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]