It reminded me of last time with the increased accidents at home due to people competing with the TV 

“I often joke that exercises isn’t necessarily good for you…which leads me to the report that states arm chair spectators of the Olympics have been trying to compete…apparently a company that repairs gadgets has received around 50 calls from people wanting to set up their rowing machines and exercise bikes so they can practice keeping up with the Olympians.  My favourite quote in this article is from John Brewer of the Lucozade Sports Science Academy:

“There has to be a degree of realism and common sense”

The ancient art of Javelin catching…”

Reblogged from It shouldn't happen in health care:

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As I get a tiny bit older (not old, just older), I realise my perception of time isn't quite right.  I see the patients date of birth and think...oooh they were born in 1994, and I look down the corridor expected some little kid with bunches and a cute smile.  Instead I am grunted at by a spotty, 6ft teenager...

Read more… 675 more words

Today a post, but I’ll make it a page and keep adding to it if I get some help from you…yes you. Please add a comment and include your own definitions. Go on you might just enjoy it!!! (Why do I bother? I can see that lack of enthusiasm glazing over your face. Go on just think of one!!! They’ve got to be better than some of the corny ones below!!)

Amenorrhoea :
1: [Amen-hurray-arr] Meaning: So be it, thank goodness, a celebration of no longer having periods, followed by the realisation that you are about to have a hot flush.
2: [Ay-men-aroun'-'ere]. A condition of absent period that can be induced by pregnancy, derived from the old Anglo-Saxon expression used by fathers who discover that there daughters are pregnant. “Aye? You’ve ‘ad a man around ‘ere!”

Cerebro-vascular Accident [CVA]: The Stroke Association states a CVA “happens when the blood supply to part of the brain is cut off and brain cells are damaged or die”. I’d like to clarify when they say “cut off”, they mean blocked and not amputated. Having the blood supply to your brain amputated is likely to cause one hell of a headache, really you’d need the police, a lawyer and not to mention one rather good neurosurgeon! The use of the word Accident also needs clarification, you can’t have a “Cerebro-vascular did it on purpose”.

Chlamydia: [clam-mid-ye-ha] Sexual infection that won’t spread if you clammed up you mid area.

Diarrhoea: [dire-rear] Something bad is happening to your rear.

Gonorrhoea: [goner-here] A sexual infection suggesting that someone that came has now gone and left something with you.

Macroscopic: [Macro-skop-ik] See “microscopic” but bigger.

Mastitis: [Mass- tit-tes] An infection of the breasts that makes you have a mass of the titties.

A red tit, not to be confused with the blue tit found on a hypothermic patient.

Microscopic: [My-crow-skop-ik]:

Sphygmomanometer. [S-fig-mo-nom-o-metre]: Truly a brilliant word, firstly if you ignore the false vowel (“y”- (y not?)). It has a full 6 letters before it reaches a proper vowel! Definition: Well the “meter” bit means obviously that it measures something. So it obviously measures “sphygmomano’s”, which are the amount of male mummies in a Sphinx. Doh!

Stroke: [st-r-oke!] Something you can do to a cat even if only one half of you body works. See also Cerebro-vascular Accident.

Syphilis: [sieve-a-list] A sexual infection in which the sexual health clinic will have to sieve through a list of all you sexual conquests and ring them up to let them know what you’ve shared with them.

Tinnitis: [Tin-ear-tis and not Tit-te-ness as my elderly relative used to call it] A noise in the ear that can be tinny.

Vaginosis: [Vag-he-noses] A vaginal infection that smells to the extent your boyfriend might notice.

“OK dear, here we are!”…. Oh if only it was that simple. 

First you have to tip toe through the mine fields of contra-indications for the various contraceptive groups: This included the medical twist on the “not tonight dear I have a headache” which is… “You have migraines…No COC for you!” If you unfamiliar with the abbreviations, all will become apparent further down!

Even if you’ve established that they may be an uncomplicated patient that can use any type of contraceptive, you then have to give the patient choices, and these have to be informed.  I find I have so much information to give out and so little time in which to do it!

Ok so you’ve 10 minutes to establish any medical reasons they shouldn’t have any particular method of contraception, discuss safe sex, be satisfied they are not already pregnant having had UPSI!  (I’ll give you that one now… as it is probably my favourite medical abbreviation: UPSI stands for Un-protected Sexual Intercourse. Obviously I like it because it sounds like the sort of thing a perfect gentleman would say when they realises his mistress is not “on the pill”.  Oooops Daisy.  I was horrified to find my daughter talking about UPSI, when she’s not even 2 yet). 

