HO! HO! OH NO!?!?!

Yes time hath flown and Christmas season is upon us again.

It’s that joyous time of the year when patients try to fatten the staff up, in hope that we’ll be nice to them next year. (As if we can remember who did and didn’t buy us what!) Still all chocolates welcome and I shall work as part of a team to ensure their rapid demise!

Now I am not going to go on about the patients rushing to surgery saying ….”but I need to be better for christmas”…. or ….”I wouldn’t have normally come, but it’s Christmas next week”…. because without even looking I’m fairly sure that I moaned about that for the last 2 years!  Although I vaguely remember writing something about Cliff Richards last year!!!  (Just put the link in and realised it was ‘07…my how time flies when your blogging!)

SO what am I going to tell you about….ahhhh, how about I tell you my top 10 things I  learnt from the works Christmas night out….Here goes….

1: Once you’ve half a brazilian wax, you have to keep on top of it, or else it itches. Incidentally older blonde women don’t have pubes worth waxing.  (Both these points I learnt from conversation, and they are not eye witness acccounts, it was a good night out but not that crazy!)

2: Most of the men I work with don’t like the idea of coming out with a bunch of drunk women….I’ve been doing it since I was 16, so am well trained and used to it.  (I’m sure I did something else as well when I was at college and Uni’, something involving books and classrooms, it’s just a vague blurry memory)

3: One of the Practice Nurses likes to grab my arse every year.

4: Those young girls in reception looked shocked by the oldies misbehaving at the start of the night, and realise that they didn’t invent getting drunk, and actually experience pays off, it’s alright though I’m sure her mum will wash her dress for her!

5: Just because you have a Doctorate doesn’t mean you have any sense when it comes to drinking alcohol. (I mean really, red and white wine together and slurping straight from the bottle!)

6: When the waitresses are your patients, you don’t have to remember what you ordered for dinner, I just hope they knew it was mine as they like me and not put it aside and spat in it!

7: When your patients are also having a night out at the same venue, you can get feedback on whether the patients like you or not….”Hic, you’re that Purse Nactitioner, I fink you’re lovely”…sweet, the effects of alcohol on people.

8: That cute girl in reception that you flirt with is going to drag you onto the dance floor, thankfully rescuing me from the drunk patients.

9: Just because you used to be able to twist down so low your bum was on the floor, doesn’t mean you still can!

10: When the taxi driver is your patient you can expect to hold a consultation for the duration of your trip home, even if you are a little inebriated.

Incidentally we have a sexual harrassment problem in the surgery…there is just not enough of it, so I’ve bought some mistletoe in,  bet I get caught by the old hag with bad breath!

We’ll I doubt I’ll have time to post next week, so in the event I don’t, I wish you  a good un, enjoy drink responsibly (i.e. don’t spill red wine and white carpet), and may the children get all they want and those of you on duty enjoy yourselves, remember if it wasn’t for you some other poor bugger would be doing it!

Sometimes there is a real “urg” in Urgent…

Imagine the scene…It’s the end of a long and tedious day, you’ve been working a full week and scarcely seen daylight as it has now reached that time of the year when you get to work in the dark and you leave in the dark. You only get to see your garden at the weekends…(like some weird divorce settlement).  You think you’ve seen your last patient for the week and an appointment slot suddenly appears, with a patient’s details in it and a red line meaning it’s an urgent appointment.

OK, so I don’t want to spend ages doing a full cardiac assessment then waiting for the ambulance and be really late home, but fair enough if it is urgent….

I call the patient, no chest pain, no breathing difficulty, but she does have a headache…could it be a subarachnoid haemorrhage (for those who don’t know a subarachnoid haemorrage isn’t a bleed in an underground spider) or perhaps Meningitis? So I take a history from this rather well looking lady.

She’s had the headache for about 5 years….

Suddenly I think perhaps my adrenaline surge was wasted somewhat.

Why is it urgent? Because the patient has the afternoon off work and she doesn’t know when she’ll next be able to get an appointment….URG!!!

The same thing has happened to me a lot recently. One of the others was also a headache, for several years, that the hospital consultant felt was caused due to cervical spondylosis, but what could be causing the headache…. urm… cervical spondylosis perhaps!

Right that’s it. I want to make a poster for the waiting room defining Urgent….

Do I think it will help???  NO!

