Eid-ul-Fitr

Eid-ul-fitr is a bit of a tough time in my family since Aisha left us. Talking to my cousins, I don’t think we miss Eid celebrations that much. Maybe it’s because we’re growing older and eid is more fun for the younger children. However I sometimes think that we should perhaps make more of an effort for my younger brother as he is still only a kid after all. Anyway who knows :-/

By the way the White House wishes everyone a happy ramadhan kareem. This is one of the reasons why I like the guy :)

< http://www.whitehouse.gov/blog/Ramadan-Kareem/ >

Head hunted

I remember when I first heard that term and thought it sounded a bit brutal for something which is essentially nice thing to be considered for. At no point in my life did I think I would be headhunted, especially not like a job like this…

There was a whole job specification outlined but I cropped it out. Way to boring :P

I had to ring the lady back and inform her that I was back at university after my placement year and she was all like ‘Oh, you’re just medical student? Ah I’m sorry…’

Usually I wouldn’t mind that comment, as she was just stating facts but it was the inflection of her voice when she said ‘just a medical student’ and sympathising for poor choice of career. I felt like saying, ’Woman, this studying malarkey is pretty tough you know!’ But as you probably already know, there is no way that I would say something like that.

Clearly I’m overly sensitive today (urgh!) so I’m glossing over the ‘just a student’ thing and be pleased with the fact I was considered for the role. I especially like the salary – that could definitely be put to good use ;)

Err, the IP belongs to me? No?

So I finally made a decision about where to go for my doctoral studies and have been sent my contracts in the post. That’s right – contracts. Not university forms to fill in but contracts that need to be signed, which makes it sound all so scary. I mean contracts are not a new thing for you, I’ve had to sign them for jobs etc but never for a place of study. An agreement to the code of conduct at university – yes; a contract at university – err, no. This contract in particular had clauses such as;

i) Your must agree to assign Intellectual Property arising from the projects to the University. Full details of this are explained in the assignment letter (see below).
I cannot be bothered copying the rather wordy and legal sounding assignment letter. Sorry! But I mean really? My intellect or more specifically the intellectual property that I may or may not develop does NOT belong to me? I really don’t get some type of ownership over this? Oh no wait I do... just a passing comment perhaps, but mostly it’s all the university. Which in fairness is ok I guess, seen as they are paying for me via my scholarship. It just feels a bit weird that’s all.

ii) During the tenure of the studentship you may undertake teaching and demonstrating duties in the university provided that the total demand made on your time, including preparation time, does not exceed six hours in any one week. You may not, however, retain or accept other employment or an appointment, which involves substantial calls upon your time without written consent of the Head of the School in which you are registered.

Ah yes lecturing, which I conveniently forgot about, eek! I’ve done like odd lectures here and there, filling in for people etc but teaching a regular class – again scary stuff! Ah well I guess I’ll deal with it when I get there, lol.

Ok, SO maybe I’m making it sound a bit scary as it is not all harsh and I will learn a lot from some really knowledgeable people. Also I got a really lovely accompanying letter of which included; congratulating me on getting the studentship (Why, thank you), the faculty hoped that I would accept the offer (which I have done) and wished that my time at the university is rewarding and enjoyable (well I hope so too).

Anyhow I now have two whole weeks off. Neither Saba or I have had much of a break this year so these two weeks really mean a lot to us. Eid is coming up and I have a lot of things to sort out before the new university semester begins again. Two whole weeks!!! Woohoo!!!

Baking with Bilal

With the my dissertation completed, I finally got the chance to chill out with my family. I fancied doing some baking and rather shockingly, Billy decided to join. I made a pasta bake, a couple of quiches with different fillings that Bilal helped to decorate, bless! We also made some pretzels - can you tell which ones are mine and which are Bilal's? lol With the leftover dough, I thought I'd leave Billy to it to see what he came up with. After cutting a tray full of round biscuits, Bilal got bored and started to try different things. My favourite thing has to be when he made our initials for all of us; A for my sister, an S each for my father and I and a Y for my mother. After he arranged them on the baking tray, he called me over to place the tray in the oven. I couldn't help but laugh :P I think he enjoyed our baking session - whether it was the actual baking or the fact that I hadn't spent that much time with him lately, who knows. But I'm glad he did and makes me think that I should do this sort of thing with him more often :) Afterwards Billy even helped with the washing up - I almost fainted from the sheer shock of it all, lol. All in all, a good day :)

My Dissertation...

