Health

Put the Paracetamol DOWN!!

I am still getting a worrying number of people coming to this blog trying to find out how many tablets of paracetamol one would need to swallow in order to overdose.

The answer is that it varies from person to person and depends on a lot of things including your physical state of health, your size and your weight.

Again, I stress if you are feeling suicidal the please talk to a doctor, counsellor or someone else.  Being suicidal doesn’t always result in having to be “sectioned” and talking can help you to get out of that dark place.  If you feel you may have accidentally taken a paracetamol overdose then call your GP or NHS Direct (or NHS 24 in Scotland) to seek professional advice on the matter).

For those planning suicide by a paracetamol overdose then remember it is not quick and it is not painless.   You often die days, weeks, months or even years after the overdose by which time you will almost certainly have changed your mind on dying.  Ironically, given that paracetamol is an analgesic, it can be quite a painful death also.

That’s been another public service broadcast from Ramblings of a Scottish Student.

Health

Schizophrenia and Bipolar Disorder genetically linked

I read an interesting article in the paper at Lunchtime.  The Independent was carrying the headline Unlocked: the secrets of schizophrenia on the front page.

The article detailed the findings of a recent report which suggests that there is a “…remarkable similarity between the genetic faults behind both schizophrenia and manic depression…”  Up until now the two conditions have thought not to be related, but now these findings could lead to new treatments for both conditions.

The “new research shows for the first time that both have a common genetic basis that leads people to develop one or other of the two illnesses.”

Thomas Insel, director of the US National Institute for Mental Health in Bethesda, Maryland, which part-funded the studies said “If some of the same genetic risks underlie schizophrenia and bipolar disorder, perhaps these disorders originate from some common vulnerability in brain development… Of course the big question then is how some people develop schizophrenia and others develop bipolar disorder.”

The full article in the Independent can be read here.

This is some really exciting research in the field of Psychiatry that could revolutionise the way doctors treat both Bipolar Disorder and Schizophrenia, both of which are psychiatric conditions that can ruin the life of those suffering from the conditions.

Health, Religion

Is it right to mix religion and healthcare?

The BBC are asking whether it is right to mix religion and healthcare.  It comes off the back of a story detailing how doctors are demanding that NHS staff be given a right to discuss spiritual issues with patients as well as being allowed to offer to pray for them.

For those who have faith and a religion the spiritual aspect to their life can almost be as important as taking the medication and treatment provided by doctors.  However, should doctors and nurses be involved in that spiritual side?  I’d suggest not.  The chaplaincy systems operated within the NHS are where the spiritual aspect of getting better are rightly concentrated.  Having priests, ministers, pastors, imams (or whatever they are called by the patient) available to come and pray for/with, meditate and talk with patients is a very good idea and can be of great comfort to the patient.  I know that when I was in hospital recently that the visits made by a few of the church elders and one of the pastors was very comforting and helpful.

Doctors, nurses and church leaders are all specialist in their own areas and as such should be left to do the job that they do.  I don’t know about other faiths, but certainly in Christianity one does not choose to become a church leader, but rather is called to be one.  They are specially chosen by God to do the job that they do and this makes them much better equipped to do the job.

I remember reading a story in a book where a junior doctor was telling about the time when he called a priest in for a dying patient who was all on his own.  The patient had indicated in their patient records that they were a catholic.  The patient died that night, but he did not die alone.  The priest sat with him until the end, praying for him and such like.  No doctor or nurse could act in this way – the just don’t have the time!

What I am trying to say is that faith has a place in medicine for those who believe in a God, but to mix them together is not the best idea in the world.  The doctor-patient relationship works because of the distance between doctor and patient, yes there may be a relationship and/or rapport built up over a long period of time, but it is quite different to the sort of relationship you start entering into with prayer.  Prayer is deeply spiritual and I think that the spiritual bond created between doctor and patient were a doctor to pray with a patient would be counter-productive.

Does anyone have any thoughts or opinions?

Health, Personal

Diagnosis

I do apologise for my abrupt and recent absence.  I collapsed on the bus on my way to work on Tuesday morning and have been in hospital.  The good news is that they now know what is wrong with me.  I have been diagnosed with Pseudoseizures (also known as Non-Epileptic Attack Disorder).

Now out of hospital and taking a few days to get back into the swing of things!

Health, Human Rights

Care of the Elderly

I watched Panorama last night which featured an investigation into the care being provided by “care” companies in the homes of elderly people and I was speechless at what I was watching.

