I’m No Longer Sure What Week This Is?

7 or 8 I would guess.  Still doing ok in the course, but I failed a quiz on British culture and history. I didn’t know, but guessed correctly, that it is an act of treason to put a stamp with the Queen’s picture upside down on a letter. It was all downhill from there. Who knew the Norwegians were involved in the Battle of Hastings  and who really wants to know what kinds of things go into “black pudding?” Here’s a question for you: who recognizes the Dorking Cockerel? 

The Cockerel should not be confused with the Giant Chicken of Bristol best known for his defeat of Brave Sir Robin. Rather, it is a landmark in this delightful little market town on the North Downs about 20 miles south of London, where I met Beth’s family (Katie, Will and Winnie) and had a fine day walking and biking in the English countryside among, get this, vineyards! Climbed a tower too. 

Fantastic day ! And the next was also spent in Dorking where Laurel and other classmates joined me in walking up and down Box Hill, which some of you may recognize as the Olympic biking venue, followed by dinner at the course director’s house.  Great food, avoided any mention of parasites and anything gastrointestinal. Highlight was their pet hedgehog Holly (how they could not have named it Spiny Norman is unfathomable!).

Box Hill in Surrey countryside

Allright, time for another pop question: What do armadillos and humans have in common? They are both purple except for the elephant. Oops, wrong joke.  They are the only known hosts of mycobacterium leprae, the cause of leprosy. Here’s an amazing fact: you have to warn people not to handle armadillos for that reason, which sort of implies that people would handle armadillos if not for that?! Really? Take a look and tell me that it is only leprosy that keeps you away.

 Speaking of leprosy, it is a hard one to rank and actually deserves its own category as the social stigma and ostracism are as devastating as anything we have come to so far: clearly an awful, awful scourge, literally of biblical proportions, but actually easily treated and “cured”, but is prone to get worse with treatment,. New test announced just this week in NEJM describing a rapid diagnostic test that may really revolutionize control and elimination.  The rest of the list includes Anthrax, Liver Flukes (anyone out there eating water cress should see a psychiatrist), more Leishmaniasis (including a patient with Kala Azar (the Indian name for visceral lieshmaniasis) and AIDS, but alive and reasonably well thanks to the miracle of modern medicine), more on diarrhea (do you prefer dysentery or cholera and why? Be sure to support your thesis with evidence drawn from our reading.), and now Nematodes, Trematodes, and eventually Cestodes, none of which are actually toads as it turns out, or even frogs for that matter. All gross, without a doubt, but probably won’t make the top ten, except for perhaps a massive infestation by Ascaris. You be the judge.

There is culture and then there's fashion...

We saw this poem on the London Underground - and being in our 50's we thought we should read it.  The sentiment of being blessed resonates with me.  (and I am sure Clay feels the same way).  The course is excellent, three months without cell phones and pagers is wonderful, and the city of London is  amazingly diverse and full of new experiences every day.  

We went on a walking tour at lunch of Bloomsbury (the neighborhood where we live).  We learned a lot about the University of London.  There is a building we walk by everyday on our way to our school that is called the Senate House.  We found out that it is an administration building (common naming for the British apparently), but was was interesting is that its architecture is so different than most other buildings.  See photo below.  It was built in the 1930's and considered Art Deco, but the world was a different place in the 30's so it is much more spare than many buildings of that style done in the 20's.

   

What is really interesting is that it has been in many movies and has been a city hall in Batman, and has also been in some movies as a Nazi era headquarters for Hitler.  The guide said that there is a theory that even in the heavy bombing raids during WWII, the building was not targeted by the Germans because Hitler wanted to use it for his London headquarters when he took over England. During the war, it was used by the British Government for its Ministry of Information - and George Orwell (who lived nearby and got TB treatment at the University hospital) modeled his Ministry's building in  "Nineteen Eighty-Four" after this one.

Now for a little diversion... I have a childhood friend who works for Burberry and invited me to the London Fashion Week Burberry show in Kensington Gardens.  This was the launch for the Fall line for women and it was a a great treat!  I have never been to anything like this and the people watching was so much fun.  Anna Wintour from Vogue was there, Tom Hooper, the director of Les Mis and the Kings Speech, singers Tom Odell and Rita Ora, Kate Beckinsdale, and the actress that plays Lady Mary on Downton Abbey, Michelle Dockery.  Here are a few pics from the glam event.  I will relieve your anxieties by assuring the readers that I dressed in gray and black and tried to blend in to the crowd.  Those models are as tall as they look - all at least 6 feet and without an ounce of body fat.  The show was absolutely beautiful with amazing music and timing.  That was one for the bucket list!

