Revitive scam

 Ads are appearing on TV and other places for a machine that supposedly improves peripheral circulation, specifically to the calves, and thereby alleviating a rather vague list of conditions said to be due to "poor circulation". Interestingly the only circulatory condition actually known to cause serious symptoms, peripheral vascular disease, is not mentioned in their promotional material. But they claim that it is highly effective for "tired legs", whatever that means.

So how does this device supposedly work. It's nothing more than an electrical muscle stimulator. The idea is that stimulating the muscles to ryhthmically contract , stimulating the muscle pump, and thereby increasing blood flow through the calf muscles. A similar effect is achieved during surgery using intermittent inflation of pneumatic boots. (Flowtron)

Revitive quote a number of research papers on their web site, but on inspection these papers are not good quality. None of the studies are blinded. Bearing in mind sham treatment is not felt, while actual treatment entails giving electric shocks it's difficult to see how it could be. Also most of the papers refer to it's use in varicose veins, which are asymptomatic in most patients. 

A good summary of the evidential basis for this device can be found here.

The only condition where the pathophysiology is one of reduced circulation is peripheral vascular disease. The use of a revitive device would increase oxygen usage within the calves, without increasing blood flow, and make symptoms considerably worse. For this reason peripheral vascular disease is considered a contraindication to the use of Flowtron in surgery.

And if you don't have peripheral vascular disease increasing blood flow through you calves is going to have bugger all benefit. You could achieve just the same effect by periodically rocking on your feet, or even just flexing and extending your feet without even leaving your bed.

The Revitive device is a complete scam. An ineffective waste of money. There is a way that you can increase the circulation through your calves for free, and also improve your cardiovascular health, and your general well being.

Go for a nice walk. Every day. Preferably with a dog.

Appraisal fails once more

 A little over a year ago DZ wrote about a surgeon who had successfully negotiated yearly appraisals  and periodic revalidation despite causing harm to hundreds of patients over many years. 

Well here is another. The emerging pattern is one of appraisal being no barrier to poor performance.

And yet DZ has seen instances where poor performance has not only been picked up, but also acted on. Not by the GMC, but, surprisingly, by private health insurance companies. On more than one occasion he has encountered practitioners who have been informed by insurance companies that they would no longer be reimbursed by those companies for certain specific procedures. Presumably the insurers audit practitioners and flag up instances where either a higher than expected proportion of patients receive a certain procedure, or there is a disproportionate incidence of complications

In those cases DZ has seen, no restrictions were placed on the doctor by their NHS employer.

So credit where it's due. The private sector has a system of identifying poorly performing doctors that actually works. Without making anyone go through the joke that is appraisal. The NHS & GMC don't. 

Well no shit Sherlock!

Abuse in the name of god

DZ has posted in the past about the physical abuse inflicted on children in the name of religious observance. Female genital mutilation comes top of the list, an utterly barbaric practice that kills an unguessed at number of girls each year, and severely affects the physical and mental health of those who undergo it. Male circumcision is less drastic, but more common, and circumcision without medical indication is highly prevalent even in the USA where there is usually no religious imperative.

But it seems even baptism can be a form of torture and murder, as is illustrated by this case, where the unfortunate victim was immersed until he drowned. What sort of people subject babies to this vile abuse. To add insult to injury there seems no regret or commitment to change from the church hierarchy.

And the mental abuse suffered by millions of children of devout (ie fanatical) devotees of multiple religions in the name of their particular superstitious delusion can not be quantified.

All over the world supposedly civilised liberal societies persist in tolerating these practices in the name of “religious freedom” What a bunch of disgusting cowards we all are. By failing to stand up for the rights and welfare of these children we are as guilty as those who wield the knife.

As Christopher Hitchens said “religion poisons everything”

Demand

 I thought I'd reassure any regulars who follow me that I'm still here. Still working, now some years past retirement age, and desperately longing for the current situation to come to an end.

And yet DZ has precious little to complain about. He works in a covid free environment, in a job he loves, with fabulous staff, and is well paid. His professional commitments and social contact makes him rarely privileged and keeps him on an even keel. He has incentive, and purpose. And little cause for fear. Especially since he has now been vaccinated.

I keep in touch with many friends and colleagues at the very sharp end. People who have now borne the brunt of professional and psychological demand for almost a year. I can not begin to imagine the strain they are under. Many are building up psychological problems that will only surface when they allow themselves to stand down. Their experience, and trauma they will carry with them for the rest of their lives and I have no doubt that many will retire early, utterly burned out and exhausted.

While most of the general population appreciates their conduct, there is a minority in the population who have an incomprehensible, to me, desire to vilify and denigrate these people. A vociferous minority of people who have the deluded belief that the pandemic is a hoax, and those doctors who express their experiences are liars and party to some bizarre conspiracy. Anti maskers, antivaxers and covid denialists who, in their narcissism believe they alone possess knowledge denied the rest of us. 

These are people who believe that the covid vaccine contains a chip that allows Bill Gates to monitor their every move. Fuck me, who do these people think they are that Bill Gates is interested in when they go to Tescos. 

No pic, or video on this post. Too sombre.  I hope you all stay healthy and come through this. There is now light at the end of the tunnel. But even when this is over, it will take years for the NHS to catch up on the backlog of work building up. And it's staff will be depleted and exhausted. 

The late hero of the orthopaedic world, Sir John Charnley worked at Wrightington Hospital right up to his death at the age of 72. The NHS may well be asking others to do the same.

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.