This is not the first time that panorama has went undercover in the “care” industry; in the past they have focused on “care” homes.  The problems exposed last night in the programme appear to be endemic across the country and throughout the industry.  This is deeply concerning.

Care plans, which are legal documents and vital to ensure that the person being cared for receives the right care at the right time were missing, incomplete or out-of-date (on some occasions by up to two years).  Details of medication that should be getting taken and when it should be getting taken was not there, including medication such as insulin.  The copies of the care plans which were supposed to be kept at the company’s headquarters were found lying around in cars – and one employee even admitted to throwing information as important and confidential as this out.

People’s visits were getting cut short to the point where no care at all could be administered or were being missed altogether.  This resulted in people lying in their own excrement and urine.

The programme told of a Scottish local authority opening up the bid for a contract to a reverse auction.  Which resulted in a company who was clearly unfit to carry out the standard of care required being awarded a care contract worth more than £2m per year.

I am absolutely disgusted at this and it terrifies me to think that while I sit here typing this blog entry that people are in this situation.  This is abuse and it has to stop.

If you didn’t see the programme it is available on BBC iPlayer for seven days from the date it was broadcast.  The programme was originally broadcast at 21:00 on Thursday 9 April 2009.

Counselling Experiences, Health

Is a paracetamol overdose quick?

In response to the worryingly high number of hits I get from the search terms “is a Paracetamol overdose quick” I thought that I would answer this question in a full blog entry.

The short answer to that question is that where death does occur it is not quick and it can be painful.

The recommended adult single dose of paracetamol is two standard 500 mg tablets. Research shows that the common threshold for liver damage to occur from a single paracetamol overdose is 15g (30 tablets) although standard hospital guidelines allow an extra safety margin and assume liver damage could occur at a single overdose of 24 standard tablets or 150 mg/kg body weight, whichever is the smaller.

The overdose threshold may be lowered in a person taking certain prescription medicines, or a person who is an alcoholic or is seriously undernourished. If the overdose is spread over a period of time the threshold may be higher, as the initial paracetamol dose is effectively metabolised. (The recommended maximum dose in a 24 hour period is 4g or 8 tablets).

There are often no symptoms in the first 24 hours following overdose, although there may be mild nausea and vomiting. In a large overdose liver function deteriorates leading to jaundice, confusion, and loss of consciousness. Death is rare but when it occurs it is due to liver failure.

Treatment of a serious paracetamol overdose is mainly by administration of an antidote which can prevent the toxic effects of the overdose. This must be done early, ideally within 12 hours of the overdose although it can still be beneficial up to 24 hours or even later.

Treatment must be supervised in a hospital. It is important that if a paracetamol overdose is suspected, hospital treatment is sought without delay.

In England and Wales on average approximately 130 deaths per year can be directly attributed to paracetamol alone. In the vast majority of these cases the overdose is deliberate, and these deaths are returned as certain or probable suicides. In a small number of cases the overdose was intentional but the individual’s expectation was not to cause death. Such deaths may be recorded as accidental.

Health, Personal

The Unhappy Triad

The unhappy triad is an injury mostly associated with contact sports such as American Football and Rugby.  However, it is the latest diagnoses that has been attached to my damaged knee, this time following a comprehensive examination by a very highly qualified physiotherapist.

Essentially, what this means is that when I fell on the ice I have torn my anterior cruciate ligament (ACL), medial meniscus cartilage and medial collateral ligament (MCL).  If this diagnosis is correct (which it probably is as all the symptoms match what I am currently experiencing) then when I pay a visit to the surgeons on 16 April I will undoubtedly be told that I’ll need surgery and the recovery time could be up to 12 months!  Which is fantastic when I take into consideration that my work is already trying to discipline me for my “unacceptable level of attendance” following my recent absence due to my knee (which was almost 3 weeks in total).

A tear to the ACL leaves the knee unstable.  Without the ACL the knee looses its ability to maintain normal function, and causes episodes of buckling (something which I have experienced quite a bit since the accident).

The Meniscus cartilage provides a cushion and reduces friction and stresses on the bones.  It can cause swelling, pain and popping or catching sensations in the knee (again, something I’ve experienced quite a lot of since the accident).

The MCL provides some stability to the knee joint.  An MCL injury produces pain, some instability, decreased range of motion and swelling (again, all things I have experienced since slipping and falling awkwardly on the ice).

So, from that information it looks highly likely that this is what I have done to my knee and was not the news I wanted to hear.  I’m still living in hope that this is not the case.  Oh yeah, and despite being told repetedly by various healthcare professionals that I need crutches, I have been unable to get a set!

