Blog posts

How to PREPARE for surgery and speed your recovery

PREPARE for surgery

All types of surgery require preparation and, afterwards, recovery time. But according to the oesophago-gastric cancer team at Imperial College Healthcare NHS Trust, undergoing major surgery is like running a marathon. The PREPARE for Surgery programme, designed by the team, ‘trains’ patients for surgery based on their individual needs. It looks at different factors important to focus on before and after a procedure, including physical activity, diet, psychological wellbeing and medication management. Here clinical nurse specialist Venetia Wynter-Blyth explains how the programme helps patients adopt the good habits needed to aid their recovery.

The PREPARE for Surgery programme is all about treating a patient holistically and looking at the whole picture. We know when someone is due to have surgery, the psychological side of preparation is just as important as the physical side; so we work hard as a team to strike the right balance and have a positive impact on our patients’ post-operative outcome.

Once we know someone is going to have surgery for oesophago-gastric cancer, we invite them to our PREPARE clinic. We assess every patient in clinic and establish their ‘baseline’ measurements. This gives us a benchmark to improve on over the four to six weeks it takes to complete the programme, and prior to the patient’s surgery. Our surgical team makes sure they schedule procedures with enough time for patients to benefit fully from PREPARE. (more…)

How teaching life skills can help children with ADHD

I started working with young people with attention deficit hyperactivity disorder 25 years ago. Over the years, our knowledge and understanding of ADHD has come a long way – mostly down to scientific research – taking the condition from a relatively unheard one to a household one. Too often, we associate ADHD with children, however it’s now recognised to be a lifetime condition with many undiagnosed adults continuing to experience symptoms throughout their lives, despite the abundance of international guidelines on the assessment, treatment and management of ADHD. With many young people reaching adulthood with undiagnosed ADHD, or even misdiagnosed, they will not receive the optimal treatment for their symptoms and associated problems. Unfortunately, many will not reach their potential, and for some, they feel their future is bleak.

It doesn’t have to be this way. The good news is that there are large treatment effects for ADHD interventions and one can intervene at any age. However, early intervention is key if children with ADHD are to mature into confident young adults who experience good mental wellbeing and can effectively plan and organise their lives. I’ve always believed that we should be providing early intervention programmes that work directly with the child as well as those involved in their care and education. Hence, drawing on cognitive behavioural therapy (CBT) – a technique commonly used for phobias, depression and bipolar – I developed the ‘Helping Children with ADHD’ individual treatment and ‘The STAR Detective’ group intervention to provide life skills to children, their parents/carers and others involved in their care. (more…)

TB or not TB? Why tuberculosis remains one of the top 10 causes of death today


I was always a sickly child – when I was eleven years old, doctors injected my forearm with tuberculin in order to check whether my immune system raised a response to the bits and bobs of dead tuberculosis (TB) bacteria in it. If it did, it meant my immune system had already been prodded into battling TB, that is, it had previously encountered or was currently encountering an infection with TB bacteria. The injection site swelled like a furious bee sting, the doctors decided TB was the root cause of all my troubles, and I was intensely medicated for the next six months. My symptoms improved, and I have since evolved (visibly even!) towards the hale and hearty end of the healthiness spectrum.

In retrospect, now that I am medically trained and pursuing a PhD in TB immunology, I can appreciate all that my care team must have had to consider before starting an eleven-year-old child on a rigorous anti-TB treatment based on an educated guess. My symptoms were not typical of classical lung TB, the most common and infectious form of TB, they were mostly gastrointestinal, but then TB has also been known to stitch the gut into uncomfortable knots. My mother had recently been diagnosed with a cold abscess, due to TB of the bone, and though this could not possibly be infectious (based on centuries of observation) it still raised flags as it meant I had a history of contact with a TB patient. I showed an immune response to the tuberculin skin test (TST), but then I had received the BCG vaccine, which is a close relative of TB bacteria. This meant I could elicit a cross-reactive immune response and result in a positive TST even in the absence of TB infection due to the similarity of the two bacteria. (more…)

