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CMJ CATERHAM MEDICAL JOURNAL ISSUE 3

2022-2023

Our reflection of the year – Holly Cook & Sally Henley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Mr Quinton’s reflection of the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Foreword - Dr Suneil Ramessur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Meet the Medics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Pathway to medical school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Pathway to veterinary school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Old Cats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Research in Medicine – Interview with Dr Alex Hinkson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Living with a transplant – Interview with Robyn Noble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Xenotransplantation – Issy Newcombe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Leishmaniasis – Katie Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Osteoarthritis – Iris Floyd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Bipolar disorder – Bert Wong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 When the clapping stopped – MJS lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Darwin Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Reaching out to the Caterham prep school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Our reflection of the year Holly Cook (President) & Sally Henley (Vice-President)

hat a wonderful year we have had in our capacities as President and Vice President of the Wright Society. It has been an honour to support aspiring medics achieve their goal of receiving an offer for a medical, veterinary or dentistry school place. Over the past year, we have been busy preparing for the BMAT and UCAT exams, as well as writing our personal statements, which are required for university application. We have also been keeping prospective medics upto-date by posting articles on the news board. Since the beginning of the school year, the Lower Sixths have presented a variety of talks to their peers, exploring areas such as: Immunotherapy, Bipolar disorder, Leishmaniasis, Xenotransplantation and ‘The mystery of autoimmune disease’. This has been a great way to introduce the Lower Sixth to the huge variety of areas you can specialise in medicine, but also to have the experience of presenting in front of a whole room of pupils. During November, we reached out to the Caterham Prep School, forging a link with The Wright Society. Sally and I taught two year 4 classes about organs in the human body and hopefully inspiring the pupils about the possibility of joining The Wright Society in the senior school. This was a very rewarding experience for us and it was very satisfying seeing the pupils engaged in making their posters.

Towards the end of the autumn term, the Upper Sixth’s focus shifted towards interview preparation. This entailed standing up in front of the whole society and answering any questions thrown our way. This was a daunting but rewarding experience, allowing us to develop our communication skills and thought processes when put under pressure. We have been honoured to have feedback from Mrs Webster (Ethics teacher), Dr Wright (our patron), Mrs Seal and Mr Quinton – all of which has been invaluable. Thank you. Mr Quinton is not only the Head of Biology at Caterham School, but he is also at the heart of The Wright Society, keeping its wheels turning for the past 3 years. Alongside Mrs Seal, they both kindly organise for external speakers to come in to talk to everyone and organise sessions. Mr Quinton has particularly been a vital part of the Upper Sixth’s journeys to medicine and veterinary practice. Recently, he conducted mock interviews on a one-to-one basis. We thank Mr Quinton and Mrs Seal for giving up so much time aiding us in our journeys!

We sincerely thank them both for giving up so much time with the mock interviews to prepare us for every question possible! We are honoured to have been selected as President and Vice President of such a prestigious society. We look forward to our lives ahead as medics and wish much luck to the next pupils who will fill our positions. Finally, thank you to Dr Wright for gracing us with your presence multiple times throughout the year and for giving up your time to inspire us.

Mr Quinton’s reflection of the year T

his year has been a stellar year. Seeing The Wright Society go from strength to strength under Holly and Sally’s leadership this year has been exhilarating. Last summer it was very difficult to see quite how we were going to make TWS even better than the year before - something I always try to achieve. However, the new innovations introduced this year has taken the Society to a new level. A new link with the Prep School saw the Year 4 pupils treated to a Wright Society lesson on human organs led by Holly and Sally. The stunning medic, dentist and vet school noticeboards in Biology are a magnificent addition. The incredible success in the UCAT & BMAT exams and in UCAS applications by our young medics directly reflects the incredible work put in to help them achieve their aspirations. As I write this, the number of interviews our medics have had has outstripped any previous year in Caterham School’s 200 year history. A medical student is considered lucky to get one or two interviews during their U6th year. By January this year most had had 3 and some all 4, the maximum that UCAS allow. This year saw us expand the associate membership scheme further, with more pupils than ever joining the Society from our partner state schools - particularly pupils from Oxted School and Warlingham School. Their contribution to the

society is extraordinary, and this year included a talk to all our U6th classes by Warlingham medic Isabel Rider about her work with the Lily Foundation, a charity set up to support patients with Mitochondrial Disease and their families. Dr Richard Wright (the Society’s patron) and I are very keen to develop this associate

I am humbled by the desire of all our medics to help support their peers in the years below member scheme further to help medics less fortunate and our own pupils achieve their dream. Dr Wright is not only our school Doctor, but a leading figure in medicine in the South

East. I cannot thank him enough for his support and contribution to the work of TWS throughout the year. I am humbled by the desire of all our medics to help support their peers in the years below. As I write this, we are running sessions on the UCAT exam in which several U6th have volunteered to offer advice to the L6th on how to approach a particular section of the exam, look at past questions and give them tips, shortcuts and other hints. There is nothing more powerful than advice from peers who have actually gone through what they are about to go through. Finally, I cannot stress enough how wonderful it has been to work with Holly and Sally. I am extremely proud of them and how they have given up so much of their time and energy to create resources, advise and help their peers. They have nothing to gain from this personally but are doing it simply to help others - they are true medics to the core. Helping young people born to be medics achieve their dream is why I set up TWS, and exceptional pupils like Holly and Sally are why it is flourishing.

