Sunday, 27 November 2016

Quote

"There are more pleasant things to do than beat up people"
               Muhammad Ali.

Not sure I entirely agree with him on this. I can think of many people that I'd derive enormous pleasure from beating up. In similar vein I'm informed on Facebook that today is National "I care about YOU DAY". And I've been invited to send a virtual bouquet to a list of 20 people that I care about. Being the Grumpy old sod he is DZ can't think of a list anywhere that long. DZ is waiting in anticipation for national "I want to shoot you between the eyes day".
 He has a list for that as long as the Greater London Telephone Directory.
There are more pleasant things to do than beat up people. Muhammad Ali
Read more at: https://www.brainyquote.com/quotes/quotes/m/muhammadal136677.html

Friday, 25 November 2016

Wonder drug

Last week I posted on my own experience of statin therapy. It was the second time my GP had arm twisted me into taking statins, and the second time I stopped them because of unpleasant side effects.

At least my GP has not yet brought up the subject of the dreaded polypill. I had thought things had gone quiet on this therapy but a google search shows that it's still out there and still has lots of proponents. Apart from the statin the polypill contains aspirin, and  2, or even 3 antihypertensive drugs. DZ has also been on an antihypertensive for a while. Frequent hypotensive episodes put an end to that. (I don't think DZ is his GP's favorite patient) Some of these episodes occurred whilst driving, and necessitated pulling over to ensure not passing out at the wheel. Bearing in mind the polypill is proposed for all over 55 year old men, regardless of whether they are actually hypertensive or not, how do you feel about sharing the roads with lots of middle aged drivers with their BP in their boots?

And aspirin of course has it's own list of side effects.

Those who would have us all on this therapy claim a number of benefits.

1. Efficacy. Various studies show a reduction in cardiovascular events, but are often dismissive of side effects. Perhaps if we knew the benefit/risk ratio there would be less enthusiasm.
2. It's cheap, since all the components are off patent.
3. Patient compliance is much better, since it's far easier to take one tablet once a day than various preparations at variable frequencies. However this has the downside that many patients will require one drug more than another, and dose adjustment of a single component is just not possible.

DZ has a better idea. There is a drug out there, a single pharmaceutical preparation which has multiple beneficial effects.



1. Cardiovascular benefits especially in congestive cardiac failure and left ventricular hypertrophy. There is also significant reduction in extent of damage in the event of an infarct. CRP is lowered and plaque formation inhibited.
2. This drug drops the blood pressure, not as potently as specific antihypertensives, but  for those who are normotensive this is no bad thing.
3. It's licensed for treatment of symptoms of benign prostatic hypertrophy prevalent in 40% of men over 50, and 75% of men over 75.
4. Early studies indicate possible benefit in type 2 Diabetes
5. It has been used to treat depression.
6. Early studies indicate possible benefits in some cancers, particularly of the throat

So what is this wonder drug? And why aren't doctors insisting it be given to all men over 55? Well cost is a factor, though it comes off patent in Autumn 2017 and should then be available generically, and much cheaper. As for compliance, it has a long half life and only has to be taken once a day. Also, it has one more effect I've not yet mentioned. It's primary licensed indication in fact. An effect which, entirely by itself would guarantee a very high patient compliance.
The drug is Tadalafil (Cialis). It's a phosphodiesterase inhibitor.


Wednesday, 23 November 2016

Goodness me!

Regulars here will know that DZ is not averse to using the odd profanity on this blog. When dealing with arseholes like the GMC it's difficult to adequately express the degree of contempt and disdain they deserve without resorting to swearing.
For many years those who swear have been accused of doing so because they have a limited vocabulary. That they are are incapable of adequately expressing themselves in a more socially acceptable way. This view of course is utter bollocks. This article confirms the opposite. That those who swear are in fact more articulate than those who don't. Fuck yeah!


Sunday, 20 November 2016

Lost

DZ was interested to read recently that a loss of sense of direction is an early indicator of dementia. Just a few years ago DZ went through a period where this was a concern. For some months he would set out in his car to go somewhere, and after a few miles suddenly realise he was on completely the wrong road, going in completely the wrong direction. Very worrying.
Was this the start of galloping brain rot, the inevitable path to incontinent vegetativism? Or someting else. A few months previously I'd been started on a new medication by my GP, against my better judgement. As a little experiment I stopped the drug. Within a week I stopped getting lost.

Fucking statins!



Thursday, 27 October 2016

unintended consequences

While studying a patient's notes today I came across the past medical history as supplied by the GP. Buried in there were two consecutive entries, as follows.

....Excess alcohol usage, many years. Stopped drinking 2007
....Depression 2007


A short, merry life, or a long miserable one?

Monday, 5 September 2016

Puppets.

That there are no depths that Hunt will not sink to in his ongoing dispute with the junior doctors is not something that should surprise anyone. That some of the high ups in our own profession should ally themselves to Hunt should also come as no surprise. So we shouldn't take too much notice of the statements by the Academy of Royal Colleges or the blatant threats of those bullying shits at the GMC too seriously. The name of the game here is to maximise the chance of a gong for various people, by seeing who can get his tongue furthest up Hunt's arse. My money is on Dickson, He's had the most practice.

The BMA has finally stirred itself, they should only contemplate one way forward.