Medical Humour

The following alternative medical definitions of some common words come courtesy of The Washington Post:

Flabbergasted : appalled over how much weight you have gained.

Abdicate : to give up all hope of ever having a flat stomach.

Esplanade : to attempt an explanation while drunk.

Willy-nilly : impotent.

Coffee : the person upon whom one coughs.

Negligent : describes a condition in which you absent-mindedly answer the door in your nightgown.

Lymph : to walk with a lisp.

Gargoyle : olive-flavoured mouthwash.

Flatulence : emergency vehicle that picks you up after you are run over by a steamroller.

Balderdash : a rapidly receding hairline.

Testicle : a humorous question on an exam.

Rectitude : the formal, dignified bearing adopted by proctologists.

Circumvent : an opening in the front of boxer shorts worn by Jewish men.

Pokemon : a Rastafarian proctologist.

Joking apart… having put up a blog post yesterday (it’s been a while), I’ve been encouraged to update my personal journey as a patient.

I shall endeavour to put up a post by the end of the week… even if I have to stand up to type it. Watch this space!

Risky Medical Procedures

A friend of mine is going into hospital tomorrow to undergo a risky medical procedure.

She spoke to her surgeon earlier today to explain that she’s feeling a little nervous, but the surgeon was able to reassure her…

“There’s only a 1 in 100 chance of anything going seriously wrong”, he said.

“Besides, I’ve done 99 of these operations before and they’ve all been successful”

Together We Stand

One year ago, on Saturday April 5th 2008, while playing rugby with his club Hammersmith and Fulham RFC in London, Stuart Mangan (25) suffered a sudden but devastating spinal injury. Sadly this sporting accident has left Stuart totally paralysed from the neck down. The horrendous injury he sustained has left an indelible mark on his life and on the lives of his family and many friends. Stuart’s care will cost millions over his lifetime and quite simply, his future is in all our hands.

Dr Fred Middleton, a leading consultant in spinal cord injury describes Stuart’s injuries “The level of Stuart’s injury at the top of the spinal cord eliminated all voluntary movement in the limbs and trunk including the muscles of breathing. This is the worst cord injury which can occur in sport”.

Photos of Stuart and his family and friends can be found here.

A fund-raising campaign – the Stuart Mangan Appeal – has been launched and each contribution, no matter the size, will help enormously in ensuring Stuart enjoys the best possible quality of life. In this context, an Irish trust fund has been established with the responsibility of managing Stuart’s needs in terms of housing, living, equipment and medical care. Find out how you can donate here.

Munster rugby legends and musicians alike have rallied together to create a one-off CD, ‘Together We Stand‘ to raise funds for the appeal. On sale from Friday 3rd April 2009 at all music stores, Munster Rugby Stores, Centra, and Supervalu.

Or you can buy the CD online by clicking here.

A programme of events is currently being drawn up and if you would like to help or support the appeal in any way, the Stuart Mangan Appeal would be delighted to hear from you.

Please show your support. THANK YOU!

Source: http://www.stuart mangan.org

Fighting For Life

People with cystic fibrosis are fighting a war against political negligence. After years of empty and broken promises, the Cystic Fibrosis Association of Ireland has had enough. It’s mounting a campaign, Irish War Crimes, to reverse the decision to delay the building of a new cystic fibrosis unit in Dublin. A campaign truck will travel the State over the next week and politicians will be canvassed locally and nationally to increase pressure on the Government to find funding for the unit.

At any given time there are up to 30 CF patients in St Vincent’s hospital queueing for the eight single en suite rooms.  Many CF patients are refusing to go into hospital to have lung infections treated because of the risk of cross infection. The new facility, which would have had about 30 single rooms for CF patients, had been promised for 2010 but last week it emerged that funding would not be available until 2011 at the earliest.

Seán O’Kennedy, Cystic Fibrosis Association chairman, said he made no apologies for the hard-hitting campaign. “People living with CF are fighting an ongoing war against CF but unfortunately they are also fighting a war against an Irish medical system that is totally insufficient for their needs.”

Seán added “The support from everyone, politicians on all sides of the Government, medical professionals, the general public and the media has been astounding and all are on board to wage a war against this injustice and human rights issue”.

People with CF deserve a chance at life.  They deserve proper healthcare.  They deserve to be free from the fear of cross-infection, the fear of watching their friends die. These are basic human rights.  The ultimate price of inefficiency, bureaucracy, politics, mismanagement and apathy is human lives. Twenty- five people with CF died in Ireland last year. As Orla Tinsley, leading campaigner asks, “Are human lives the new currency?”.