Note the celebs in the front row

The beauty and the beasts

 Some of you commented that you like the stories of the parasites and vectors of diseases - and let me tell you both Clay and I could both go on and on and on... (maybe we should start a request line.)

Anyway, for the moment I thought I would show some images that are particularly beautiful - and then move to the beasts.  Here on the left are electron microscope images of trypanosomes.  The top one has red blood cells and a few white cells too.  These are really elegant, and have a flagella that propels them through the bloodstream.  They are responsible for African Sleeping Sickness, Chagas disease and other forms of illness -none of which you want to have. 

Above is the image of some malaria parasites that have taken over the inside of a red blood cell and is reproducing itself.  So beautiful, and yet when you realize that it will release millions of more parasites that will invade other red cells and destroy them, it could be considered a beauty and a beast.

Now the BEASTS...  Below left is the Loa Loa worm.  It causes filariasis which means that a vector - like a fly - injects tiny forms of the worm into you where they grow into long travelers that migrate through your body to irritate you and make you ill.  See the worm in the eye?  Tell me that isn't creepy. apparently it stings and hurts as it moves under your conjunctiva across the eye and disappears... WHERE?  Who knows, and it can live for 15 years.  Why isn't there a horror movie about this?

This fearsome guy is the culex mosquito and he carries Yellow Fever virus around as a gift to you.  This is called a hemorraghic fever because it gives you terrible headache, fever, and organ failure from disseminated bleeding.  Good news is that there is a vaccine.    Phew.

 African sleeping sickness is carried by the
Tse Tse Fly - to the left.  Believe it or not, he or she carries the beautiful but deadly trypanosome from the top of this post in the gut and then the saliva and injects it into you.  Yes, he spits or vomits the parasite into your circulation where it multiplies and unbelievably evades your immune system because it changes it's protein coat every week or so, making it "new" to your immune system.  Hence the recurrent fevers, as your body tries to mount a response each time.  Clever beasts.

This is a body louse (or lice).  He or she is holding an egg (or operculum) on the shaft of a hair.  Of course lice can be just a bother, and not really a beast (unless you have had to spend hours combing your kids hair with a nit comb to get rid of the buggers - then they are beasts).  But they also carry disease - specifically Typhus (caused by the bacteria Rickettsia or the spirochete Borrelia which are carried inside the louse, and then when you squish them they get into your bloodstream from a tiny abrasion or bite).  Millions of people died in WWII in the ghettos and concentration camps from typhus - and many soldiers too.  Now typhus is common in refugee camp situations... Beware the louse!

Finally, a tapeworm.   It is remarkable to think that millions and millions of people have these attached on the inside of their intestines for years.  Nice mouthparts to hold onto you, eh?  They feed on your blood and your food while shedding bits of themselves in your stool so they can get inside other people.  (Well, if this isn't a good reason for vigorous hand washing I don't know what is.)

Till next time.

Gung Hay Fat Choy

 A very brief post from Laurel - as it is hard to follow Clay :)

Today was Chinese New Year and London's Chinatown is only a short walk from our apartment.  The food, parade, dragons, firecrackers and general atmosphere was a lot of fun. London claims the biggest celebration outside Hong Kong, but I am not in any position to judge, except that I enjoyed every minute and too many steamed buns.

PS  Someone should challenge Clay with his constant "this is on my top ten list of worst diseases"   Is anyone counting?  He is way over 10, and we still have 6 weeks of the course to go.

Week 5: What’s so fun about filariasis? Or: I have yet to meet a vector that I like!

It has been awhile since I took my turn at the wheel of the blog so this is really a combination of weeks 4 and 5. . Finally, some things that you can get, if you want, which you probably don’t, but if you did, it wouldn’t be quite as awful as some of the others previously mentioned, that you really don’t want to get!  Highlights: various filarial infections, occasionally referred to as hilarious filarial infections, but they are really not that funny, more like amusing. Loa Loa for example (sung to the tune of Louie Louie by the Kingsmen) will just annoy you for twenty years with an occasional worm crawling across your eye and won’t kill you unless you happen to be treated for another infection, also caused by filarial worms. I will spare you the details about treatment (mainly because I haven’t really mastered the details) but we were shown an amazing self-video by one of our lecturers (a gorilla researcher, or more accurately, a person who does research on gorillas) of an adult loa loa crossing his lower eyelid. Creepy but nothing compared to plague!  Just when you thought it might be safe to enter the jungle, however, we run smack into sleeping sickness, Chagas, espundia, and Kala Azar. These are a couple of ugly customers if I ever saw one and are now tied for first.  The diseases are miserable and eventually fatal, but at least the treatment is highly toxic, miserable and potentially fatal too. And what about the vectors? Horseflies, blackflies, tsetse flies, sandflies, and worst of all, the triatomine bugs (big, buggy, stealthy, and numerous!).  Makes me itch just to think about it.

reduvid bug - aka kissing bug, assassin bug 

The real highlight was the visit of Jinny and Steve. Laurel has already filled y'all in on most of this but would add that Jinny and I went to the opera. Beautiful music and singing told the story of Edward Onegin, youngish, somber Russian aristocrat with a poor sense of humor, an overdeveloped sense of honor, and unfortunately good aim, who spurns love, humiliates then kills his friend in a duel, wanders aimlessly, is spurned by love, then declares in song, somewhat obviously I thought, that he is destined for nothing but anguish. 

It was a great way to celebrate Jinny’s birthday (someone other than me will have to blog which birthday) and ever since I have not been able to stop humming: “always look on the bright side of life…..

 

Finally, I would be remiss not to mention our trip to Parliament where we learned the origin of  “towing the line” (two real lines on the floor of the house of commons which kept opposing parties just over two sword lengths apart) and lobbying (MPs are obligated to grant their constituents an audience which takes place, where else, but in the lobby of Parliament).  We also learned that there were at least 17 pubs or bars in Parliament but these, sadly, were not included in our tour. 

a little break from school...

In the early part of last week we studied all the causes of diarrhea - and let me tell you there are a lot.
From norovirus, rotovirus, shigella, typhoid, malaria, campylobacter, nasty amoebic dysentery that can dissolve your insides, worms, protozoa, giardia,
etc. etc. etc.

Because of this theme it seemed like perfect timing for the gastroenterologist to arrive.

Steve flew over on Wednesday night - landing Thursday am.  Clay's wife Jinny flew over as well - but I'll let him tell you about why he needed a pediatrician (?).    We let them have a brief nap and then went out to dinner and a fantastic play in the West End - Richard III.  The acting and staging was stellar, and it was done as it might have been performed in Shakespeare's time with real candles on the chandeliers, actors putting on costumes on stage before the performance, and men playing women's roles as well.

You might have heard about the DNA confirmation of Richard's body recently found in an unmarked grave under a parking lot.   Amazing to find a skeleton over 500 years old and be able to identify it from mitochondrial DNA.  We saw the brilliant actor, Mark Rylance, limp as he might with a "hunchback" - which was likely scoliosis in the real Richard... and low and behold, the skeleton shows it.  Cool stuff.

Friday Steve came to class so that he could appreciate ALL the things I was learning, and I could prove that I was working hard.  Actually, it was a lot of fun, and as I suspected Steve kind of wished it was him in class.  He has his college degree in Medical Microbiology and probably deserves to be here more than me, but I signed up.  :)

We took a fun bus tour of London on  Friday afternoon and then hit a wonderful London restaurant, Newman Street Tavern.  On Saturday morning we took the bus to Oxford to see Rachel and have a whirlwind tour of the city and a few of the many "colleges".  Our evening tour of various little pubs was especially fun for Steve as he got to sample some of the many beer offerings.  (Rachel gave advice :)

Here is a pic of them in front of the Bodleian Library's "Radcliffe Camera"  a beautiful reading room that is only open to official "readers" at Oxford.  This library is one of the oldest in Europe with a huge collection - second only to the British Museum.  Rachel's Bodleian library card is one of her proudest and most necessary possessions as she studies here.  All in all a great trip for Steve who kept saying - "wow, I really love London"  and seemed truly surprised he liked it.  (I kept telling him the city had changed a lot since Dickens time, but he hadn't believed me.)  Now back to studying....