Anxious Jew Redux, Professor Ian Robertson & Blindboy

Doctors are great at diagnosing or assigning diagnoses. It is something that makes many of them very happy. It provides the doctor with certainty, a finite box in which to insert their patient and to focus treatment – antibiotics, pain killers or anti-depressants. (I am sure there is a dopamine release every time a doctor signs a prescription).

When your batteries are running low, turn down the lights. Permanent pacemakers and other medical follies.

Recently, I received a message that my patient’s battery was running low.

Weight loss junkie (the pitfalls of too much safety)

Family-doctor-dietician and still losing weight; you must be failing the person, not meeting their needs, not creating innovative or adequately tasty food, not supporting mealtimes, not doing your job.

Photographic evidence. A long, convoluted road.

Sorry, you are inadequately tenacious to change the world. Go to prison. Do not stop at Go. Do not collect…

Long distance relationships

It was a toughie. It took me an hour to unravel what was what, which medicines were which, what had been stopped, started, changed, what he could and couldn’t do, what he understood, what the family understood, the plans for further tests and follow-up.

The cost of loneliness (Roubles, dollars or robots?)

One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.

Should I or he or she or they stay at home or go into care?

Locked in a room, when you are 90 and if you have dementia and significant physical and cognitive impairment is horrible. It is cruel and harmful. It is what our older folk have to do, whilst we, the rest are out and about, living it up.

Bob Ross, Happy and Unhappy accidents (healthcare and filler-TV)

I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.

Broken hearts, or why telephone consultations are less than 35% effective (homage to Heathcote)

Although doctors are being battered over the head for not enough F2F appointments, in reality, telephone reviews are much harder than seeing a person in the surgery.

Take away, facial expression, eye contact and body-language and it is far more difficult to know or understand what is going-on.

Manor Field Surgery Blog 10 Dizziness (three-part series) 

The most significant, particularly for older people (the definition of older is anyone who is older than you) when the effects of ageing can impair balance, coordination, and reflexes. 

Shady Towers, Social Care, Nora and Whitey on the Moon.

The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).

To stop or not? (Jerzy Kosinski, Oliver Sacks & other ideas)

If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.

If I told you I’m good, you would probably say I’m boasting & Teamworking

We want to be associated with the best – the best team, country, organisation.

Others don’t really care.

Some see the whole of the moon.

Others Brigadoon.

Function versus behaviour

Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.

Pressure ulcers (bedsores) & PCHC

I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”

How long until I die? (Locked down and out in 2020)

Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.

this is me, again, and what you and i want or do not want when the ambulance is on the way.

I have become victim to the system bias of considering diagnoses and discharge destinations to be of more importance than the person I am discharging.

Covid, my brain and the computer interface

Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”

Charles-Bonnet Syndrome and other thoughts about physical and mental illness

Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.

Lockdown, solitary confinement and loneliness

Imagine the harm done to those people previously ‘living well’ with dementia who for six weeks have had a dramatic reduction in visitors and day-centre attendances; even the bitter-sweet routine trips to GP surgeries or hospitals have been done away with.

Do Not Attempt (Cardio-Pulmonary Resuscitation) and Advance Care Plans in the time of Covid

Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?

In a few hours it will be Mother’s Day.

I feel awful. The message came through that the care home I support was opening for an hour to allow relatives to see their mums. Just an hour, strict hygiene, in the resident’s bedrooms. I asked the manager to stop. ‘If one person gets Covid, many will die.’ I said. It is almost impossible toContinue reading “In a few hours it will be Mother’s Day.”

Broken sleep & Coronavirus (Bruce Lee, the philosophy of time and space and this week)

Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)

Why an ECHO focusing on human rights in relation to dementia and frailty?

…designed for maximum efficiency of staff and outcomes, not necessarily for the comfort or dignity of patients – we erect a thin curtain between beds and pretend it is sound-proof, for example.

Metrodome Part 2 – agitation in Alzheimer’s disease. (Words and the complex nature of a problem)

You will note this is the opposite of ‘There is no bus to Upton, you are 93, you have dementia, you are in hospital’ approach, which is likely only to worsen the anxiety.

Too negative, too positive, or should I just be quiet? (thoughts on the experiences of people living with dementia in the UK)

Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.

Anticoagulation and possible head injuries in care home residents

Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.

General Practitioner and General Physician

A patient with a headache is more likely to receive paracetamol from a GP, a CT scan from a General Physician and an MRI from the specialist.

Who is more effective?

My Job

Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.

London to Glasgow (cardiologists and frailty)

First, I wanted to mention Neprilysin (and its inhibitor) as it seems to me to be such a cunning piece of high-tech science it should reach this blog. Then I’ll get to the cardiologists!

