Doctoring without doctoring, a state of being, non-being. I am therefore I might be.
Category Archives: Drugs
Squeeze the capsule and empty the contents on to their sugar puffs. The 21st century balm.
If you open the capsule and sprinkle, everything will be ok.
An unusual half hour – just a sharp scratch.
Vaccinations and Mystery photo…
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.
London’s burning. Damn those firemen.
No one in healthcare works harder than GPs.
Belly. Thank you to Denise Lewis and the theory of misattributed causes
What happens when you blame others (things) for your own failings. Look within young Padawan.
Minimally invasive medicine
They perceive the wonder of human spontaneity, the fragility of hope and fear, the layers of anxiety, of prejudice, hope, joy and deprivation spinning atomic around the patient’s sense of self.
Just say no.
The doctor might say, ‘I won’t give you any more pain relief until you have a test,’ a kind of pharmacological blackmail.
My blood pressure is too high and when I get out of bed in the morning, I almost collapse. What should I do?
Thanks to Nigel for inspiring this blog. If follows-on from yesterday’s about postural hypotension. I don’t think, in fact, I am almost certain, no patient has ever asked me this specific question, although it is a thing. It is a condition that is tricky to manage and I suspect, one which is becoming moreContinue reading “My blood pressure is too high and when I get out of bed in the morning, I almost collapse. What should I do?”
The Brazil nuts from Brazil
As a consequence of not scoffing sweet-salty popcorn or Sports Mixtures I have been consuming more nuts.
Have I got dementia?
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
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.
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.
The default mind network, flow and magic mushrooms
I worry that I might not have enough time to complete all the work I have planned on Monday prior to the deadline when I will be asked to present the results of the…
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.
Every time I stand up I fall over.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
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”
State of frustration
I wanted to begin by discussing my recent practice FB post. I called it >very frustrating situation<. That was the best I could think at the time. What is or has been frustrating? Well, I won’t go on too much about Covid (lie). The vaccine has been rolling out over the past month. And, inContinue reading “State of frustration”
Would you want to risk missing God?
If I was in my last hours of life and the tunnel and the bright light were there
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.
Placebo – Serotonin, what it is to be a doctor, foray into shamanism and farewell Maisie
I have always accepted this concept; it has taught me humility.
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.
Covid – My blog is calling (Week one, through a doctor/dad/outsider’s lens)
Fear of doing the wrong thing is a fundamental of quality improvement. If you are afraid to act because people might call you out or think you stupid, you won’t do anything, and the quality won’t improve. It won’t necessarily deteriorate either, yet, in times of radical change, that is worse.
This is black-belt medicine (areas of uncertainty in health and social care)
Ever been breathless at three in the morning? Do you have any strategies to sort yourself out, particularly when to begin you have a bad chest?
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.
Manor Field Blog Number 19 COPD
It is never good to start something with an obscure medical acronym; ‘Chronic Obstructive Pulmonary Disease’ is however a bit of a mouthful and I suspect for many, even those who have the condition it doesn’t explain much more.
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!
Purple Urine Bag Hubris
‘The out of hours doctor says he has an infection…’
Manor Field Blog number 18 Flu!
Some people claim to get the flu from the flu vaccine.
This does not happen.
It can’t happen.
It is not the way it works.
Influenza
This morning I had a brief discussion with one of our patients; she is on the cusp of her 65th birthday. And, for those involved in the administration of the flu vaccine, this is a thing. Under 65s get one vaccine and overs another. Why would this be? At first, my assumption was that asContinue reading “Influenza”
Manor Field Surgery Blog Number 15 – Sick Day Rules
Whenever I heard this phrase, sick day rules, it makes me think that someone is celebrating sick days, as in, ‘Rod Rules!’ it isn’t meant to mean that, although I can’t think of an alternative. So, what are these rules? They are in effect advice for people taking different medicines (or who have specific healthContinue reading “Manor Field Surgery Blog Number 15 – Sick Day Rules”
Manor Field Blog 12 – Aspirin
Size doesn’t matter here.
This is not Land Rovers!
The problem with Eureka!
…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.
Manor Field Surgery Blog No. 9 – What about anti-inflammatories?
Well, part of how they work affects certain enzymes and chemicals in the body that stop or reduce inflammation (duh!), and, somewhat unsurprisingly, inflammation although a problem at times, for example, a sore knee, is also part of our general human adaptation to life, in other words, it is how we have evolved.
Manor Field Surgery Blog Number 8 – Pain
Pain is one of the most common reasons for a patient seeking medical advice. It also plays a major role in the progress of all sorts of diseases and conditions, in other words, sometimes the pain is the thing, and at other times it is an outcome of the thing.