The core basics of my research project...
Title: “Investigation of combined cerebral oximetry and transcranial Doppler cerebral blood flow measurements in the common dementias.”
Location: The University of Manchester (course admin) and Wythenshawe hospital later renamed University Hospital South Manchester (study location).
Area: Department of Academic Surgery and the Vascular Studies Unit (VSU) at UHSM.
Duration: The MSc officially ran from September 2008 and September 2009. This time period also included my clinical study.
Supervisor: Dr Maureen Thorniley
Other people of interest: Numerous helpful associates but a few that I’d like to mention are Professor C. McCollum (Head of academic surgery), Dr V. Sekar (PhD Student), Dr Z. Bashir (Post doc), Miss J. Mercer (Researcher), Mr T. Kelly (Student), Mrs S. Cooper (MSc course administrator), Dr J. Oldham and Dr P. Gardener (Course directors) and finally C. Slinger, D. Anglin and E. Greenwood (fellow 2009 scholarship students).

The techniques/technology used:
Transcranial Doppler (TCD) – Measures the cerebral circulation parameters such as speed, direction, resistance, presence of emboli and so on. The middle cerebral artery (MCA) was the prefered vessel for insonation.
Near infrared spectroscopy (NIRS) – Measures the levels of oxygenation in the cerebral circulation.
Cambridge (CANTAB) – A total of 22 computerised cognitive tests that focus on different areas of the brain and aid in the diagnosis of different neurological conditions.
Mini-mental state examinations (MMSE) – A quick cognitive test (usually under 5 minutes) used to test the mental acuity of an individual.
CAMCOG/ CAMDEX – Other types of cognitive testing procedures commonly used in patient assessments.
Atorvastatin – Medication; statin used to break down plaques in arteries used formed from cholesterol.
Clopidogrel – Medication; anticoagulant used to disperse blot clots.

Hypothesis:
Premise – The process of embolisation is thought to be an early indicator for the onset of dementia. Tiny atherosclerotic plaques give rise to tiny break off particles (named emboli) which travel around in the cerebral circulation. In some cases, these tiny emboli can become lodged in narrow vessels thus decreasing the blood flow and oxygen to certain areas. The decline in cerebral parameters is thought to contribute to the memory decline associated with dementia.
Aims and Objectives – Based on the above hypothesis my project had a number of aims and objectives to fulfil, which were as follows;
- 1st – To screen patients and if they were emboli positive, then the participants underwent further testing where cerebral oxygenation levels (NIRS) and blood flow velocities (TCD) were analysed to see if there was a change in parameters associated with the presence of emboli.
- 2nd – Compare the cerebral parameters of the patients with dementia in the study to normal healthy volunteers of a similar age to see if there were any significant differences between the two groups, which may help to answer some of the questions linked to this area.
- 3rd – To evaluate potential therapies for dementia by analysing TCD and NIRS parameters on a monthly basis. Prior to this the patients were randomised to receive each of the following drug phases, Atorvastatin, Clopidogrel or a no treatment phase.

Methods:
My study had two protocols:
Protocol 1 – Testing normal subjects and patients with dementia.
The aim was to recruit 20 normal and 20 patients with dementia. We ended up with a total of 43 participants - 23 normal subjects and 20 patients with dementia. Both groups of participants (normal and dementia) underwent just a single test session with identical testing procedures. The session involved using TCD and NIRS probes to measure the cerebral parameters whilst the participants underwent the CANTAB test method followed by the MMSE and a full medical history. The results from both groups were analysed to see if any differences could be detected. From all the participants tested, 10 normal subjects were age and sex matched to 10 of the patients with dementia and their results were analysed in greater detail to see if age and gender had any affect on the cerebral circulation. The pictures below show the typical output from each of the methods used (TCD, NIRS, CANTAB).