Anyway with Christmas fast approaching I will invariably be inundated with urgent cases that “wouldn’t have normally come” but… “don’t want to be ill for Christmas!”  ‘Tis the season to be a wally….Tra la-la la-la, la la la aarrrrg!

This week I feel good.

Mr Brown is awaiting his hip replacement

Most of the time I see my patients, I feel I do my job well, and sort out whatever it is they have dragged their sorry arses in to the surgery to see me about. Sometimes they have to come back and try something else which will work, or I’ll need to refer them on to someone with specialist knowledge (or just someone brighter than me!)

Last week I exceeded my usual ability to resolve short-term problems…Here’s what happened. A 78 yr old with phimosis (that’s foreskin tightening to those who don’t have the misfortune to already know!) presented as the end of his foreskin was itchy and red. I asked him about how long it had been a problem and he said the rash was only there for a few days.

When I asked about the phimosis, he looked surprised and said he’d been like that all his life, or at least as long as he could remember. He thought it was normal for his foreskin not to retract…”surely that was only for circumcised men”… 

Sorry America…this is Britain Uncut!

So I gave him a prescription for some clotrimazole cream, and said he need to return in a week so I could see if anything much had changed, I wasn’t hopeful with such a basic treatment, but I needed to start somewhere.

One week later he comes back impressed as anything, as he can now fully retract his foreskin. Not often can you resolve a life long problem with a £1.84 product!

I wonder what he found under there!

And then of course there are all those people who come in limping and coughing and leave without a cough or a limp…. the laying on of my hands must be miraculous!

Anyway enough bragging!

For every one miraculous occurance, their are aproximately 3 who leave muttering: “What a waste of time, he didn’t even give me any antibiotics”.  But lets not go there!

A patient came in today complaining of having a sore throat, runny nose and feeling awful… 

Aaarg- tichoooooooooo!

I assessed him and advised him that he appeared to have a virus…not an uncommon occurence, but the fact he told me he was feeling awful sort of amused me, then started my brain ticking…(oh no!!)

Why do viruses have to make us feel awful?  I appreciate this microscopic life forms need to reproduce and spread from person to person to keep their existence, and as annoying as this is, it is basically the same as any other life form on the planet, so good luck to it. If the survival of their species is the only reason colds and other viruses exist, would it make evolutionary sense to encourage the host (AKA us!) to stop trying to get rid of them?

Surely if viruses evolved to make us (the host) feel good it would become a happy symbiotic relationship, a bit like the bird that eats the annoying bugs off the hippos back, leaving the hippo less irritated and the bird fed (only the poor bug loses out!)

3 birds on his back…Sounds like being married with two daughters to me!

Why can’t we have airborne viruses that make us feel energised and full of the joys of spring with a euphoric bounce in our step?  If this was the case then people would want viruses, we would feel great when we had them and the virus would be encouraged to thrive.  Sure you’d have some virus abusers, trying to get a viral fix all the time, but perhaps it’d cut down on drug abuse.  See now I’ve ruined this idea with a vision of slutty dressed girls going up to greasy old men in clubs, and slyly whispering in their ear…”Eh mate, fancy a virus?  20 quid???”

There is a down side to every nice thought…what’s that expression…Every silver lining has a cloud?

My original nice thought was this…

Pt: “Good morning Max!  I’ve had a virus and I think it’s gone to my chest”

Max: “So what symptoms did you have and when did they start?”

Pt: “Well before the weekend I started with a tickle in my throat, really made me giggle and feel happy, then I think I had a raised temperature because I felt like someone was giving me a nice warm hug all day, but over the last few days my chest has been tickly as well.  I’m sure it’s just a virus, but would you mind listening to my lungs and check?”

Max after throughly examining the patient: “Your chest is as clear as a bell, it must just be an Upper resp-giggle-tory infection. The bad news is it’ll be cleared up in a few days”.

Ahhhh….how nice….

Max!! Max!!! STOP dreaming….my nose is streaming!

It’s crunch time…the H1N1 jabs are here.

We were one of the last places to receive the first batch. Patients and staff are approaching me, asking whether they should have one or not.   My instinct is to shirk the issue and hide under my couch, but alas I can not do that.

Everyone asks me all the questions, and I can give the answers to all but one….”Are you going to have the jab?”  So lets answer that now….