Foreword Dr Suneil Ramessur Consultant anaesthetist at Guy’s and St Thomas’

hat an honour to be invited to endorse this Caterham Medical Journal! Caterham School pupils are truly very privileged to have the advantage and opportunities which the Wright Society brings. As a parent of the School myself, I know what a really special place Caterham School is. Pupils are very lucky to have devoted teachers such as Mr Quinton and Mrs Seal who give up so much time to help future medics. I am also particularly delighted that this year has seen the Wright Society open its doors to pupils from Warlingham School and Oxted too - sharing and extending the opportunities to a wider pupil base. This year, I was delighted to be invited to present the Christmas lecture together with my friend and colleague (Professor Nick Hart) for the Science society, the Moncrieff-Jones Society. I hope this offered prospective medics from the Wright Society an insight into how we, at Guys & St Thomas’ hospital, managed the response to the COVID pandemic. Both Nick and I were delighted with the turn out and the calibre of the insightful questions from students (as well as parents and staff!) Last year I had the pleasure of speaking to prospective medics about my own career in medicine and the challenges and rewards it brings, somewhat

facetiously entitled, “reasons not to do medicine”. More recently, the Wright Society benefited from a workshop from another parent, Dr Yasir Mehmood Shaukat, an Emergency Medicine Consultant who shared his experiences of Emergency Medicine (both positive and negative), as well as the reality of working in a pressurised environment. He let the students ‘get stuck in’ with interactive stations: how to deal with a dislocated wrist; how to use ultrasound to insert a cannula into a vein and how to conduct a surgical suture on a banana! It has been an absolute privilege to be invited to endorse this magazine, which I hope both students and parents will enjoy reading. To this year’s out-going President, Holly and Vice President Sally, well done for all your hard work and devotion to supporting the Society and fellow pupils. And, finally, good luck to all the Upper Sixth prospective medics, vets and dentists from Caterham School, Warlingham School and Oxted School - I hope many of you receive the offers you are hoping for. If you don’t, remember, medicine is extremely hard to get into and life is all about accepting the challenges presented to us and developing resilience to them. I myself took a year out before getting into medical school and as I said in my talk, I believe we learn the most from our failures in life, so don’t give up.

Meet the medics Holly Cook President Upper Sixth Medic

Motivated by my goal in life of helping others, I have aspired to be a GP for many years. My personal journey has presented many challenges over the past few years, which my own GP has supported me through – being a source of inspiration and a real role model for me. These challenges have given me first-hand experience of MDTs working together to provide the highest level of care for their patient. Through my volunteering in a hospital, I have observed the huge impact I can have on patients and am excited for my future. Membership of the Wright Society has been a significant part of my life whilst at Caterham and I will no doubt maintain a connection as I move on in the hope of studying medicine at Brighton and Sussex Medical School.

Sally Henley Vice-President Upper Sixth Medic

As Vice President of the Wright Society, I have thoroughly enjoyed my time helping the L6th with their journey to medicine and engaging with external projects within the school. As a person with allergies, I believe allergies deserve the same dedicated scientific research as other medical conditions and look forward to pursuing this in the future.

Izzy Singleton

Upper Sixth Medic I want to pursue a career in medicine with the hope of becoming a humanitarian doctor. Non-Governmental Organisations such as Medecins Sans Frontieres inspire me greatly, as without them, healthcare would be inaccessible to so many of the most vulnerable people. It has been an immense privilege attending the Wright Society for the past two years. It has been so helpful to have the support of Mr Q and Mrs Seal with the application process and is a wonderful environment to be surrounded by so many medics.

Iris Floyd

Upper Sixth Vet I really want be a vet because throughout my life I have always adored animals and have dedicated a lot of my spare time to caring for them. Recently, my fascination with science has sparked more of an interest into Veterinary medicine. That, combined with my satisfaction when I can help and connect with people via a common interest, has finalised my choice to become a vet. I’m very open to all routes but becoming a small animal radiologist or equine sports medicine specialist appeal to me most at the moment!

Yushi He

Caterham Lower Sixth I would like to become a medic because I have an interest in STEM, especially biology and how the body functions. The Wright Society has allowed me to gain insight into how different diseases are handled and how these treatments can positively impact an individual, ensuring they have a better quality of life. I am particularly interested in pathology - which is the study of illnesses, diseases and how they work.

Annie Ho

Caterham Lower Sixth Being a doctor has been my true vocation. It never ceases to amaze me how healthcare professionals relieve patients’ pain and suffering using their professional knowledge, skills and philanthropy. I love the fusion of science and sympathy in medicine, as well as the never-ending challenges and breakthroughs. The Wright Society provides me with an exceedingly valuable opportunity to meet like-minded aspiring medics. What’s more, it supports students with a splendid array of medrelated resources in which we can gain a better understanding of medical science and doctors’ clinical works.

Tiffany Ku

Caterham Lower Sixth I want to be a doctor because science interests me a lot. Medicine involves a lot of science, from human biology and biochemistry to mathematical modelling, and being a doctor allows me to apply science to help people. Through The Wright Society, I have gained a deeper understanding of the profession and the NHS. I enjoyed listening to presentations and participating in workshops about different diseases and medical topics.

