The Most Disgusting Diseases in the World (and how to catch them) – part 3

If your stomach has now settled post-Christmas, you may be ready for the final instalment of the most disgusting diseases in the world. Those who were born a lot longer ago than yesterday may notice that it’s in the same vein for which the late lamented Punch magazine was known.

Should you fancy a condition that goes the distance, consider keeping a pet worm like dracunculus medinensis, aka the Guinea worm. The best place to pick one up is in Africa with your drinking water. Maintenance is dead easy. There’s no need for an aquarium, hutch, or a garden, as it lives just under the skin.

I remember one patient who had his worm for so long that he named it Ali, which seemed the best bet as he couldn’t tell if it was male or female. Ali kept him company for some time, forming little red bumps all over him, until the day she (as we discovered) tried to escape through a huge blister on his arm.

When the blister finally burst, the little dracunculus poked through. Ali turned out to be several feet long. She had to be wrapped around a stick and pulled out gently to avoid breaking her during her outward journey which took two and a half weeks. Bon voyage, Ali!

You needn’t leave these shores to catch something sensational. Syphilis is all Columbus’s fault since, or so the story goes, his sailors brought it back to Europe in 1493.

An epidemic of syphilis spread from Naples throughout Europe in the 16th century. The English and Italians called it the French disease, the French called it the Neapolitan disease, and pretty well everyone thought of it as the Great Pox because smallpox was small potatoes by comparison.

Syphilis is far more contagious than leprosy, as just a few minutes in a shared bed will do. A bed may even be superfluous. One man, inspired by notices in public WCs, claimed to have caught the infection in the loo. “That’s a filthy place to take a woman,” replied the consultant.

Syphilis can mimic anything from tonsillitis to athlete’s foot. It all depends on the stage of the infection.

Early syphilis can be just a painless ulcer called a chancre (pronounced Shankar, which is most unfair on Ravi and family). A few months later, the secondary stage produces symptoms like fever, headache, general malaise, aches and pains, mouth ulcers, enlarged lymph nodes, and rashes. Of course, that’s pretty much what everyone goes to the GP with.

Late syphilis takes years to develop, and it’s downhill from there. Nerves in the legs no longer transmit signals about position, which is one cause of the stomping gait you can see all over London. It also makes you fall into the handbasin when you close your eyes to wash your face. If very wobbly, you may fall into the toilet unless you’ve closed it.

No account of dreadful diseases would be complete without that scourge of the western world that has medics clamping their hands over their mouths and recoiling in horror. You may not be able to get a hospital referral, or, if you do, you’ll find yourself being bundled out of the clinic as soon as possible, usually while you’re still talking, so that the consulting room can be fumigated forthwith.

They may offer you surgery, but you may not live long enough to get to the top of the waiting list. Should you manage to reach the operating theatre, the procedure is likely to be relegated to the most junior doctor because nobody else wants to do it. Blood and pus often pour out, and the hapless trainee surgeon may throw up as a result. The patient has it relatively easy by now, as the whole gory mess is soon tidy and bandaged.

Unfortunately, this unsavoury condition is on the increase. Experts call it IGTN and claim that it spreads via shoe shops. It will impair games of footsie-footsie. It may even interfere with walking.

Like many disfiguring conditions, IGTN has a long incubation period. As I’d like you all to enjoy a healthy and happy New Year, I believe the public should be told more about this disorder. I particularly look forward to the day when every pair of winkle-pickers carries the government health warning Wearing shoes may cause ingrowing toe-nails.

 

Is Your Classic Car a Sex Symbol?

On a sunny summer day, the grounds of Burghley House proved a good place to ponder this question. The occasion was the annual rally of the Rolls Royce Enthusiasts’ Club on the 100th anniversary of the marque, no less. Some of the visitors seemed of similar vintage. But, if the setting of England’s greatest Elizabethan House didn’t evoke lust, the Flying Lady (aka the Spirit of Ecstasy) probably would. 

FreeImages.com/Artur Szeja

Arriving in my neighbour’s Arnage, I thought we fitted in rather well. OH and I posed in front of cars like this classic green Bentley.

If you’re wondering about the definitions of classic, vintage, and veteran, here’s one widely accepted version. Classic is over 20 years old, while vintage is 1919-1930, and veteran is pre-1919.

Some of the motors we saw were for sale, but most were for show, closely guarded by their owners as if their charges were entrants in a teen beauty pageant.

Some, like this Corniche, were watched over by dogs.