Protocol 2 – Patients analysed from the drug trial.
These patients were selected from an ongoing clinical trial. 10 patients that had completed the trial in full had their results analysed. Each participant underwent a screening test to see if they were emboli positive of negative, If emboli positive, the participants were randomised to receive the different medications on a monthly basis followed by a month long ‘washout’ period between each drug. At the end of each month (and thus at the end of each different drug phase), the participants underwent 2 x one hour long TCD sessions. Each scan last one hour and each phase requires two scans therefore a minimum of 6 scans per person. A total of 10 patients equals a minimum of 60 scans. These 10 patients also had a monthly MMSE test and a blood sample that was analysed for Interleukin 10, an inflammatory marker.

Results and conclusion: Papers are being written for publication so I will post the link online soon.

Taken by one of the VSU staff. Me working through about a 100 scans (Protocol 1 – 43 scans and protocol 2 – minimum of 60 scans. I look cheerful don’t I?

Further work: Things I would further like to investigate (provided I had the funding and time) would be...
1) Larger patient numbers to increase the validity of my results
2) Validation of CANTAB tests to form part of a diagnostic method
3) Assessment of other neurological defects such as Parkinson’s using the CANTAB method
4) Comparison of other cognitive assessments such as the MMSE, CAM ICU and so on

All in all I enjoyed my project immensely. It was a lot of hard work, long nights and I often felt like packing it all in but I guess I have a strong stubborn streak. And I’m grateful it kicked in because it gave me the fantastic opportunity to learn many things about life in the medical world. Aside from the science/ clinical aspect of the project, from my placement I also learnt many other non-medical stuff.

Two major learning points for me were...
1) Patient responsibility – It seems kind of obvious but some people get so caught up in the end result that they forget everything else. It’s essential to keep patients well informed at all times as they often panic and become anxious very quickly. I learnt that theory and practice are very different in real life. It is VERY hard to recruit people as they can often be very sceptical but mostly scared. Sometimes it’s not even the patients but their carers that are reluctant to some extent. I also learnt very quickly that you must always to be very clear with your aims and what you are doing. Furthermore working with vulnerable populations; especially people with dementia that are often scared/confused, requires the utmost care and attention. Old or young, patients need plenty of patience and need to be constantly reassured. Personally I found those who tried to be a friend and not just their doctor/nurse/researcher or whatever were more successful than those who were strict professionals. I’m not saying that the professional boundaries are not required as they are vital working in such an environment and as part of the clinical team we shouldn’t get too attached but at the same time we should try to be a friend as well, as it helps to break down a lot of barriers.

2) Interdisciplinary teams – Communication is key! Bad communication leads to a lot of infighting between staff and placing blame back and forth as I observed in other departments. It’s bad for staff morale and also for junior staff i.e. students such as me etc. Although I didn’t have any clashes myself – it did show me that sometimes medicine isn’t always about saving lives and includes building on skills that maybe aren’t linked to your scientific and clinical knowledge. Those experiences help make you a good all rounder. I’m sure that all teams go through a few rocky patches but unless they work through it, they’re not doing themselves or their patients any favours. I’m pleased to say that the clinical team I worked with are genuine hard working individuals who are dedicated to their work. I couldn’t have asked for a better place to learn :)

So there you have it... the story of my dissertation. Here’s hoping I get good marks for this past year and for my dissertation (iA). The pictures below show the clinic and work areas, my equipment and patients being tested.

MSc stuff...

Disclaimer – I apologise in advance if anyone dies of boredom reading this post. It wasn’t my intention ;)

All in all, this past year has been dedicated to my MSc in medicine at The University of Manchester. The major focus was my dissertation which involved a lot of long work hours at the hospital, sleepless nights and quite a fair bit of travelling. Seen as it was such as major part in my life for this past year – and at certain moments the ONLY important thing in my life (sadness I know!)... well I thought I should explain what I have been doing for these past twelve months. So here goes....

