MEDICAL MATTERS

[Tardis]

Tomorrow I see what it is like from the other side of the transplant service, holding a live volunteer's hand

[Tripps]

Well - this seems to be good news, and it's scientists that are speaking.

Food myths

[Stanley]

It's a good article and in line with all the latest research. People are always looking for a 'magic bullet' and it may be that none exists. Personally I have always tended to think that contaminants in our lives are more likely to be the cause of the increase in cancers. Think Ozone Layer and melanoma, particulates and lungs cancer etc. Mind you, there is also no doubt in my mind that a good balanced diet is one of the best health insurances overall and perhaps that is the message that needs pushing.

[Stanley]

See this LINK for a complete U-turn in official advice about giving birth in specialised midwife units or at home. Mind you, I suspect that cost-saving and reducing pressure on hospitals is at the back of it but even so, good to see the midwives getting the recognition they so richly deserve.

[Stanley]

See this LINK for the latest twist in the march of statins. Despite what they all say, I don't like the idea of 'magic bullet pills' and will continue to refuse them, I am not a statistic!

[Stanley]

I've just heard Sir Magdi Jakoub (LINK) on BBC Today advocating that all men and women over 40 should take a statin pill a day and they should be available without prescription over the counter like aspirins. I suppose we have to take notice of such an eminent man in his field but why do I recoil in horror from blanket statements like this?

[Big Kev]

I rely on chemistry for living and part of that is taking statins, I would like to not take any pills or potions but, unfortunately, you can't choose your genetic make up. Of course, there is freedom of choice but I don't know how refusing some drugs would affect my overall treatment at the surgery.

[Stanley]

Understood Kev. I base my position on the fact that I'm perfectly well, doing all the right things, have excellent blood stats and BP of 120/80 or thereabouts. Arthur Morrison once told me that if anything bad was going to happen to you the chances of it decreased after the age of 75. So I have taken my own gamble.... Don't even take aspirin now.... All I do is my Metformin 500mg three times a day.

[Tardis]

At the end of the day, the patient has the last call on any medication and thus it is best to be fully informed and take into consideration all effects before coming to that decision.

At any time you can refuse treatment and ask for a second opinion. They don't tend to like that, but it does remove some barriers

[plaques]

The new health centre in Colne opened today. Last Friday, a typical workshop mishap resulted in an unscheduled visit to the Urgent Care unit in Burnley. Very impressed by the new Burnley set-up, that is once you have found it. The treatment was first class, although to be honest I'm not planning any more visits. The Colne Health Centre is my next stop for tidying up. So far the preliminary appointment visit looks like we may have moved into the 21st century at last. Well done Lancashire NHS.

[Tardis]

After a two week wait for an appointment, I turned up (Monday) for the blood test to check my antibody levels to be greeted with "We don't have any tubes that colour, you'll have to go to Airedale"

45 minutes each way, for one tube of blood? Only the NHS could think that this was a valuable use of my time?

My transplant team were open mouthed. Next time they will send out the tube with the request.

Lucky, I suppose, that I didn't have to go all the way to St James Hospital in Leeds

[Stanley]

Look on the bright side, thanks to the Labour government of 1945 it's free.....

[Tizer]

I've explained in the past about how the Body Mass Index (BMI) is a bad way to judge whether someone is normal weight, overweight or obese. It was designed in the 1800s for a different purpose and should never have been used to assess obesity and we all know that BMI values are often misleading (for example, muscular athletes are judged as obese according to their BMI). At last some progress is being made with a better method. Canadian scientists have developed a better method using near-infra-red spectroscopy to measure the proportion of body fat. It uses a portable instrument with a handheld device that is applied to the skin and detects how much fat is present in the body tissue. This will give a more accurate and meaningful way of determining degree of obesity instead of relying on BMI which is simply based on body weight and height.

[Tardis]

Look on the bright side, thanks to the Labour government of 1945 it's free.....

Is it? Think of the knock on effects to others trying to use the service.

Turns out that the issue is simple lack of standardisation within different pieces of the NATIONAL Health Service. They all have a long list of different blood tests to be put into whichever medium to best preserve them, but don't qualify the colour, so just apply their own colour coding when they buy the vacutainers from their suppliers. Hence, what is standard in one hospital trust, isn't the same in another. This must lead to difficulties when staff move between different hospitals and have to relearn basic skills.

[Stanley]

You don't have to pay at the point of use... therefore it is not costing you any money. Of course it costs money but well spent and one of the cheapest health delivery systems in the world. Good enough for me. If you were in the US you would soon find out the difference and there cost of delivery is twice as much as the NHS under the 'efficiencies' of private health care.
Tiz, about time too! I have short legs and a long body and according to BMI I am in deep do-do! My late mate Danny Pateman (who was very rotund) always said his weight was fine, the problem was he was too short.

[Big Kev]

I've explained in the past about how the Body Mass Index (BMI) is a bad way to judge whether someone is normal weight, overweight or obese.

I have had many an argument with "Health Care Professionals" about this. I remember having a medical 20 odd years ago and being told I was 6 stone overweight, I had no fat on me, did a manual job on building sites, weight trained 3 or 4 nights a week and went running and swimming. They said that at 6ft 7in tall I should weigh around 13 and a half stones, needless to say I laughed...

[Bruff]

Interestingly, at my last review, BP, bloods and all that and having gone through the amount of alcohol I drink a week ('that's OK, but you might want to keep an eye on it'), yes I'm still off the fags and won't be going back ('very good'), yes I do a lot more exercise and my diet is very good ('you need to keep the exercise up'), I mentioned that I did think I was somewhat overweight and so could probably do with getting a bit off. Immediately, the response came back 'why'? Well, I said, I'm only about 6ft and I'm knocking on 16st. Dr said, 'So what? Are you comfortable in your clothes'? Yes, I said. I wouldn't bother then, she said. Not worth it, she said.

