Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD) or Causalgia, is a condition that is fairly close to home for me, namely because I suffered from it for six months and therefore learned quite a lot about the disease through frequent trips to the hospital, seeing various different specialists.

CRPS is hard to diagnose, as there is no specific test for it, it is simply diagnosed through a 'process of elimination'.  It  is a progressive disease which usually affects the extremities (arms and legs) but can spread to other parts of the body.

There are two different types of CRPS; Reflex Sympathetic Dystrophy and Causalgia.  RSD does not have obvious nerve damage, whereas Causalgia does.

The cause of this condition is currently unknown.  Contributing factors include injury and major surgery, however there are cases, like mine, where there is no obvious trauma to the area and therefore no clear reason.

There are three stages of CRPS:

• Stage One: severe burning pain at the sight of the injury, muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth and changes in the colour and temperature of the skin
• Stage Two: more intense pain, swelling spreads, hair growth diminishes, nails become cracked and brittle, osteoporosis becomes severe and muscles atrophy
• Stage Three: irreversible changes in the skin and bones, pain is unyielding, marked muscle atrophy, severely limited mobility

The picture (right) paints a fairly comical picture of Reflex Sympathetic Dystrophy, but it is far from that. The picture is actually a picture of my foot at its worst. 

It's hard to tell from the picture, but the swelling around my foot and my ankle was so severe that I began to develop stretch marks, the skin was pulled so taught that it was dry and cracking in places and the swelling had begun to travel up my leg at this point, reaching my knee.  

The pain that those six months caused was too much to describe, not only did I have the hideous burning sensation when I tried to weight-bear, but I had the added problem of spending six months on crutches which was, at times, unbearable, I had severe joint pain in my ankle and my toes and even now, six months on, I cannot move all of the toes on my left foot.

As you can see from the picture (left), the swelling in my foot and leg was simply fluid, which I was able to manipulate and make dents in.  

I had to visit a Rheumatology clinic once a week for four months, where I saw a consultant and was given a treatment plan of intense physiotherapy and hydrotherapy.  

I was prescribed dose after dose of high level painkillers; ibuprofen, paracetamol, co codamol, dicolfenac - but none of them ever seemed to work.  Eventually the rheumatology consultant precribed me a 25 mg dose of Amitriptyline, which at a higher dose is used as an antidepressant, because I wasn't sleeping at night.  Amitriptyline acts on the nerve cells in the brain, and whilst it relieved enough of the pain to sleep, the symptoms were never fully gone. 

After months of grueling physiotherapy and hydrotherapy (and wearing compression socks and tubular bandages), I managed, with the help of my physiotherapists and my hydrotherapist, to desensitise my foot and remove all swelling and most importantly, learn to walk after six months of crutches! 

(Left) My foot at its normal size, six months after recovering from RSD. 

When Does Fat Become Too Much?

Fat supplies us with energy and transports nutrients. Adults require only about 5% of their diet to consist of fat, whereas children require nearly 30% of their diet to consist of fat.

Many people assume that all types of fat are the same and that they all result in negative effects, but this is simply not true - there are good fats!

Some fats (omega-6 and omega-3) are called essential fats, they only come from the foods we eat.  These fats are also referred to as 'Fatty Acids' and are required to allow the body to function normally. 

The fats that are generally bad for the human body are saturated fats.  These fats are usually found in processed or packaged foods.  The word kind of saturated fat is called trans fatty acid (chemically altered or processed fats).  Trans fatty acids are formed through the partial hydrogenation of vegetable oils and has been linked to an increased risk of Coronary Heart Disease.

Coronary Heart Disease describes the condition when the blood supply to your heart is blocked or interrupted by the build up of fatty substances in the coronary artery.  If the coronary artery becomes completely blocked, it can cause a myocardial infarction.

The total recommended intake of fat for an adult in a day, based on a calorie intake of 2000, is 65g.  However, only 20g of those 65g are saturated fats.  Examples of foods high in saturated fats are: cream, cheese, butter, lard, fatty meats, coconut oil, cottonseed oil, palm kernel oil and chocolate.

Saturated fats have been associated with many other diseases, other than coronary heart disease, for example: Dyslipidemia (an abnormal amount of fat in the blood), Breast Cancer, Colorectal Cancer, Ovarian Cancer, Prostate Cancer, Small Intestine Cancer etc. But these can be avoided through changes in diet.