Weighing up dodgy diets

Weighing up dodgy dietsMagazines and newspapers are full of so-called ‘tips’ or ‘advice’ for the image conscious, detailing extreme diets followed by the rich and famous to achieve dramatic weight loss, or new diets apparently supported by the latest scientific research. One example is the gluten-free diet, made fashionable particularly in the sporting world by former world number one tennis player Novak Djokovic (1). Having had a reputation for being physically weaker than his rivals, Djokovic was eventually diagnosed with coeliac disease and the resulting gluten intolerance. Eliminating gluten from his diet transformed his career.

Many have since adopted the gluten-free diet with the hope of boosting their own energy levels, but have had mixed results. Recent studies show that being ‘gluten-intolerant’ is hardly a medical condition that can be diagnosed and scientists have struggled to establish a mechanism for supposed gluten intolerance. So unless you suffer from coeliac disease triggered by gluten, following a gluten-free diet could do more harm than good, as gluten-free foods are often low in fibre and key nutrients, and high in sugar. (more…)

The magic of crystallography

Light micrograph (LM) of Insulin crystals
Light micrograph of insulin crystals.

Originally published in the Imperial Magazine in June 2017, Professor Naomi Chayen explains why, when it comes to medicine, crystals may indeed have magical properties.

To grow a crystal used to be considered a kind of magic. Perhaps that’s because crystals are so beautiful: it is easy to understand why so many people are fascinated by them and believe that they bring good fortune, or have healing powers. And yes, they do have powers. Crystallise a substance – a protein, for example – and you can understand its structure. We prize diamonds for their beauty: I prize protein crystals for their potential power to unlock new treatments, in everything from cancer to diabetes. They are my diamonds.

My own involvement with crystallography was a happy accident. I was encouraged into the field by one of its great pioneers, Professor David Blow. At that time, growing a crystal was regarded as more of an art than a science. There was a sense that one had to have ‘green fingers’, like a gardener: knowing the basic components of success but also using some kind of indefinable sixth sense.

I became fascinated with them. I wanted to bring scientific fundamentals to the process and create crystallisation methods that would work all over the world, from Kathmandu to Tokyo. Of course, crystallisation is not new. In 1914, Max von Laue won a Nobel Prize for his discovery that X-rays could be diffracted by crystals, making it possible to work out their structure. In those early days, there was a great rush to crystallise as many things as possible. Any substances that were simple to crystallise, were crystallised. (more…)

Ten minutes in Beirut: the harsh struggle for health and life facing Middle-Eastern refugees

Beirut, Lebanon
Beirut, Lebanon

20 June is World Refugee Day, and my short morning walk to the American University of Beirut (AUB) provides a daily and grim taste of the global refugee crisis. At 8:50am I take a right out of my Beirut flat onto a bustling and polluted Lebanese street. I live opposite a cheap hotel that hosts medical tourists – Iraqis, mainly – due to crippling of health systems in the region. A quick glance to my left and I’ll see two women outside a supermarket holding babies and pleading with ingoing shoppers for a small bottle of milk. To my right I see a large but flattened cardboard box, knowing this will soon become the cushion for a young mother and her two children. I’ll see them on my way home and I’ll worry about the toddler, who looks thin and tends to wander into the road.

By 8:55am I’m on a steep descend towards the main entrance of AUB. As I pass by a beautifully colourful series of flower shops on my left, I see an elderly man in plain clothes sitting on a white, plastic chair and holding a cup of tea. He has an expressionless face, he has damaged red skin around his ankles, he is obese, and he is silent. We exchange a look and I feel despair; not just for him, but for the nine year old girl who used to be in his place up until April this year. Also silent, she would sit and curiously watch passers go by. She was from Aleppo, a city brought down to its knees in recent years, and she told me her mum wouldn’t let her go to school in Lebanon. I dare not ask the elderly man what happened to her, but let’s not be under illusions – gender-based violence and early marriage are a feature of armed conflicts. (more…)

How does the charity Leuka support blood cancer research at Imperial?