Marcus Kwok

Caterham Lower Sixth I want to be a doctor as I believe it is the occupation that allows me to use my strengths and abilities to bring about the largest positive impact to whoever I treat. This has come from seeing how helpless my family and I were, when people we cared about, succumbed to sicknesses or conditions that were serious and long term. Watching their doctors restore health and reassurance to them has inspired me to pursue a career in medicine to be able to do the same. The Wright Society has helped me further my knowledge in medicine and given me valuable insight on what to expect in the future by talks from guest speakers.

Justin Leung

Caterham Lower Sixth The reason I aspire to become a doctor is due to suffering from an uncommon disease called Axial Spondylitis which has caused me knee and back pain and has largely affected my daily life. However, through the diagnosis, medicine administration and kind care by a rheumatologist, my condition greatly improved. Due to this experience, I wish to graduate as a rheumatologist and support other people who may have similar conditions. I have greatly enjoyed the Wright Society so far and feel like I have learned a lot of new things from the presentations of my peers.

Justin Liu

Caterham Lower Sixth To dive into the world of medicine is to pursue a pathway of limitless discovery. Aside from my deeply rooted interest in science, I have always admired a doctor’s ability to communicate clearly, critically think and make important decisions. Being able to directly apply knowledge learnt during work and alleviate people’s pains, as well as saving patients is such an amazing gift. Being part of the Wright Society has increased my exposure to the diverse language that is medicine, and I feel like I am one step closer in achieving my dream of becoming a medic.

Sophie Niven

Caterham Lower Sixth My aspiration to study medicine at university is driven by me wanting to help and support lots of people and to improve their quality of life. I have really enjoyed attending the Wright Society because I have gained insight into areas of medicine and science that I might not have heard about otherwise. I have found the talks engaging and interesting and a valuable use of my time. I am interested in going into paediatrics in the future, however, I am not entirely set on a medicine career path currently.

Winston Tai

Caterham Lower Sixth My passion for pursuing medicine is derived from the capability of improving one’s quality of life. That capability is extremely rewarding. A lot of jobs can provide a great satisfaction, however, the meaningfulness, the sense of duty and the art of communication involved with being a doctor is incomparable. Moreover, it is not solely about a career, but it is also about progressing to become a better individual with selflessness, integrity and empathy for life. Despite the expectedly tough journey, such challenge ahead does not deterrent me but only excites and motivates me to work harder.

Max Behnert

Oxted Lower Sixth Being a student at Oxted school and having the rare opportunity to participate in the Wright society has given me the confidence and skills to pursue a career in medicine. Mr Quinton (and all the speakers) have helped me to gain an insight into the profession and an understanding of the necessary UCAT and BMAT exams. My passion to study medicine derives from an early fascination with biology and the inner workings of the human body. Consequently, I plan on training to be a general surgeon, perhaps specialising in cardiovascular conditions. Fortunately, I was able to arrange work experience at Sevenoaks hospital in the surgery department during the summer. I hope my future work in the field will lead to a happier, healthier tomorrow.

Bella Brazier

Oxted Lower Sixth Medicine, in my eyes, is the perfect way to put my love of science towards helping others. It is endlessly fascinating and since deciding to pursue medicine I have never looked back. I really enjoy being part of the Wright Society as I feel I can meet people who share my interest in medicine. After just one session I was recommended wonderful books to read and observed interesting demos of hospital procedures. I feel honoured to be a member of the Wright Society.

Mollie Fenton

Oxted Lower Sixth I aspire to study Medicine due to my fascination with the complexities of the human body and the science behind the remedies operating in optimal conditions. As an external participant, I feel extremely lucky to be a part of The Wright Society due to the resources, talks and UCAT preparation workshops I have been invited to particate in. The support I have received from Mr Quinton has been phenomenal; for example, the advice I have received concerning my wider reading has greatly assisted my progress in making a competitive medical application.

Ayla Fantini

Warlingham Upper Sixth I have always been interested in pursuing a career in the healthcare system, from consistently enjoying science lessons at school but also for the pleasure of helping members of our society achieve their best quality of life possible. I feel extremely happy for the opportunity to be part of the Wright Society as it is a type of program that is not available in my school. Through this program so far, I have gained a greater insight into what being a doctor is and what needs to be done to achieve the career I aspire to have. Ophthalmology has always fascinated me, however, I might change paths in the future.

Ellie Oliver

Warlingham Upper Sixth My first exposure to medicine was when I was 11, my dad was diagnosed with cancer so we spent a lot of time in the hospital. By watching how the doctor interacted with my dad along with the clinical research he conducted has inspired me to give back and impact the lives of other patients and their families in the same way he did. The Wright Society has helped support me and develop my public speaking and communication skills which are a crucial part of being a doctor. It has been extremely worth-while and I am very grateful to have this opportunity.