My MSc kicked off in September where after my initial induction meetings and lectures, I started to attend a number of interesting talks from the MIMIT seminar series that were a part of one of my MSc modules. It was also a good way to get to get to know my fellow students better as we had all come from different med courses. Soon after this we started choosing our preferred tutorial sessions which involved a lot of research, preparing and giving presentations and then submitting written assignments on our chosen topics. All fine so far, just like my undergraduate degree… and then came the difficult part. Who knew choosing a dissertation topic would be so difficult both for the MRes (purely research based) and MSc (partly taught element) students alike.

The great thing (or bad thing, depends on how you look at it) is that at Manchester university, the MSc students were given the option of either carrying out a full 35 week project for the dissertation OR splitting it into a 10 week and a 25 week project which are written up separately and submitted for their dissertation. I initially thought this was a good thing and I was very keen to carry out two projects that were both in different disciplines; one would be clinically based and the other would be lab based. I felt this was a great way to pick up a larger skill set, provide me with a better all round knowledge base and also create a lot more options for my further medical degree. My initial 10 week project was to be lab based as I felt I could get on with this relatively quickly whereas the clinical project would require a lot more planning time etc and so that was allocated to the 25 week project. Also the various project titles indicated the time span that would be required for completion of the project.

I chose the topic of wound and keloid systems for my 10 week lab based project with my supervisor who was a plastic surgeon at one of the Manchester Hospitals. After the initial meeting, my supervisor felt that the keloid system project would be quite hard to complete in the time I had in terms of training and lab set up etc. Therefore I was offered an alternative project which I thought was fair enough. The alternative project was on the topic of breast implants and the adherence and rejection by the fibroblasts that grow around the implants. Basically it was in the area of cosmetic surgery and I’ll be honest, although it may be an interesting topic for others, personally it wasn’t what I quite I had in mind. However despite the niggling feeling, I stuck with it and went away and did some reading on the topic.

A week later, I returned to my future supervisor and told him that I was happy to undertake it for 10 weeks after which I intended to switch to a clinical project for the 25 weeks. My supervisor was initially taken aback and wanted me to stay for the full 35 weeks but I stood firm and a terrified me explained my reasoning about gaining a larger skill set etc. His response was that although my reasons were good, he felt it was more beneficial for me to stick to one project as it would provide me with more in-depth knowledge and also I would be able to publish more papers and attend conferences, which in turn would look better on my CV and future interviews. I thought about it and realised that he was also right and very appreciative of his advice. As a final warning he asked me to reconsider my decisions as “clinical projects are not always what they seem”, but I stood firm and told that my interest in medicine had always been patient orientated. He shook my hand and wished me the best of luck - it was a sort of terrifying but very informative meeting.

I started and successfully completed my clinical project and this was the result...

My dissertation - for which I will hopefully get a decent mark (iA)

The story of my dissertation ... Well that’s dedicated to a separate blog post altogether seen as this post is getting a bit too long :)

DONE!!!

Woohoo!!! My dissertation - printed, bound and submitted on time – DONE!
And I’m finally heading back to Leeds where I belong!
A friend’s sent me a T-shirt which summed up the past year of my life –

... funny I know :) Please feel free to order it from here if you really want to own one :)

So on Thursday night with my dissertation completed to my satisfaction, printed and nicely bound, I thought I could afford to relax a little the night before my submission deadline. TEDx Leeds on a Thursday evening with my cousins. Ok maybe a little geeky but I was genuinely looking forward to it. I should have been there... but instead I spent the evening surrounded by blank CD's waiting to be filled with study data and statistical analysis spreadsheets. I guess archiving my study data took much longer than I had expected. A little disappointed with not being able to go but at least I had the satisfaction of knowing that work wise everything was done properly.

