Friday 31 December 2010

Happy New Year!

Happy New Year!

I must admit to being dull and boring as New Year is meaningless to me!  In the good old days when I was young and wanted to celebrate - we could never get babysitters as they were all young and also wanted to celebrate!  So we were stuck inside and accepted our lot!

So, New Years Eve, across time, has become  just another day, as have birthdays.  (Birthdays to me are just the day after yesterday - I am just one day older!)  This does not really mean I am dull and boring, as as an eternal optimist, I am happy 99.999% of the time

Nevertheless, I am aware, that folk put great stead in the beginning of a New Year!  The New Year is a time of renewal, of change and of hope that the dark side of the past year will not infiltrate the possibilities of a bright new beginning.  A new start.

So let us all start anew and accept the things that we cannot change and endeavour not be downhearted by them.  This is easy for me to say as a moronic optimist, for we all have our crosses to bear and my experience of life is not yours.  Whatever burdens you might carry - I hope they become lighter; reach out and touch those who can give help and guidance, or just comfort.  Give comfort to those who are less fortunate than you.

I sincerely hope that this New Year is good to you!

On a lighter note - things look good for me financially next year as my SPAM reports that there is over £3 million just waiting for me to collect!  Sorry, I must go soon as I have to provide my name, occupation, bank details, etc to collect this welcome booty!

I cannot recall meeting jung-c, w-moulder or e-puentes - but I must have made a hell of an impression on them - for they want to give me millions!  Yes!!!

Life is good!

Happy New Year!

Anna :o]

Thursday 30 December 2010

Asthma and cigarette smoking

I am sorry, I know this is flippant - but I was clearing out my 'My Pictures' and came across this:

I don't even remember saving it!  Times have changed and evidence based medicine has come to the fore - unless, that is, evidence is manipulated by Big Pharma and those in medicine with a particular agenda, .However, at least, those under six were protected!

Anna :o]

Saturday 25 December 2010

Dr Who and A Perfect Christmas Day

Dr Who and A Christmas Carol

What a wonderful Christmas Day this has been!  A lovely dinner - half an hour late as usual as I can never get the timing quite right!

My marvelous family are the most precious gift on this day.  Who needs material presents when you have your family?

And then, the best Dr Who Christmas edition ever!  Perfect!  Matt Smith and a wonderful cast of actors, complimented by the brilliant Katherine Jenkins.  If you missed it, see it here on iplayer.   You have until January 2nd!

This day has been perfect!

Have a great Boxing Day!

Anna :o]

Friday 24 December 2010

Merry Christmas Folks!

Merry Christmas and a Happy New Year!

If you're going last minute shopping - don't forget the honey!

Anna :o]

Saturday 18 December 2010

Smokers to be denied routine surgery to cut costs.

I have admitted it before - I am one of those evil people, whose smoke drifts menacingly into every nook and cranny, polluting the atmosphere with its particulates from mainstream and drift smoke as I suck away on a cigarette.  I am the harbinger of death; my second and third hand smoke infiltrating the very core of the young and innocent.  I deserve the remarks I receive from passers by who are predominately middle class and middle aged males who feel they have the right to abuse me.

I do not doubt that smoking is damaging to health and it is estimated that one in six to one in ten deaths are related to smoking.  It is probable that this estimate is correct and equally probable that it is a gross overestimate depending on what research you read.

Science and research are wonderful things, that is, unless they deliberately mislead.  Most of my research is based on data provided by Scotland as England doesn't appear to have its finger on the button here.

We are led to believe (as science provides the figures) that since the smoking ban in Scotland (March 2006) that coronary heart disease (CHD) and heart attacks (MI) have continued to decrease in numbers year on year on; a 17% decrease in MI admissions in the year after the ban.

Now this is odd!  If you visit isdscotland and download Table MC2 you will see that CHD has continued to fall since 1995 year on year on.  Research would suggest that this decline could be attributed to effectiveness of cardiologic treatments and changes to risk factors (including smoking) prior to the ban; but of course after the ban, the decline is only due to the ban!

During my research I came across the Iron fist, velvet glove blog and with Chris's kind permission I have reproduced a graph which illustrates that MI's actually increased after the ban.  Please visit his site; Chris as you will see, is not a chain smoking half-wit! 

I have also researched respiratory disease, particularly asthma.  I don't have any respiratory problems nor to my sons, despite being raised in a smoking household.  I know that asthma is unpleasant  and frightening for the sufferer.  It has become more common in the last thirty years and scientists do not really know the cause, but believe it could be our change in lifestyles, i.e., central heating, carpeting and lack of ventilation in homes which provide an ideal environment for the house dust mite; less fresh food and less exposure to infections and of course exposure to cigarette smoking.  I do not doubt the latter.

It has been reported that childhood asthma admissions have dropped 18% per year since the Scottish ban, Chris has debunked this again.

You might think that I am a rabid smoker demanding my place back in the world, but I am not - I am just an ordinary person, saddened that research has been manipulated to give a false impression of health gains to suit a particular agenda.

The reason for this post is this article in Pulse.  It appears that smokers will be denied routine surgery unless they quit or complete an  NHS Stop Smoking course.  NHS Surrey has take the lead here.  Read it all, including the comments.

Smokers will contribute (as tax revenue) £10.5 billion into the coffers this year.  Source: HM Revenue & Customs.  This equates to 11.55% of the NHS budget for England (£110 billion).

Who will next become society's dog to beat - alcoholics, the obese, the elderly or you?

Anna :o]

Sunday 12 December 2010

Victims of Alcohol (Part Two)

Alcohol Related Dementia

At the end of my second year as a nursing student I had to give a presentation on a self-chosen topic related to health.  I chose alcohol.

