What happens when you blame others (things) for your own failings. Look within young Padawan.
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.
The doctor might say, ‘I won’t give you any more pain relief until you have a test,’ a kind of pharmacological blackmail.
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?￼”
As a consequence of not scoffing sweet-salty popcorn or Sports Mixtures I have been consuming more nuts.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
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.
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…
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
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”
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”
If I was in my last hours of life and the tunnel and the bright light were there
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 always accepted this concept; it has taught me humility.
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.
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.
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?
…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.
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.
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!
‘The out of hours doctor says he has an infection…’
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.
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”
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”
Size doesn’t matter here.
This is not Land Rovers!
…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.
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.
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.
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.
If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.
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.
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
All of these add richness to relationship and whilst not essential for me prescribing penicillin are essential to my humanity.
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
In the hospitals (the hole) we sit and wait.
Eventually, inevitably, the older person will fall-in;
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.
I didn’t say anything.
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.
(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.)
She did not like that.
Should they stay?
Well, often I just don’t know;
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;
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 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.
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”
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”
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”
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.
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.”
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”
In most instances it is straightforward, and here is the trick.
Stop, look and listen.
When in doubt, don’t UTI.
Once this shift, this change in perspective has occurred, nothing can ever be the same.
We not I.
Us not me.
That is less perhaps of concern, as the more any of us learn , the less we all realise we know.
‘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?’
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
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.
Balance is the essence of nature; winter and summer, hot and cold, dead or alive, we constantly fluctuate between these extremes.
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.
Habits are our liberation, they are also a limitation
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.
I can’t imagine what modern medicine would be like without these colourful pieces of plastic.
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.