Category Archives: Drugs

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.

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?”

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. 

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.

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”

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.

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!

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 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.

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

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.

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”

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”

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”

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.