Source:  Irish Times online and The Cystic Association of Ireland.

The HSE recently published a HealthStat programme which aims to provide a snapshot of health services by measuring performance. In terms of CF care in Ireland, it deserves a great big fat red rating!

Red = Unsatisfactory, requiring urgent attention.

Time For Action

Here’s a follow-up to my recent post  ‘Did Not Attend‘ and the comments it generated. A new study has found there is a high rate of non-attendance by patients at hospital appointments and these ‘no-shows’ are placing a significant drain on time and resources. Now, there’s a surprise!

PATIENTS WHO do not attend their hospital appointments are a serious drain on time and resources, according to studies conducted by the medical profession.

Figures produced for two of Dublin’s biggest hospitals show that almost 25,000 did not attend appointments at St James’s Hospital last year and and the figure for St Vincent’s Hospital was almost 27,000.

A report in Britain estimates that those who do not attend (known as DNAs), cost the NHS almost €1 billion a year. No equivalent figures are available here, but the most comprehensive study carried out in the Republic to date, by Beaumont Hospital’s dermatology department, has indicated the extent of the problem.

More than one-third (36.5 per cent) of all patients did not attend their appointments in January and February last year, according to research carried out by consultant dermatologist Dr Gillian Murphy and by student doctors Hafsah Sazli and Sheena Gendeh.

An examination of other departments in the hospital indicate that the DNA rate at the dermatology department was not exceptionally high. “My students looked to see if it was disease specific and it wasn’t,” said Dr Murphy.

According to the research, 26 per cent gave not receiving their appointments as the most common reason why they did not attend. A further 22 per cent forgot their appointments, 17 per cent gave medical reasons such as a cold or diarrhoea and 12 per cent claimed they had cancelled but their names had not been taken off the list.

Other factors were wrong addresses, patient cancellations, a mistaken appointment date and work commitments. Emergencies such as a family bereavement, a broken down car or a cancelled babysitter accounted for only about 3 per cent of DNAs.

Appointments are more frequently broken by the elderly, mostly above 80 years of age, and patients with a record of previously broken appointments are more inclined to be serial absentees.

Dr Murphy said DNAs were not only a waste of hospital time, but also increased the burden on GPs whose workload was automatically doubled if they had to re-refer a patient for a hospital appointment.

Beaumont Hospital estimates that there are an average of 13-16 DNAs at the dermatology department alone on every day the clinic opens. It takes one-two hours a day to deal with the non- attendee administration.

“For all the additional work that is done in processing that information about those people, you could actually employ another secretary,” Dr Murphy said.

Luckily, modern technology offers two obvious and very cost-efficient solutions. Text messaging has been used with some success in the UK and e-mail could also be used as a back up.

Trials of a system called Managed Appointment Reminder Service (MARS) sends out a text message reminder to all patients’ nominated mobile phone at an agreed date ahead of the appointment. It has proved to be extremely successful in bringing down rates of DNAs.

Not only is it beneficial to the patient, but it also cuts down enormously on administration costs if a reply service can be updated automatically. Getting through to the relevant department can be a major problem for patients wishing to cancel.

The fundamental problem with text message, however, is that elderly people, who are more likely to miss appointments, tend not to use it.

However, Beaumont is examining if it would be possible for an elderly person to give the mobile phone number of a relative who then calls to remind that person of their appointment. Not only does it ensure that more appointments are kept, it facilitates cancellation of appointments by people who cannot keep their appointment. This in turn allows those appointments to be reallocated to others awaiting appointments.

Dr Murphy said more research needed to be done to ascertain why less than half of all patients receive their appointments in the first place, a figure which the hospital has found to be very puzzling.

However, she also said that patients must take responsibility for their own treatment and especially the nearly third of all patients who forget about their appointments or claim that they have cancelled but there is no record of such a cancellation.

“If people were more careful about their appointments, took them more seriously and were given a timely reminder closer to the date, the situation would improve.”

Source: The Irish Times Healthplus

It seems that The Biopsy Report and it’s merry band of commenters are a way ahead of the posse. We didn’t need the results of any study to know how to tackle the serious drain on hospital resources. Our health service is awash with reports that have never been acted upon. We don’t need any more reports, we need action!

Stroke Awareness

Would you know how to recognise the signs of a stroke? The sooner somebody who has had a stroke gets the right medical attention, the better their chances of a good recovery. So minutes really do matter. Act F.A.S.T. is a new government awareness campaign (in the UK) which aims to educate healthcare professionals and the public on the signs of stroke and act to save lives and reduce the damage caused.