The Girl Who Was Worshipped as a Deity

At Medlink, we learnt about Lakshmi Tatma.

Lakshmi Tatma was born in 2005, in a village in the Araria District, Bihar.  She was worshipped as an incarnation of the god, Lakshmi, due to the fact she appeared to have been born with eight limbs.

In reality, Lakshmi's extra limbs, were the result of her being an ischiopagus (the fused lower half of two bodies) conjoined twin.  The two babies had joined and her twins head had then begun to disintegrate and its chest was severely underdeveloped, resulting in, what looked like one child with eight limbs.

Lakshmi came from a very poor, labouring family (her parents earned less than 40 rupees per day), which meant they could not afford the 8201966.42 rupees for the surgery.  However, Lakshmi's spinal chord was fused with that of her twins, their nerves were entangled.  Lakshmi's abdominal aorta gave off arteries that supplied her parasitic twin's legs with blood and doctors predicted that without surgery, she was unlikely to live into her teens.

Lakshmi's surgery began on 6 November 2007 and was funded entirely by the hospitals charitable wing.  The surgery lasted for 27 hours and was split into the following sections:

• Abdominal surgery to remove the twin's organs
• Remove Lakshmi's dying kidney and replace it with the twin's functioning kidney 
• Move the reproductive system and urinary bladder into Lakshmi
• Amputation of the twin's legs at the hip joints (which caused heavy bleeding)
• Cut the fused backbone (had the possibility of causing paralysis)
• Separation 
• External Fixation (to hold the pelvis in place)
• Sutures

Due to the work of 30 surgeons, Lakshmi's operation was successful.  She was in hospital for a month after the surgery and has now recovered and leads a normal life.

Stem Cell Research

Been doing some research for the Stem Cell Paper and found this article that really interested me and has possibly inspired me to take the 'Stem Cells Being Used To Grow Organs' research route.

http://www.telegraph.co.uk/science/science-news/8584443/Pigs-could-grow-human-organs-in-stem-cell-breakthrough.html

Essentially, it's an article explaining how stem cells from one species can be injected into another species and will then grow the organs of the species that the stem cells originally came from.

To begin with, scientists created genetically modified mouse embryos, designed to have an inability to produce their own organs.  These genetically modified embryos were then injected with the stem cells of rats, producing mice with the internal organs of a rat.

Scientists also tried this technique on mice that were unable to grow their own pancreas, and found that as the mice matured, they showed no signs of diabetes and had fully functional rat pancreas'.  And scientists are now travelling down the route of 'curing' diabetes, a previously controlled, but not curable condition.

This is of particular interest to me, because there could be the possibility of growing other vital organs, potentially saving patients and reducing transplant lists.

The current trend in the number of cases of diabetes, that are diagnosed, is significantly rising and the ability to be able to grow patients new organs could prevent the complications associated with diabetes, such as: Blindness, Heart Attacks and Heart Disease, Strokes, Kidney Failure, Blood Vessel Disease and Amputation of the Extremities (especially the feet) and Nerve Damage.  These problems are usually as a result of patients improperly treating themselves and research has shown that patients who manage their blood sugars at a normal level reduce their chances of developing such complications by almost 50%.  However, if these patients were offered a new pancreas, patients could lead a much more normal life and be free of complications, especially if the organ was grown from their own stem cells, as their body is less likely to reject the new organ. 

Medlink 2011

So, just got back from my amazing experience in Nottingham.  WELL WORTH IT.

Learnt so much over the last few days (so much love for the cardiovascular system right now!!), and loved every second of it.  Medlink has really made up my mind to be a doctor, and has just made me even more determined to prove all those critics wrong!

In a moment of madness last night, I signed up to write a paper on Stem Cell research. It may take some time, but in terms of experience and just general interest in the topic, I think it would be most definitely worth the time and effort required, and I shall post my research on here!  Actually something worthwhile to write about! haha.

I would recommend medlink to ANY hopeful med student.  I would say I am a student of average intelligence (target straight A's, but in terms of GCSE's, average), and would just advise people NOT to be put off by the fact that there are going to be so many people at Medlink that are much cleverer than them academically.  Just remember, medicine is largely about the grades, but not solely!