Tuesday, February 24, 2015

The List

The young bride recently bought a kitchen blender which now sits proudly on our kitchen bench. It’s a wonderful machine and apparently does amazing things. I haven’t been allowed to play with it yet, but I have eaten of the fruits of the machine and they are definitely good!
Before she bought this blessed electronic gizmo, she made a list of everything she wanted from it. She then did a search of similar gizmos in order to work out which one was best for her. Finally she checked out Choice Magazine to see what they thought and where the best bargains might be found.
By now you might be thinking that I’m going to write about healthy eating. But I’m not. This is all about that strange and sometime scary event:

 “Going to see the Doctor”

From my early years when I was on the other side of the desk, to the more recent years when we've moved around to sit next to our patients, one of the 'heart sink' moments that we Docs all experience is the patient who comes in with the dreaded “List”!

Early on in life, a visit to the Doctors is usually a fairly simple  - earaches, sore throats, rashes, soft tissue injuries etc. But as we age and things start to creak and go wrong, then many people resort to “The List”. 

But beware, sometimes “The List” can end up being a double-edged sword especially if you leave your Doctor to decide which items on the list need his/her attention immediately. This is becoming more of a problem as most patients rarely get to see their own Doc these days. The reason being that most Docs are now part-timers who work in large clinics and they’ve probably never seen you before in their lives. All they have is you, your medical history and “The List”.

So my suggestion is to take a leaf out of the young brides book and do some “due diligence” yourself.

  • Make a list of all the things you want to talk to the Doctor about.
  • Prioritise that list with the things that you’d like to get attended to first.
  • Show your prioritised list to your pharmacist or Community Nurse to get their opinion. And if you’re a little nervous about it all then take an advocate along with you - family member or friend.

Be aware that if you have more than two things on your list it is wise to make more than one appointment to deal with all your issues. Believe me, one interview will never allow enough time to properly analyse multiple problems or to allow your Doctor to explain their thoughts to you.

Finally, if you think your Doctor is not giving you adequate time or failing to treat each issue seriously, then feel free to get a second opinion. 

Ask my young bride, if you were buying a food processor you’d look around for the best deal - so why not do the same for your life!
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Tuesday, February 17, 2015

NSAIDs - the debate that continues to inflame!

A good friend of mine, who just happens to be a retired medical man, recently fell and broke his hip. Nothing too unusual for a man in his seventies, but when we visited him in hospital he was furtively hiding his pain medication in a tissue and tucking it under his pillow. “It’s an Anti-Inflammatory” he confided conspiratorially The look of  confusion on my face prompted him to continue “They might be OK for pain relief but they interfere with bone healing and I want to get back on my feet as quickly as possible”.

I have to admit to always being a little nervous about using NSAIDs - Non steroidal Anti-Inflammatory Drugs - having studied medicine during the period when Phenylbutazone, the first proper NSAID, was introduced. BTZ, as it was popularly called at the time, was later discovered to cause bone marrow depression in many of those who took them and swiftly removed from “The Market” . 

But first a piece of history:

The fascinating ability to treat fever and inflammation dates back about 2500 (400 B.C.) years ago to a time when the Greek physician Hippocrates prescribed an extract from willow bark and leaves. Later in the 17th century, the active ingredient of willow bark Salicin was identified in Europe. Acetylsalicyclic acid (Aspirin), a more palatable form of Salicin, was produced commercially by Bayer in 1899. However, the mechanism of action of anti-inflammatory and analgesic agents such as aspirin, and its later derivative Indomethacin, were not discovered until the early 1960’s when medical science was really beginning to find it’s feet. Things really changed in the seventies, when John Vane discovered the mechanism of action of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) opening the door to a pandoras box of new pharmaceuticals to treat pain and inflammation.

Since then the place of NSAIDs has become embedded in our lexicon of treatments for all things that involve inflammation and pain - especially those involving our joints. But the target tissues for these medications don’t just lie in our bones and joints, they are also to be found throughout the body in our stomachs, our kidneys, our hearts and our brains too. As time has gone by, the goal of Pharmaceutical Companies has been to develop medications that produce fewer side effects whilst maintaining their anti-inflammatory effects.

So what are the possible side effects of NSAIDs
  • Stomach ulcers
  • Raised blood pressure
  • Kidney Disease
  • Liver disease
  • Bleeding
  • Induce asthma attacks
  • Rashes, drowsiness, headaches

All of these side effects reflect the areas around the body that these medications have a collateral action upon, as well as the inflamed areas they’re principally targeted at.
A concern that I’ve had for many years is that some of these NSAIDs are now available “Over the counter” and are commonly used in children too.



The vast majority of childhood inflammations and infections will settle without the use of medications. Common sense and patience are far better treatments than rushing to the Pharmacy for a magical “quick fix” - because that is exactly where those “quick fixes” should remain, in the realms of fantasy and fairy tales!

