Thursday, 12 July 2012

Your Health Dr James Le Fanu: 13 July

Seven degrees of surgeon, when separated by shifts, gut wrenching weight loss, and benefits of a healthy lifestyle

Written by Dr James Le Fanu
The path to perdition is paved with good intentions. And what better intention could there be than that everyone, doctors included, should work civilised hours with time to eat, sleep and pursue other interests. So over the years the hours worked by our junior doctors have fallen from more than 100 to 72, then to 56 and now are a mere 48 hours per week.

The catch, of course, is that medical problems do not keep 'civilised' hours, so hospitals must be staffed by doctors working three shifts of eight hours a day. This can adversely affect the 'continuity of care', as Belfast lecturer Pauline Prior discovered when she developed a painful swelling under her jaw.

She started with surgeon No 1, who diagnosed a stone in the salivary gland and recommended surgery. This, she was pleased to hear from surgeon No 2, was a simple procedure, although it carried a small risk of cutting a nerve that would give her a lopsided grin.

On admission to hospital she saw surgeon No 3 who told her he was doing the operation, so she was taken aback while waiting on the trolley to be anaesthetised when she was approached by surgeon No 4 who asked to examine her neck.

Back on the ward after the operation she realised the complication she had been warned about must have occurred, as her face was completely crooked. But surgeon No 5 sought to allay her fears and prescribed medication. The ward round the next morning was conducted by surgeon No 6 who cancelled the medication and told her the operation had gone as planned, 'But it seemed he had little information about it. I was not reassured,' she writes. Finally, she saw surgeon No 7 a week later who observed that the wound had healed well but 'had no idea' when or if the crookedness would improve.

It did but, only after she had consulted a physiotherapist privately who advised her on a daily exercise routine. This may be an extreme example but it illustrates the difficulties encountered by hospital patients when rotas make it unlikely they will see the same doctor twice.

This week's medical problem comes courtesy of a lady from Brighton writing on behalf of her husband who, ever since he had a flu-like illness four years ago, has been troubled by bouts of violent diarrhoea every two weeks, lasting 24 hours. He initially lost a couple of stone, some of which he has regained but is still short of 'normal'.

The gut specialist at his hospital could not have been more thorough but has been unable to identify the cause, despite extensive blood tests, scans, an endoscopy and a barium meal. This is strongly suggestive of a particularly severe form of irritable bowel syndrome that can follow a generalised viral infection – though his weight loss would be against this. This may improve with a 'live yoghurt' such as Yakult, which recolonises the gut with friendly bacteria. But beyond that, the best option would be to control attacks with antidiarrhoeal drugs such as Imodium or cholestyramine, in the hope they will eventually resolve.



Seven Commandments

The seven pillars of a healthy lifestyle were first identified by the late Professor Lester Breslow of the University of California: moderate alcohol consumption; no tobacco; regular exercise; six to eight hours' sleep at night; regular meals with no snacking; maintaining a normal body weight, and regular consumption of breakfast.

It is only recently, however, that the full potential benefits have become apparent – as recently described in the British Medical Journal. They are certainly very impressive: it turns out that a 60-year-old with all seven habits, is as healthy as someone half his age with two or fewer of the habits. Similarly, the life expectancy for a 45-year-old with a 'full house' is a staggering 11 years longer than someone of the same age with three or fewer.

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