In those days education was given in a school in the hospital grounds and also at a general hospital in a nearby city.  We had ward based - both in psychiatric and general hospitals - and community based placements, and gathered a great deal of practical experience there.  I overcame my dread of giving injections at a depot clinic in a day hospital.

My only observation of the old school v graduate nurse debate is that both produce excellent, good, mediocre or bad, indifferent nurses.  That is it!

We had hospital based libraries and much information could be found there.  Computers were very much in their infancy in the sense that it was pre-Wiki and the gathering of all the information that existed in the world had not begun.  And, I did not possess a computer.  My research then was purely library based and also involved contacting agencies and charities who focused on alcohol related problems.

My presentation was well received, but in hindsight, alcohol related dementia was not a part of it.  I never came across it in my research, nor was it mentioned by charities etc, nor was it highlighted that a relevant section and thus learning was missing from my project.  I do not recall any patients diagnosed with it during my time as a student nurse.

But, it existed.

After qualifying I worked in the community for many years and during the last fifteen years, in a nursing/care home setting.  I have worked in my present home for thirteen of these years and am proud to work there.  Initially our resident group was what you would expect of a nursing home, those suffering from age related dementia and a few with enduring mental health problems.

However, over the last five years or so, our resident group has changed; several of our residents have alcohol related dementia and the age at admission is getting younger and younger.  This change is also apparent in our sister homes across the country (we are a very small group and do not wish to become an uncaring chain).

What is Alcohol Related Dementia?

Alcohol related dementia is related to the excessive drinking of alcohol and affects memory, learning and other cognitive  functions.

Recent research suggests that moderate drinking may have a protective affect against Alzheimer's as against heavy drinkers or those who do not drink alcohol.  But is this information reliable?  We have to consider who is included in the research, who drops out and how dementia is identified.  Would some of the subjects in this research not develop Alzheimer's regardless of moderate drinking?

Alcohol has a serious negative effect on the central nervous system and can affect the brain directly as a neurotoxin.  Alcohol generally effects the brain as a result of malnutrition when the person does not eat properly, resulting in vitamin deficiencies (particularly Vit B1 - thiamine) or through alcohol  related liver damage.

Is alcohol related dementia a true dementia?  Evidence would suggest that in its early stages recovery is possible, especially in women.  Alcohol related dementia can present in the early thirties, but is more usual in the fifth to seventh decades.  For recovery to be possible, the person must abstain from drinking, improve their diet and receive vitamin  (especially B1) supplements.

What is Korsakoff's Syndrome?

Korsakoff's is very much like alcohol related dementia, same causes, but results in destruction of certain areas of the brain and changes in memory are the main symptoms.

Korsakoff's is usually preceded, but not always, by Wernicke's encephalopathy.  Wernicke's usually develops suddenly and presents with three main symptoms - although these are not always present.  These are involuntary jerky eye movements or paralysis of muscles that move the eyes, drowsiness and confusion and poor balance, a staggering gait or an inability to walk.

If Wernicke's is suspected treatment must be immediate, consisting of high doses of intravenous or intramuscular thiamine and most symptoms reverse in a few hours.  If left untreated or not treated early enough, brain damage occurs in the mid part of the brain resulting in severe short-term memory loss and is then considered as Korsakoff's.   Wernicke's is a giant alarm bell - it means stop drinking NOW!

This memory loss is filled by confabulation, which is an effort to make sense of the present by filling in the  gaps of the past.  Confabulation, although the reasons for it are sad, is an amazing thing and the stories (not lies) that our residents tell us and truly believe, are wonderful.

Our residents with Korsakoff's are the very same people they were before alcohol abuse took over their lives, mainly good people and sometimes, but rarely, bad.  They accept their situation, that is, living in a care home and rarely, if ever, question the reason for it.  I find them amazing and have a great deal of respect for them.

It is estimated that alcohol related dementia affect over 150,000 of our population; this may seem a small number, but it is probably only the tip of the iceberg, many sufferers being protected by their brave families, or street and hostel dwellers that do not come to the attention of the medical profession and are therefore unreported.

It is estimated that there has been an increase in reported alcohol related dementia - 20% today as apposed to 10% ten years ago - in those of early onset dementia, that is, before the age of 65.  My home would reflect that.

Why are most of us not aware of this alcohol related harm?  Most of us do not realise dementia can be a consequence of alcohol abuse.  Why?

It is not my intention to be a party-pooper as we near this time of festivity.  I drink alcohol myself and enjoy it.  But let us consider that Christmas and New Year will be very difficult for those families who have a alcoholic in their midst.  I shall delay my post re their plight until the New Year.

Anna :o]

Friday 3 December 2010

Victims of Alcohol (Part One)

It is not my intention to preach here - just to make aware.   I like alcohol - I like the way it makes me feel; it makes me more creative; it is another guest when good friends visit.   It can add a warm glow to life or it can be the stuff of nightmares  You can control it or it can control you.

There are many quotes attributed to Churchill in regard to alcohol, such as "Always remember I have taken more out of alcohol than alcohol has taken out of me" and "My rule of life as an absolutely sacred rite smoking cigars and also the drinking of alcohol before, after and if need be during all meals and the intervals in between them."

There has been debate as to whether Churchill was an alcohol abuser and historians would contend that he was not so, but alcohol dependent.  Alcohol abuser or dependent - he was undoubtedly a great man and a great leader.