Izzy Rider

Warlingham Upper Sixth My interest in studying medicine was initially sparked during GCSE Biology and PE lessons, whilst learning about the human anatomy and its intricate mechanisms. My fascination was extended when my family set up a charity in memory of my cousin who bravely lost her battle to a rare disease, called mitochondrial disease, at just 8 months old. Through this charity, I’ve been able to see the huge impact doctors have on the lives of not just their patients, but also the patient’s family and loved ones. I aspire to have the same impact on the lives of many patients in the future. I was invited to join TWS in early 2022 and was immediately provided with so many resources related to the medical school application process, alongside a multitude of support and guidance. TWS has played a huge role in my medicine journey and I am so grateful for the time and effort put in by the staff and students of Caterham

The Journey to Medical School STEP

STEP

Work experience, reading and competition 5th year onwards

Personal statement Summer of Lower 6th

Taking the UCAT or BMAT Summer of Lower 6th

Choose your universities and apply through UCAS

Interview Prep December to March

Work experience is key to getting into medicine, it is up to you to find work experience at hospitals, GP’s and other healthcare environments. There are many resources on firefly and springpod offer many online work experiences. Reading wise, there is a vast array of books which are available, and Mrs Seal has a collection of them which you are able to borrow.

During arts week in L6TH you will have the opportunity to go through your personal statement with Mr Quinton and Mrs Seal.

In the summer term of L6TH we take part in a UCAT day where we sit a mock test. We also have external people come in to talk through both tests in detail.

Applying to your four medical schools in October.

Mr Quinton will give mock interviews with real questions from past interviews.

How to get in to Vet School Maintain a good academic record Grades of AAA are usually good enough with the exception of Cambridge.

Further your knowledge about the profession Look at ‘hot’ Veterinary topics in the news. Do MOOCS and read books such as ‘An Introduction to Veterinary Ethics’.

Undertake a variety of work experience work shadowing in a practice, working at kennels, farms, stables. These opportunities don’t just appear, you have to actively go and find them! Call/ email practices to enquire about work experience, but an even better option would be to directly go and ask, with a reference in hand.

Reflection of work experience Quality is better than quantity of work experience. Note down memorable moments and lessons you’ve learnt from work experience and how has this helped your understanding of the veterinary profession?

Writing a personal statement Reflect on work experience rather than listing - use the PEEL structure. Your wonderful teachers will help you with this!

Interview Preparation Congrats on getting an interview! Now look at what type of interview it is: Is it MMI? Panel Interview? If MMI, reading Bemo’s Ultimate guide to MMI helps a lot. Prepare for common questions that could come up. Also practise evaluating animal welfare from photos and ethical scenarios.

Research universities to apply to Go to the website of the universities, look at their entry requirements eg. minimum grades, work experience, assessments prior to interviews.

Old Cats Phoebe Wearing

I am studying veterinary medicine at the University of Nottingham. I am currently in my fifth and final year! It has been a challenging five years, more so than I could ever have imagined. Being a vet isn’t always cuddles with cute kittens and I have faced ethical dilemmas and emotional challenges on a daily basis. However, with this has come great rewards and a degree of which I am very proud. From working in guide dog breeding centres, cheese factories and abattoirs to seeing MRI brain scans, beehives and postmortem exams on RSPCA cases. Veterinary medicine is one of the hardest degrees and by far the smelliest! My advice to aspiring vets would be to remember that despite the challenges, a vet degree can take you anywhere in the world whether that be an elephant sanctuary in Africa or a pharmaceuticals company in London. However, be prepared to hear about the bowel movements of every pet in your neighbourhood when you qualify!

I am a Veterinarian currently based in the Gower Peninsula, southwest Wales. I practice Veterinary medicine and surgery on a wide and varied caseload comprising small companion animals, exotics and wildlife species. I look back at my time at the University of Bristol with great fondness - having the opportunity to develop, conduct, and then publish, peer-reviewed original research into free-ranging marine mammals was not only something I found incredibly interesting, but also invaluable in terms of kickstarting my career in the Veterinary sector. One tip I would give aspiring vets is to prioritise a good worklife balance and keep on top of your mental health!

Dr Lucas Desclos-Dukes I am currently in my second year of studying medicine at Newcastle University. I am really enjoying immersing myself in medicine and having the opportunity to study the interaction between anatomy, physiology and pathophysiology underlying health and disease. I particularly enjoy the vast amount of clinical exposure and experience offered at Newcastle, with days spent in hospital and sessions in the clinical teaching labs. One piece of advice for prospective students would be to pursue and explore your specific interests within medicine. This will greatly enhance your enjoyment of the course and make you a more well-rounded medic!

Louie Steel 12

My name is, and I’m a fourth year medical student in the University of Navarre, Spain. I guess the main thing I can say is that the massive workload and constant examinations that people warn you about, are not an exaggeration! However, if like me, your mind is set on medicine (or veterinary), don’t let that put you off! Organise your time well: you can study your career, join societies and sports teams and even attempt a social life. Organising your time and having a balanced life is vital in these high-pressure careers - living in the library weeks on end with no breaks, you’ll find yourself overwhelmed very quickly!

Enia Arveschoug (right)

The first couple of years in my uni were purely theoretical. I didn’t start having rotations in hospitals until third year, for me that has been the biggest turning point in my career. I’m definitely a practical and visual learner who gets bored of reading textbooks one after another, so this change was a positive one. Hence, it is so important to research your potential medical schools and their structure well and look for those which offer an integrated curriculum. I would encourage those people who have been doubting whether to study abroad to consider it and check out their possibilities, there are many very good medical schools with international programs scattered around Europe - go for it! Good luck to everyone on their medical/veterinary school journey. Enjoy it!