The human body has evolved brilliantly over the millennia to deal with minor injuries, minor illnesses and local inflammations. For major stuff you should always seek medical advice, because in most cases, Doctors do know more than you do.

But let me finish by saying that although Doctors know a vast amount about the human body, they are still far, far, far away from knowing everything. My medical friend with his broken hip refused his NSAIDs because he believed that NSAIDs slowed bone healing. Well, a thorough search of all the scientific papers written on the subject came to the conclusion:

“There is no robust clinical and/or scientific evidence to discard the use of NSAIDs in patients suffering from a fracture, but equal lack of evidence does not constitute proof of the absence of an effect. The majority of the available evidence is based on animal findings and these results should be interpreted with caution due to the differences in physiological mechanisms between humans and animals. ….. Till then, clinicians should treat NSAIDs as a risk factor for bone healing impairment and (they) should be avoided in high-risk patients.” 

ScientificWorldJournal. 2012; 2012: 606404.
“Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis”
Ippokratis Pountos, 1 Theodora Georgouli, 1 Giorgio M. Calori, 2 and Peter V. Giannoudis 1, 3 , *


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Thursday, February 12, 2015

Hospitals make you better - don't they?

"Pyotr Petrovich admitted that he'd been a fool--but only to himself, of course.” 
― Fyodor DostoyevskyCrime and Punishment

There’s a good chance that you went to primary school with someone who ended up at Med School and is now a Specialist at something-or-other. You probably played together, got into trouble together or maybe you did/didn’t like him/her for any number of reasons. Then High School came along with different sports, activities, first dates, broken romances all the things that go with that decade of confusion.

The reason that I mention all this is because Docs are just like you and me - they’re human. At least I hope most of us still are! And being human we’re subject to good days and bad days, being brilliant one day and making mistakes the next. The only trouble is that when Doc’s make mistakes, it’s the rest of us who can end up in trouble!

In a  Swedish study from 2007, 12.3% of the studied population suffered an “Adverse Event” whilst staying in Hospital.  “Fifty-five percent of the preventable events led to impairment or disability, which was resolved during the admission or within 1 month from discharge, another 33% were resolved within 1 year, 9% of the preventable events led to permanent disability and 3% of the adverse events contributed to patient death. Preventable adverse events led to a mean increased length of stay of 6 days…. When extrapolated to the 1.2 million annual admissions, the results correspond to 105 000 preventable adverse events and 630 000 days of hospitalization".

Their conclusion: “This study confirms that preventable adverse events were common, and that they caused extensive human suffering and consumed a significant amount of the available hospital resources.

Another study in Italy reviewed the case notes of 1501 patients who had been discharged from hospital. A part of their discharge summary recorded Adverse Events in 3.3% of those cases. Significantly less than the Swedish study, but still a huge number when extrapolated to the entire population of hospital patients over one year.

In Australia, the Australian Institute of Health and Welfare defines Adverse Events as “ Incidents in which harm resulted to a person receiving health care. They include infections, falls resulting in injuries, and problems with medication and medical devices. Some of these adverse events may be preventable”.

In 2011–12, 5.3% of separations (Discharge from Hospital) reported an ICD-10-AM code indicating an adverse event.

These figures are from our Health Care and Hospital systems where “Best Practice” is constantly being reviewed and updated, and where there are procedures for every conceivable situation. 

 Far from scaring people off from going into Hospitals, the message I am promoting today is:

 Never be afraid to ask questions of your Doctor or treating Medical team.

If you’re a bit overwhelmed by visiting your Doc or by being a patient in a hospital, then get someone to act as an advocate for you.

One final comment about my medical colleagues. We’ve all met those people who are arrogant and think they know everything. Or perhaps those who treat their fellow citizens with arrogant disdain. Well the bad news is that some of those went on to become Docs too! Thankfully, I’ve only met a few over my long career, but believe me, they are still out there. If you believe that your Doc has treated you badly, ignored your questions, not informed you of your treatment options or has just been plain rude - you are not powerless. Write a letter to the relevant Medical Board who are there to protect your interests. They are on your side and will not ignore your complaint.

The Caring Profession should be just that - The Caring Profession. Sometimes it doesn’t work to our advantage through no ones fault, but sometimes the Medical team can “drop the ball”. We are all part of the solution: we all need to make sure that we are responsible for our own health and that means daring to seek out information that will be beneficial to our long term health.

There should be no one on this planet more vigilant about your good health than YOU. In the case of those who need an Advocate, then take that responsibility seriously. Believe me, when Docs are patients, they are never afraid to ask questions of their treating team - because they know that things don’t always run as smoothly as the Hollywood image of Hospitals would have us believe.

95% of Medical stories have positive outcomes. But that’s not good enough. We are all a part of the solution.
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