G. falls over and possibly bangs his head

He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.

This afternoon I described death.

In the Yorkshire and Humber Clinical Network for Dementia we are working to increase knowledge and understanding of delirium. This is a state of reversible confusion and disorientation that occurs more frequently in those living with dementia and at times can be mistaken for dementia itself. It isn’t, dementia, that is. It is different, withContinue reading “This afternoon I described death.”

London, Glasgow and the hospital. (for Sandra)

Working as he does with people who have dementia, is it even worthwhile sending the GP a note – ‘Your patient did not attend the clinic this morning; we will see them routinely in six months.’ Or worse, ‘Your patient did not attend the clinic. We have discharged them.’

To stop, or not: that is the question.

A new class of drugs, originally called ‘novel anticoagulants’ (NOACs) and now, that they aren’t that new, ‘direct oral anticoagulants’ aka ‘DOACs’ have overwhelmed the marketplace

Mental

In Glasgow, if you say somebody or something is mental it means little more than whatever they are doing or saying doesn’t make sense. It isn’t pejorative. In the world of health and care where the stigmas of good and bad still at times run rampant, mental can have a different implication. In general, itContinue reading “Mental”

Today there was a thing about falls.

Old man. In his nineties, he fell. He fell again after arriving in hospital. What to do with him? He wants to go home; we risk and capacity assess. Determine what is right, good or not and let things happen. We tried to get him home. I can tell you something; he’ll fall again. WeContinue reading “Today there was a thing about falls.”

Asleep

When was the last time you saw someone you don’t know asleep? This happens to me every day. It is a standard of hospital practice; take a person, young or old, lay them in bed, add the complexities of an acute medical illness and there you go. Asleep. This does not mean that at threeContinue reading “Asleep”

Housebound

I struck upon this last night after reading the section in Hilary Cottam’s book, ‘Radical Help’ (See below). It is interesting, how people acquire certain statuses – handicapped, disabled, impaired; the same applies to housebound. This is a term we use to describe – I imagine (I haven’t consulted the dictionary), a person who isContinue reading “Housebound”

Frailty. No.

I had intended this blog to focus on my planned trip to India in a couple of weeks; readers will have to wait. I want to talk about frailty. For those of you who haven’t kept-pace with my career moves over the past few months, I am now working on the Assessment Unit in RotherhamContinue reading “Frailty. No.”

Death plans…

Do you have a death plan? What should happen if you die? I ask these questions as I facilitated a table at the Yorkshire and Humber Dementia Network event on Thursday about ‘Dying Well with Dementia’ The table could just have been ‘dying well’ as what kills you doesn’t really matter – when you’re deadContinue reading “Death plans…”

Shtetl

I have just watched Marian Marzynski’s Shtetl on Vimeo; here is the link. He documents his journey to the village of Brańsk in Poland in 1996, with Nathan Kaplan – a 70-year-old American who is researching his family’s history – aided by an anomalous moustachioed Polish man called Zbigniew Romaniuk. I found it fascinating andContinue reading “Shtetl”

Collected blogs on delirium 2015 to 2018

How many older people enter hospital and never leave? Are never aware that the paramedics who carry them from their living-room floor will never bring them back; their secrets, mementos, curios, stashed-away in corners only to be discovered by relatives when clearing-out the house after they have moved-on or died.

Blogs, Poems, etc 2017

Rod’s Blogs, Poems, etc.  Table of Contents I search for meaning. 6 ‘Behavioural’ 8 10 Years. 10 10 years. 11 99+. 13 1559 days. 15 A response to Henry. 17 A tale of two times?. 18 Acute. 20 Advance Care Plan, Human Rights & I want what I want 23 alea iacta est 25 AllContinue reading “Blogs, Poems, etc 2017”

Rod’s dodgy drugs top-ten countdown!

This medicine is an old-fashioned anti-depressant, taken in small doses to help pain caused by nerve injury or damage – we call this neuropathic;

Post-diagnostic support in dementia

I thought I would get back to my origins this morning and write a little about what I am meant to be doing as a doctor. Dementia – most of us hate the word; without mind. Bollocks. The Japanese went as far as changing the name to their version of ‘disease of cognition’ – perhapsContinue reading “Post-diagnostic support in dementia”

UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson

Dr Rod Kersh’s first blog for us is about Urinary Tract Infections or UTI’s. At Dementia Congress this year, we both heard a presentation about how home carers should respond to issues like UTI’s. It is fair to say that Rod didn’t agree with all that was said, so I asked him to share hisContinue reading “UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson”