Monday, July 10, 2017

Pre-Raphalites & GBM!

The Art Institute of Chicago has quite an interesting collection. What caught my eye the other afternoon was a Pre-Raphaelite, well one of three that Rossetti did and the original I believe was in the Tate, London.

Beata Beatrix, 1871/72
Art Institute Web Site


A founder of the Pre-Raphaelite Brotherhood, Dante Gabriel Rossetti was both a poet and a painter. In this picture, he portrayed the dying Beatrice from Dante Alighieri’s Vita nuova, a medieval tale of idealized love and loss that had personal meaning for Rossetti, who had lost his wife, the artist Elizabeth Siddal, in 1862. He began the first version of the work, now in the Tate Gallery, London, in 1864, after finding an unfinished oil sketch that he had made of Siddal. The Art Institute’s painting is one of two replicas of the Tate composition, but it is the only one with a predella, the small panel at bottom showing the final meeting of Dante and Beatrice in paradise.

Pre-Raphalites reminded me of our librarian.

She and her husband retired to Dorset and one year we decided to visit their new place and have a taste of the old England they have always raved about. They were from Sheffield but spent a lot of their live there before moving to Sussex. So it was a bit like returning home.
They proudly showed us the guest room because it was decorated with some of the last scrolls of William Morris wall paper that they happened by.

How charming.

After dinner the conversation somehow turned to the Pre-Raphaelites and our librarian promptly produced a book with an amazing painting on its cover.

In a chance encounter with Andrew Lloyd Webber, Josceline Dimbleby asked him bluntly if she could go and see the portrait he had of her great-aunt, Amy Gaskell.

“Ah, that wonderful dark picture,” Andrew said. “Yes, please come……Well, I think she looks rather like you......”

“Did you know that she died young?” Josceline asked Andrew.

“Of a broken heart.”

She told Andrew that she would try to find out more. This led her to start researching into the life of Amy, her mother May and the famous Pre-Raphaelite painter Edward Burne-Jones and the result was the book A Profound Secret[1].

I looked at the book cover and thought the portrait reminded me of the Picasso I used for my Anorexia Blog.

It is said that as a young man Picasso admired the pre-Raphaelites and Edward Burne-Jones so much that in 1900 he would have gone to London rather than Paris had he had the fare.

“There was a hint in the book that she might well have died of Anorexia!” My hostess said.

It was a fascinating book, like good family biographies are, as long as you accept that it is not going to be as organised as fiction. A good writer helps and Josceline Dimbleby is a well established food and travel writer.

For a psychiatrist, it is especially interesting as he is allowed glimpses into the various personalities, their psychiatric problems and the resulting family dynamics, without the interference of the usual psychiatric labelling or coding. Unfortunately self medicating with alcohol, opium and other fancy substances was rife in that era (and perhaps now too) and the result could often be tragic.

Indeed Josceline thought at one point in the book that Amy might have suffered from Anorexia although it was not a known condition at the time. She left it till the end of the book to let us into the final secret. You will have to find out for yourself.


Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.
Psychiatry may need to look again at what we have been doing, as we do not seem to have found another Burne-Jones.


[1] http://www.amazon.com/Profound-Secret-Gaskell-Daughter-Burne-Jones/dp/0385603231


Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?

Fortunately for our librarian, her GP (family physician) has managed to keep that ability.

My friend was blessed with good health all her life.  She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.

She would not have gone to the doctor except the extended family was going on a skiing holiday.

She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.

I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.

Also any patient that you have not seen for a long time deserves a thorough examination.

She was seen immediately.

So no quick prescription of a stronger pain killer and no “have a nice holiday” then.

She took a careful history and did a quick examination including a thorough neurological examination.

Nothing.

Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neurological Unit.

She asked my friend to count backwards from 100.

My friend could not manage at 67.

She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:

“We are taking it out in the morning!”

The skiing was cancelled.               


Glioblastoma Multiformis (GBM)

In 2013, I came across an article in the Washington Post[1] about none other than a doctor that was diagnosed with the condition. But his story took a bit of a twist that my further research was to reveal.

When we met our librarian, she told me that the hospital neurosurgeon had also been diagnosed with GBM. He has now retired and is being treated at Queens Square where he trained.

Then another London doctor friend, a paediatric cardiologist has also been diagnosed with the condition. He decided to move back to Hong Kong to be treated, yes by his old Medical School.

Since it has been quite a few decades since I was at Queens Square, I was desperately searching for any information I could find.

Is it an infectious condition? Why all the people I know are linked to hospitals. Could we have a Dr House style brain storming. Is there any modern treatment as I vaguely remember it as one of the most vicious brain tumours.

OK,  Senator Kennedy has no hospital link, except for treatment there.