Health, Human Rights, Legal System, Scots Law

Advanced Directives

Yesterday my mum was picking my legal brain on the issue of Advanced Directives (living wills) and it has spurred this post.  In this post I will briefly explore the legal minefield of Advanced Directives.

What is an Advanced Directive?

An Advance Directive (AD) is a document that relates to the medical treatment you would or would not wish to receive, should you become seriously ill and were unable to state your wishes for yourself.

The Advance Directive is particularly relevant where degenerative diseases are concerned. For instance, if you developed cancer you may not wish to undergo chemotherapy even if it would prolong your life. On the other hand, you may wish to be provided with more effective pain relief, even if this would have the consequence of shortening your life.

The Legal Minefield

Readers south of the border who are familiar with ADs and English Law will not see any legal minefield existing today thanks to the Mental Capacity Act 2005.  However, the law in Scotland surrounding ADs is a lot less settled.

The Scottish Executive omitted any reference to ADs in the Bill that later went on to become Adults with Incapacity (Scotland) Act 2000 on the view that the proposals did not command sufficiently general support and that “attempts to legislate in this area will not adequately cover all situations which might arise, and could produce unintended and undesirable results”.

The issue again arose when the Mental Health (Scotland) Bill (now known as the Mental Health (Care and Treatment) (Scotland) Act 2003) was going through Parliament.  There was some passionate debate within the Parliament chamber.

It is largely being left down to the common law to deal with this area, but the problem is cases are not reaching the courts in order for the courts to consider the issue and give rulings on it.  However, the Mental Health (Care and Treatment) (Scotland) Act 2003 provides statutory provisions on ADs relating to Mental Health.  It is likely that the Scottish Courts will adopt a similar approach to the issue to the law in England and Wales on the matter.

Even if an AD was held to be legally binding would it be binding in all circumstances or just when the circumstances relate directly to the terminal/degenerative condition?  For example, if the AD was one of non-recitation in the event of the patient’s heart stopping would this apply also where the patient’s heart stops because of a car accident or other unrelated medical problem?

The answer seems quite obvious in common sense, but in law there is no answer to that question.

Should ADs even be allowed to exist in the first place?  The European Convention on Human Rights and Fundamental Freedoms 1950 gives an explicit right to life, but can this right to life extend to the right to decide when your life ends (and this applys equally to the question of Euthanasia).  Does the right to a private and family life afforded by the same convention cover this choice as well?  So many questions that cannot adequatly be explored in what is fully intended to be a brief examination of the topic.

So, in Scotland the law is still quite confused and is a minefield.

Health, Random

Blood and Guts

I’ve been unable to sleep tonight, so I decided to have a look at what was on BBC iPlayer.  I clicked onto BBC Four and have just enjoyed 90 minutes of interesting programming.  One programme, lasting an hour, in particular was one of the most remarkable and interesting television programmes that I have seen in quite sometime.

Blood and Guts:  A History of Surgery focused on the historical development of cardiac surgery which has resulted in us being able to perform complex operations in the most remarkable of circumstances.  I was amazed by just how far we have come in such a short time in the ability to perform complex cardiac surgery.  I was not aware that cardiac surgery was such a recent medical achievement.  I had just assumed that it was a lot older given the history of other forms of surgery.

The programmed aired on Wednesday night and can be seen on BBC iPlayer for one week after it was originally aired.  I’d recommend it to anyone who can stomach it.  The next episode in the series will focus on transplants and I will be sure to watch it.  Fantastically interesting stuff!

The other programme I watched was Doctors to be:  20 years on:  The surgeon’s Tale.  This programme caught up with a consultant surgeon who the BBC had first met when he embarked upon his studies as a medical student.  It was an interesting 30 minutes watching his story as he worked his way up to the top of his chosen specialisation. Again, an interesting one to watch!

There is another programme on the BBC Four iPlayer site that I am keen to watch, and will do once I have had some sleep.  I am now starting to feel tired (not before time, I’ve been up for 18.5 hours having only had five hours sleep last night).  The programme is listed as Medical Mavericks:  Series 1:  Anaesthesia. The description on the BBC iPlayer website is as follows:

Dr Michael Mosley explores the ways in which pioneering doctors laid the foundations of modern medicine by experimenting on themselves. In charting the development of pain-free surgery, he starts with Humphrey Davy, who inhaled up to 50 pints of laughing gas a day and yet missed its true significance. Conman-turned-dentist Dr William Morton slept with a skeleton by night and experimented with ether by day, while James Young Simpson’s enthusiasm for chloroform led to many deaths.

Again, another truly interesting sounding programme!