The Night Mail

[jamie92208]

2 hours ago, Erichill16 said:

Hmmmmmm…..

Been looking through SWMBO’s paperwork and recent card receipts and my requested ‘birthday surprise’ holiday in Switzerland is still to be arranged! Getting a bit late, perhaps another hint/reminder is in order!  

Sunday 15th September is the day in Basel. 

 

Jamie

[Northmoor]

36 minutes ago, iL Dottore said:

The experiences of @The White Rabbit, @polybear and @AndyID really, but really p*** me off. There is absolutely NO excuse for not listening to the concerns of the patient. Perhaps the concerns are unwarranted, but it is a doctor's job to also reassure his or her patients when their concern are unfounded (and explain why).  
 

In my view a good doctor takes his time and listens very carefully to his patient on what they are saying, how they are describing what they are experiencing and – sometimes more importantly – what they are not saying!
 

I know quite a few excellent clinicians who worked in the NHS who left because of their frustrations with the NHS (amongst which  was its seeming inability to provide timely diagnostic intervention for patients). I have also met more of my fair share of arrogant NHS doctors who were complete and utter t0ssers.
 

I interviewed a number of these types when they applied for a job with the large Pharma  company I used to work for. Needless to say, they didn't make it past my interview (or get the job)

When our first was born, an extended labour (probably due to lack of maternity staff that afternoon) lad to problems that led to his first ten days being in the SCBU.  The senior pediatric specialist would speak to us every day and the first thing he would ask was, "How does he seem to you today? What have you noticed?".  Only then did he talk about what he believed might be the diagnosis, and how our observations aligned with his own.  He must have been good as he looked after at least one of HRH Earl and Countess of Wessex's children after birth complications.

 

This contrasts with the doctors who failed to diagnose my FiL's cancer - or seemingly even run the tests for it - until six months later, by which time it was well beyond being operable and he spent much of his last weeks doubled over in constant pain.

[J. S. Bach]

Night Owl from the Piedmont.

[AndyID]

3 hours ago, iL Dottore said:

The experiences of @The White Rabbit, @polybear and @AndyID really, but really p*** me off. There is absolutely NO excuse for not listening to the concerns of the patient. Perhaps the concerns are unwarranted, but it is a doctor's job to also reassure his or her patients when their concern are unfounded (and explain why).  
 

In my view a good doctor takes his time and listens very carefully to his patient on what they are saying, how they are describing what they are experiencing and – sometimes more importantly – what they are not saying!
 

I know quite a few excellent clinicians who worked in the NHS who left because of their frustrations with the NHS (amongst which  was its seeming inability to provide timely diagnostic intervention for patients). I have also met more of my fair share of arrogant NHS doctors who were complete and utter t0ssers.
 

I interviewed a number of these types when they applied for a job with the large Pharma  company I used to work for. Needless to say, they didn't make it past my interview (or get the job)

 

When we moved the the US we were a bit concerned about the quality of medical treatment we might receive here. I'm sure there's an element of luck involved based on location etc but we've lived in five US states over the years and we have no complaints at all, and that includes cancer treatment for both of us. What was particularly good was the speed of diagnosis and treatment. My recent little episode was a good example. As soon as they figured out what was going on I was operated on almost immediately.

 

[jjb1970]

My boss was in England a couple of weeks ago as his son has started working at a hospital on the south coast. A lot of doctors here go to the UK at the start of their careers as it's easy to get a job if you are a doctor and there's no language barriers for Singaporean people. Getting junior experience can be quite difficult in Singapore and even when they do they apparently miss some stuff so they like going overseas then returning home when they're in a position to work as a consultant or as a partner in a practice. He was horrified to see his first salary slip and the amount deducted, he asked me what is this 'national insurance ' thing, and what is this council tax thing. 

 

On the NHS the nearest I have come to popping my clogs is a botched appendectomy which was a comedy of errors. Even the first discharge letter was wrong and obviously just a standard template they issued without bothering to check if it was right. 

 

My father was told he had an ear infection when he had a brain tumour. In the end it was a neighbour who worked at the local hospital who decided it was nonsense and asked a specialist to have a look, who had him admitted to hospital immediately.  Earlier diagnosis wouldn't have altered the outcome but it doesn't instil confidence. My brother was told he had gout. Years later a new doctor diagnosed a damaged tendon, confirmed by medical investigation.  The hospital specialist opened that if diagnosed earlier it would have probably been quite straightforward to repair but there wasn't much he could do by the time he got involved.

 

So I am afraid I am not a cheerleader for the NHS.

[iL Dottore]

One of the numerous problems with the NHS is the obsession with “free at the point of care” - which leads to misuse of the system on one side and an “it’s free, what are you complaining about” attitude on the other.

 

Obviously, whilst you don’t want to have a system like in the US where although the standards of care and outcomes are impressively high, if you don’t have the right sort of insurance (and sometimes spare cash) you are totally FUBAR’d; you do want to have a system where immediacy of care, rapidity of diagnostics and outcomes are prioritised over it being “free at the point of use”.
 