I virtually hang out with a few conspiracy theorists who tell me that the jab is a government ploy, or that the jab itself has been rushed through the testing stage. I know the 1976 jabs were blamed for neuro problems including Guillain Barre, see below…

but convincing evidence is difficult to find.   The coincidence factor is always a concern.

Every year I hear : “I had my flu jab, and the next day…<add any random common presenting feature here>…my hair turned blue!

I argue with myself….I’m perfectly healthy (physically, mental health is debatable….I mean I blog therefore I must be a tad nutty!)

So why should I have the jab??? Well….

In 1991 I did a research project looking at the effect of the Measles, Mumps and Rubella vaccine (MMR) and specifically looking at the WHO target of complete UK eradication of the three childhood diseases.  My research found that indeed the three nasties would be eradicated by the year 2000 as planned…. it didn’t happen of course as some twit Andrew Wakefield in 1998 decided the vaccine caused autism… which was later disproved ad nauseum, none-the-less the damage was done and the diseases were not eradicated. So I am quite pro- immunisation and aware of the detrimental effects of negative press.

The H1N1 vaccines are much the same as any other flu jab, just one aspect of it has changed, surely the risks must be fairly minimal.

Perhaps a microbiologist opinion might be worth having….

Then I argue back with myself… It’s just another upper respiratory tract infection, mild flu symptoms in the vast majority of cases, why bother getting stabbed.

Then the good angel appears on the other shoulder…if I get piggy flu and feel just a bit sick, I can still pass the bugs on to someone else who may not cope with it as well, that may be an immune suppressed patient or one of my precious kids, and that wins the case.

I get the jab and I get some brain altering weird extra head growing side effect…well that is rotten luck. Cash in on the critical illness cover, pay the mortgage off.

I don’t get the jab, I pass the bugs to my nearest and dearest and they get really ill… and it’s my fault, the mortgage doesn’t get paid off early.

Yes I’m a cynical nurse, but I’m a dad first.

…and “Yes” Deborah, that’s just a government ploy to get us all jabbed, but it’s a good one!

and “No” Sister, you don’t have to make any jokes about just having a small prick, my sleeve is up, just get on with it!

OW!

I consider myself spiritual, but not particularly religious… Lets leave it at that… but today I shall start by quoting the bible….

Here goes….

In everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus himself said: ‘It is more blessed to give than to receive.’

Acts 20:35

Wow!!! I feel better for that!

Anyhoooo, where am I going with this.  I’m definitely a “giver” at work.

I give to my patients my time, my experience and expertise, handsome good looks and a listening ear…as shown in the following picture…

But sometimes on the battle front of primary care, it is the patient that gives and I who receive.  The things I receive are not flower or chocolates, but health care battle wounds….

Patients give me….

Urine samples in bottles not designed to have urine samples in them. Some make patients appear diabetic when they are not (you really mustn’t put wee in honey pots!) and others in pots that seem to be specifically designed to ensure the contents goes anywhere but on the urinalysis stick.  (Yes! I am writing this post with someone elses urine on my trousers!)

Flying microscopic bugs. Debatably when you sneeze the bugs and grubs that come out along with all that forced air travel at 100mph. Coughs are less speedy, but probably more germ ridden….please don’t aim them at me, and as I have said before the Peak flow meter is not a germ pea shooter, face away from me.

Flying macroscopic bugs: Tic’s and flea’s and head lice! No thanks. I believe you, you really don’t need to get any closer!

Pus.  OK it’s not your fault, but your abscess just erupted…(all the following have happened to me and I feel a little poetic…)

I squeezed your big juicy spot 

Messily it erupted like it oughta.

See that gunk and watch it fly.

Nearly hit the picture by my daughter.

Pus now dripping down my tie,

across my keyboard and into my water,

and somehow just missed my eye!

So, as you can see my job is give and take. It’s a war zone and I stand up and take my place to fight, but if you could keep the above ”gifts” to yourself….and bring me some chocolate I’d appreciate it. 

This post was slightly motivated by getting wee on my trousers and slightly by NYCRN’s new blog “Pee and Sympathy” and his Nurse manifesto.

All this talk of war zones in humour at this time of year, lets not forget the real heros…

I have a battle just trying not to lose my poppy, still it’s for a good cause so I’ll just have to buy another!

Well it finally seems to have happen..I think! (hmmm, I’ll rephrase that before someone makes a smart arse comment about me finally thinking…)

Well I think it has finally happened!

No not that!