The Night Garden?…Upsy Daisy? The Ninky Nonk?  Sounds a bit perverse to me!

If the patient has had UPSI, then you can give them a MAP!!!  (that’s the Morning after pill, and not directions on where to buy cots, and absolutely nothing to do with helping men finding the “G” spot).

…and then still in 10 minutes you have to go over the following options.

COC: That’s the Combined Oral Contraceptive. Whoever decided to think that title up should be shot. What’s wrong with calling it a CCT (Combined contraceptive tablet)?  It would save patients seeing it written down and saying…”If it wasn’t for COCK I wouldn’t need a contraceptive!”  This “funny” gag gets reused later in this post too!

With COC’s you have to advise the patient that it can cause:

 - headaches…(more “Not tonight love, I’ve a headache” gags!);

- weight gain (but not as much as an 8lb baby);

- and increased risks of thrombosis and cervical cancer, but not much.

POP: Progesterone Only Contraceptive (and not the sound of a condom allegedly breaking).  Easy peasy, less risk of complication, although if you miss one by mistake there is an increased risk of getting a parasitical infection with life altering effect. The parasite slowly increases in size, cause body swelling, nausea and after about 9 months burst out of your vagina and starts screaming at you, you then need to look after it for about 18 years, before it moves away, but still rings you asking for money and bringing it’s dirty washing to your house.  Surely that would scare you enough to remember to take the pill at the same time every day!  With the modern POP’s you can even be relatively late taking it and be fine.

Next we have the LARC’s: These are the Long Acting Reversible Contraceptives. They are progesterone based and can cause some people to bleed, although normally this resolves and they can stop periods for the full duration of use (and a bit afterwards).  The LARC’s include:

Implant: A simple procedure where a small implant is popped into the patients arm and gives contraceptive cover for 3 years.

Injections: A twelve weekly injection that keeps your patient from getting pregnant,

Both these involve needles and so give the patient an opportunity to giggle, when the clinician says “Just a small prick” and the patient retorts: “If it wasn’t for a small pricks I wouldn’t need contraceptives”. Oh hilarious …again!

Then there is the IUD – Intra- Uterine Device! An IUD is a small, T-shaped contraceptive device made from plastic and copper that fits inside the womb (uterus). The clinician inserts it via the vagina…(If it wasn’t for things going in my vagina I wouldn’t need contraceptive…oh give it a rest now, would you?)…and basically it acts as spermicidal barbed wire with a hint of chemical warfare.

Other LARC’s include actually having children, for the next 18yrs you and your partner will be too knackered for sex and on the odd occasion you can muster the energy and enthusiasm, one of you children will cry, vomit or do something else that ruins the mood.

Permanent Contraception: These include “the snip”, getting the man in the relationship so drunk and on so many promises he agrees to have a vasectomy.  This contraceptive only works if the female is only having sex with the man who has had the vasectomy!!! Female sterilisation is another option, or becoming a nun, a lesbian, or just abstaining from sex, or better still a lesbian nun that’s abstaining from sex, (although I suppose there’s always the immaculate conception risk!  An angel came from heaven…discusting high velocity splatter!)

…and there you have it, the most cram packed 10 minute consultation….Come on! Decide would you?!?  Sadly that 10 minutes I spend talking to woman about sex, is probably longer than they’ve ever talked about sex with their partners, or even worse, longer than the act itself actually takes…surely not!

During pregnancy the Mummery Gland gets to work at suppressing normal intelligence, but it is after labour that the gland really kicks in.

The Mummery gland releases GSH into the blood stream. (That’s Guilt Stimulating Hormone and NOT Good Sense of Humour!). 

The effects of GSH are that the previous rationale woman goes nuts, a progressive post natal dripping of guilt builds into a life long problem.

Lets take a case of Mrs A. You know the kind: The childless professional, who from 20 metres can criticise and find fault in the way all her family and friends bring up the children, with classic common sense and states things like…

“Fancy putting them in front of the TV with a bowl of chocolate 30 minutes before dinner!”

…or…

“Well no wonder the baby won’t sleep in its cot by itself at night, if she spends the first 3 hours of the night cuddling it and singing to it…really!!”

Mrs A then gets herself “in the family way” or as we used to say in the posh town I grew up in “up the duff”.

