The health and fitness thread about random things

[ian]

Seems to be, but this is now four weeks old (I had a nasty cold after a trip to Switzerland) that seemed to decline but then came back (might have been a second infection, or something weird with the covid booster I had in between) and for the last two weeks I've been struggling and now I've strained and pulled a lot of muscles. Gets worse every evening and sleeping is annoying as my chest/throat vibrates and makes me sound like a demonically possessed purring kitten. If it were the size of an elephant. I worry my wife will euthanize me with the pillow. She did record me last night and declared THIS IS THE NOISE YOU ARE MAKING. It's not a good noise. I may play it down the phone.

It just seems pointless to have a telephone consultation which will then, I am sure, just mean they still have to find me a GP to see face-to-face. They already have all the information, my reciting it down the phone won't add any further value. It's just stalling. It doesn't feel like we have a functional health service.

[Kim]

I'm still exhausted from spending over three hours listening to our GP's hold music (having spent most of the night on bucket duty) in order to secure some emergency prochlorperazine for barakta last winter.

And they're usually pretty good.

[andrewc]

https://www.prospectmagazine.co.uk/politics/how-not-to-save-the-nhs


https://archive.ph/FRCwz  (archived version of above, in case you can't get past the paywall).



Article comparing the British & German systems, saying it would be difficult to change. 

[ian]

It seems a mess at the moment; not so many years ago, I could wander down to the surgery between 8.30 and 10.30 am and wait to see a doctor (which never took more than 30 minutes or so) or book an actual appointment if it wasn't urgent. Then that was deemed 'too popular' (in my limited experience, it was busy but not excessively so, but they would turn people away if there were too many people to see).

Personally, I don't think our obsession with a 'free' NHS is helpful, but everything seems very conservative. We seem unable to approach primary care differently (not to mention the wholesale change to preventative care, but that involves cultural changes). The medical establishment is very orthodox (if you want to pickle their onions, ask a group of senior medics involved in training why a successful nurse can't become a doctor, seriously, they turn puce and start to splutter like a 2CV on a cold morning). Since I was involved in research around this, not much has changed, mostly because the establishment won't change the way (and who) they want to train, or the processes they follow. They'll always agree that being a junior doctor is terrible but immediately pivot to how they 'benefitted' from the character-building (and often patient-killing) experience. There's a weird thing about 'resilience' they mutter on about. None of this is a uniquely British phenomenon, of course.

There doesn't seem to be any real planning for how we maintain any kind of service in the future given the rapidly increasing health burdens and costs; mostly because we have a government only interested in selling bits off to their friends, of course.

[ian]

I'll eat my words and cough-them-back-up, as apparently, I don't need a face-to-face. Suck it up, kiddo, and hack it back out. Call that consumption? Write a book, moon over some poetry, have a wayward and ill-advised affair or three, etc. I'm not sure this is a NICE-approved care pathway.

Pretty much what I expected, if it doesn't get any worse, or doesn't go in a few more weeks, or I die, seek further advice. In the meantime, I shall continue my noctural celebration of the giant demonically possessed kitten purr. Part badly maintained earth-mover, part congested tiger. Le sigh.

[Polar Bear]

A few months ago (late June to be a little more precise) youngest son commented that I seemed to have shaky hands.  I didn't dismiss his observation but sought confirmation from family and friends.  Having established that a few had noticed this I booked in to the quack.  Quack booked me a consultation with the consultant.

I had that consultation on Tuesday.  I have what is termed essential tremor and mine is so mild as to be uninteresting unless it ever gets worse.  There is no imminent danger of anything even remotely bad, thankfully.

I was worried about it being Parkinsons as my father suffered from Parkinsons as does one of my cousins. 

And coincidentally the background tension headache that I have been nursing and bearing for weeks has magically disappeared.

[barakta]

I am glad you have an explanation and it is not scary news, and that your headache has gone too. Stress is surprising in how it manifests sometimes.

[Polar Bear]

Apparently we all have essential tremor to a lesser or greater extent.  An explanation of mine apparently worsening was offered as a remote but possible reason which I'd prefer not to share so as to avoid speculation and criticism of the consultant.

What I would say though is that her suggestion of what I might do which does not involve medication is something that I will be working on over the coming months and years.

[Polar Bear]

And many thanks Barakta.  Much appreciated.  ☺️

[chrisbainbridge]

Nurses are becoming doctors. Slowly I accept but it is happening. 2 of my recent trainees were nurses. Another nurse in theatre has trained as a physician assistant. We have 3 nurses and 3 therapists who are doing work previously done by doctors (slowly and expensively). Each therapist sees a fifth of the patients seen by a trainee surgeon at the same cost.

GPS are doing more F2F appointments than ever but more people are turning up.

Everything now takes longer. I see about 20% less patients per clinic partly because I am getting older but largely because people want more explanation, discussion, etc. I am not objecting to that but you cannot have more appointments if you have not trained more doctors, nurses, pharmacists, etc.