Dr Cesci Adams Hey, I’m Hayes, I graduated 2019 and I am now studying my intercalated degree at Imperial College (4th year) on Translational Respiratory Medicine. So far, university has been great. My cohort spent tons of time online (COVID) so pre-clinical years were not my favourite. However, placement was much more fun, since I’m learning practically from doctors, nurses etc. Plus, if you’re nice to them, they are generally nice back. Unlike some lecturers… My advice - make sure you like medicine. Read online what a junior doctor does. Most doctors I know love their job but unfortunately some endure years of exams & tuition to work unsociable hours, receive lessthan-ideal pay, all for something they don’t enjoy doing.

Dr Hayes (Ka Hay) Fan 13

I left Caterham in 2018. I am now in my 5th year of medicine at UCL! It’s daunting to think that in a year’s time I’ll be a qualified doctor. Although I had thoroughly researched my course, there were still so many things I wasn’t expecting. For example, I anticipated being busy 24/7 with my studies and placements, but there are actually so many opportunities and ample free time to discover new hobbies, keep up old interests and get involved in research opportunities. The people you chose to surround yourself with is also vital for support.

Natalie Bishop

In my intercalated BSc in Paediatrics and Child Health, I had the privilege of working with patients and surgeons at Great Ormond Street Hospital. More recently, I have explored a multitude of clinical specialities and had hands-on experience with patients, from clinics to scrubbing in operating theatres. I recently delivered babies on a night shift in Labour Ward, which was a moment that I will never forget. To have the privilege of patients trusting you with intimate and vulnerable conversations makes medicine a truly special and unique profession. Keep positive and persistent - the medicine application process is gruelling, but once you get there everything is worth it!

I studied Veterinary Medicine at University of Surrey and graduated in 2020 with first class honours. Mr Quinton’s blue book method of compiling class notes prepared me well for organising the reams of information we were required to revise for exams! I have been working in small animal practice since graduation, and live near Reading with my dog, a labrador mix called Victor (who is an angel and willingly donates blood in exchange for treats if my patients are ever in need!). Navigating being a new graduate saw the pandemic throw an unprecedented case-load to the industry. This was due to millions of households acquiring new pets during lockdowns, and further exacerbated by ongoing staff shortages which have long plagued modern veterinary practice. Though this period was challenging at times, even for the most experienced vets and nurses, I know this has only enhanced my clinical expertise and efficiency, by exposing me to high volumes of cases. I am now endeavouring to become a veterinary specialist, having begun an internship at Lumbry Park Veterinary Specialists, with the hope of being accepted onto a residency (specialist training programme). I currently have a keen interest in neurology.

Dr Lauren Talbot

Research in medicine

Interview with Dr Alex Hinkson (Old Caterhamian)

When did you leave Caterham? I left in 2010. What support did you receive in Caterham that helped you gain a place at Medical School? I was president of the MoncrieffJones Society, this meant I had a good opportunity to develop independent research and public speaking skills, as well as something good to put on my application form. Mr Quinton and Mr Keyworth were very supportive in helping me to achieve the marks I needed. In particular, Mr Quinton took a select group of us on a visit to his old Oxford College: St Peter’s, which was great because it enabled us to see what it was all about and we also received the opportunity to speak to a professor of neurology who gave a very engaging talk. I then ended up speaking about this in my interview. Where did you go to University? St Catherine’s College, Oxford. What has been your journey to where you are now? I completed the six years of medical school at Oxford and then completed my two foundation years, 15

where I rotated around placements including: gastroenterology, general medicine with endocrinology, general surgery, stroke and neurology, general practice and trauma and orthopaedics. In my gastroenterology job, I was particularly interested in hepatology. One particular consultant introduced me to a patient with an interesting history which I later wrote up and presented at an international meeting in Barcelona. After the end of my Core Medical Training, I decided to contact the hepatology department in Leeds (where I had been working) which opened the door to a research post where I have been working since August 2020. What do you do on a weekly basis? I am a Clinical research fellow which means 3 days a week I am conducting research, which entails processing data we collect and producing papers from it. The rest of the time I am usually patientcentred running clinics or on-call work. I also teach undergraduates occasionally too. Please can you explain what your recently published research involved? I read a lot of papers and synthesised the data to produce some new numbers. Liver disease is very common, but not everyone who has liver disease actually ends up having a bad liver-related outcome. Patients who are most at risk of bad liver-related outcomes are those with fibrosis or scarring in the liver. In hepatology our goal is reliably quantifying fibrosis, so we can identify the people who are at risk and focus our resources on helping them and leave the people

who aren’t going to have an adverse outcome to get on with their lives. The tests we have available to us are: Liver Biopsy (which is not practical) and blood tests. My role was to study all the literature about The Enhanced Liver Fibrosis Test, to analyse how well it performs in stratifying fibrosis. What motivated you to do this research? When you are practising medicine and training to be a consultant, you need to have a specialised area as well as being a good clinician. This will drive the health service upwards and improve service to patients. You can also improve your skill set by teaching or through management roles. How do you feel your research will be beneficial to the NHS? The idea is by triaging patients with liver disease and directing them to the right area for their treatment and managing resources, we increase efficiency. By accurately identifying patients with increased risk of adverse outcomes, we follow them up in clinic and provide screening tests. We can reduce the money spent investigating people who don’t need to be investigated because they are at very low risk of adverse outcomes. What do you wish you were told at the beginning of your journey? Your journey will be different from everyone else, and it is important to understand it will be difficult along the way, but if you stick at it and put the work into it, then eventually it will come together and all be worthwhile.