Manor Field Blog number 6. Doctor, how much should I drink?
Well, most of us – adults that is, have been drinking for many years, and, if you have made it into your 50’s, 60’s or older and are in reasonable health, you are probably close to the sweet spot.
Manor Field Blog #4 Lying and Standing – Know your numbers!
If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.
Manor Field Blog #3 – what is de-prescribing?
In the UK we have a fantastic primary prevention service that aims to maintain the health and wellbeing of our population. It is perhaps not as great as Germany or Norway, but it’s pretty good.
Manor Field Blog #2 – I am a GP not.
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
Doctor, doctor, can’t you see?
All of these add richness to relationship and whilst not essential for me prescribing penicillin are essential to my humanity.
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
Tigers, long-term conditions & my new life
In the hospitals (the hole) we sit and wait.
Eventually, inevitably, the older person will fall-in;
Jean Bishop (*warning – graphic images!)
Hard work, when translated into a vision that makes a significant difference is itself transformed, it becomes meaning, its return on investment is not necessarily financial, it is something more profound and longer-lasting.
Safety and confidence
I didn’t say anything.
Why I like urine
When I say negative, I mean urine that has been analysed and found to be normal; just the right level of sugar, protein or salt; not too much or too little. Goldilocks pee.
Little blood pressure thing.
(In health your blood pressure rises when changing position; in disease if it falls, the blood supply to your brain, at times precarious, drops, you feel woozy, light-headed, you fall.)
Drugs and drug reps
I refused.
She did not like that.
Should they stay or should they go? (A paean to physicians everywhere)
Should they stay?
Well, often I just don’t know;
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;
Doctor
Doctor, you know that medicine you gave me last night, to help with my pain, well, it seems to have made my skin itch and I have become all shaky and my mouth, it is very dry and I feel awful, do you think it might be the medicine that has made me feel worse?Continue reading “Doctor”
The long-tailed tits
The long-tailed tits Move erratically. Jittering, flighty, Pecking at the peanuts. The film, running at double time, twice normal speed, constant alertness; cortisol through the roof. Good job they only survive a season or two or else They’d be on Ramipril Like, everyone else.
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”
The Hazards of Polydoctory
I started writing this, a little chuffed with myself as I thought I had invented a new word. Alas, someone has beaten me to it, although their meaning is slightly different from the one I intend to use here. In the Encyclopaedia of Ageing and Health edited by Kyriakos S Markides*, Polydoctory is defined asContinue reading “The Hazards of Polydoctory”
Delirium (2)
Our health and social care staff need to gain a better understanding of this condition – how to identify the early signs, how to diagnose and treat.
Something medical.
We debated yesterday during the ward round, as to whether I should discontinue one of my patient’s medicines. 85, he’s not in good shape; struggles to walk, confused at night, the stroke ten years ago took his ability to speak. Of all the drugs that are forced upon him morning and night, one is toContinue reading “Something medical.”
Sleep
There is a science of sleep. This evening as I was driving home, I heard Peter White discussing sleep disorders in those who are blind or have significant visual impairment. Unlike our crepuscular cousins, humans are diurnal; we are designed to sleep when it is dark and potter during the day, creating industry, building things.Continue reading “Sleep”
UTI
In most instances it is straightforward, and here is the trick.
Stop, look and listen.
When in doubt, don’t UTI.
Me, we, dementia and Donne
Once this shift, this change in perspective has occurred, nothing can ever be the same.
We not I.
Us not me.
Delirium
That is less perhaps of concern, as the more any of us learn , the less we all realise we know.
1328 and some
‘Did my dad die because someone didn’t follow policy, didn’t pay attention or, was the outcome inevitable?’ ‘Might my mum have survived the operation if she had a different surgeon or she was at a different hospital?’
Medicines, etc.
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
Gut microbiome, antibiotics and older people
We, the homeostatic organisms that have evolved over the past four billion years, exist in a state of serenity when well, but things can be thrown out of kilter by disease.
There is a balance
Balance is the essence of nature; winter and summer, hot and cold, dead or alive, we constantly fluctuate between these extremes.
Innocence and experience – sorry, I don’t know
Unless I am 100% sure that it is the left kidney, surely I should ask before I remove the wrong one, or prescribe the wrong medicine or convey the wrong information.
Habit, hospital & older people
Habits are our liberation, they are also a limitation
What do you do?
I have recently been asked to show what I do, to demonstrate, I guess, how much value I am for the money spent on me.
Cannulas and Cannulae
I can’t imagine what modern medicine would be like without these colourful pieces of plastic.
Some more thoughts on urine infections…
It is likely that a doctor, a nurse or carer admitting, ‘something is wrong, I don’t know what,’ is better than heading off down a therapeutic blind alley.