Alcohol has been a common feature in those that have occupied Number Ten.  Tony Blair confessed to using alcohol as a prop during his time as prime minister; Nye Bevan and Micheal Foot were hard drinkers; Harold Wilson was a bit more secretive about brandy consumption; Maggie liked her Scotch an HH Asquith - the last Liberal PM was nicknamed "Squiffy."  Other party leaders or deputies such as George Brown, Charles Kennedy and John Smith have/had problems with alcohol; Brown and Kennedy's careers being seriously affected by same.

Handel, Bach, Schubert, Brahms and possibly Mozart were all dogged by alcohol abuse and in most cases it was the death of them.  These were great men and think what more they could have accomplished without alcohol - or maybe, alcohol fired and enhanced their genius?

Other great alcoholics in the field of writing are Dylan Thomas, Ernest Hemingway and Brendan Behan; WC Fields, Richard Burton, Liz Taylor in the world of acting: Elton John, Eric Clapton and Robbie Williams in music and George Best and Paul Gascoigne in football - in both instances, alcohol ruining their careers and in Best's case, taking his life.

All of the above are people of great talent - but they are remote from us.  They may touch our lives with their music, their writing or we may love/hate them as politicians; but they are not part of lives as family, friends or neighbours.

In some of our lives, the effects of alcohol are close enough to touch a raw nerve.  We may be an overt/covert alcoholic ourselves; our partner might be one, our father or mother, our friend or workmate.  In some way, our life might be affected by alcohol abuse, and if so, it will probably be our unwanted little secret.

Alcohol can be a good companion or our worst enemy.  Out there, in that big wide world, there are many hidden victims and following posts will focus on their plight. 

Do you think alcohol can inspire and enhance genius?

Anna :o]

Saturday 27 November 2010

Christmas is coming....

Yay!  It's nearly Christmas!  I love Christmas!  Despite a (non oppressive) religious upbringing - I hold no religious beliefs - but still love Christmas!  Christmas is the time when there is the spirit of goodwill - although I do think 'it' and the magic of Christmas are fading; merriment abounds, families gather and all is well with the world.

Like many people, I am beginning to stock up on alcohol; this is the only time that stocks exist in my household; okay, there may be a few tinnies left over from last week - but that's about it!  There is the box of Liebfraumilch to be purchased for Christmas Dinner - I realise that this identifies me as a wine peasant as opposed to a wine connoisseur and indicates that I am stuck in the past - but me and my family like it!  I can only find it at the Co-op - God Bless the Co-op!  I must admit, that despite being a wine peasant, I do look down on those that drink Lambrusco - ugh!  There will be vodka for the eldest son and lager for me (spirits do not agree with me as I become, erm, well drunk - quickly!) and youngest son.  Apart from what we might receive as prezzies - that will be it!

I am not interested in celebrating the New Year and never have been.  I usually see it in with a cup of tea, that is, unless it falls on a Friday.  Friday is the night I drink alcohol (and a very occasional Wednesday) in the comfort of my home.  As New Years Eve does fall on a Friday this year, I may see it in with alcofrol or a cup of tea!   I may have finished imbibing before midnight!

Working as I do in a care home, I am aware of the devastating effects of alcohol (if abused), for there are some residents in my home with alcohol related dementia.  I found this while researching and am not surprised by it.  I think the general public are largely unaware of this aspect of alcohol related harm, which I find concerning.

So, what is it with us Brits and alcohol?  Do we have a national problem?  I think that probably we do.  Yes, some of us drink sensibly - but many of us don't.  Drinking (to excess) has become culture based; a rite of passage for the young that develops into a habit (dependence?) with some, particularly the middle classes.  This last fact always suprises me as I guess I am a bit of a snob, thinking that only those who exist on the peripheries of society might have a drink problem.

In the UK, it is estimated that 24% of adults drink in a hazardous or harmful way and alcohol related disease is a significant NHS burden.  In the UK there are approximately 5 million non-drinkers, 40 million social drinkers, 10 million "at risk" drinkers, 1 million problem drinkers and 200,000 dependent drinkers.

Hospital admissions relating to alcohol are rising on a yearly basis as are deaths related to liver cirrhosis related to heavy drinking.  It is estimated that each year, 5-10,000 people die prematurely from alcohol abuse.

In England in 2009, there were over 150,000 prescription items for the treatment of alcohol dependency.  This is an increase of 12% since 2008 and 49% since 2003.

The financial costs to the UK in respect of Health (£217 million spent in 2003-4 by PCTs and local authorities in support of alcohol treatment alone ), Work (absenteeism), Crime & Public Disorder and Family/Social networks (cost not qualified) runs into billions.  Source: Institute of Alcohol Studies  - download pdf 380kb.

So "Yes", I think we do have a problem, although it is said, that the country still thinks it is a "population of responsible drinkers".  You wouldn't say that if you saw my nearest city centre some nights!

In the days when I was young - which is too many moons ago than I care to remember - I was a regular social drinker, but I don't recall binge drinking; I did get drunk on occasion, the most memorable(?) being at a works Christmas 'Do' held in the furniture store where I worked in admin.  But I remember this because it was a rarity - would I recall this today if being drunk was a nightly occurence, which it seems to be for some of our young folk today.

But I might not be telling the whole story..... perhaps in the past, I have had an unhealthy relationship with alcohol..... perhaps I haven't!

Are some of us deluding ourselves that the UK does not have a problem with alcohol, as we know that we drink over the recommended (but arbitrary) limits, and do not wish to wear the label of a 'problem' drinker?  In today's criteria, as I drink my limit on one night - I would be classified as a binge drinker.  Do I think I have a problem?  No - but others might.

What do you think about alcohol consumption in the UK?


Friday 26 November 2010

Panorama - a narrow and unbalanced view

Pan-o-ram-a: a comprehensive presentation; a survey

"What Have the Drugs Done to Dad?"