The atmosphere seemed designed to prompt extravagance. Sunshine, free fizz, and John Timms’ Jazz Band make such an intoxicating mix that a 1962 Silver Cloud begins to look a steal at just £395,000.

I had my eye on a sky blue Bentley, but doubt I could have afforded its dinky little brother.

Exploring stalls with items for sale, we admired shiny cylinder heads, members’ spares, and picnic sets for a mere £3,000.  I turned away from a perfectly lovely Louis Vuitton suitcase. It was £2,800 and it didn’t even have wheels!

Perhaps the less car-related merchandise would be within my budget. I tried on a splendid coat by Gabriela Rose Ltd. The mirror told me it fitted perfectly. The label told me it was £995.

In the Gallery Marquee, I enjoyed an affordable piece of fudge before wandering off again among the rows of cars. We traipsed as elegantly as one can in a field. Turned out to be easier without shoes. Who knew?

Owners were only too happy to tell everyone about their pride and joy. As it happens, I know something of their fervour. I did own a classic 1973 Beetle for over 25 years. It might not have swanned about stately homes, but Sauerkraut and I clocked up plenty of miles on camping trips to France and Spain.  And Wales. Mustn’t forget Wales. The speedometer gave up the ghost on the way back.

Lacking even the most basic cocktail cabinet, Sauerkraut was a tad low-tech by Rolls Royce/Bentley standards. Did it have air con? Only if you opened the quarter-lights as far as they would go and kept up a steady speed of 70mph. As for heating, what’s wrong with a coat and gloves? My very first Beetle didn’t even have a fuel gauge. Instead there was a lever for deploying a reserve tank when you were out of petrol.

Was my classic car a sex symbol? It was probably more of a fertility symbol, especially with three child seats across the back, a double buggy shoved haphazardly into the front, and a random assortment of toys meant to keep little boys quiet on long journeys.

You won’t find my beloved Beetle standing in front of Burghley House, but it has graced some of the finest NHS hospitals in the land. Here it is at the Canadian Red Cross Memorial Hospital, in Taplow, Berks.

When I went into general practice, Sauerkraut and I got to know every single street in Borehamwood. I recall one particular patient who called for a visit for back pain. When I examined him, I told him his back didn’t seem too bad. “I know,” he replied. “But I want to buy your car.”

Many years later, I sold Sauerkraut to a lovely family from Liverpool who renamed it Carol.

Go on. Give it a wave if you see it.  

Happy Birthday to Hope Hospital

April 5 is the end of the tax year, but, if you’re hoping for a side-splitting post about ISAs and tax returns, you need to look elsewhere. This week it’s a serious message about sick kids.

Just over two years ago, the People’s Convoy set off from London on an overland journey, taking with it supplies to build a new children’s hospital in Syria.

War has devastated Syria

After six years of war – with the deliberate and outrageous targeting of hospitals – the humanitarian situation was dire. There was no children’s hospital left in Eastern Aleppo, leaving about 250,000 people without medical care.

Hope Hospital, enabled by the People’s Convoy and run by the Independent Doctors’ Association, literally rose from the ashes of oblivion. As the world’s first crowdfunded hospital in a war zone, Hope is a triumph of humanity.

It took 8 dedicated organisations, over 5,000 generous people and £246,505 to open Hope Hospital. When the hospital was damaged by a car bomb, it was repaired. And when funding ran low last year, people raised an additional £480,505 to keep the light of Hope on.

Hope Hospital has now provided 98,707 consultations, checked 26,309 children for malnutrition and given specialist treatment to 52,846 children – children like Hanan, shown here.

Young Hanan’s story

Hanan’s mother suffered hugely during Hanan’s birth in October last year, not least because she had to travel for more than 60 km to reach hospital. Then, at 10 days old, Hanan developed a fever which wouldn’t respond to initial treatment.

Dr Hatem, Hope Hospital’s Director and lead paediatrician says, “Hanan came to the hospital suffering from convulsions… A CT scan showed cerebral oedema, which can cause irreversible damage and even death.” 

Thanks to Hope Hospital’s specialist care, Hanan improved enough for her to be discharged, to the great relief of her mother. She needs to continue with treatment and have ongoing hospital check-ups at the hospital, but is expected to make a full recovery.

Thousands of children need medical care

Dr Hatem says, “We receive dozens of cases like Hanan’s monthly. We are so grateful for the unique presence of this free hospital. Despite the dangerous environment, we are able to save the lives of thousands of children annually.”

Friday 5th April will mark two years since Hope Hospital officially opened its doors. To celebrate, CanDo – one of the lead organisations of the crowdfunding campaign – and the Independent Doctors Association of Syria are sending messages of thanks, hope and humanity.