A stroke is a brain attack. It happens when the blood supply to the brain is disrupted. Most strokes occur when a blood clot blocks the flow of blood to the brain. Some strokes are caused by bleeding in or around the brain from a burst blood vessel.

If you suspect someone has had a stroke, act F.A.S.T. The FAST test is essentially very easy to use. It stands for the FACE, ARM, SPEECH, TIME test.

Facial weakness – Has their face drooped on one side? Can they smile?
Arm weakness – Can they raise both arms and keep them there?
Speech problems – Is their speech slurred?
Time to call 999 for an ambulance if you see any one of these signs.

In 90% of cases, people who have had a stroke display one or more of the FAST test signs. Any ONE of these symptoms could indicate a stroke.

Knowing the symptoms of stroke is a positive step you can take to avoid the severe damage or death that can result from this condition. Prompt diagnosis and treatment within 3 hours can save lives and prevent disabilities. The FAST test can make a real difference.

See video: Recognise a stroke: The FAST test

Source:  The Stroke Association

Rapid MRSA Identification

Ireland is one of only three countries in Europe where antibiotic prescribing outside of hospitals, is on the rise. Antibiotics are frequently taken for viral colds and flu, when in fact they are only effective against bacterial infections. The more frequently antibiotics are used, the more resistant forms of bacteria become to them. The HSE recently launched a national education programme to change prescribing patterns in a bid to curb the use of antibiotics. The level of superbugs like MRSA and C. difficile in our hospitals would fall if antibiotic use was reduced. However, there’s another side to the superbug problem in our hospitals which I believe, has been overlooked.

When I developed serious symptoms of infection some years ago, it took three days for a nasal swab report to come through from the laboratory. In the meantime, I was treated in a ward shared with four other patients, two of whom were recovering from surgery. When my positive MRSA status emerged, I was quickly moved out of the ward and into isolation. You have to wonder at how many patients were cross-infected as a result of this delay in diagnosis. Multiply this by the huge number of MRSA cases passing through our hospitals each year and you get some idea of the scale of cross-infection.

The sad fact is that there is a Rapid MRSA test available which gives same-day results but it appears that the HSE restriction on budgets has ruled out it’s use in Irish hospitals. This decision is short-sighted as rapid MRSA identification can help hospitals make cost savings.

“The 3M BacLite Rapid MRSA test allows fast, affordable screening of patients for MRSA. It also has the potential to improve patient outcomes and decrease treatment costs. Rapidly identifying MRSA colonised patients provides hospitals with another tool to assist in pro-actively managing health care associated infections (HCAI).”

If I’d been rapidly screened, the result would have been available in hours, not days thereby enabling infection control teams to act quickly. My MRSA infection was hospital acquired (HCAI) following surgery and resulted in six weeks of expensive in-patient treatment. The infection recurred a year later and since then I have frequently been screened for MRSA as an out-patient. I always have to wait 2-3 days for a result and as far as I know, a similar delay still applies for in-patient screening.  I’d be very interested to hear if anyone knows different?

Everyone has a role to play in stopping hospital infection, patients and their families included.  However, if the HSE seriously wants to reduce MRSA figures and make reductions in their budgets, then it should address the problem of delayed identification. The rapid MRSA test would ultimately lead to huge cost savings for hospitals and more importantly, save lives.

Research Progress

A breakthrough in reversing the symptoms of multiple sclerosis (MS) has been reported in the medical journal, Lancet Neurology. To date, all treatments for MS have been designed around slowing down the rate of neurological decline. This is the first treatment to address reversing neurological dysfunction. It’s an exciting new development but it’s still early days and there is no proof yet that it can cure a person with MS.

Multiple Sclerosis (MS) is an autoimmune disease, whereby the body destroys its own myelin (protective coating surrounding the nerves in the central nervous system). Because the myelin is damaged, messages moving along the nerve are transmitted more slowly or not at all.  It affects 2.5 million people globally and can cause mild illness in some people and permanent disability in others. Symptoms may include numbness or weakness in the limbs, loss of vision and an unsteady gait.

