Know the score

In medicine, different scores are used in different situations to assess the condition of a patient. These scores are a useful way of summarising a patient and can therefore be used to decide the next step in that patients care. I’m going to concentrate on two of these scores.  The first we would all have been scored against at least twice in our lives while the second is something I hope none of us never have been and never will be scored against.

The Apgar score: 

This was a score developed in 1952 by an Anaesthesiologist called Virginia (surprise surprise) Apgar, one of the few female consultant Anaesthesiologists of her time. What makes her endeavours to promote this score so amazing is that she never had any link to obstetrics throughout her career yet made a system which would save the lives of thousands of babies. 

            So what is it? It is a score from 0-10 which every new baby is given normally one minute after birth followed by five minutes after birth. There are five criteria used in this score, each one given a weight of 0,1 or 2 points. The different criteria and how the score is decided is shown below:     

A baby with a score of 7 or above is generally healthy, while 4 and below there is cause for concern. There are many factors which can affect the initial apgar score but generally it is worsened if the baby was born by caesarean section or by a complicated delivery. What made this score so revolutionary was that people noticed that if proper care was applied to babies that had a low apgar score after one minute, their condition could vastly improve when the second score was given. Previously however blue and limp babies would be assumed to be still born and left to die.

GCS:  

            You’ve probably heard this abbreviation shouted across ER’s in your favourite episode of Casualty so prepared to be enlightened as to what these three letters signify. Glasgow Coma Scale……. Ok maybe it doesn’t sound that exciting but it has proved to be very very useful. This scale is a measurement of the conscious state of all trauma and acute medical patients. This particular scale is from 3 to 14 (or in the revised version 15) and similar to the apgar score is used to determine what the immediate next stage in the patients care should be. It was first created in 1974 by Graham Teasdale and Bryan J. Jennett who were professors at (yehp you guessed it) the University of Glasgow.  

            The scale is made up of 3 independent tests each concentrating on an individual section, the score from each section is then added together to determine the final score. Below again is a summary of how the score is decided.    

From this the severity of the brain injury can be estimated:

• Severe, with GCS <9
• Moderate, GCS 9-12
• Minor, GCS >12

For more information on the apgar score:

http://kidshealth.org/parent/pregnancy_center/q_a/apgar.html  

For more information on the GCS visit: 

http://www.patient.co.uk/doctor/Glasgow-Coma-Scale-(GCS).htm 

Alex Butcher 

Is it really possible to cough up a tumour?!

The simple answer, apparently, is yes. Prompted by a recent article in the metro I’ve done a little bit more research into an idea which truly seems impossible. In the article, it was described how a woman through two coughing fits coughed up a large tumour which had been accumulating in her trachea. At first the woman thought nothing of it, believing the small object from her first cough was just some viscous phlegm. However after her second round of coughing and the appearance of a much larger piece of flesh she went to her GP where the substance was sent to be tested. When it emerged that the malignant tumour this woman had inadvertently coughed was what it was she was scanned in an attempt to see if the cancer had spread. Miraculously, it hadn’t. The woman was perfectly healthy. These cases are incredibly rare with around only 30 known cases but even the one instance proves it is possible.    

Though there are few cases where a whole, previously undiagnosed tumour is coughed up there is something similar which is far more common. Through my research it seems that for patients undergoing radiation for lung cancer, coughing up parts of their tumours is surprisingly common. While it definitely does not happen in every case, many people find that they will produce small fleshy lumps after undergoing their treatment. I could not find any studies on this subject but what I could find was a blog forum with a doctor discussing instances such as these.

For the blog visit:  

http://onctalk.com/bbPress/topic.php?id=221  

For the original article in the metro visit:

http://www.metro.co.uk/news/887005-mother-saves-herself-from-cancer-after-coughing-up-inoperable-tumour

Alex Butcher 

Don’t worry it’s only your heart failing……..oh……..

            Recently many people close to me have been having cardiac problems and with increasing obesity and life expectancy in this country heart problems are becoming ever more common. Around 900,000 people have in the UK have heart failure with 68,000 new cases every year, primarily found in people above the age of 70. What heart failure definitely is not is your heart just stopping, (that would be a problem…) rather the weakening of a part or certain parts of your heart so that it becomes incapable of pumping the volume of blood around your body that is needed to for everything to function correctly.

There are different types of heart failure:

1. Systolic heart failure is when the ventricles of the heart do not contract properly with every beat. Severity of symptoms depends on how much the ventricles are affected. The left, right or both ventricles can be affected.
2. Diastolic heart failure is when the chambers of the heart do not fill correctly in between beats when the heart is at rest. This can be due to the ventricle walls becoming stiff and incapable of stretching far enough to accomodate a sufficient volume of blood. This can again be found on both sides of the heart.
3. Unfortunately there is a third option and this is that you can have both types at the same time!   

Heart failure rarely presents itself on its own, more often it comes accompanied with many other conditions which might include high blood pressure, certain arrhythmias and faulty heart valves.  

What are the symptoms?

            The symptoms normally depend on the side of the heart that is affected. For the left side these tend to be respiratory problems (mostly shortness of breath) made worse when lying down or doing exercise.

            If you have right sided heart failure swollen legs and ankles are commonly seen along with nausea, dizziness and loss of appetite.

How is it diagnosed?

            Heart failure is quite difficult to diagnose as the symptoms presented can be related to many many other conditions, however if it is suspected a echocardiogram is normally done (ultrasound of the heart) and from this a confident diagnosis can be made. In addition to this a blood test to test for natriuretic peptide can be done as this is sometime raised in patients with heart failure.

What can you do to protect yourself from heart failure?

            There’s nothing very specific that can be done but the usual suspects of drinking, smoking and lack of exercise all increase the risk of heart failure.

For more information on the drugs used to treat heart failure visit:

http://www.patient.co.uk/health/Heart-Failure.htm  

Other source of information:

http://www.nhs.uk/Conditions/Heart-failure/Pages/Introduction.aspx     


Alex Butcher