I did not watch this programme at the time of its broadcast, nor was I aware that it was to be broadcast; I was only made aware of its existence by my manager, when (s)he reported that a few relatives had phoned the home, worried sick, in that their mum/dad were receiving antipsychotics and therefore believed that a drug induced premature death was imminent.

I have not long viewed same on BBC iPlayer.   I was alarmed by its almost sensational Daily Mail format, in that it only portrayed negative views of antipsychotic prescribing; Jeremy Vine stating: "...But perhaps worse of all. we know that 180,000 people with dementia are routinely being given powerful drugs, which in the  majority of cases harm them and which may actually shorten their life."

Cheryl Byrne reported on the sad case of her father who had been prescribed antipsychotics (while in hospital) and his apparent immediate decline.  It is a sad fact that hospitalisation (or care home admission) results in increased confusion, agitation and decline in mental status, as all that is familiar is suddenly taken away.  When our residents - with moderate to severe dementia - are hospitalised, upon their return, the decline is noticeable - but expected.  This is dementia.

Prof. Tim Kendall (RCoP) weighed in with his views of off licence prescribing, remarking that antipsychotics had a powerful sedative effect and were a chemical cosh, and should only be used after exhausting alternatives (I have never known antipsychotics being used as a first line treatment of aggression) and then only for a short while.

Prof. Sube Bannerjee (Inst. of Psychiatrists, King's College), put in his two pennyworth regarding antipsychotics shortening the lives of 1,800 dementia sufferers per year.  Costs, as in financial, were mentioned too - £80,000 million per year.  I wonder if this has anything to do with anything?

We visited the Spring Mount Care Home where residents were weaned of antipsychotics - as talking to people and interaction was a viable alternative. Methinks a little selective of residents here!  Could this be the only home where staff talk to their residents?  No!

Dementia is progressive whether receiving antipsychotics or not.

Before I continue, I should state that I am not an uncaring nurse who hides in a cupboard, drinking a secret bottle of vodka while reading Hello magazine; leaving the poorly paid and undervalued carers - which they are not - to deal with whatever the residents (who aren't drugged up to the eyeballs) care to throw at them.

Dementia has, and is, touching my personal life.  Ma, I can talk about - but the others still live.  I am not for unnecessary drug prescribing - I am against it!  But I am definitely for necessary drug prescribing!

Ted is one of the residents whose family phoned the home concerned about antipsychotics and possible premature death.  The move to our home is Ted's fifth!  His family were, in all cases, asked to find another home for Ted, due to serious 'Safeguarding Vulnerable Adults' issues.  There is no doubt that Ted is a vulnerable adult - but so were the quiet little old dears he punched on the face.  Ted is severely mentally infirm (yet very mobile) and to put it bluntly - there is not much going on upstairs.  He exists on auto-pilot, in that somewhere in the recesses of his mind - somethings strike him as not right.

It took four members of staff to prepare him for bed or assist him to rise in the morning - or change him after episodes of incontinence.  Ted would punch, kick, headbutt, shoulder, bite, slap, scratch, etc; staff did not take this personally, recognising Ted was not like this by choice, and realising that in his mind, he was defending himself.

Ted was prescribed antipsychotics and became calm - and dare I say it - HAPPY!  He was not heavily sedated, just carrying on before - but without the aggression; he ceased to be defensive during interventions, he slept well, ate well (admittedly while on the hoof) and didn't punch little old ladies on the head.

His psychogeriatrician succumbed to family pressure and halved his dose; Ted is no longer happy and the agitation and aggression is returning.  Observations are now required as Ted is a risk to others.  This is not fair on Ted or his fellow residents.

Ted is not alone in that he was given a certain level of peace and quality of life, that has now been taken away from him; others receiving the dreaded drugs are in the same boat.  Thanks Panorama!

As said in other posts, I would rather live five years of relative drug induced calm than exist for seven years in pure hell.  Wouldn't you?

Please note that I am reporting from my view of the world and accept that residents elsewhere may be over sedated.

Anna :o]


Wednesday 24 November 2010

Care Homes and Drug Errors

Okay, I admit it, when it comes to adverse reporting on care homes - I am definitely hypersensitive, defensive and probably many more ' 'ives' than I can bring to mind at this moment in time.

I know that in the big bad world out there, there are indeed, many bad care homes - as, as is, dire care in hospital settings (I acknowledge some of the reasons - dangerous staffing levels, etc), but nevertheless, bad care exists there too.  There are uncaring doctors both in hospitals and GP practices.  But, whatever the wrongs outside care homes - it doesn't make bad care in care homes right!

The reason for this post - stuff I read in Pulse today.  It was "Call to reduce 'counter-productive' cardiovascular drug prescribing in the over-80s"  Video to watch at the bottom of this (Pulse) page too.  I have no problem with this and have also considered the chemical cocktails that the elderly receive.  I know I am not a doctor and therefore readily admit, I don't know what the hell I am talking about!  However, it appears to me, that even though drug A does not interact with drug B, or drug F does not interact with drug H (or even if it does - Flossy needs both of them anyway) - does a combination of A, D and E unknowingly interact with drug G?

Is polypharmacy a GP and/or hospital doc initiated (possibly fatal in the elderly - or anyone?) chemical cosh, that falls outside the care home initiated (in your dreams) chemical cosh of antipsychotics?

Nevertheless, I digress!  A bullet point in the aforementioned "Call to...." in 'Problems with care home prescribing' was "On any one day 7 out of 10 patients experienced at least one medication error" - Ooh, dear me(!), this sent the defensive hackles into overdrive!  I am not brilliant at stats, but easily worked out, that on an average day/night; I routinely gave (on my shift), 30% of my lovely residents, the wrong meds!  Am I thick!?  Would I not know?