At this time, it is not known what causes MS. There are two main classifications of the disease: progressive and relapsing remitting. Within the first classification there are two more differentiations, primary progressive and secondary progressive. Primary Progressive MS (PPMS) is characterized by a slow and continuous deterioration from the beginning, while Secondary Progressive MS (SPMS) becomes progressive following a course of attacks and recoveries. Within the second classification there are also two differentiations, benign and relapsing remitting. People with benign MS suffer the least amount of disability and seem to recover fully from their attacks, while people with relapsing remitting MS (RRMS) do not recover as well from attacks but do enjoy remissions.

Researchers in the US have succeeded in reversing the symptoms in early stage MS patients by using bone marrow stem cell transplants to ‘reboot’ the immune system. In this uncontrolled trial, a new low intensity conditioning regimen was used and unlike some of the previous studies of this procedure, this one involved 21 people with relapsing-remitting MS, rather than people with later stage, progressive disease.  It involved people who had signs of very active immune attacks who had not been helped by standard therapies such as interferon beta. The average age of participants was 33 years and the median duration of their disease was five years, with moderate disability scores ranging from 2.0 to 5.5 points. In this trial, they found that the procedure was relatively safe, and after an average of 37 months, none had progressed and a significant portion experienced a reversal of at least 1 point on their disability (EDSS) scores, and 76% remained free from relapses. Many had improvements in walking, vision, incontinence and limb strength.

As pointed out by the investigators, it will take larger-scale, controlled trials to determine whether this expensive, potentially risky procedure is superior to other approved treatment options. This new research is still only in the early phases of development but at least, it’s a step in the right direction. Fingers crossed Damien!

Source: National Multiple Sclerosis Society and The Irish Times online.

Over My Dead Body

My daughter and I each took a deep breath yesterday evening and ventured into BODIES, the controversial exhibition which is currently showcasing in Dublin. Real human bodies are on display, all of which have been dissected to feature every organ in the body. The specimens have been preserved permanently by a process called ‘polymer preservation’ so that they will not decay. This exhibition is highly educational but it’s also raises something of an ethical dilemma.

The origins of the bodies used in this exhibition continue to create controversy, prompting an allegation, denied by the exhibitors, that some of the bodies are those of executed Chinese prisoners.The exhibitors claim that all the people whose bodies are being exhibited, died of natural causes. The ethical dilemma raised here is the fact that the exhibitors are profiting from displaying the remains of individuals who have not consented to their remains being used in this manner.

A sign on entry to the exhibition states that “the specimens  have been treated with the dignity and respect they so richly deserve.” I’ve no problem admitting that I found the exhibition far more interesting than disturbing. Having once studied anatomy and physiology using bodies donated for research, I loved having another opportunity to look inside the body and marvel at it’s sophistication. Our bodies are amazing things really when you consider how they function without us even thinking about it. My daughter has just completed a college semester in the dissecting room and she felt the exhibits helped her to put her recent learning into context. One curtained off part of the exhibition contains foetal and embryonic specimens but visitors are given the option to skip this section due to the sensitive nature of it’s display. A sign outside states that “all specimens perished in utero from complications during pregnancy.” While sad to look at, my daughter and I marvelled at  the various stages of development in utero and we were able to relate what we saw to my own experiences of pregnancy loss. This is not for everyone but it does form a useful learning experience and if nothing else, it makes you stop and think about how precious life is.

We left the exhibition feeling that we’d witnessed something very special. Some might argue that this exhibition teaches that there is nothing wrong with exploiting the dead in order to make a profit, as long as it is in the name of science or education or art. I believe that it offers a unique insight into the wonders of the human body and allows access to sights and knowledge normally reserved only for medical professionals. By understanding how the body works, you are in a better position care for your own body and keep it healthy. Having said all that, I’m happy to keep my body to myself.

Another article on the exhibition can be found here in the Irish Times.

Matters of the Heart

If you’re into real-life medical documentaries, then Superdocs is for you. This new 3-part series features some of Northern Ireland’s leading surgeons and the dramatic stories of the patients in their care. The series follows the patients and their loved ones as they prepare themselves for their surgery, learning of their hopes and fears before their operations; witnessing the drama in the operating theatre; and meeting up with them after their operations to see how their lives have changed.

Earlier tonight, I watched the first programme in the series and was on the edge of my seat throughout. The focus was on cardiac surgery – Matters of the Heart – where viewers got an insight into the intricacies of a triple coronary artery bypass operation and also two further aortic valve replacement operations. It made for compelling viewing.

Next week’s programme – The Brain Doctors – will feature neurosurgery while the final programme – Quality of Life – follows the work of a plastic surgeon and a breast surgeon. Don’t miss it!

SUPERDOCS  Mondays  9pm  BBC 1  NI