[Kim]

Apparently we all have essential tremor to a lesser or greater extent.  An explanation of mine apparently worsening was offered as a remote but possible reason which I'd prefer not to share so as to avoid speculation and criticism of the consultant.

What I would say though is that her suggestion of what I might do which does not involve medication is something that I will be working on over the coming months and years.

My grandmother lived with a significant essential tremor for decades.  Thanks to a typewriter, microwave and careful choice of kitchen implements, cutlery, etc. (being a child, it took me years to realise why she had a specific favourite drinking glass) she was able to function pretty much normally, even when she lived alone after her husband died.  The only thing I remember her really struggling with was knots.

When I last had contact with my mum, she was developing it too.  Sort of thing that makes you glad to be adopted, admittedly, but it certainly beats Parkinson's.

[barakta]

Nurses are becoming doctors. Slowly I accept but it is happening. 2 of my recent trainees were nurses. Another nurse in theatre has trained as a physician assistant. We have 3 nurses and 3 therapists who are doing work previously done by doctors (slowly and expensively). Each therapist sees a fifth of the patients seen by a trainee surgeon at the same cost.

GPS are doing more F2F appointments than ever but more people are turning up.

Everything now takes longer. I see about 20% less patients per clinic partly because I am getting older but largely because people want more explanation, discussion, etc. I am not objecting to that but you cannot have more appointments if you have not trained more doctors, nurses, pharmacists, etc.

How much is stuff taking longer because of NHS bureaucracy and bad IT?

I recently read Henry Marsh's biographies (he's a retired neurosurgeon) and he claims that NHS changes and rules up to 2015ish when he retired reduced how many patients he could operate on at once. Crappy IT systems often slowed down clinics because he couldn't access imaging or records properly.

Interestingly I would say my appointments with hospital docs are about the same as they were in the 80s and 90s but then I suspect paediatrics perhaps run slower and my current hip surgeon is very chatty and keeps having to take my case to the MDT.

[woollypigs]

This should nearly be in the grumble thread. Some months ago I had a scan at the hospital, who said they would send the result to my GP. Weeks later I contact GP via their fancy new system. Get a text reply back saying no results here yet. Some weeks later I contact GP via same system, since I have heard nada. GP comes back 3 days later, the results have gone back to the hospital and I should call them. I call the hospital, very nice staff on the bone, tells me that they can't give me the results. But will put a note in the system for the consultant to contact me with the result, though couldn't tell me how this would happen or when.

Now the question is, should I be worried, since the GP send the stuff back and what if it is serious have it become worse in the nearly 3 months since said scan.

[DaveReading]

This should nearly be in the grumble thread. Some months ago I had a scan at the hospital, who said they would send the result to my GP. Weeks later I contact GP via their fancy new system. Get a text reply back saying no results here yet. Some weeks later I contact GP via same system, since I have heard nada. GP comes back 3 days later, the results have gone back to the hospital and I should call them. I call the hospital, very nice staff on the bone, tells me that they can't give me the results. But will put a note in the system for the consultant to contact me with the result, though couldn't tell me how this would happen or when.

Now the question is, should I be worried, since the GP send the stuff back and what if it is serious have it become worse in the nearly 3 months since said scan.

It's very hard to believe that your GP no longer has access to your scan results.

I had a similar issue a couple of months ago with echocardiogram results which my practice claimed they couldn't give me (and the hospital said that only my GP could).  I insisted on a telephone consultation, and the outcome was that they agreed I could call into the practice to pick up a paper copy of my results.

[chrisbainbridge]

Actually admin is great. Notes are now online, I can order tests online and I can see x-rays for almost half of England.
Staffing is probably the biggest impact on who I can operate on. Staff my theatre properly and I could operate on 50% more people.

[barakta]

Sounds like you have one of the good IT systems at your place! 

I wish the changes needed to improve staffing could be made so people like you and other HCPs can all use your skills properly and efficiently.

[mrcharly-YHT]

A few months ago (late June to be a little more precise) youngest son commented that I seemed to have shaky hands.  I didn't dismiss his observation but sought confirmation from family and friends.  Having established that a few had noticed this I booked in to the quack.  Quack booked me a consultation with the consultant.

I had that consultation on Tuesday.  I have what is termed essential tremor and mine is so mild as to be uninteresting unless it ever gets worse.  There is no imminent danger of anything even remotely bad, thankfully.

I was worried about it being Parkinsons as my father suffered from Parkinsons as does one of my cousins. 

And coincidentally the background tension headache that I have been nursing and bearing for weeks has magically disappeared.

Essential tremor can be hereditary. My mum had it, I have it, my nephew has it.

Mum was the worst - she struggle carrying things like trays, since anything on the tray would rattle around like there was an earthquake. She couldn't do things like pouring tea without spilling it.

Nephew isn't as bad as mum, but still they were worried when young until diagnosis.