Yes, on one (known) occasion, I did give a resident somebody else's meds (distracted by World War Three, for care home residents are not continually semi-comatose by home inspired antipsychotics!) - but I instinctively knew that I had!  I immediately consulted the BNF - thought "Oh My God" (possible bad drug interactions) and contacted the local A & E - for I would rather lose my job, than have somebodies death on my hands.  Given instructions on observations and luckily, everything was tickety-boo!

I have digressed again!  Further research at NHS Choices gave a wider view!  I am relieved!  It is not only care home staff, but pharmacists, GPs et al that produce the 7 out of 10 figures.  But will the general public see this?  No - they will not!  They will just see that care homes are dangerous places (and 'Yes', some of them are) and they will be so afraid.

I do remember Copperfield writing a post on this issue, earlier this year - but I cannot find it.  Yet again, Copperfield's understanding of this situation earned my respect.  I don't care that, at times, Copperfield  alludes to 'granny'stackers' for he/she/they are in touch with the real world.

In my experience, many GPs enter homes with a negative view - and the vicious circle continues - mistrust abounds.  The patient  (or residents)  interests are paramount - and we must remember this  For if not, we are doing the most vulnerable a great disservice.

Anna :o]

Tuesday 16 November 2010

Rank Indifference

An Old Man.

Yesterday, I worked a night shift.  As per usual, I boarded a bus for the forty minute journey from the town in which I live, to the city in which I work.  The next part of my journey involves a ten minute taxi ride to my place of employment.

Prior to this second part, I usually enjoy my last fix of nicotine - and I make no apologies for being a smoker - as I stand (like a leper) in the street.

As I stood there, I became aware of a man some ten yards away, standing by and holding on to the guard rails (on the road side) that straddle the entire street - bar a pedestrian crossing - which lies between two bus stations.  This road also includes a taxi rank of which there are two points of access.  It is a busy road.

The man appeared to be talking to passers by who just ignored him.  As I neared him on my approach to the taxi rank, I became aware that he was saying "Excuse me.  Can you help me?"

He was a strapping fellow, over six feet tall; solid, but appropriate for his height.  Dress wise, he was ill-equipped for the presenting weather; wearing uppermost, just a T shirt on that cold, wet and windy night.  His right shoe was off, so on that side he stood barefoot on the ground.  He had also been incontinent and his jogging bottoms were wet and saggy.  He had a walking stick and he was old.  I am not skilled at judging ages, but would say, early to mid seventies.

Only when I was very close to him, did it became obvious that there was alcohol on his breath, but the folk who were ignoring his pleas would not be aware of this.  However, he was neither inebriated nor tipsy; he was fully coherent; he was old, cold, wet and vulnerable and was politely asking for help.

I asked him what was wrong and he told me that he just wanted to go home as he felt he might die, stuck where he was.  He told me that no taxi would entertain him as he had been incontinent.

Mindful now that I needed to set off to work - or be late, I told him I would ask the taxi driver to phone the police who could come and help him.  The taxi driver told me that the old man had already been 'thrown out' of one taxi for peeing on the seat and that he wouldn't contact the police.  I informed the driver that I was not prepared to abandon the old man and got out of the taxi and went back to him.

I offered to assist him to walk to one of the many empty seats in the bus station and I then would go into a shop and ask them to phone the police.  He attempted to walk, but cold and tired, he couldn't get himself moving.  I told him I would have to leave him for a while, while I attempted to find help.

I entered a major national department store and told the security guard of the problem and requested he phone the police.  He informed that it was not in his remit, so he couldn't do it (phone) as the problem was outside of the store.  After much badgering, he agreed to come out and see the old man.

The old mans wet jogging bottoms had by this time, fallen down, leaving him fully exposed.  Not a soul had offered assistance and the good people of the world were jeering at him, shouting "Pull your trousers up, you dirty old git!"

I attempted to pull the old mans trousers up - but to no avail as they had partially slipped under his feet, which he couldn't lift.  I asked the guard to help, but was met by the response of "I'm not touching him!"  The reason, I presume, to be the pee.

I implored him to contact the police.  He contacted his 'control' requesting that they send a private hire cab and stated that if the driver refused to take him, he would then call the police.

The cab arrive some ten minutes later and in that ten minute period, not one good citizen would help me pull the old fella's trousers up.  They had time however, to stand round in unconcerned little groups, uttering variations on the "Pull your trousers up!" theme.

The taxi driver agreed to take him, and after I had pleaded with him, he assisted me to walk the old fella to the cab as I could not manage alone.  So the old man - with his trousers still down - was finally going home.  I then took a taxi to work.

In today's Elf'n'Safety world, I should have carried out a mental risk assessment of every action I took - but I am pleased I didn't, or I would have thought of me first.

It appears to me, that in this risk assessment/risk aversion society that we now live in, we are losing our compassion, and becoming selfish and indifferent to the needs of others; we are beginning to lose our humanity.

What concerns me more is that, for that brief moment when I first sat in a taxi, I was more concerned about me and me being late for work, and thus was prepared to abandon that old man and attempt to pass the responsibility onto someone else.  That does really worry me.

Are we slowing becoming an uncaring, selfish society - or are we nearly there already?  What do you think?

Ann :o[

Thursday 11 November 2010

I am Dementia (Part Two).

Look at You!

Look at you!
I used to love you!
You loved and guided me
Through my childhood.
Ooh! That warm embrace,
The hug of hugs
That made wrong things right!

A hug:
A mothers elastoplast on
The wounds of life.
What skills you had!
A child cherished,
Wrapped in the comfort of
Unconditional love!