Leuka is a charity that supports life-saving research into the causes and treatment of leukaemia and other blood cancers.  Funding from dedicated charities such as Leuka provides an important source of support which enables high-quality research programmes here at Imperial to develop and progress.  In this post, four Imperial researchers write about the different ways in which Leuka has supported their work at the College.

Dr Nichola Cooper and Dr Andy Porter on lymphocyte mutations

Lymphocytes are immune cells designed to recognise and fight infections, as well as to seek and destroy cancer cells. In order to create the diversity required to recognise and kill all possible infections, lymphocytes undergo an elaborate diversification process involving changes to genes, such as rearrangement, mutation and selection.

Sometimes, diversification can produce lymphocytes that mistake the body’s own cells (self-cells) as invaders. To prevent such lymphocytes from killing self-cells, which would result in the immune system attacking its own healthy tissues (autoimmunity), another elaborate process has evolved that either kills these autoreactive lymphocytes, or keeps them in check through regulation.

Together these diversification and regulatory processes allow lymphocytes to distinguish between harmful infections and the body’s own vital cells, involving many different genes. Defects in these genes, called mutations, can lead to reduced immunity, autoimmunity or uncontrolled reproduction of lymphocytes resulting in cancerous immune cells (lymphoma). (more…)

His job, her job: our kids

Dr Tregoning

Dr (John) Tregoning and Dr (Charlie) Tregoning discuss roadblocks and solutions to equality in childcare.

We have as a couple, tried and sometimes succeeded but most often failed to share parenting fairly. Drawing from our own experience and a very shallow skim read of how to books, here are what we consider to be some of the major problems to equality at home as two working parents and some possible solutions. This is not to say every parent should go back to work; do what is best for your own family, but remember to be honest with yourself about what you really want and include yourself in the ‘what is best for my family’ calculation.

What society wants

Since the introduction of split parental leave in the UK in 2015, only 1% of fathers have taken it (based on 2015/16 figures). Why is this? Societal expectations are the major barrier to equality in childcare (in 2014 – 33% of people thought mums should stay at home compared to essentially 0% who thought dads should stay home: the flipside 73% thought dads should work full time and 28% thought mums should work full time – but only after the kids go to school). Going against the societal norm is tricky and requires reserves of energy, time and self-belief that you are doing the right thing. When the right thing is also difficult and financially unrewarding these reserves can be depleted, eroding your will. (more…)

Smoke and the burnout of muscles

Image: Shutterstock - SMOKE & THE BURNOUT OF MUSCLES
Smoking is a leading cause of preventable death and disease in the world. It is estimated that the society costs associated with smoking are approximately ₤12.9 billion a year, including the NHS cost of treating smoking related diseases and loss of productivity.

Chronic obstructive pulmonary disease (COPD) is one of the major diseases caused by smoking. The disease ranks third among the leading causes of death worldwide. Around 1.2 million Britons suffer from the disease (Source: British Lung Foundation). The usual clinical picture is that of a smoker with symptoms that include shortness of breath and chronic cough. The muscle lab team at the Royal Brompton Hospital’s BRU, led by Professor Michael Polkey and Dr Nicholas Hopkinson is looking at different ways to improve COPD care, and at the different mechanisms by which interventions improve patient outcomes in the disease.

Wide-ranging consequences

In recent years, it has been discovered that the negative consequences of the pulmonary disease are not just limited to within the rib cage. The wider effects of the disease on multiple body systems has a large and solid evidence base to support it. More than half of COPD patients suffer simultaneously from at least two other conditions known to often occur alongside the disease (so-called ‘comorbid’ conditions); the presence of which is commonly used as an indication of disease severity (1). The disease burden usually takes its toll on the patients’ quality of life, daily physical activities and social interactions. (more…)