Dr Rola Hallam, co-founder of CanDo who travelled with the People’s Convoy, says, “Hope Hospital is a shining beacon of what we can do when we believe in our shared humanity. The amazing staff there are saving lives every day thanks to people-to-people care, action, and hope.”  

Hope Hospital is a beacon in a dark world

My grandmother’s family was Syrian, and I’m often glad so few of them are left to see what the conflict has done. But, in a war that has been raging for over eight years, has killed hundreds of thousands and displaced over six million people, the story of Hope Hospital is a rare and precious positive. So I thought you’d like to hear this uplifting story.  You can watch a short video celebrating two years of Hope Hospital.

And here’s where to find out more from CanDo

You too can send a message

Many happy returns to Hope Hospital. If you too would like to send a personal message for #2yearsofHope, it’s easy to do on this link Happy Birthday to Hope

CPR: Why You Should Jump on a Stranger’s Chest

We’ve all seen spectacular examples of CPR (cardio-pulmonary resuscitation), especially on TV, where it leads to equally spectacular results: the previously pulseless patient sits up and tucks into pizza while vowing undying love for his family.

CPR ventilating with bag

In real life, the story is different. Outside Casualty, Grey’s Anatomy, and other small screen dramas, CPR is far less successful. Cardiac arrest in hospital has a survival rate of around 35%. Out in the big wide world, survival is more like 8%. This UK figure is especially dismal when compared with other western countries.

I learned all this and more at a CPR refresher course this week, courtesy of the Hospital of St John and St Elizabeth in North London. Tutor Philip Howarth is a brilliant mimic as well as a gifted teacher, and he was assisted by his fellow resuscitation officer Christilene Kiewiets. I can’t actually think of a more worthwhile way to spend a rainy Wednesday afternoon.

CPR manequin

We went through various scenarios of increasing complexity, but the principles are simple and they’re things everyone should know.

In a cardiac arrest, the heart stops pumping. This deprives the body of vital oxygen.

After five minutes without treatment, this damages the most important organ in the body (that’s the brain, in case you wondered).

CPR buys time. After a cardiac arrest, it can keep life going for up to 20 minutes (possibly even longer). That means time for paramedics to get there.

But CPR needs to start as soon as possible, ideally within two minutes.

Classic CPR uses chest compression and rescue breaths (in a ratio of 30:2 for adults). But hands-only CPR is a useful alternative. (Chest compressions make the lungs move, so they deliver some ‘breaths’. And people are more likely to give CPR to strangers if they can avoid mouth-to-mouth.)

Chest compressions should be fast and deep. A rate of 100-120 compressions a minute (two per second) is better than the old advice to keep time with the BeeGees’ Stayin’ Alive. ‘Deep’ usually means to a third of the depth of the chest. It’s tiring, and it can be noisy. The sound of ribs cracking is par for the course.

AED

Defibrillators can make all the difference to the outcome. In the UK there’s an increasing number of public-access defibrillators in airports, stations, and the like. The best bit is that these automated defibrillators are very easy to use, with voice prompts that are simpler and far more reliable than sat nav.

The most important thing of all?

Have a go. If someone has a cardiac arrest and you stand idly by, that person is dead. So there’s nothing to lose.

If you’re wondering about the best place to cash in your chips, a Las Vegas casino is probably the safest location of all in which to suffer an out-of-hospital cardiac arrest. Security guards trained in CPR and the prompt use of defibrillators can achieve impressive results.

FreeImages.com/Bob Townsend

Photo credit Bob Townsend

***

The free app Lifesaver is a live-action movie you play like a game. It’s a great way to learn how to save someone’s life.

The British Heart Foundation runs HeartStart training courses around the UK.

First aid courses for the public offered by other charities such as the British Red Cross also include CPR.

Some ambulance instructors also teach the public. Get in touch with the Community Defibrillator Officer or the ambulance training school nearest you for more details.

The latest Resuscitation Council UK guidelines can be found here.

Here’s an easy tweet:

CPR: Why You Should Jump on a Stranger’s Chest http://wp.me/p3uiuG-1qC via @DrCarolCooper #CPR #cardiacarrest 

A Day on a Hospital Trolley

Even though he’s a fictional character, GP Geoff is not so very different from most other medics. If he needs to see a doctor, all he does is look in the mirror.

hospital entrance

But the swelling and dragging sensation in his left groin have become hard to ignore, and today he’s going into the Day Surgery Unit of his local hospital. Hernia repair used to mean a sizeable incision and several days in hospital, but, with keyhole surgery, Geoff will be home the same day.

About 90% of operations are now done as day case surgery. Beds are as rare as unicorns, thinks Geoff as he meets Cecil, the day care nurse who’s looking after him today.

Today Geoff doesn’t get a bed, just a trolley on a six-bedded ward. If a patient turns out not to be fit to go home the same day after all, then he gets to stay overnight. On that same trolley.

Geoff has been qualified just 15 years and already things have changed beyond measure. Or have they always been like this for patients?

surgical dressings

A junior surgeon pops round with a consent form, then the anaesthetist visits. Geoff is distracted by her dazzling smile, her shock of red curls, but mostly by her multiple nasal piercings. What happens when she has a cold?

“With modern anaesthetic drugs,” she tells him, “you wake up so clear-headed that you can do The Times crossword.”

Which is wonderful because Geoff’s never been able to do The Times crossword.

He won’t get a pre-med, which is a shame. It used to be the best thing about having surgery, but there’s no scope for such things on the day surgery conveyor belt. Besides, Geoff needs to be in charge of his feet, because, when he’s changed into a flimsy gown and paper underpants, a nurse takes him for a long trek to the operating theatre. He hopes he doesn’t run into any of his patients.

Geoff meets the consultant surgeon for the first time in the anaesthetic room. He’s more Doogie Howser than Dr Finlay. Geoff resists asking if his mother knows where he is.

scalpel

When it’s all over, he can hardly feel he’s had anything done, but he’s lying in a large well-lit room where a nurse is telling him to drink. He had not realised he was clutching a small Styrofoam cup.

Back on the Day Surgery Unit, Nurse Cecil checks his pulse, blood pressure, and oxygen saturations every half hour, and reminds him to eat and drink. There’s an obligatory six hours before he can go home. There’s also the requirement to consume the tea and roast beef sandwich placed next to him.

The man on the neighbouring trolley is smiling at a film on his iPhone. Geoff can’t see the man opposite, as his girlfriend is busy delivering a prolonged post-op snog.

Geoff decides against powering up his phone. The pre-op instructions were clear: do not do anything important in the next 24 hours. The last thing he needs is a spirited twitter exchange with one of those anti-vaccine types.

Geoff doesn’t have a newspaper so he can’t test the anaesthetist’s promise. He brought the latest British Medical Journal, but he doesn’t much feel like it now. Or the sandwich. 

British Medical Journal

The patient by the window has already regained his appetite, judging by the takeaway his family brought in. The red and white packaging is already open, filling the ward with the heady aroma of grease, along with 17 different herbs and spices.

Eventually Geoff does what’s required of him: drink, eat, and pass urine. Post-op pain is breaking through by the time he gets to the tiny WC, where someone has already hosed down the floor.

In the corridor, one of the female patients is asking Cecil where she can find a nurse, oblivious of the fact that she is speaking to a nurse. “I’m a nurse,” says the nurse. The patient’s face is blank.

Finally Geoff goes home with a paper bag. It has spare dressings, a packet of painkillers, and instruction leaflets on not picking your scabs.

There’s supposed to be a responsible adult with him for the first 24 hours at home. Geoff, who’s single, fibbed about that bit. Luckily nobody checks, and he absconds in an Uber.

Nothing will go wrong, Geoff tells himself. Aside from the little lie he told the hospital, he plans to be a good patient and take careful note of all the instructions. At first, he is a little confused by the stated telephone times.

Then he realises it’s exactly like Sainsbury’s, trolleys and all.

 

Geoff lives in North London where he looks after patients, longs for a meaningful relationship, and rants about the NHS. You can find out more about him and his life in the pages of Hampstead Fever.

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A Christmas Gift for Syria

For two weeks now, I’ve felt proper sorry for myself, wallowing in a sea of tissues with a voice that’s no more than a croak and a brain that’s as sharp as blancmange. The world can feel like it’s ending when you run out of LemSip, and neither husband nor cat will get near you for the stink of menthol and eucalyptus.

symptomatic relief for a cold

Then I turned on the TV.

After six years of war, the humanitarian situation in Syria is catastrophic. Hospitals and medical staff have been deliberately targeted. It’s a war crime, and it has left hundreds of thousands of civilians without access to medical care, even as the bombs rain down.

There is no children’s hospital left in Eastern Aleppo, and about 250,000 people are estimated to be without medical care.

But that could change by Christmas.

The People’s Convoy is crowdsourcing funds to build an urgently needed new children’s hospital. Dr Rola Hallam, a UK-based doctor (founder of CanDo and previously headed Hand in Hand for Syria), launched the campaign a few days ago. Here’s a piece from Channel 4 News which includes her interview. 

Laden with supplies for the new children’s hospital, the convoy will set off from London on Saturday 17th December for a seven-day overland journey arriving in Turkey. There it will meet the Independent Doctors’ Association (IDA), the Syrian medical/humanitarian organisation that is still operating in Northern Syria. 

incubator

The supplies will then be used to refit an existing building as a new hospital, which will be the first crowdfunded hospital in the world. It’ll be in the countryside north of the city, and will serve 185,000 people.

The convoy is a collaboration of leading medical relief agencies, humanitarian organisations, medical workers’ associations and campaign groups, including Medics Under Fire, the Independent Doctors’ Association, Physicians for Human Rights, Doctors of the World, and the Syrian American Medical Society, as well as Rola Hallam and David Nott, considered one of the world’s most experienced war surgeons. 

While governments fail to resolve the crisis, people can act, and you can help right here: The People’s Convoy.

You can keep up to date with the campaign and the convoy here: CanDo.

doctor examining baby

This is more than a convoy of medical supplies. It’s a convoy of hope, sending a strong message of solidarity and support to courageous Syrian medical and relief workers, telling them that they aren’t forgotten or alone.

It’s also a convoy of defiance: a strong message that humanitarians and human rights’ advocates will not be silenced or stopped from their life-saving work.

Please help spread the word, and give what you can to the People’s Convoy.  

It’ll do far more good than a box of tissues.

FreeImages.com/T. Al Nakib

December 18 update:

If you’ve already donated, thank you very much. The campaign exceeded its target, and the convoy left central London yesterday, as you can see in this piece from today’s Sunday Times.

What Happens When You Become a Doctor

Any day now and it’ll be the Killing Season, so-called. August 1 is the date when a fresh crop of newbie doctors arrives on hospital wards, bursting with enthusiasm and theoretical knowledge but woefully lacking in experience.

Jeremy's scalpel

In fact August is no longer worthy of that macabre tag. The month now begins with a sensible induction process for newly qualified doctors, with proper training in the tasks and procedures they’ll need to do in the coming months. Gone are the days of ‘See one, do one, teach one.’ The Killing Season is well and truly dead. Induction is a recent trend. I will never forget the utter panic on my first day as a doctor as I crept around in squeaky new shoes trying not to look like the rawest recruit. It was a Sunday—was there ever a more stupid day to start work?—and a patient had the misfortune of dying within 45 minutes of my arrival at the hospital. Now don’t jump to conclusions. I hadn’t even seen her before she died.

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

Wet behind the ears, I had no idea of the procedure to follow. Even scarier was the realization that I had two whole wards full of people to keep alive as long as possible. I rushed round to say hello to them all and check they were still breathing. At the same time, I said goodbye to many things: sleep, leisurely weekends, sitting on the loo without being bleeped. In short, to normal life. iv nutrition

While a lot has changed since then, including working hours, some things haven’t, as I realized from a recent blog post by Salma Aslam (by which I mean Dr Salma Aslam) Transitional state: med student to doctor It all came back to me. When you graduate from medical school, you may get a number of different reactions. 1 “Well done, but don’t go round thinking you know it all.” Don’t worry, I didn’t. And still don’t. 2 “So what?” That’s what I got from a group of arts students sitting around in the bar. They acted like they couldn’t care less about my news, but they were probably envious. 3 “Can you have a look at my verruca?”

plantar warts

Count yourself lucky. It’s much worse to be subjected to the long saga, in multiple episodes, of their entire medical history. This is when you get envious of those jobless arts graduates. 4 “The only thing that works for my migraines/arthritis/autism is kinesiology/homeopathy/acupuncture.” The implication is that allopathic medicine does nothing. Well, I’ll keep an open mind about that, only not so open that my brain falls out.

tablets

5 “You should get a job as a medical adviser on Casualty or something.” Yeah, right. Like nobody else with more experience wants to do it. 6 Perhaps the weirdest reaction was from my mother, who insisted I should now call her Dr Cooper. Why? “Because my daughter is a doctor, it’s like I’m the doctor. You may congratulate me now.” Get used to all of it. It may be a while before you hear the most welcome response of all: Thanks, doc. I feel a lot better.”

medical bag

Easy tweet: What happens when you become a #doctor? http://wp.me/p3uiuG-12N via @DrCarolCooper #medicine