You gave me
All of you -
I took, but hope to God
I gave back.
I think I did.
I hope I did!

The pinny!
The cooking lessons!
Dusty flour on
My face (my nose!) and scuffed on
Everywhere imaginable!
That was life then
And girls were girls!

But life moves on
And things change.
You have changed
And no longer
Offer me hugs.

You are an empty shell!

I do not know you!
Who are you?
You have taken up residence
In my mothers body
But I don't know who
You are!

I hate you
For taking her away from me!
I hate you
For saying
"Look!, this is who she was
But I own her now!"
As you thrust
That empty shell
Of (who was) my mother
In my face!

Look at you!
You were my mother.
I idolised you!
But not now!
I no longer love you
And wish you would go

It is
So difficult
To gaze on someone
You loved so unconditionally
Who still lives
But no longer


Thursday 4 November 2010

I am Dementia!

I am Dementia.
 I am not selective
When choosing my victims:
Doctors and nurses,
Politicians and plumbers,
The good and the bad,
The majestic or mediocre
Of intellect;
I welcome all to my world.

I slip quietly into your mind
(While you are not looking)
And slowly wreak havoc there.
My hallmarks of amyloid plaques and
Neurofibrillary tangles;
Multiple vascular lesions
Or abnormal proteinaceous
Cytoplasmic inclusions
Is all evidence of me!

Initially, you will not know I am there!
Then an odd thing forgotten
That should be remembered
Is dismissed as part of natural aging;
It happens again and again
And doubts are sown in your mind
That perhaps all is not well;
Or maybe you forget that you have
And unknowingly
Begin to walk down the path of
My journey
That I have gifted to you.

The form of dementia
I have gifted to you
Decides what happens

Failure of higher cognitive
Memory decline and
Difficulties in judgement;
Problems in spatial awareness:
Funny little thing that you are -
You even get lost in conversation;
You are losing everything that
Defines you as you
And you give all of your self to me!

Depressed or agitated,
Apathetic or aggressive,
Or just plain psychotic;
We shall see - for it is my decision!
Disinhibited (you take all your clothes off!)
As you wander aimlessly
In that private, terrifying world
You inhabit
That really belongs to me!

As you progress on your journey
Towards total loss of identity,
My ownership of you
Now extends to your family as
They are caught in the terror
Of my destruction of you.
You are strangers to each other
And they mourn their loss
While you still live and breathe.

You become a burden on society
And you are hidden away.
Friends have long ceased to visit
And your family feel guilty as
They can no longer cope with
This unbidden stranger.
You are not you!

I love the smug indifference of some
Who think they are immune to my grip.
To all -
Including some in the medical
And nursing professions,
Who presume that they are
Somehow excluded from my touch
And view my victims
With disdain -
I ask you to consider
That in time
I may select


Wednesday 3 November 2010

Bringing up Baby

In years gone by, it was well recognised that women were weak, fragile, muddle headed little things who were unable to cope with the stresses of motherhood; thus requiring 'liquid' crutches. :o]    Manufacturers of said liquid crutches were quite blatant in addressing women's frailties.  :o]

I just love the honesty in that "Mother's NERVES can ruin a child" in this advert from Wincarnis.  How true! :o]

Toothache could be fun.....

....but teething was better!  Mrs. Winslow's Soothing Syrup for "children teething" contained 65mg of morphine per fluid ounce!

Coca had been removed from coca cola and mum ensured junior drunk as much as possible from an early age, as the soda content ensured a well rounded, socially acceptable child.

Lard ensured the happiness of the entire family - yummy I love lard!  Not really!

And dear doc endorsed "Luckies" as they were less irritating!

Haven' t times changed?

Anna :o]

Sunday 31 October 2010

The CQC: death, gender, disability, mental health, religion and sexual identity.

The CQC is a giant spider that has been directed to spin its web over the former Health Care Commission and the Commission for Social Care Inspection (CSCI).  It is not mature enough to deal with the massive task that it is expected to undertake, nor does in have the spider power to fulfil its required tasks.  It makes mistakes!  Its intricate web is full of holes.  It has become a predator that eats itself!

It does however, have the ability to write great paper work!  Although I realise that its territory is now wider than 'starring' nursing  homes (which it doesn't do anymore and there is nothing yet in place to replace it!) - it does write a pretty mean 'Statutary notification' of death, that covers both hospital environments and care home settings.

This is (or was) was going to be it (the viewing of the document) - but now it aint!  Although I can recover the document on my personal site as I have saved it - it now shows 'error on the page' if I write the URL here!  So much for the CQC!  I have re-entered the CQC site and can no longer find this document!

Breaking it down on my print out (lucky I did this!), Sections 1-3 relate to location,  person and circumstances of death and are mandatory.   Section 4 asks for details of  the last person involved in providing care - but it is not mandatory.  Why not?  Sections 5-9 relate to medicines and medical devices and possible errors that could have caused death - yet are still not mandatory.  Why?  If we are going to have all this paperwork - it has to mean something.  It must have a purpose.  If not, why the need for it?

Section 10 deals with gender, ethnicity, disability, mental health, religion and sexual identity - again not mandatory but...why O why does it matter?    It is requested that non-mandatory information be provided.

If Mrs. Miggins was a white, Irish, disabled Zoroastrian with mental health issues relating to her doubts over her sexual identity - why does it matter?  She is dead!  Who will collate this unnecessary information?  What purpose does it serve? 

Please tell me - for I do not know!

Anna :o[  ???

Thursday 28 October 2010

29/10/10 is 'Wear it Pink Today!'

October is Breast Awareness Month.

One of the tiny little problems of being a nurse is that some folk think you have the knowledge base of a doctor - which of course you don't!