But lets see what our doctor/patient found:

Why me[2]?
Why did this tumor happen to me? I never smoked and had had no brain injuries, and there is no history of such tumors in my family. As a cardiologist, I had implanted close to 400 pacemakers in my life and during the procedure was exposed to ionizing radiation (X-rays). In the early days we used portable X-ray machines and gave ourselves some protection by using thin lead gowns. Nowadays, heavy lead gowns are worn, and doctors and technicians protect their thyroid and eyes with shields and glasses. We also use heavy sheets of radiation-protective glass that hang from the ceiling.

At some point in my research, I was surprised by an article by a Johns Hopkins-trained cardiologist who now practices in Israel. He had collected data on 23 invasive radiologists and cardiologists who had developed tumors, of which 17 were GBMs on the left side of the brain. I wrote to the author, who told me that he had learned of several more such cases since his article was published, and he added mine to his file.

Well, I think that is as far as we can go on the hospital link. What about others.

Sharp eyed readers reading Anderson’s article would have noticed that it opened with some detail that he did not quite link to his condition but further research revealed some interesting findings.

I have always maintained that in ancient times, there are very observant people that noticed links that few people would have noticed. In order to drive fear into people for their own protection, these observations were somehow incorporated into religious believes.

Yes: Pork[3].
I also had a blood test for cysticercosis, an infection that results from eating undercooked pork contaminated with Tenia solium. This common parasite produces cysts all over the body, including the brain. It is the most common reason for seizures in many countries, particularly in India, where children with seizures are first treated for this disease even before other studies are done. My blood test was strongly positive. I started a course of oral medicine to treat it. The test reassured me.

He obviously did not relate Tenia solium to GBM, but my further research showed something rather extraordinary.

There has indeed been case reports of neurocysticercosis[4] associated with GBM. This would now explain what Dr. Anderson reported as a by-line. There is even a case of both husband and wife “catching” GBM[5] and to me Tenia solium infection would be the natural explanation.

Then I discovered something quite shocking: Tenia infection can occur in Orthodox Jews[6]. No, I do not think they secretly eat pork, but apparently they can catch it from nannies from endemic countries.

But the main exciting part of Dr. Anderson’s article was his treatment when the traditional one failed.

It was the use of a modified Poliovirus Vaccine at Duke[7] that attracted his attention.

DURHAM, N.C. – An attack on glioblastoma brain tumor cells that uses a modified poliovirus is showing encouraging results in an early study to establish the proper dose level, researchers at Duke Cancer Institute report.

The treatment, developed at Duke and tested in an ongoing phase 1 study, capitalizes on the discovery that cancer cells have an abundance of receptors that work like magnets drawing the poliovirus, which then infects and kills the cells.

He decided to have the treatment and two years later he appeared on a CBS 60 minutes about the new treatment[8].

Part of the transcript:

Dr. Fritz Andersen showed us the results in another patient -- himself. He's a retired cardiologist and at age 70, he became the second person in the polio trial.

Dr. Fritz Andersen: This is a fairly sizeable temporal tumor, which means...

Scott Pelley: That we see right here.

On the left is his tumor before treatment, on the right a hairline scar where it used to be. Like Stephanie, that was nearly three years ago.

Dr. Fritz Andersen: So when they said that this thing is just a small scar, and we think it's possibly cured. I nearly fell off my chair. I said, "that's, that's, that's impossible." They said, "well, we don't know, but so far it looks fantastic."

Scott Pelley: Do you consider yourself cured? Or do you call it remission?

Dr. Fritz Andersen: I feel it is a cure, and I live my life that way.

Well, he has done well, both our Librarian and the Paediatrician that returned to Hong Kong did not make it.

 




[1] https://www.washingtonpost.com/national/health-science/surgery-radiation-and-chemo-didnt-stop-the-tumor-but-an-experimental-treatment-did/2013/09/23/1b8e8f92-0f4f-11e3-85b6-d27422650fd5_story.html?hpid=z9
[2] https://www.washingtonpost.com/national/health-science/surgery-radiation-and-chemo-didnt-stop-the-tumor-but-an-experimental-treatment-did/2013/09/23/1b8e8f92-0f4f-11e3-85b6-d27422650fd5_story.html?hpid=z9
[3] And the pig, because it has a cloven hoof that is completely split, but will not regurgitate its cud; it is unclean for you. You shall not eat of their flesh, and you shall not touch their carcasses; they are unclean for you.

[4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579054/
[5] http://www.ncbi.nlm.nih.gov/pubmed/24348390
[6] http://www.nejm.org/doi/full/10.1056/NEJM199209033271004
[7] http://bit.ly/20fFFVy
[8] http://cbsn.ws/1BUFFvc

1 comment:

Anonymous said...

Very interesting article.