Mine comes and goes. If I have a virus it gets worse and I have to use two hands to pour something.

Keeping fitness levels up seems to help. If I'm tired it gets worse.

[ian]

Nurses are becoming doctors. Slowly I accept but it is happening. 2 of my recent trainees were nurses. Another nurse in theatre has trained as a physician assistant. We have 3 nurses and 3 therapists who are doing work previously done by doctors (slowly and expensively). Each therapist sees a fifth of the patients seen by a trainee surgeon at the same cost.

GPS are doing more F2F appointments than ever but more people are turning up.

Everything now takes longer. I see about 20% less patients per clinic partly because I am getting older but largely because people want more explanation, discussion, etc. I am not objecting to that but you cannot have more appointments if you have not trained more doctors, nurses, pharmacists, etc.

Good news at least on some fronts (I used to work with the various Royal Colleges etc. and the general suggestion that nurses and other medical professions become actual practitioners did make some older members turn literal puce).

Of course, it doesn't deal with the fact that the burden on healthcare is increasing, we're getting older, less well, have a constellation of issues of which an increasing number aren't simple organic-here's-a-pill, and everything costs more but we want to pretend it's free.

[T42]

A few months ago (late June to be a little more precise) youngest son commented that I seemed to have shaky hands.  I didn't dismiss his observation but sought confirmation from family and friends.  Having established that a few had noticed this I booked in to the quack.  Quack booked me a consultation with the consultant.

I had that consultation on Tuesday.  I have what is termed essential tremor and mine is so mild as to be uninteresting unless it ever gets worse.  There is no imminent danger of anything even remotely bad, thankfully.

I was worried about it being Parkinsons as my father suffered from Parkinsons as does one of my cousins. 

You too, huh? My hands started to shake 30 years ago and have got steadily worse ever since, to the extent that I can no longer play the guitar. I have to do printed italic rather than joined-up writing at risk of sending a loop over the line above, I continually hit the wrong link when I use a tablet and if my tremor matches the resonance frequency of my coffee I need to get another hand to it PDQ.  A couple of years ago I was trying to show my son something on the banjo and one thumb went into oscillation rather than just shaking.

I put it down to diabetes attacking motor nerves and/or the wondrous quality of the roads around here - my hands have taken a right bashing in the last quarter-century.  I'll maybe ask for a referral just to get an idea; I have no hope that it might be cured.  I haven't stuck the fork in my ear yet so it doesn't stop me eating, which is what really counts.

Hope yours stays off the Richter Scale (the low end).

[BrianI]

Sticks of any kind only work if your arms are up to the job thobut and I seem to recall Brian has difficulties with his hands as well as his legs.

Regardless, if Brian doesn't feel listened to, then the physio hasn't done their job. They've not made the time to listen and think rather than blat out advice willy nilly.

Brian, I am sorry, that really sucks.

Thanks barakta.

Anyway, I did request from my physio that I get referred back to Prof Jon Stone (the FND Expert). So physio has had a meeting with my usual neurologist Dr Zeidler, who has agreed to refer me back to Prof Stone.

Probably many months before I get an appointment though.

With regards to the physios suggestion of taking up Nordic Walking, maybe no harm in giving it a try, they seem cheap enough to by on Amazon / decathlon etc.   Especially since I don't feel particularly safe cycling at the moment, perhaps this will be a good way to keep some form of exercise going.

[T42]

Good luck, Brian.

[barakta]

Glad you managed to secure the re-referral. Neurology in the UK, especially for chronic shit like FND and migraines is pretty poor. I think if you are clear you want some nerve conduction studies and whatever else hasn't been done, that's a good start.

I think if the poles are cheap then giving Nordic walking a try is a good idea. Maybe don't go out if it is icy for obvious reasons, but start out small and try and build up slowly. Definitely try to take a logical approach and don't overdo it at the start which are common failure modes of any kind of "rehab".

[woollypigs]

Good luck Brian and as Barakta said start slowly and build up. I'm sure there will be videos on the tube for the best setup on the sticks for the benefit for the kind of walking you want, they are different kettle of fish if you go up or down.

If you go and get nerve conduction studies, do check that the person testing you, turn it to low before they start to zap you. First time they did, but second time they didn't. And boy did that smart!

[MikeFromLFE]

Actually admin is great. Notes are now online, I can order tests online and I can see x-rays for almost half of England.
Staffing is probably the biggest impact on who I can operate on. Staff my theatre properly and I could operate on 50% more people.

When I compare the hospital and the GP IT systems of today (purely by looking over shoulders as a patient) with the 'wonderful' IT systems we thought we had when I retired from the NHS a decade ago, it's like night and day.
The different parts of the services now actually communicate with each other seamlessly instead of having to remember six different logins.
My GP can see my hospital results and images and the electronic referral systems seem to 'just work'.
Certainly round here the IT systems do not seem to be a bottleneck.

[BrianI]

So I now have teh Covid....