They will show you lumps and bumps and ask your opinion - or ask you this and that and expect an answer.  I can't give them one and suggest they see their doctor.  I have often been asked about mammograms and until earlier this year - would always suggest it made good sense to go ahead.

I have had one myself which proves I am ancient!  Of late, I have been swayed by medical opinion that it is perhaps not a good idea.  Or is it?

October is Breast Cancer Awareness Month.  Astra Zenaca, who manufacture Arimidex and Tamoxifen, founded the Awareness Month in 1995, its aim being to promote mammograms as the most effective weapon in detecting breast cancer.

Is this Big Pharma serving their best interests, directing medical care or just a nice thing to do; maybe the latter?

Although hearing similar stories last year, the seeds of doubt were sown in my mind in January, when I read reports such as this in The Telegraph.  It suggested that, despite a reported 1,400 lives saved per year - there is no evidence that the breast screening programme has saved lives and in fact, women have wrongly been told that they have breast cancer and undergo unnecessary surgery on tumours that would not progress to being harmful.

This article was based on this at the Nordic Cochrane Centre and was swiftly refuted by NHS choices who claimed that the research was a narrative review critiquing the 2008 Annual Review of the NHS Breast Screening Programme (NHS BSP), which reported on twenty years of mammogram screening in the UK.  See here for further details.

In March this year this article appeared in The Telegraph stating that two lives are saved 'for every woman unnecessarily treated'.  It is interesting reading.  It is admitted here that leaflets supplied did not inform of potential risks of screening.

Adverse effects of mammographic breast screening include:

Psychological and physical morbidity - mainly associated with false-positives.

False negatives - approximately 5% of cancers in women over the age of fifty are mammographically invisible.

A diagnosis of cancer that would not have become symptomatic during a woman's lifetime.

Radiation risk - an estimate that one extra breast cancer develops every year in women over fifty, after a latent period of up to ten years, for each million women screened.

There is undoubtedly harm related to breast screening - but there must be some good!?  A detection rate of 6.2 cancers - although some would be of the 'no harm' kind (?) - per 1000 women screened; of these, invasive cancers accounted for 1.4 per 1000.  This reported 1.4 - to me - suggests the risk is worthwhile?  However, if you visit NNT it seems that breast screening is a harmful waste of time.

Furthermore, regular self-examination is a waste of time too!  See here!

There is so much conflicting information, I am left a little confused!  I think I shall probably attend my next, unless something more robust convinces me otherwise.  I will still recommend that other women do too.  But should I?  Should I say - "Look at the evidence and make your own decision"?

What are your thoughts?

Anna :o]

PS We must (as girlies) take some responsibility for our health!  Poor diet, obesity and binge drinking may lead to breast cancer!

Thursday 21 October 2010

Good Old Copperfield!

"Life Is Not A Bed Of Roses"  or
"Living With Dementia".

Good Old Copperfield!  I love this blog in Pulse!  These two GPs always offer a wonderful insight into the joys and woes of their world.

Take a look at this weeks article "What, if not antipsychotics?"  It is pure truth and I love them for it!

The majority of people I am proud to care for have some form of dementia.  We are strange in our home for we regard the residents as our employers - we work for them!

Living with dementia is not a bed of roses; it is not two sweet little old ladies enjoying tea and scones and a confused chat - although it can be for a lucky few.  Some residents are lucky in that they are totally apathetic and appear to suffer no emotional harm.  But perhaps they do in the quiet strange place in which they dwell - I don't know.

Living with dementia is about existing in a frightening, alien world where even you closest family will eventually become strangers.  For some - it must be akin to being in a permanent drunken stupor where you touch, feel and attempt to understand and make sense of  all that is around you - but you can't.

It is about Annie, who, when waking in the morning finds herself in a strange room and she is frightened!  Strangers enter her room and talk to her - but she doesn't understand what they are saying.  They continue talking as they help her from her bed and begin to undress her and prepare her for her day.   But she screams "Police!  Police!" and kicks and bites and punches, for she fears she is being raped.

It is about Jim - who despite family fears that it would be harmful - has been told that he has dementia by his psychogeriatrician, for he believes that Jim has a right to know and it is in Jim's best interests.  What about Jim's right not to know?  Jim is angry, agitated, anxious and so very afraid.  He is tormented and his family can no longer cope with the stress that caring for Jim brings.

He has entered nursing care much earlier than would perhaps have been required if he had not known.  He is resentful and insulted by required, personal interventions and reacts with extreme violence.  He sleeps little and wanders the home, entering others bedrooms as he searches for his wife.  He requires 1-1 observations through the night as he is a danger to himself and others.

After other meds have been tried and have not alleviated his distress - he is prescribed antipsychotics and after a while he is calmer, but still a little troubled.  He now eats and joins in activities and sleeps.  His life has regained a certain quality.

It is about Betty who is a long term resident.  She has in her time, worked as a barmaid and a carer.  When she first arrived she would attempt  (as if driven by routine) to tidy the home - clearing away plates and cups before residents had finished their meals.  These residents reacted in anger and sometimes physical conflict ensued - for social inhibitions often fly away when you have dementia.  She attempted to 'go home' with staff - thinking she had finished her shift - and when she couldn't, would erupt into violent behaviour.  She was prescribed antipsychotics and calmed and regained a certain quality to her life.

They were taken away from her earlier this year, following the DOHs insistence that side effects outweighed benefits with regards to the elderly.  She is now again that poor, mad, tormented and very distressed soul; she wanders the home, interfering with others and invading their space.  They slap her and she slaps back.
We fill in Safeguarding Vulnerable Adults forms for all involved and send them off to the powers that be and all is tickety-boo!  But who is the vulnerable adult here?  Betty who is now permanently tormented to meet DOH directives or the poor souls whose space she persistently invades?