Living with a transplant Interview with Robyn Noble “Hi, my name is Robyn Noble, an Old Caterhamian, who is living with a liver transplant. For me, my liver transplant journey was a whirlwind: only two months from diagnosis to my transplant. In the summer of 2020, I was experiencing a swelling of my legs (Oedema) but as this was during the COVID-19 pandemic, I was unable to do anything about it. Then, in January 2021, I began to feel quite fatigued and got a blood test. I was called very early the next morning about my low platelet count and in A&E I was diagnosed with Autoimmune Hepatitis. My health then rapidly declined and I was put on the transplant list at the end of May and received one 5 days later.”

What positive things do you take anyway from your experience? “I am alive because a grieving family said yes to donating the organs of their loved one. For me, this sums up the best of humanity. I am very grateful and carry this with me.” What are you doing now? “I am training to become a psychotherapist and hope to work within the Liver Unit at King’s Hospital. I have an interest in trauma and dissociation and hope to entwine my experience in my future work.” What is life like after a transplant? “I currently take 3 different immunosuppressants. This is tough as it means I get ill much more and remain ill for longer, with COVID-19 being a constant worry. You have to take your medication at the same time everyday and must not eat it with food. This means my eating schedule is arranged around my medication. Further intensifying the difficulty, I have 5 more chronic conditions, therefore have to take 10 more medications daily.” How can doctors better care for liver transplant patients? “I think doctors should try to recognise the mental impact of a transplant. This is a life-changing experience.” Addressing the misconception “Liver transplantation is a treatment, not a cure. You have to live with it after your surgery.”

Xenotransplantation Issy Newcombe

orldwide there is a shortage of organs suitable for donation and even less people willing to donate. Xenotransplantation is any procedure that involves transplanting, implanting or infusing into a human recipient of either live cells, tissues, or organs from non-human species. A significant religious example is Lamassu from the ancient Mesopotamian religion.

Pigs express Galacto Obligosaccharide also known as the Gal antigen. Humans produce anti-gal antibodies creating an issue with using pig’s organs. The antibodies in humans immediately bind to cells of the graft and activate complimentaries causing hyperacute rejection of the organ within minutes.

Key Xenotransplantation Pioneers

Safety and regulatory aspects

Serge Voronoff’s research focused on cell rejuvenation utilising cell xenotransplantation. His most accurate theory was that hormone-producing cells could be transplanted into patients who lacked those cells. Later, by implanting human pancreatic islet cells, this hypothesis cured severe type 1 diabetes. Xenotransplantation utilising a chimpanzee kidney, done by Keith Reemtsma in 1964 was the first documented success. Reemtsma demonstrated that some form of close genetic relationship across species may help with the success of transplants.

One of the main questions surrounding pig to human xenotransplantation is whether the procedures will be safe. Due to the likelihood that swine microorganisms might spread, which could cause more disease and illness. Pigs must be raised under rigorous barrier circumstances with strict monitoring and tests for various bacteria and every transplant would need to use tissues that have been archived.

Risks and complications when using xenotransplantation The Gal antigen is the key complication preventing the progression of xenotransplantation.

Ethical issues With human recipients, there is the question of consent and the significant risk of infection and rejection. The process of obtaining informed permission must be approached slowly and with great seriousness considering the risks to the public, and the patients physical and mental health.

Leishmaniasis the “neglected” tropical disease Katie Roberts

What is Leishmaniasis? Leishmaniasis is a vector-borne parasite. Due to the disease being considered endemic in over 90 of the world’s poorest countries, over 1 billion people are at risk, according to WHO. Leishmania, a genus of parasitic protozoan responsible for Leishmaniasis, is spread by the female phlebotomine sand fly. It is one of the deadliest parasitic diseases causing over 20,000 deaths annually. Cutaneous Leishmaniasis (CL) Cutaneous Leishmaniasis is the most common form of the disease and is typically localised to the location of the sand fly bite. Responsible parasites include Leishmania tropica, L. infantum, and L. donovi. In general, CL causes skin lesions which can persist for months, potentially years if a patient suffers from other diseases such as HIV/AIDS. The ulcerative lesions can be characterised by a raised boarder and central depression. The ulcerative lesions can spread, and secondary infection is likely to occur if left untreated. Mucosal Leishmaniasis (ML) Following the resolution of Cutaneous Leishmaniasis, there is a 5% risk of developing mucosal leishmaniasis. It is the result of dissemination of leishmania parasites 18

from the skin to the naso-oropharyngeal mucosa, where if left untreated, ulcerative destruction may occur. ML usually becomes evident within several years of a patient’s having cutaneous lesions. Visceral Leishmaniasis (VL) In most cases, Visceral leishmaniasis is caused by L. donovi and L. infantum and affects the internal organs. VL can be characterized by a fever, weight loss, hepatosplenomegaly or pancytopenia (i.e. anaemia). Diagnosis and treatment Diagnosis can be challenging due to a lack of resources and funding in less economically developed countries. Subsequently, cases tend to be assessed symptomatically. Where available, bone marrow biopsies are performed to confirm the diagnosis. Some cases can self-resolve; other more complex cases require treatment. Where available, cryotherapy and heat therapy are used to treat localised lesions. In extreme cases, antimonial drugs are required which are administered through chemotherapy. Extreme side effects accompany the drug, including cardiotoxicity. Due to a lack of funding and the complexity of the disease, no vaccines or drugs are currently available to prevent infection.