When I first started out in General Practice, I felt a little intimidated and a lot impressed when I went to the Doctors and asked advice on a particular patients care and, on just hearing the name, they would rattle off about that particular patient as if they had memorized their notes.  I mentioned this to one of them, and they said…

“You’ll be the same in a few years!”

Surely not!  I have a slight disadvantage, the GP’s usually see their own patients, and as there are 5 GP’s they only have a 5th of the patients to deal with, whereas I see everyone. Now I am less naive I realise the GP’s can’t recall every patient, but it seemed that way because on the rare occasion I go to them for advice, it is usually about a regular with complicated issues, and thus their Doc knows them quite well.

So yesterday was a sunny day, and I went for a lunch time stroll around town. I realised that several patients smiled and said ”hello” to me.

I’m always cautious about saying “Hello” first. I suppose it’s a bit of a confidentiality issue, if I say “Hello” then everyone in the street might realise they’ve been to see me, especially as I live in a different town.  Mind you it’s not like I say:

“Ah, hello Mrs Smith and Mrs Jones. So Mrs Smith, how are those tricky piles today? Mrs Jones I trust you’re wearing a good incontinence pad, after all you’re a long way from your house!  Ah young Charlie is over the road….’Afternoon Charlie,  how’s the crabs?!” 

Instead it’s a nod and reciprocated “Good Afternoon” if one is received, and a half smile and nod to Charlie on the way down the road. 

Psst, how’s the crab’s?

After all it’s not just about confidentiality, it’s my bleeding lunch break!

Anyhow, I’m walking down the street, several patients saying “hello” (what’s the plural of Hello?  Hellos, Helloses, Helli, Hell I don’t really care!) and I look around, I see a Schizophrenic chap walking up the road, and then I see the woman with depression, and that bloke in the motor scooter with diabetes, who I have recently started on levothyroxine, and over there is one of the twins, with her friend who just had an unplanned pregnancy and didn’t know how to react when she had a miscarriage…and then I realise it’s happen!

No! I haven’t developed that ultimate nurse super power of being able to diagnose people just by passing them in the street, (Is it just me, or does anyone else pretend that they can do that when walking along sometimes!?!?  It’s not crazy, it’s just like people watching with a diagnostic twist – hmmm, OK sounds a little nuts!)

I realise I now know enough of my patients and have had enough encounters with them to know who someone is and be able to recall a fair chunk of their medical history, just like the Doc. said I’d be able to!

So I feel a little strange about this occurence. Is it time I moved to another area? Am I now part of society in this area, someone who is known by lots of people in the town?

I go back to my consulting room feeling like some kind of local celebrity, part of society, intergrated into the towns folk law of the future. I call in my first patient of the afternoon and I get greeted by….

“Oh hello, I was expecting a lady Nurse Practitioner, are you new here?”

The next thing I hear is the thud as my feet land firmly on the ground!

Some while ago, I wrote a post called “You called your baby what???”  Well I thought perhaps I should turn it on its head and tell you what I get called from time to time, this post amazingly doesn’t include swear words! 

Yes, amazingly I have been called some unpleasant things in my career.

I decided to write this post after a week in which I have seen 3 of my regular patients and have been called several things, most of them quite sweet.

As a Nurse Practitioner I have a few problems with people calling me “Doctor”.  I’m a man, I wear a tie, and I run a clinic from a consulting room, I suppose the stereotype is bound to cause problems. I always correct my patient, after all I don’t want my employers to think I’m not being paid enough, imagine the guilt they would feel?!?!?!?!

None-the-less one of my patients used to call me Doctor Brown Bear, now I am Nurse Practitioner Brown Bear…but it’s a bit of a mouthful especially when you are 3 years old. For those of you not in the know, Dr Brown Bear is Peppa Pigs Doctor….

Oink, Oink!

I also get called several things by one particular patient. A charming gent with a slight mental health history, who always gets in a muddle. He is one of those people who likes to say your name at the end of every sentence, which would be fine if he could manage to say the same thing every time. He starts off OK, calling me Mr Nurse, the starts to get confused between my first name, surname and eventually starts to spoonerise. So I go from Mr Nurse, to Mr Max, to Mr Murse and Mr Nax. All in the space of a 10 minute appointment. Still at least I’m not called Friar Tuck, I never know whether that’s a terrible spoonerism or a proposition?