The Mummery Gland develops in pregnancy and eradicates all this previous “logic” about child care. During labour GSH is produced and from that day until the day Mrs A. final finds herself terminally ill with scabies in an old folks home, she suffers from severe, irreversible symptoms as shown below:

Overwhelming feeling that if she plays with her children she is failing as a domestic goddess and an overwhelming feeling that if she does house work she is a failure as a mother.

She strongly believes if she shout at her children she is too strict and that if  she doesn’t she is too soft.

She also feel that if she cuddles her screaming child at night it’s because she is a bad mother and  just doing it to stop the noise, but if she doesn’t cuddle that screaming child at night she is traumatising them and causing separation anxiety that will lead to life long psychological problems.

Mrs A thinks that helping her children get ready for school suppresses their independence but if she doesn’t help them she is making them feel that she doesn’t care, especially as it takes 4 times longer and she end up shouting at them.

In later years Mrs A will feel that  holding her teenagers hair so they don’t vomit in it after their first encounter with alcohol excess, is giving non verbal signal that it is accepted to binge drink but if she doesn’t hold their hair, they will choking on their own vomit and it’ll all be her fault as a bad mother.

These are simply key examples – there are many others!

Childless women should be warned of this wide-spread occurence of Post natal drippiness and the dangers of the Mummery glands with the life long devastational effects of Guilt Stimulating Hormones.

Chesty coughs, are you listening? 
In the waiting room, snot is glistening
A hideous sight,
We’ve been coughing all night.
Sneezing in a winter wonderland.

Slipping down,  went the old bird,
Fractured Hip… How absurd?,
In hospital for too long,
Sleeping in the NHS corridor.

Last night, we had a hall for hire,
All got drunk, filled with desire
Now to face unafraid, 
The mistakes that we’ve made,
Shame in the staff party wonderland.

 In reception we can build a snot-man
from all the snotty tissue left around

When surgery closes it’s thrilling,
Though in out-of-hours we could make a killing

Well that’s that job done for this year. Have a smasher of a christmas period, and remember to go careful out there!!

2 main exacerbations this week:

Firstly a patient who was a little snotty – both in psychologically and physiologically,  presented with sinusitis.  Now sinusitis is a condition that always gets on my nuggets. I can sympathise having had blinding sinusitis myself, but sometimes patients come in with such minimal signs and symptoms and demand antibiotics. So I confess in this particular case my heckles were well and truly up, as she had symptoms for a few days and very little to show for it clinically. Now I kindly pointed out to this nicotine stained, eau d’ashtray adorned lady, that smoking was one of the worse things she could do. 

She then snapped in snotty tone that last time she stopped smoking she nearly killed herself.   As she was apparently exaggerating her sinusitis symptoms, I assumed she was exaggerating here also, and thus I blurted out:

“Well killing yourself would prevent sinusitis of course!”

She then pointed out that she really had attempted suicide when she last quit smoking. Furwham!!! (The sound of my foot smacking its way through my teeth).  At which point I agreed to give her an unnecessary prescription for antibiotics and let her go and have a fag!

Secondly, a pleasant chap came in complaining of penile warts. I should explain that he had a bit of a northern accent. For those not in the know, British Northerners tend to skip a few word out of their sentences. Now I love Northerners, and have even dated them, and I am fond of the accent, so I am not taking the mick out of their accent, cos ee by ‘eck the last thing y’want is ‘  mardy northern on yer case!

To avoid the wrath of my silly/inappropriate comment what the gentleman should have said was: “I’ve had warts ever since I was a boy”

What he actually said was: “I’ve had ‘em from a young boy!”

I knew what he meant.

What I should have said was: “OK”

What I actually said was some comment about him being a paedophile.

Lead balloon anyone?

Old Max??

Don’t worry, this doesn’t bother me, but I just have to accept that as sure as the leaves turn brown in the autumn, there are signs I am getting older! (Well we all are, let’s face it, from the day you are born you are moving closer to death all the time!!)

The first thing I noticed that told me I was getting on was when those medical students knocked on my office door the other week, as stated previous, I thought it was a pair of  12 year olds doing some late trick or treating dressed as doctors!  One was an attractive young “girl”, I felt like taking her home, not cause she was young and sexy, but because she looked too young to be hanging around without adult supervision…

“Does your mother know you’re at medical school?”

Then I find myself on a rare coffee break with the reception staff.  The girls that I feel I fit in with because they are young and fab, (like I falsely think I am) are listening to a conversation the “older” staff are having. I join in the conversation and my young friends both say together something wholly depressing like “What’s an LP?” and we weren’t talking draining CSF, but Long Play records… you know a 12 inch?