Osteoarthritis in Animals Iris Floyd

Are Monoclonal Antibodies the way forward to treat Osteoarthritic Pain? Osteoarthritis has been a long-term problem for many animals all over the globe, until now, it has been managed through NSAIDs, which come alongside various side effects and the risk that not every animal will react well to continued use. Osteoarthritis effects between 30%-50% of cats and dogs, but in 2021 two new drugs were approved for treatment of pain caused by osteoarthritis.

What is Osteoarthritis in animals? Osteoarthritis is also referred to as degenerative joint disease (DJD), it is a worsening inflammation of a joint caused by cartilage breakdown. Osteoarthritis is most common in the synovial joints of the leg. In synovial joints, the ends of the two bones are covered in cartilage, a tough yet smooth tissue, to allow for an almost friction free movement between the bones. Over time, cartilage may become thinner and rougher, preventing the joint from working as well. Osteoarthritis is more common in older animals, same as with humans, however it can occur at a younger age depending on the level on strain put on the joints. Signs of arthritis include but are not limited to: stiffness, lameness and tenderness or pain when the joint is palpated. 19

New treatment for Osteoarthritis: Bedinvetmab is a specific canine monoclonal antibody manufactured to bind to Nerve Growth Factor and inhibit its interaction with receptors, therefore inhibiting pain transmission. Bedinvetmab is sold under the brand name Librela and it was launched for open market use in the EU, UK and Switzerland in 2021. The drug so far has seen to have very few side effects. Frunevetmab is the feline monoclonal antibody used, it is sold under the brand name Solensia and works identically to Librela in dogs.

Are they worth it? The development of Librela and Solensia has given many dogs a new lease of life. The ability to develop a treatment with few side effects such as Librela and Solensia will be of extreme benefit for pets in years to come. As the full long term side effect of the drugs have not yet been discovered, nor the longevity of the drug been fully researched, it is difficult to suggest whether they will be the ‘go-to’ treatment for osteoarthritis by vets, although the future is looking promising and many vets are already administering this treatment and seeing promising results.

Bipolar disorder Bert Wong

ipolar disorder is a group of mood disorders, where patients experience dramatic shifts in emotions, mood, and energy levels from extreme lows (depression) to extreme highs (mania). The seriousness of bipolar is yet unrecognised: it affects 1-5% of the population; causes 20% of patients to be suicidal; reduces an average of 9.2 years lifespan. Diagnosis There are two main types of bipolar disorder: Bipolar 1 and Bipolar 2. Bipolar 1 is diagnosed with a manic episode, which may have psychotic features and require hospitalisation, lasting from a week to months. During the mania phase, a patient might feel ‘on top of the world’ or exceed ordinary feelings of joy and irritability. They might experience symptoms such as racing thoughts, sleeplessness, rapid speech, risky behaviours, and inflated self-esteem. Bipolar 2 is diagnosed with less extreme periods of mania, with periods of depression. A person experiencing a depressive episode might have symptoms such as loss of interest, changes in appetite, feeling of worthlessness and guilt, and persistent thoughts of suicide.

Treatment Medication is the first line treatment for bipolar disorders. However, meds prescribed in each case are different, and the effective treatment is found via a trial-and-error process. Lithium salts are the most common treatment, working by modulating signaling pathways and is also found to increase the grey matter in the brain. With its long-term efficacy and effect on reducing risk of suicide. Antipsychotics are also found to be the most effective in treating mania in the shortterm. In treating bipolar treatment, antidepressants are not as effective as other medications such as Lamotrigine, Quetiapine, which influences neurotransmitters. Psychotherapy could also play a role in teaching patients coping mechanisms. Further directions Bipolar patients cope with symptoms 10 years on average before getting an accurate diagnosis. Between 37% and 60% of patients relapse into bipolar in 1 year and 2 years respectively. Bipolar disorder is still not yet effectively treated at this moment. For further reading, it would be useful to understand its underlying biology and its association with neurotransmitters, brain structure, and genes.

