You can say, ‘Molly, you are 95, your mum is dead, you have dementia, you live in a care home, sit down.’
For the most, I think I know what I am talking about when I talk about dementia.
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).
Recently, I received a message that my patient’s battery was running low.
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.
Sorry, you are inadequately tenacious to change the world. Go to prison. Do not stop at Go. Do not collect…
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.
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
In today’s blog Rod tried to explain what he meant when he wanted to say something was to complicated to be summarised by the word ‘screen’
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.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
Death – tradition – Jewishness – family – education – self-consciousness
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
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.
Rod reflects on the interface between anxiety and a long-line of Jewish ancestors.
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
Occasionally the nurse in attendance might advise the paramedics or the doctors, ‘He was 100 years old, he was very unwell,’
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.
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).
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
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.
Imagine being able to converse with a cat.
That’s what Nakata can do.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
All resonating, taking me back and creating an atmosphere.
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.
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”
A basic human right – the right to family life has been bolloxed.
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.
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.
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”
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.
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.
All we can do in the Time of Covid is to do our best and act in good faith.
We have closed schools which has reduced transmission; we can’t close care homes.
Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?
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.”
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’)
…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.
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.
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.
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.
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?
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.
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!
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.
I have been asked to write the outline of a chapter for a book about dementia from a doctor’s perspective. I am struggling. here are my thoughts… * I have lost my Hearing aids & specs & my dentures are gone. * I feel low. Trapped; The doors you see, are locked. * The carerContinue reading “Dementia”
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.”
…dementia, for example is more than a broken gene, it is how society acts and behaves, it is relationships between families and friends, nothing a pill can magic.
100 years ago, dying in your sleep in your 70’s was the considered a good-innings. Where will we be in another 100 years?
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
This tells you how many boxes are ticked – it doesn’t tell you anything else.
And that is the thing.
It doesn’t tell you about quality or whether the interaction led to change or care.
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.’
For someone who has dementia and, as previously described, there isn’t ‘dementia’ but infinite individual variations based upon the person’s life history, experience, physiology and, well, pathology.
Now we are learning that language, behaviour, how we behave and relate to people living with dementia is probably more important than the medicine;
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
Outside I could hear Michelle.
I don’t know what she was doing but, there was laughter.
Camerado, I give you my hand!
I give you my love more precious than money,
I give you myself before preaching or law;
Will you give me yourself? will you come travel with me?
Shall we stick by each other as long as we live?
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”
Time almost always does the trick;
And staying calm.
The NHS has a tried and tested technique; it is called hospitalisation.
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.”
As a generic
I now request that we pull on another string of person-centredness.
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”
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”
Thinking again of Bruce Lee – back in the 60’s he was aware of the potential harm of naming; the risk of distortion, perversion, narrowing our horizons.
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.”
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…”
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”
None of my patients seem to fit-into pathways, and that is a problem, for, as I say, the system is bedevilled with them.
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.
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”
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;
Even Stephen King says that dementia keeps him awake at night.
Sure, we know that unnecessary hospitalisation is bad, but what about inappropriate institutionalisation?
Boab hands me my phone and is longer shouting, he is calm the rest of the day and the next.
There’s no need to talk to me like that. I was just trying to help. Don’t, swear either, and, No, you’re not going home. It’s not safe tidy ready You’re not safe well able Stay here. Sit down or you’ll fall. Passive-aggressive tropes that fill me with sadness.
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”
I know it is Christmas Eve Day & all, but, I couldn’t help myself – you see, the way it is, when I get these thoughts in my head, the options are either to put them to paper or allow them to dissolve; a little like dreams. Some thoughts hang around longer than others, forContinue reading “Dead”
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”