That was unexpected

DZ, like many men his age is affected by benign prostatic hypertrophy, an inconvenience rather than an affliction. He held off for some time reporting this to his GP, knowing what would happen, but eventually bit the bullet and had it confirmed. We then discussed therapy. Treatment of this condition has come a long way since DZ qualified and most patients receive symptomatic relief with drug treatment, surgery being reserved for the worst cases.

DZ may have mentioned that his GP is usually subject to my own strong views on what therapy I should receive, to which he seems to respond with weary resignation. I was quite clear that I wasn't prepared to take the testosterone antagonist, Finasteride, with it's potential for causing decreased libido and impotence. The possibility of growing tits did not appeal either. The thought that some people will endure these side effects when taking the drug to treat male pattern baldness seems to me illogical. Why make yourself more attractive if you lose interest and can't get it up? 

To Quote Chuck Jones;

"A true fanatic is one who redoubles his efforts when he has lost sight of the original objective"

So my GP wrote me up for the second line drug, Tamsulosin. I didn't get on with that at all. Not only did it not seem to improve symptoms at all, it also gave a rather unpleasant side effect. I won't specify exactly what it was  but it was reminiscent of the limerick about the young man of Gwent, who found that instead of coming, he went!

Back in 2016 DZ published a post extolling the virtues of the Phosphodiasterase Inhibitor, Tadalafil. One such was that it is licensed for the treatment of benign prostatic hypertrophy as a third line treatment, and DZ has now been on this for some time. And over that time it appears to have caused a totally unexpected and unreported side effect.

Prior to starting the drug DZ had total male pattern baldness. Head as smooth as a billiard ball. It wasn't something that he was concerned about, as advised here. About a year after starting Tadalafil there was distinct fuzz starting to appear on the billiard ball which has continued to develop to this day.

Not quite as marked as this, but most definitely an improvement. I know that a series of one patient hardly qualifies as significant research, but then I'm not an academic.

Coronavirus

 I suppose sooner or later I would have to comment on the pandemic. It seems only yesterday that our lives became dominated totally by this awful disease, and yet it seems an age since we enjoyed the simple basic pleasures of life, involving free interaction with other human beings. To a species as gregarious as humans this is surely distressing, though not as much as losing a loved one.

DZ has come back to work, very much full time and has not had a week off since April. Until now. One of his offspring who works in areas with considerable contact with others, has brought the disease home. So DZ is in isolation and forced time off. I've noticed two things. Firstly, how much I have enjoyed being back at work. The social contact, the sense of professional satisfaction, and purpose have resulted in my realising how much I now miss being back in the saddle, albeit temporarily. Secondly. DZ is no spring chicken, and has one or two health conditions which, while being by no means disabling or serious, nonetheless put him in a much more serious position in the event of him coming down with the virus. And yet, in spite of having been in direct contact with someone infected I don't feel particularly anxious or afraid. I seem to still have that attitude, common in the young, that I am immortal. I seem to have got away with it this time, it's been nearly two weeks since contact.

And now finally there is light at the end of the tunnel. The work of the scientists who have developed vaccines in such an extraordinarily short time is astounding. Within just a few weeks DZ is hoping to have been vaccinated, and then breath a sigh of relief. Maybe even in time for Christmas. 

My isolation has drawn ne back to the blog after quite a while away, and I think I will be back to being very busy in the new year for some time to come. For now I'm taking advantage of the down time, and I'll raise a glass to this man, for the millions of lives he has saved during his lifetime, since his death and even still now and into the future.

Edward Jenner 1749 - 1823

Private practice

Very early in DZ’ career he watched a debate on regional TV about the place of private practice in UK healthcare. On the one side was an eminent and respected local surgeon who I shall call “T” practicing in a speciality noted for very considerable potential for lucrative private work. He vehemently and passionately argued that private practice was an abomination, promoting inequality and conflict of interest and wanted to have it outlawed. On the other side was a surgeon “A” with considerable private practice arguing the opposite. He was known to be wealthy and it was clear a lot of his wealth had been spent on pies. To the young, idealistic doctor I was at the time I quickly formed the view that T’s arguments were well supported, cogent and came from a man of enormous principal and integrity. A’s arguments came across as spurious, contrived and flawed and A himself, a greedy fat bastard. It left a suspicion and discomfort with private practice that has stayed with me all my working life, even though at times I have practiced in this area.

After over 40 years I have become, if anything, even more cynical about the area. I have seen doctors make dubious clinical decisions clearly where there was a conflict of interest, promoting treatments to private patients that they would not recommend in the NHS, purely for financial gain. I have seen entire departments bitterly divided by the issue of private practice, which worked it’s way into almost every other issue. I’ve seen backstabbing, abuse, harassment, denigration all arising out of the area of private work. I’ve seen doctors deliberately cultivate long waiting lists in order to encourage patients to take the private route, and when Trusts have opted to increase capacity I’ve seen syndicates of doctors press hard to ensure that this work is accommodated at the local private hospital, where they can insist on full private rates to treat NHS patients. Waiting lists became regarded as gold mines.

At worst the system has spawned doctors like Ian Paterson, but for every doctor like him who gets caught and disgraced there are hundreds who practice a lesser degree of the same principles.

I’ve seen good conscientious dedicated doctors have their careers destroyed by vicious but baseless attacks by others whose ulterior motivation arose from a perception that their private income was threatened.

I’ve seen doctors whose competence was highly questionable carry on working because they had the support of colleagues based on financial interdependence.

The happiest, least dysfunctional,  most dedicated, professional hospitals I have worked in were those where private practice was non existant.

So, after over 40 years of experience and reflection, I agree with T. Private practice is an abomination and should be outlawed.

?????????

DZ recently came across this in a hospital changing room. It raises a question to which he would rather not know the answer.

Pandemics

DZ has not written anything here for some time, in no small part because he is now back working full time in the NHS. The worst of what may only be the first wave of the Covid 19 pandemic is, in the UK at least, on the decline. Elsewhere in the world the picture is variable, the most badly afflicted places being those with poor infrastructure or appalling government administrations.

DZ has been doing a lot of reading and has learned a great deal about virology, immunology, public health and epidemiology, and going down the rabbit hole has found some fascinating and informative sites. I'm old enough to still be awed by what the internet can provide

DZ distinctly remembers when he was a child, being vaccinated against smallpox, a disease with a 30% mortality. . In 1962 there was a small epidemic of the disease in Bradford and it caused utter panic in the UK. I remember standing with my Mother in a queue maybe a quarter of a mile long going into the clinic where they were engaged in mass vaccination. The fear was palpable even to me at that age. Not an antivaxer in sight.

In my reading I came across this fascinating account of the response to the outbreak written by one who took part. What struck me in reading it was the sheer speed and efficiency with which the public health authorities responded. The outbreak was nipped in the bud very quickly. When it was over there had been only 12 cases, of whom 6 died. A truly stunning result from consummate and astute professionals. I will not compare this to the response to the current pandemic, other than to say it appears to me that we have been guilty of enormous complacency.

Smallpox was still a blight on humanity when I went to medical school. I remember when I did my paediatrics being taught by a paediatrician in a district general hospital, who spent some time on talking about the disease. He emphasised that, early in the disease it could be difficult to distinguish Smallpox from Chicken pox. I still remember his simple teaching on how to distinguish by a single sign. "Look in the armpit" he said. He told us, in chicken pox there is always at least one spot in the armpit. If there was no spot there it may well be smallpox.

Of course, in 1980 Smallpox was eradicated. An unimaginable success by the WHO, the pinnacle of many years of sustained work and dedication.

Or was it?

It has long been known that the USA and Russia have kept smallpox virus in highly secure laboratories. But any secure system is only as safe as the weakest link. In 2019 there was a fire at the Russian facility where the virus is kept. The virus did not escape, or so we are informed. The reason given by both nations for retaining the viable virus is "research" Definitely not for possible weaponisation by the leaders of the two countries then. Let's face it Putin, currently trying to engineer the system so he stays in power for life., is ex KGB. He's ruthless, ambitious and deranged. And as for Trump. He has now withdrawn from 3 nuclear treaties, destabilising the world. Recently Noel Casler, someone who has worked with Trump on "the apprentice" has defied a non disclosure agreement to release some very unsavoury information about the president. Click on the link to access the site and pick Noel Casler- Captain Valtrex, on the menu.
Once you get past the bit about Trump being so drug damaged that he wears a diaper to cope with his double incontinence, (yes really!), Casler points out that Trump simply likes to break things. The thought that he has access to nuclear weapons is small beer compared to the fact that he has access to Smallpox Virus.

If that wasn't enough as early as 2002 there was evidence that Smallpox virus is secretly retained by France, Iraq, and North Korea. Who knows who has it today?

In 1980 we had an opportunity to rid the planet of Smallpox totally. It should all have been destroyed. It wasn't, and the opportunity was lost.

DZ believes that it is only a matter of time before, by accident or design, this disease will be unleashed again on humanity. If the current situation is anything to go by we will not be prepared, and the ensuing carnage will make the covid 19 pandemic look like a sniffle.

Grifter

I see that, in the midst of the pandemic, with public gatherings now banned for some time, this mendacious wanking charlatan is still taking money for evening shows which are highly unlikely to go ahead. I don't claim to be a medium, but I'm prepared to make a prediction. I predict, if you give money to this fraud, my first prediction is that the show will not go ahead. My second prediction is that you won't get your money back.

Covid consequences

Long queues and empty shelves at the supermarkets are a bizarre phenomenon. The selfishness and greed displayed are disappointing to say the least. But at least there's no threat inherent in swiping all the bog roll. Things in the states are somewhat more disturbing.

Return

In my post of 10 days ago DZ expressed uncertainty over whether he would return to work to help with the Covid 19 crisis. He's had a little time to think about it, and was finally swayed when he remembered this.

I will go back, because I would be too ashamed not to.

Says it all

Covid 19. Statistics

Josef Stalin once said, "A single death is a tragedy. A million deaths is a statistic".
With this in mind lets look at a few statistics relevant to Covid 19, assuming a 70% infection rate, and a mortality of 3.4% (the latest WHO estimate) of those infected.

The world population is currently 7.7 billion. If Covid can not be contained, which is looking a very likely scenario, we can expect a total global death toll of 183million

The UK government is making plans for a worst case scenario of 315,000 deaths. Using the assumptions above a more realistic figure for the UK is 1.59 million.

The Grand Princess cruise liner has 3,500 people on board, of whom 2 have already died. Statistically we might expect 100 deaths total. However, there is likely to be a much higher infection rate due to the enforced close proximity of those on board this floating prison. They are likely to be older people, and they have no medical care. 100 is likely to be a forlorn hope.

The USA, with a population of 329.5 million  should expect to lose nearly 8 million of it's citizens. The denial coming from their dear leader is staggering. He has stated that the disease has been stopped, due to his actions, and facts can not be allowed to contradict him. Just like sharpiegate. The response of the US administration is to produce statistics supporting Trump the lunatic. Simply do not  test for the condition. To date fewer than 500 US citizens have been tested. If you don't test, you don't pick up cases and the official current figures confirming 332 cases are a joke. In addition 27 million americans have no health insurance, and many can not afford the test, being billed at over $300. When Mike Pence was questioned on this at a press conference, 4 times, he simply walked away.  17 deaths have been confirmed, a much higher percentage than expected, precisely because the US are suppressing infection rates to assuage the ego of the liar who will not allow people who know what they are talking about to contradict him. Perhaps he'll just tell the angel of death he's fired, his standard approach to those who won't fall into line. Good luck with that.

Opportunity

I see that the health secretary is considering asking retired doctors to volunteer to come out of retirement to look after patients with Covid 19. Hmmm.. Lets ignore for a moment that these people are the most likely to die if they become infected. Lets ignore that they are really going to be very unenthusiastic about returning to work at all.. What is interesting is that it is suggested that they will arrange "emergency registration" to allow them to practice. He seems to realise that if these people will have to appraise and revalidate prior to working they are likely to tell him to fuck off.
So, if it's OK for these doctors to work without revalidating, why do the rest of us still have to do it?

DZ still has a licence to practice, so might actually consider it. Not out of any sense of altruism or dedication. He just wonders how much they're prepared to pay. Not nearly enough I suspect.

Revalidation fails again

Regular readers here will be well aware with the contempt felt by DZ (in common with most doctors) for the process of appraisal and revalidation, and for the General Medical Council in their continued blind delusion that this process has some value in protecting the general public from underperforming or rogue practitioners.
There can be no better illustration of the futility of revalidation than the case of this man.

Mr Ian Paterson is exactly the sort of doctor that the GMC would have us believe that revalidation would pick up, and at an early stage. And yet for 13 years he was able to sail through appraisal every year, and perhaps 3 revalidation cycles. Could anything more illustrate the utter worthlessness of the process, and incompetence of the GMC. Every 5 years he was able to find the requisite number of colleagues to write a decent feedback despite his failings. Apart from anything else what the fuck were his anaesthetists doing about the butchery that was being performed on their patients. Far be it from me to suggest that these same anaesthetists were making a good living from Paterson's putting private patients their way.
To be fair, DZ has also known of colleagues who were cause for concern. But we all know the opprobrium that is heaped on the whistleblower, while the guilty escape.
Again. Appraisal and revalidation, is an experiment that has failed dismally.

DIY and blood.

Those of you of a certain age may remember a comedian called Kenny Everett. One of his comedic characters on his TV show was Reg Prescott,  a spoof TV  DIY handyman who, during the course of his show would invariably cause himself the most appalling injuries.

DZ never met Kenny Everett. But Reg could quite easily be based on DZ. If I embark on a DIY project it's only a matter of time before blood is drawn. Only recently I've sustained injuries with such mundane items as a car door, and a pan of potatoes. My history is such that one of my offspring has commented that I have "more lives than a cat". In addition to numerous cuts, blows, burns & scalds I have, in my life electrocuted myself a good half a dozen times, including once in the mouth. Tip. If using your teeth as a wire stripper take the fucking plug out of the socket!

The only thing that has allowed him to get to this stage of life with nineteen remaining digits is that most power tools today are designed and manufactured with all sorts of safety devices, such that even the most inept and clumsy can usually get away with it.

But lately my facebook account has been filled with adverts for a new generation of power tools, seemingly designed to put the user in A & E. Power assisted pruning shears for example that look horribly easy to take off a finger with. Or garden trimmers, where the reasonably safe nylon cord is replaced by six steel razors rotating at high speed, with no guard. Note the advert states "Can cut through anything!" I bet they can. And note also the nice soft footwear being worn by the users, sometimes with their feet perilously close to the blades.  And why anyone would want one of these is a mystery to me. I can't even imagine why it should be legal.

So as the spring and summer approach I predict that our A & E departments in Britain are going to start seeing an influx of injuries associated with these tools. People using the trimmer in the garden whilst wearing sandals on their feet. Others lopping off branches and getting distracted. 

DZ, hopefully will not be one of the injured. Mrs DZ has made it quite clear that he is forbidden from acquiring one of these items. I think she has a point.

God's will

The world, and the USA is not short of nasty, bigoted, raging apoplectics who label themselves as Christians. But a few of them are so vile that they stand head & shoulders above the rest. One such is this man.

Steven Anderson. To get some idea of just how thoroughly unpleasant this guy is just have a look here. So absolutely undesirable is he considered that he is now banned from entering 31countries, including every country in Europe.

And six months ago he was banned from entering Australia.

His response to this has been to claim that the recent bushfires in Australia are god’s punishment to them for not letting him in. Nothing new here. The evangelicals are not at all averse to claiming that any natural disaster anywhere is a manifestation of god’s displeasure with the people of that nation for some perceived failure to follow the bible.

I wonder what comment, if any, Mr Anderson has on the fact that rain has now started falling, putting out at least some of the fires. 

Sounds like divine intervention to me.