A change of priorities that would certainly require both a big change in the NHS modus operandi (it is not unfair to claim that at present, the NHS is more reactive than proactive in terms of patient care) and a change in the way the system is funded.

 

If the British public decides (and any change of such magnitude to the NHS should be proceeded with after extensive consultation with the public as well as the usual professional bodies) that it should be paid through taxation as opposed to through a Mutuelle or Krankenkasse, then it should be through a specific tax levied just to pay for the NHS and social care and ring fenced, by law, against its use by the Treasury and politicians for any transient political whim.

 

Some of the posters on TNM have indicated that if they were not happy with the care and attention they get from the NHS, they would go private and be seen promptly (and often with better care and outcomes). But I wonder, has anyone really thought about why this is so?  I would argue that there are two principal reasons: firstly, less pointless bureaucracy (I recently reviewed a 10 page document from an NHS trust concerning standard of care for a medical procedure. Of these 10 pages , 2 pages were dedicated to the procedure and the remaining pages dedicated to things like “awareness“, “impact” “inclusion” and other things which had minimal if any relevance to that particular medical procedure); and secondly, (as some have claimed) it is because there is a different perspective about giving out treatment and doing tests, for the NHS sending a person for an MRI is an expenditure. On the continent, as such things are done mostly by private companies, doing an MRI is considered as income.

 

Paradoxically, spending more money upfront on rapid diagnostics will save the NHS a hell of a lot of money in the long run. A good example would be that of the “well person colonoscopy” recommended by many medical bodies for the over 50s. Most of the time the colonoscopy will either reveal nothing or some polyps (which are biopsied and sent to a path lab to check if normal, pre-cancerous or malignant). Occasionally, the colonoscopy does reveal initial malignant changes in the wall of the colon (or the path lab report shows the polyps are malignant) which then leads to immediate intervention, usually a relatively simple and straightforward surgical procedure and possibly (depending on what is found), adjuvant, chemotherapy, or radiotherapy.
 

Fast, efficient and a lot less expensive than waiting until a patient has a distinct symptomatology and the colonoscopy (when eventually done on the NHS) shows extensive colon cancer, possibly with metastases elsewhere, leading to complicated surgery and a lot of post operative care, including chemotherapy, radiotherapy, targeted therapy and other interventions you need to do to take care of a patient with metastatic cancer. 
 

Outcomes? For the first approach the cure rate is incredibly high; for the second approach the cure rate (given that you have metastatic disease) is very low.

 

Financially? Overall, the first approach results in a considerably smaller total expenditure on the patient, than the second approach.

[iL Dottore]

4 hours ago, jjb1970 said:

My boss was in England a couple of weeks ago as his son has started working at a hospital on the south coast. A lot of doctors here go to the UK at the start of their careers as it's easy to get a job

The appeal to young doctors about working/training in the NHS, is that because there is such a huge demand for treatment and not enough specialists to meet that demand, a young doctor will get a hell of a lot of experience in a short period of time (the fact that English is now the language of science and medicine also plays a not inconsequential role).

Major London teaching hospitals, such as the Royal Free, Barts or Saint Thomas’ often see and treat in a week more patients with a certain condition than most regional hospitals (and many continental hospitals) will see in a year. And this is simply down to demographics.

 

For the young doctor in training, being able to do a large number of a certain type of surgery or see, diagnose and treat a certain condition in a short period of time allows them to get a high level of experience and expertise very quickly. I don’t know the statistics, but I do know that the Royal Free does more cabbages (CABG: coronary artery bypass graft) in a year than the University Hospital here does - again simply for demographic reasons.

 

Another appeal of training at a London Teaching hospital for a young doctor, from elsewhere, is because of London’s demographics and its ethnic make up, a doctor will see in a London teaching hospital rare and obscure conditions that he or she may never see in 10 years working elsewhere. 
 

Elephantiasis (lymphatic filariasis) is a good example: i’ve only seen one or two people with this condition and that was when I was on holiday in the Dominican Republic (people affected by this disease are very hard to miss); however, although very rare in the UK cases of elephantiasis (lymphatic filariasis) are not unknown in London.

 

Edited August 11 by iL Dottore
Grammar

[jamie92208]

The French health system is not perfect but seems to work pretty well.  It is centrally governed but top up insurance through a mutuelle is virtually universal but not actually compulsory.  We have to pay, or arrange to pay before every hospital appointment. It's €26.50 pervisit to see a GP.  However I can usually get an appointment the day I ring up. There are strains in the system. Rural GP's can be thin on the ground and there is a shortage of dentists.  

 

Jamie

[jjb1970]

A big attraction of the UK for Singaporeans is it is seen as a good 'western world for beginners' option.

 

They speak the language, drive on the left, the legal and administrative system is pretty much as the colonial regime created using British practice and there are still enduring cultural influences. 

 

It's the reciprocal of Singapore being a good 'Asia for beginners' destination for British people. I used to find it amusing that prior to 1997 when Hong Kong was still a British territory it always felt much more foreign and alien than Singapore despite Singapore being a Republic. 