Other patients also call me ”sweety”, “darling” and even “gorgeous”.

Needless to say my patients are often riddled with poor eyesight and mental health problems!

Yesterday I did get called “Wayne Kerr”. Well the statement was as follows… “You Wayne Kerr, I need my sleeping pills!”  The patient was quite drunk, so perhaps that’s why he thought I was called Wayne!  Unfortunately I didn’t give him his sleeping pills, because he had been drinking excessive alcohol. He thought I was being unreasonable as he’d only had 2 beers all day.  Perhaps I was being harsh, but I hadn’t yet had my morning coffee!

In other news…

Apparently Scientistist have found the Pheromones that can make you irresistable to the opposite sex…that’s apparently not as exciting as it sounds as the studies have only been carried out on flies!

Still having the opposite sex attracted to your flies is a good start!

Buzz…. off!

It looks like I’ve gone from Peppa Pig to Dora the Explorer…. (She has had a makeover, kids they grow so quickly, …before you know it Diego will be showing us how to use condoms…)

Arrg…it’s happened again. So busy the week has disappeared and my blog has remained unposted…. Kim can relate…in fact read her post…

One thing did get my attention this week….Yes I was fasinated by a story about combatting erectile dysfunction. Apparently the venom from a poisonous spider can help as a remedy for erectile dysfunction.  Seems quite obvious really, any insect bite can cause redness, heat and swelling….well what more do you need to combat ED (That’s Erectile Dysfunction not Emergency department…..nobody knows the cure for the latter!)

Quite how the researchers came up with the hypothesis -Toxic Spider bite cures ED,  I don’t know, and if I did have ED I’m not sure how keen I’d be to try this approach…. “Well hello, nice legs, fancy going down for a bite???” (Sorry I’m feeling smutty this week!)

Hmmm, I think I’ll have to stop there, sorry it is short and random, this week, next week promises to be worse…but I’ll try my best…

So over my few weeks off I hear a story on the news, that makes me stop and scratch my head a little…

(and no I didn’t get splinters).

Now perhaps I’m missing the point, perhaps I’m being controversial and am going to get slated for the following post, but it seems to me I am not the one missing the point, and from what I hear and read about the subject the more I seem to be the only one who thinks it’s laughable.   Anyhow, lets look at the story….

The BBC website entitled their article :

Heroin supply clinic cuts crime

No! Not crimes against heroines!

Now if you don’t fancy reading the article here are the basics of it…

100 drug addicts are given either FREE methadone or FREE diamorphine (AKA medical class heroin), and then assessed to see how much they were getting in trouble with the Police, how much they were using street drugs and how much they were spending on drugs…

Guess what…the pilot scheme showed that:

Three-quarters reduced use of street heroin

Offences down from 1,731 in 30 days to 547 in six months

Spending on drugs down from £300 to £50 a week

Everyone seems to be screaming what fantastic results these are and that it should be rolled out nationally.

 

Really am I missing the point? Of course these drug addicts are spending less on drugs and committing less crime to support their habit…they are being given them for free on a trial partly funded by the tax payer…

 

Perhaps the next big incentive will be to give free mobile phones to everyone and free upgrades every few weeks to stop people stealing mobile phones, or free BMW’s to all car thieves to stop them stealing cars. 

 

 “Stop Police!!! Let me get that for you sir!”

 

If this approach continues to spread I am going to become an alcoholic so I can get free beer when that incentive comes in!  Maybe we could also reduce gun crime, by allowing people previously convicted of gun crime to ask members of the armed forces to shoot people for them, thus stopped them from re-offending!

 

The drug addicts on the trial talk about reducing their intake over the coming weeks, well of course they do…if they said otherwise they’d be kicked out!

Here’s another quote:

“One of the heroin addicts on the programme, a 34-year-old man called John, had been addicted for eight years when the trials began.  He fed his habit by dealing.

“My life was just a shambles… waking up, chasing money, chasing drugs,” he said.

But John said the scheme had transformed his life “100 per cent” and he now had a part-time job.”

Well of course his life has been transformed, some nice clinic is supplying his drugs so he does not have to worry about it.

I’ve been thinking more about this kind of initiative, I commute to work, and that’s not very environmentally friendly, so perhaps the government can do some research on the benefits to the environment by paying me the same wage to stay at home and get someone else to do my job… I bet the results show I use less fuel by not driving to work!