Have to say, regarding the post earlier, that I had no idea that vacutainer colour coding varied across hospitals. I also have to say it seems so self-evidently obvious to the lay-man (that's me) that there should be a rigid standardisation across the Service there is probably a simple explanation why this might not be the case. I wonder whether it's awrapped up with giving Trusts the freedom to do their own thing, make their own arrangements and so on?

Richard Broughton

[Wendyf]

Mum is being looked after very well at the moment by the NHS on an elderly care ward at St James's in Leeds. She is suffering from the effects of dehydration and Digoxin toxicity. She has been taking Digoxin to control her heart rhythm, which gets out of control because of leaking valves and a blockage to her aorta, but apparently the dosage adjustment is very delicate and when she was discharged from the heart ward at the LGI with a prescription they couldn't have taken into account that she would refuse to take food & drink when she got home. Her kidneys aren't recovering as quickly as hoped, but she does seem to be coming round a bit.
I have just learnt that Digoxin is the drug form of digitalis, or foxglove...no wonder it can be poisonous!

[Marilyn]

Patients generally have weekly blood tests when first placed on Digoxin, Wendy.
They must also have their pulse checked before EVERY dose is given. If pulse is below 60 beats a minute, the dose is withheld and the patient reviewed by doctor.
Dig toxicity is quite common. Even the most stable patient can suffer it. Staff should be on the lookout for it.

[Stanley]

Wise words from Maz who knows what she is talking about.
Richard, your GP sounds like a treasure! What a sensible response....
On the general subject of medications causing problems, I remember how surprised I was when I read Illich ('Limits to Medicine) many years ago. He said that iatrogenic problems accounted for over 50% of patient's ills. I had to look it up, it means 'caused by doctors'. Food for thought.....
I sent a copy to my friend John Pudney who was being treated for a throat cancer which eventually killed him. He thanked me for it, said it had frightened him to death but added that he'd got a couple of good quotes for his piece 'Nil by Mouth'. (LINK)

[Wendyf]

Patients generally have weekly blood tests when first placed on Digoxin, Wendy.
They must also have their pulse checked before EVERY dose is given. If pulse is below 60 beats a minute, the dose is withheld and the patient reviewed by doctor.
Dig toxicity is quite common. Even the most stable patient can suffer it. Staff should be on the lookout for it.

Her pulse was being checked in the care home Maz, and it was the results of a blood test that prompted them to send her to hospital. We weren't given that information when she was discharged from hospital after first being prescribed the drug, so for the week we were looking after her at home there were no checks done. Her doctor visited at one point and never mentioned it.

[Tizer]

He said that iatrogenic problems accounted for over 50% of patient's ills. I had to look it up, it means 'caused by doctors'. Food for thought.....

Our 90-year-old neighbour is in the late stages of stomach cancer and it looks like he won't be coming home but will go into a hospice. His wife has major problems too and is hardly able to walk or look after herself. She's on lots of drugs including an antidepressant and a tranquillizer and is now getting more panicky due to her husband's situation. At last the doctors seem to have seen the light and her GP has taken all her drugs away in a big bag and is starting her on a single drug at a time to see what she really needs. It's a major problem now with doctors prescribing one drug after another but often not deleting the earlier ones, so we end up on a cocktail of drugs that are very likely to interact, with unpredictable consequences. But then what can we expect? The doctors have been over-prescribing antibiotics for decades and look where that's got us...on our way back to the bad old days where any injury or infection could mean death or lifelong disability. (But for antibiotics we have to also blame drug companies, veterinary drug companies, agriculture companies, farmers...)

[Stanley]

Some of the members may remember when Doc had his heart attack. In the aftermath he did all the right things, followed instructions and took the pills. It got to the point where he knew something was wrong, went to his GP and collapsed in the surgery. His BP was so low he should have been dead. It transpired that he was still on the standard cocktail given to all patients when he left the hospital and these included drugs to reduce high blood pressure which wasn't a problem. Doctor did what he should have done in the first place, reviewed his prescriptions and deleted all drugs not connected with his condition. He never looked back after that.
In my father's case they were treating him with diuretics but not replacing the Potassium he was losing. I think that contributed to his last illness that killed him but didn't find out until much later.
Both cases could be classed as iatrogenic I think.....

[Tizer]

(But for antibiotics we have to also blame drug companies, veterinary drug companies, agriculture companies, farmers...)

Talking of which...
Concerns grow over farm drugs used like 'sweets' (BBC News, 28 May 2014)
"The widespread use of antibiotics on farms without medical supervision has been condemned at a meeting of the World Organisation for Animal Health (OIE). There are particular concerns about the US where authorities say it contributes significantly to resistance. There are also worries that a new US-EU trade deal will see a watering down of tougher European laws on their use. The OIE says it has tried to broker a compromise between the two regions. But so far this has been unsuccessful. It's estimated that 80% of the antibiotics purchased in the US are used on farm animals."
http://www.bbc.co.uk/news/science-environment-27541663

[Marilyn]

That is very disturbing Tizer.
Saw a documentary on China the other day that had me thinking too. It was regarding birth defects...way out of proportion to natural occurrences and there has to be a reason. You can't be too careful about what you consume...

Stanley, not all diuretics deplete Potassium...in fact there are Potassium depleting and Potassium conserving types. ( I am on a Potassium conserving one and must not take Potassium...dietary Potassium is OK...but there is a warning not to eat Grapefruit! I must not overdo the Bananas either).
You probably knew there were two types?