MONCRIEFF JONES CHRISTMAS LECTURE

‘When the clapping stopped’ Izzy Singleton

e had the honour of hosting Prof. Nick Hart and Dr. Suneil Ramessur for this year’s Christmas lecture, both of whom were very involved with the COVID-19 response at Guy’s and St Thomas’ hospitals.

response to the pandemic, as well as being directly involved in frontline clinical care. He talked of the additional precautions the

The lecture “When the Clapping Stopped” discussed what really happened during the pandemic and the ramifications it has had on healthcare now. Too often, healthcare news and information about the NHS is masked by what the media wants us to see, so it was truly eye-opening to hear from doctors who witnessed the pandemic first hand. As medical director of the heart, lung and critical care group, Prof. Hart directed the critical care response for 1300 patients. In the lecture he talked about how he used data science to facilitate this, and to predict the course of the pandemic. As the deputy clinical lead to theatres, anaesthetics and perioperative medicine, Dr. Ramessur was on the COVID-19 tactical team, where he helped to design the anaesthetics 21

The team took 5 main interventions to ensure the best chances of recovery for COVID-19 patients. They ensured patients had a regulated fluid balance and a safe oxygen saturation. Treatments included antiviral medication, anti-inflammatory medication, and anticoagulants. Although it now seems we have come out the other side of the pandemic as a society, this isn’t necessarily the case for healthcare professionals. Other health needs were neglected in the summit of it all, and now the NHS is faced with a huge backlog, forced into taking extreme measures like the HIT approach in the anaesthetic’s department. Moreover, this is all being carried out by an already exhausted workforce.

anaesthetists had to take in terms of PPE to ensure staff safety. With an increase in need for patients to be put on ventilators, a huge burden of the pandemic fell onto the anaesthetics team.

All in all, the lecture was truly inspiring to aspiring medics as we listened to two incredibly selfless and dedicated individuals reflect on their own experiences during the pandemic, and how much they sacrificed to provide outstanding care for those who needed it most in the nation’s hour of need.

his year, the biology department launched The Darwin Society: a club designed to stretch L6th and 5th years to see beyond the constraints of the A-Level specification. Each week the talks are delivered by U6th pupils on a Lower Sixth topic they are passionate about. Talks have ranged from the cytoskeleton to amino acids, cell-cell junction to glucose straight chains. The society provides a great opportunity for students to relish their love for biology and discuss cutting edge topics. Each week, the biology lab is packed full of intrigued pupils, all sharing the common thread of curiosity.

atric cardiac surgery and a public enquiry ensued in 1999.

Alder Hey Tissue Scandal

Ryan Li

Izzy Singleton

The Alder Hey Tissue Scandal involved the unauthorised removal, retention, and disposal of human tissue between 1988-1996. In total, 850 organs and body parts were removed from infants and stored in over 2000 pots. An investigation was sparked when Samantha Rickard died during open heart surgery in 1992 in Bristol Royal Infirmary. Her mother asked for her medical records as there had been reports of unusually high rates of infant mortality in this hospital. The records showed letters between pathologist and surgeon, stating that Samantha Rickard’s heart had been retained, something her mother never consented to. Doubts started to arise about the quality of paedi22

Two years later, the Redfern Report uncovered that 100,000 organs, body parts, and entire foetuses were stored across 210 NHS facilities. Alder Hey hospital seemed to be at the centre was, where pathologist Dick van Velzen had ordered a post-mortem and stripping of organs, even when parents had directly specified that they did not want this. The Human Tissue Act 2004 made it illegal to remove, store or use human tissue without consent or to collect DNA.

Cell Junctions Cell junctions are a lot more dynamic than they first present themselves to be and their proper functioning has implications for our body that reaches far beyond their primary role in cell adhesion. Cadherins are crucial in tissue morphogenesis; gap junctions, while in their simplicity, are fundamentally incorporated into our neural networks

Glucose Straight Chain Natalie Watt

The glucose straight chain is a fascinating topic in biochemistry which involves many different mechanisms, including ring chain tautomerism, and explains in depth what happens when a Benedict’s test is performed on reducing sugars. Glucose exists in different

forms: the ring structure which we learn about in lessons, and the straight chain, which is less familiar and exists in aldehyde form. This is the reason why glucose has the ability to oxidise copper 2+ ions present in Benedict’s reagent to produce copper (I) oxide which is brick red in colour. Exploring deeper, I explained how the structures of hemiacetals and acetals differ, resulting in the difference in chemical properties. The hemiacetal functional group is in equilibrium with an acyclic aldehyde, whereas acetals aren’t. Therefore sugars, more specifically monosaccharides and disaccharides with hemiacetal structures, are able to reduce; while ones with acetal structures instead, like sucrose, aren’t able to reduce and therefore produce a negative result when tested with the Benedict’s reagent. Further study explains why ketose sugars with ketone structures produce a positive result in the Benedict’s test and are normally able to be oxidised. One example is fructose, which has a ketone structure in its straight chain form instead of an aldehyde. With a hydrogen attached to the alpha carbon involved in the carbonyl group, it allows carbonyl isomerisation to take place. Under basic conditions, the ketose is in equilibrium with an aldose and can be further oxidised into a carboxylic acid, reducing Benedict’s reagent in the process.

The Prep school & the Wright Society Sally Henley

uring November, we reached out to the Caterham Prep School, with the aim of forging a link with The Wright Society. Holly and I taught the Year 4 classes all about the organs in the human body. We tried to make the sessions interactive and as fun as possible while still relating to the Key Stage 2 Science curriculum. We were keen to impart our love of biology to the Prep pupils as we recognise the important of health promotion and education an essential role as a medic. We discussed the function associated with the major organs of the body. Then the pupils were given large sheets of paper to draw the outline of their bodies and proceeded to draw and label the organs. This was very successful, and we were delighted to see how engaged the pupils were! It was also rewarding to receive such positive feedback from the class teacher. We are sure some of these pupils will join The Wright Society in the future.

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