I was so caught up in the submission of my dissertation (filling in forms and making sure my work was complete) that I completely forgot the date today. Upon my arrival at University, I had noticed an unusual number of people heading in and out of the church nearby but just it didn’t click in my mind. At around midday, the clock tower chimed, which for some unknown reason made me stop in my tracks. Oxford road, which is notoriously busy throughout the day, seemed to standstill as a sudden spell of silence descended upon it. I’m not sure if my mind was just imagining this quiet spell or if it actually was happening. But I’m pretty sure it was real as many of the students nearby stopped what there were doing and just bowed their heads in silence. I didn’t remember being told about this but still I stopped what I was doing and joined in with the two minute silence. There sat in this eerie hush on the steps of the Stopford building, in the heart of Manchester, it dawned on me that today was 9/11.

I thought about the families that had lost loved ones and what their lives must be like and whilst everyone else got up and went about their day; I remained seated on the cold stone steps. For some reason, I felt incredibly bad that I had forgotten and part of me couldn’t understand why. I wasn’t personally connected to any of the 9/11 victims so why this sudden guilt? And then it hit me. Whilst I was going about my daily life, doing what needed to be done, how easy had it been for me to forget those we had lost? I don’t just mean the people associated with this day, but people closer to home - our own loved ones, our family and friends. If I could forget this day that was incredibly well documented and talked about, how easy would it be for me to forgot those people that I love who are no longer in this world. Those people that aren’t well known to the rest of the world but for me they hold a special place in my heart.

In all honesty that scared me; that I may one day forget and I made a promise to myself that I would try and avoid that all costs. However this past year at the hospital has taught me that sometimes it is out of our control. The patients with dementia had no idea that they would be struck down by this terrible illness and in essence they have been stripped of their memories. It has made me appreciate life a lot more and I learnt (from my own patients in fact) that we should cherish every moment as we never know when we may lose it all. And so I believe I owe it to those that have gone; to keep their memory alive. Some people might say that it is unwillingness on my part to let go of the past, which they may deem as unhealthy. However I see it differently. It is those losses that have made me who I am today and taught me some invaluable life lessons. To forget those people would be an ungrateful act on my behalf.

Childhood toys - Lego

One of my strongest childhood memories was playing with Lego. Not the big blocks for toddlers but the proper kind and each of my cousins had a set so no matter which house we went to, there would always be Lego to play with. I had quite a small collection, Saba and Sara had a few bits and bobs but the biggest collection by far was at my eldest cousin, Imran bhai’s house. It was an assortment of detailed Lego sets such as pirate ships, a space station, a police set up, an army of some sort and the list went on.

I remember that I had built my Lego set into a house with each room clearly defined and kitted out i.e. kitchen, bathroom, bedroom, lounge – I even had a garden! The house took pride of place on a high shelf where it was not in danger of being broken. I have memories of trying this recreate this house on larger scale using bhaijaan’s Lego set only to find that Fari bhai would continually break it down as there *ALWAYS* seemed to be some war going on or some baddies needed defeating whenever we played together. I may be generalising but that memory pretty much defined for me the fact that, girls are more about building and preserving things whilst boys just want to make a lot of noise and break stuff – although it has to be said Fari bhai did produce some fantastic sound effects ;)

Anyhow that model of my Lego house stayed with me for a while and I would continually improve it every time I thought of something new and liked the fact that I could do alterations without too much hassle. I then started jotting down my ideas for houses in an art scrap book I had at school and I suppose as silly as it may sound, that that may be where my interest in architecture came from. I eventually lost track of where my Lego house went, probably still somewhere in Halifax I should think. Just recently I came across an article about how James May (part of the Top Gear trio) is going to live in a house made entirely from Lego! How weird is that?! Also how badly do I want a go making this house?! I wonder how much weight the Lego pieces could take before they buckle and the whole house falls apart? Realistically it probably won’t last that long but it is something fun to do :)

James May's lego house.

A link to the Mail online article can be found here.