Given the choice - I would rather live five years of a drug-induced calm - where my life had a level of quality than seven years existing in a permanent, living hell on earth.

I agree with Copperfield in that it is socially unacceptable to allow the elderly to suffer in torment.  Why do we allow it?


Saturday 16 October 2010

Isn't Technology Wonderful?

Microsoft's SenseCam
Please visit Time magazines photogallery re "A Simple Camera Helps an Amnesiac".

Also when there, click onto Claire's story.

As no doubt you realise - I love Time magazine!  I love the little snippets of information it gives as well as a wider view of all that is happening in the world around us and often above us.

I love the way it plops through my letterbox on a Saturday morning as if in an invitation to share its knowledge within.

Anna :o]

Saturday 9 October 2010

A 1,000 Registered Managers are Missing From Care Homes!

I have just read this in Nursing 
It states that registered managers are missing from 1,000 care homes.  I can understand this as you must be a masochist to take on this momentous task.

No longer are care managers able to operate hands on care - for they are bogged now with mandatory paperwork!  Duplication is the name of the game!  Local authorities now demand  the same paperwork (if not more) than the CQC and do their own inspections.

This must be in place and that must be in place for innumerable agencies!  Risk assessments are there for everything, including possible toxic vapours from photocopiers!

Local authorities now demand their own induction for new starters!  Managers must now sign off over a hundred and twenty questions relating to the care that new carers and nurses provide.  Nurses must now state on Mar Charts why they administer analgesia, anti-emetics, meds for constipation and creams!  I don't know - why do we?

There are so many mandatory training requirements - that you need to employ more staff than the home needs - purely to cover staff that are attending training.  Staff are so dazed with all these training requirements that they cease to listen - they are tired of it!  I am!  I truly believe that repetitive training videos are a sure fire cure for insomnia - as I certainly fight sleep!  Doctors - pick up on this!

Employment laws now mean that carers or nurses who don't care, can no longer have their employment terminated - unless gross misconduct is involved.  Their rights are paramount and stuff the residents!  I would think that a caring attitude is essential in these roles - but not so!

It is well recognised that some of those newly pregnant seek out roles in care.  They declare their pregnancy not long after starting and the law entitles them to 'soft options' and their fellow carers have to take the brunt of this.  There is also a knock-on effect to the level of caring offered to the residents.

On top of this, there is the antagonistic approach of some GPs - but after reading an article in Pulse - I understand this a bit more and will write about it later.  GPs - talk to us as we do not realise that care homes put pressure on your practice!

If care homes are breaking the law by not having registered managers in the home, what are the CQC going to do about it?  Provide saints or people teetering on the edge of insanity to fill the posts?  At present - you have to be one or the other!

Care of residents will suffer.  It is inevitable.  Managers cannot manage a home if they are swamped in paperwork!

Anna :o[

Friday 8 October 2010

"For the Beauty of the Earth"

Time magazine photo gallery.

Please visit Time magazines photo gallery of newly discovered species in Papua, New Guinea.  Truly beautiful!

As an aside,  the title of the post "For the Beauty of the Earth" is a hymn written by Folliot S. Pierpoint (1835-1917).  Wiki reports that he wrote the hymn while "mesmerised by the beauty of the countryside that surrounded him".  I know the feeling!  And No, I am not trying to sell religion as I am an atheist!

One day, while still at junior school, a worrying rumour spread like wildfire round the school, in that, the following day (at noon) would be the end of the world!  The earth would be enveloped in catastrophic tidal waves and life would cease to exist!  Worried kids sought comfort and explanations from teachers and parents - but did not believe what we were told.

The Armageddon morning, in assembly, we sang "For the Beauty of the Earth" for the first time; the hymn being hauntingly beautiful and the tune a little melancholy - which was certain proof (to us) that indeed, the end of the world was nigh!

I lived by the South Coast then, and the school dining room had one very large wall which was made entirely of glass.  We kids on first sitting cringed in fear as we stared at the panoramic window, waiting for the tidal wave to envelop us all.  Never happened of course and I can't remember whether the dinner was good that day!

But I have always remembered the hymn and therefore the memory of that day.  Have you any interesting Armageddon stories?

Possibly interesting: "Dear God!  Man!" is an anagram of Armageddon.

Anna :o]

Thursday 7 October 2010

A Nice U-turn by NICE.

Will our elderly and vulnerable be respected and given the drug treatment they deserve?

Thousands of patients with early stage Alzheimer's could now benefit from drug treatment following a U-turn by The National Institute for Health and Clinical Excellence (NICE).  Presently, doctors are unable to prescribe donepezil, rivastigimine and galantamine to early stage patients to enable them to retain their mental faculties longer.

In 2005, NICE ruled that no Alzheimer sufferer should receive these drugs on the NHS (based on efficacy of treatment and value for money), and they then conceded in 2007 that only patients with moderate disease should receive them.

However, the decision was contested by drug companies and the Alzheimer's Society who queried the 'secret formula' used by NICE to calculate value for money.  The case went to the House of Lords and the secret formula was amended after NICE conceded technical inaccuracies.  This did not lead to a change in outcome.

Further campaigning by doctors, patients, families and the Alzheimer's Society has led to the new guidelines and recommendations.

NICE has also ruled that a fourth drug Ebixa should be made available for those with severe forms of Alzheimer's and for some with moderate disease.

It does appear to be good news!  In fact, brilliant news!

Anna G :o]

PS  For those of you who doubt the integrity of drug companies - you might find this interesting  which I stumbled across while researching.