Tuesday, January 31, 2006

Grand Rounds

Grand Rounds are up at Barbados Butterfly, who provides a superlative snapshot of the weeks events in medical and health blogging.

Dr Dork is very pleased to rate a mention so early in his blogging career.

Dr Barbados is a surgical registrar with a penchant for interesting, thoughtful clinical tales, a literary flair, and some excellent advice for medical students and interns.

One of Dr Dorks favourites. Dr Dork highly recommends spending some time perusing her site.

Monday, January 30, 2006

Palliating Ron, Part II

Dr Dork had done everything he could for Rons pain.

Ron was the rock that held his large family together. Yet, they were strong, like him. They were always polite. Always courteous. Always grateful.

Dr Dork could see Rons agony mirrored, deep within his wifes eyes. But they would both laugh and joke. On the surface.

Ron's cancer ceased to cause him much pain. He was on doses of morphine and other painkillers that would drop a horse. But once or twice a day, every day, a giants hand would grip his chest. And squeeze.

Dr Dork spent more time with Ron than any other patient, that week. He discussed it with the consultants. He explained everything to Ron, to his wife, to his children, to his older grandchildren.

It was up to Ron, to decide what to do.

Ron knew his time was short. He was completely lucid, almost all of the time.He had things to say to his family. Kind words. Wise words. He wanted to hang on, and be awake, to say these things. While he could.

To Ron, his pain was nothing in comparison.

Ron spent his last week in the unit, in this manner. Surrounded by his family. He died on a Friday afternoon. Surrounded by his family.

They held up well. They grieved, but in a quiet, dignified manner. They were effusive in their thanks of Dr Dork and the nurses.

Dr Dork went home that night, and cried silent tears.

A week later, Dr Dork recieved a gift basket from Ron's wife. Flowers, chocolates, a card. Dr Dork received cards from patients at times. Sometimes a bottle of red wine at Christmas. He had never received flowers. He placed these in a vase, at the ward entrance, where all could enjoy them. He gave the chocolates to the nurses.

He kept the card. It is one of his most treasured possessions.

Fizzy Drinks Make You Smart

Dr dork is laughing.
Did Coca-Cola-Amatil sponsor this joke of a study ?

The brain runs on glucose. Sugar, in other words.

The brain accounts for 15% of the total metabolism of the body. But 2% of the mass. So if you put lots of sugar in the bloodstream, when you are a bit low on sugar some will show up in the brain. Quite a lot.

We need a certain amount of glucose to live.
Most of us consume far too much.

It doesn't mean it makes you smarter. It will give you diabetes and make you fat, though.

Dr Dork cannot find this research on medline/PubMed.But the sample size is only 25, and he doesn't know if there was even a control group, or if there was caffeine in the drinks as well.

He suspects it is complete bollocks.

Saturday, January 28, 2006

Palliating Ron. Part I

"It's not working, doc"

Dr Dork walked up to the side of the bed. Ron was pale, sweating. He looked all of his 80 years. But he was stoicism personified.

Not a grimace, not the faintest moan escaped his lips. He calmly had answered Dr Dorks query about the new GTN infusion. Who now sat next to the bed to take his BP, negotiating past the nurse recalibrating the fentanyl pump.

Ron had come into the unit the week before. The cancer, arising in his hidden, treacherous prostate, had spread throughout his bones many years before. He had known this was a death sentence for at least a couple of years. It was beyond curative treatment.

Death loitered on the porch, but the knock on the door still seemed distant.

Now his heart had begun quickly to fail. The strain of the cancer had become too great. The cardiologists had done all they could. All that Ron wanted them to do. He needed an operation to fix or replace the heart. But the operations would kill him. He needed the cancer to go away. But it had spread its malignant tendrils far and wide and deep.

All that could be done was to help with his pain.

Normally Rons family was there whenever Dr Dork visited. Today, Dr Dork knew Ron was suffering greatly. So that Ron would not play down his symptoms, Dr Dork had asked them to step out briefly. Ron was dying, but he was more concerned about his wife, his children, than himself.

Ron had been a soldier. A pilot, in the war. He had gone down in enemy territory. He had suffered greatly as a POW. Dr Dork didn't know a lot of the details. Ron didn't like to discuss it, and Dr Dork suspected he had untreated PTSD He suspected this mainly from what the night nurses would sometimes say. Ron had terrible nightmares at times.

Dr Dork had "left the door open" for Ron to talk if he wanted. He didn't think it was likely. Ron had managed his PTSD himself for 50 years. He had worked a farm for decades.

It was coming back a bit, Dr Dork suspected, as Ron suffered anew.

To be continued

The Hidden Epidemic: Mental Health

Dr Dork is angry.

Morbidity - a measure of disease prevalence or incidence
Mortality - a measure of death.
Prevalence - the amount of disease at a given time

The psychiatric illness category with the highest mortality rate, generally thought around 20 %, are the eating disorders. Anorexia nervosa particularly. About 1 in 5 people with this condition will die as a result. Public hospitals have no facilities to treat eating disorders in the state Dr Dork works in. You can only get treatment if you are privately insured.