Yes it’s true my young friends have never seen a 12 inch…I’d offer to show them mine, but fear a slap.  Still they probably don’t know what an “inch” is anyway!

Then I call a patient into my room and see they were born in 1990. I should be thinking, hmmm, contraceptive advice etc, but no, I’m thinking: “Where are my “I’ve been good for the Nurse stickers”?”  There they stand, not cute kids, not even teenagers, but proper grown ups with their own kids!  Had I started my reproductive life earlier, I could be a grandad now without either me or my children having underage sex.

Then the life changing realisation hit me… the next bunch of nursing students to leave school and start Uni where not even born when I started training.  The babies I saw being born on my midwifery placement, could soon be nurses!! (Thanks to Kim for the picture!)

The sad thing is in the current climate the older I get the further my pension gets!  I’ll be 70, stooped at my desk, incontinence pads on my chair, needing a 12-year-old medical student to listen to patients chest cos I’m so deaf… I’ll be using a dermoscope just to see chicken pox, and unable to test patients for dementia because I can’t remember the questions I just asked… What an image!?

I think I’ll go quiet again for a while!

There are better ways to off load…but not many…

So I get to work, and rather than a friendly…”Welcome back, did you have a nice week off”  I get “Don’t turn your computer on, we’re havin’ trouble!”

So 1 weeks worth of emails, scanned post, blood results etc. I can’t check.

Oh well I crack on with the “actual” post rather than virtual post!  A letter from the prescribing authority stating I have prescribed two control drugs that I shouldn’t be prescribing. I know I haven’t but I am going have to look at why they think I have and they can’t give me the patient details, but just the month it was prescribed. Another unnecessary time consuming exercise, but I can’t sort it yet because…. the computers are down.

Then the patients start coming, an influx of complicated patients whose note I can’t access…sweet joy! Once again I find myself wishing for a UTI (not personally of course!) But no, I get patients that have been discharged from hospital awaiting heart surgery, patients wanting to know the results of investigations I have never heard of, patients who want some more of the tablet they had this time last year but have no idea what it was.

Eventually the computers come back on-line, by which time I am running more than ever-so slightly late!

There’s a knock at my door mid consultation and I find two school children dressed as doctors… a weeny bit late for trick or treat… Oh hang on! One has a stethescope around his cute little neck… Medical students!  I would have known they were coming, if  I’d read my emails…which I couldn’t as the computers were down when I got in!

“Oh do come in!!”

So now I have to try and catch up, look competent and entertain the children students.  I get to the end of the morning clinic feeling completely ragged. 

Do I need another holiday? Hell no! I’d have to come back again!

Still, I have kind of caught up with myself today, so much so that I could have a quick blog.

I feel better already.

Highlight from the week so far:  I called on one of the GP’s for a second opinion of a prostate.  He stood there, finger firmly up the patients arse and said quite proudly with confidence and in a reassuring tone:  

“Oh yes! That feels wonderful!”

I’m sure the patient was reassured, but I doubt he thought the experience “felt wonderful!!

The more intelligent of my readers…

…are probably well aware that rich dark chocolate can improve blood pressure and has other cardiovascular advantages.  Now however research has found that chocolate also decrease the risk of heart failure.  Personally it seems highly likely to me, if I don’t get chocolate I get total body failure and a broken heart…surely it’s the same thing. Those poor researchers spending time finding out something that we all already knew made us feel better. 

Closer inspection is obviously going to reveal that we should only eat small amounts…oh hang on it says…”moderate habitual chocolate intake”.  Ooooh, “moderate”.  Cool, that’s nicely subjective.  One lorry load is moderately less than two lorry loads…

For those of you who are perhaps a little unfamiliar with the term “Heart failure”. It’s one of the diagnosis that sounds a little more acutely severe than it actually is. “Failure!”  Oh my god, If  you get brake failure then they completely stop working and you end up dead….(although confusingly if your brakes fail you keep going!) So heart failure sounds pretty much like death. Fear not if you don’t like chocolate*. It’s not quite that drastic (it’s not great but not immediate death either).

The symptoms are of heart failure are: Shortness of breath on exertion, swollen ankles, lethargy, nausea and often weight gain… interestingly this is the same symptoms you get if you eat too much chocolate.  Perhaps the research just identified that if people eat lots of chocolate it’s difficult to spot heart failure from chocolate over dose.

Oh well. I’ll take the risks… back in that next lorry load for me.

*if you don’t like chocolate please seek psychiatric help immediately there is clearly something wrong with you!