciency’ about diving and how you all may be able to relate to it. It is called the mammalian diving reflex.

Now this mammalian diving reflex is a primitive reflex that many mammals have. This includes (a little more weakly) us humans. It is a reflex that aims to slow down your respiration rate or ‘breathing rate’ simply put, while under water.

In humans, the trigger is when our face hits cold water (that’s less than 21 degrees Celsius)! Interestingly it is only triggered by our face – if you were to put your hands into ice cold water, or your leg, the same effect would not occur. It happens specifically, you see, when the sensing sites in the nose called ‘receptors’ are hit with cold water and trigger the 5th cranial nerve known as the trigeminal nerve. This nerve then sends a cascade of signals to the brain and activates your autonomic nervous system. So, what actually happens when your face plunges into cold water and this is autonomic nervous system is activated? Well two key things:

1.  Your heart rate slows down by a fifth (called a ‘bradycardia’), and

2. Blood vessels on the outside of your body and muscles narrow (called ‘vasoconstriction’) to help keep the blood flowing to your important heart and brain

…and incidentally while we are on the subject, that is why people can survive for longer underwater – basically their need for oxygen by the body goes down. I love how the body can survive by conserving oxygen in this way – it is yet another marvel of our body. In medicine this understanding makes it one of the more novel ways in which you can slow down a very fast heart rate in a child (i.e. a supraventricular tachycardia) -that is, by plunging a child’s head first into ice cold water! Quite simply, the reflex we talked about is triggered and the heart rate slowed down as a response. The parents look horrified obviously….

I could go on to talk about nitrogen narcosis and decompression illness but I am sure that I can tell you about those another time! One thing I would like to end with is this question: do you know why, when you are underwater, you end up taking that breath or having to come up for air to stop you from taking that horrendous mouthful of chlorinated, urinated, pool water?! Is it:

a) Lack of oxygen?

or

b) Too much carbon dioxide?

Ok, so this is a bit of a loaded question but the answer is in fact a build up of carbon dioxide. You see our respiratory centre which lives in our brain and tells us how much and when to breath, is very sensitive to how much carbon dioxide there is in the blood.

We make carbon dioxide when our cells use oxygen and release energy. As we hold our breath therefore the oxygen is used in the cells and the carbon dioxide is made as a bi-product – and gradually builds up. When it hits a threshold of too much carbon dioxide the brain’s respiratory centre says “time to breathe” and so you breathe – this is not voluntary at that point!

That’s why before a ‘breath holding competition in the pool with your friends or family everyone automatically takes those big breaths – not only are you loading your blood with oxygen but you are also blowing off as much of the carbon dioxide in the blood so that it takes longer to build up – and hence take you to breath-holding competition glory!

A few fun facts to round this week’s blog off with:

1. World record for deepest ‘free dive’ (I.e. one breath hold) = 253.2m!!

2. World record for deepest ‘scuba dive’ (i.e. with breathing equipment) = 330m

(note that the reason we cannot go deeper currently is largely to do with the massive pressure that would be exerted on the body down in more depths)

3. World record for deepest dive of a mammal = 2,992m by the Cuvier’s beaked whale (and they were down there for 138 minutes!)

It is clear that human physiology, as amazing as it is, still has a lot to learn from mammalian physiology – when it comes to life under water.

Have a great week everyone!

Dr Nick