The highest morbidity is for mood disorders. A 2003 study in NSW found 3.2 % point prevalence. (J Affect Disorder 2003 Jul;75(2):155-62).

That is, at any one given moment, about 1 in 30 people have clinical depression.

The prevalence per year is 1 in 5. The lifetime prevalence is generally given as 20 to 30 %. It's hard to measure. Recall bias. It's possibly even more.

Suffice it to say, this is a very common problem.

But it is politically unattractive. Depression is rarely easy to treat. It often takes a long time.It is a complex, multifactorial illness. It is stigmatised.

Dr Dork likes to refer to antidepressant medications as emotional anaesthetics. They certainly have their role. He prescribes them not infrequently.

But very rarely are they a cure. The other critical modality of treatment is psychotherapy. This can be given by psychiatrists or clinical psychologists. Not by someone with a high school diploma and a 10 week "counselling course". It may involve a few weeks, or many months, even years of treatment.

There is virtually no public funding for clinical psychs. Psychiatrists are overburdened with managing more overtly biological illness such as psychosis and bipolar disorder. Most choose not to do psychotherapeutic treatment. That in itself is a rant for another day. Dr Dork thinks "biological psychiatrists" are kidding themselves.

This is a growing problem. Especially in men, who are unlikely to seek treatment. They get angry, or hide in a bottle.The Aussie bloke is "macho" personified.

Dr Dork doesn't have an easy solution. More funding would obviously help. But health resources are finite, and this is not a politically glamorous area.

Maybe we just need to look under the carpet.

For more info, and to find treatment for yourself or a loved one, go here.

Dr Dork needs a cuppa and a lie down.

Friday, January 27, 2006

Dr Karl Kruszelnicki, AM

Dr Dork is amused.

Dr Karl has been given an AM - A Member of the Order of Australia.

Dr Karl can talk. He could talk underwater.

But good on him. Information and knowledge are wonderful things. We can never have enough.

But even Dr Dork thinks he needs sartorial advice.

Killers in your Supermarket

Dr Dork is perturbed.

It used to be that the only medications available from a supermarket were paracetamol and milder aperients.

Paracetamol is relatively benign. It really only has the one single danger, of overwhelming hepatic metabolism in overdose. That is enough of a danger in itself.

Impulsive and perhaps non-serious attempts at suicide by overdose by those ignorant of the genuine risk can lead to dramatic liver failure unless promptly treated.

I have seen one case of a young girl who took a mere 16 tablets. A normal supermarket packet contains at least 20. Her liver started to fail. She did not want to die. It was never her genuine intent. Thankfully she presented early enough that she made a full recovery with treatment. Without treament she would have been dead within days.

But NSAIDs (non-steroidal anti-inflammatories) such as nurofen, brufen and the like are a more insidious problem. Now I begin to see more and more advertising of traditional NSAIDS, particularly ibuprofen. Marketed direct to the public.

Firstly, there is the risk of gastrointestinal bleeding. Although the work of Profs Marshall and Warren - itself a fascinating tale for another day - shows that H. Pylori is often the cause, NSAIDS and aspirin are probably the commonest precipitant.
These were taken off the OTC (over the counter) market many years ago in Australia (Oz), and there was a resultant fall in kidney failure due to analgesic nephropathy. Which is a fancy name for kidney damage from painkillers. Which had been rising significantly prior to this intervention.

Why on earth were NSAIDS put back on the OTC market ? They are now again being aggressively marketed.

How many ruptured ulcers and ruined kidneys before this decision is again reversed?

We all make mistakes. Stupidity is repeating them. Especially when people will die as a result.

Even docs, in prescribing software applications, are vulnerable. And we're supposed to be able to see through this crap. What of the general public ?

Sunday, January 15, 2006

What is my medical expertise ?

Yes, I am a practising physician.

No, I won't divulge my area of specialty.

How long have I been practising medicine ?

Long enough to know how little I know.

How old is Dr Dork ?

I am in the "middle years". Somewhere between 30 and 60 terrestrial perambulations.

What is this site ?

At present, this is not an active blog.
It may become one, someday, time permitting.

At present it saves me typing in my name when commenting on the blogs of others.

Sloth personified ? Maybe.

Disclaimer: This site is for entertainment purposes, primarily. An attempt to educate is halfheartedly made on occasions. It never serves as a substitute for medical advice.All patient stories are sufficiently fictionalised to ensure no violation of privacy. Patient stories may be amalgams of multiple cases. Or cases related by colleagues. Any resemblance to persons or events, past or present, is entirely coincidental. It is not a substitute for medical advice. Real living patients should see real living doctors.

Dr Dork is, furthermore, a figment of your imagination.

Please see the Creative Commons Licence link on the right sidebar if you wish to share any of Dr Dork with the world. In essence, Dr Dork is happy to be quoted, but please reference him as the source. Thank you.

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