Edited August 11 by jjb1970

[polybear]

1 hour ago, iL Dottore said:

Obviously, whilst you don’t want to have a system like in the US where although the standards of care and outcomes are impressively high, if you don’t have the right sort of insurance (and sometimes spare cash) you are totally FUBAR’d; you do want to have a system where immediacy of care, rapidity of diagnostics and outcomes are prioritised over it being “free at the point of use”.

 

What's the situation for those residents in the USA (so not Tourists etc.) who can't afford insurance etc.?  Are they totally shafted?

[polybear]

When Bear was suffering with the dreaded "Big H"** the GP quickly sent me for a Brain Scan - which was ok, fortunately.

After that?  He was totally lost, so did sweet F.A.  For over 3 months, despite continually being prompted by an increasingly more P.O. Bear. (as well as several Checkpoint Charlene's as well).

Eventually I decided enough was enough and got stroppy (in a polite way) with the Practice Manageress; I was seen that day by the Senior Partner who said "we'll do what we should've done 3 months ago and refer you.....".

 

And what did the Consultant do as soon as I had been referred?  Upper Body MRI plus Gastroscopy - the sort of tests where you really, really don't want them to find anything.....

 

Now if either of those tests had found anything (and in particular The Big C) then it would've had a least 4 months to carry on growing undetected....

Disillusioned?  Moi?

 

(**Intractable Hiccups, for those "not in the know".  On one particularly memorable day (and not unusual, either) it was 28/min x 60 x 18 - so 30K in 18 hours.....

 

Eventually a rather clever young-ish Neurologist from NZ sorted it; a precise cause couldn't be identified (summink to do with irritation of the Phrenic Nerve IIRC - which apparently comes in handy for doing useful things like controlling breathing, amongst others, meaning removal isn't an option) but he knew a sweetie** that (after much dosage experimentation) may well help.  It did - with 99.9% reliability as well.  I call that one of almost certainly the most MAHOOSIVE Tick I've ever accumulated.

 

**Normally prescribed for MS; the GP was very twitchy about dishing it out but a stroppy letter from the Consultant sorted that, which also mentioned that Bear was responsible for determining dosage as required, not the GP....

 

Edited August 11 by polybear

[Happy Hippo]

9 hours ago, jamie92208 said:

Sunday 15th September is the day in Basel. 

 

Jamie

Battle of Britain day...

 

Well, it used to be!

[polybear]

10 hours ago, Ozexpatriate said:

The motto is "Faster, Higher, Stronger – Together" - it's not about evening the playing field so everyone gets a better chance. 

 

 

What about "More Skilful"?

 

8 hours ago, Winslow Boy said:

It's Sedum or it was in my day. 

 

Bear's version is a lot easier to remember

 

4 hours ago, Hroth said:

I'm only here because I had an odd and disturbing dream about a curious restaurant.  Think I'll read a book until I doze off again....  🙂

 

 

The Chef wasn't a retired Doc by any chance?

 

56 minutes ago, iL Dottore said:

Tonight sees the closing ceremonies of the French Olympics. I cannot begin to contain my indifference!.

 

However, I might just tune in just to see what sort of “car crash TV“ spectacle they put on. It can’t be any weirder than their opening ceremony.

 

Or could it? 
 

 

The French Ollimpiks Boss was asked on Radio how successful he thought they'd been, on a scale of 1 to 10.

"15 - and go upwards from there....."

 

I guess he's forgetting the dodgy opening ceremony, the sh1tty water quality in the Seine, the....

 

41 minutes ago, jjb1970 said:

Funnily enough some of the events I enjoy if I do see them on a monitor are the newer ones like skateboarding. I have no idea what it's all about but I enjoy the combination of skill and nerve to do the crazy stuff.

 

👏

 

edit:  All of the above should be in ER'ers.  Oh Poo, I give up.....

[Northmoor]

Grumpy old man alert:

https://www.bbc.co.uk/news/articles/c5y83kj3wg2o

 

So now (some) people expect to be congratulated for being able to sit and stare out of a window for a few hours?  While it would come under their heading of "stimuation" I never found it difficult to pass the time on a long journey with a thing they're probably unaware of, called a book.

 

Muppets.  I thought the comments from the medical professionals to be very pertinent.

[The White Rabbit]

11 hours ago, Northmoor said:

...The senior pediatric specialist would speak to us every day and the first thing he would ask was, "How does he seem to you today? What have you noticed?".  Only then did he talk about what he believed might be the diagnosis, and how our observations aligned with his own.  ....

 

That sounds both very sensible from a medical perspective and a good way of maintaining doctor-patient trust/confidence. You are the one around all the time and most familiar with symptoms and behaviour, whether we're talking about yourself, a child, parent or even - down the vets - your pet. The [doctor]/vet is the one (hopefully anyway!) with the specialist knowledge but lacks the familiarity of the individual - what's good/bad, usual/not etc.. If you can both work together, hopefully the [doctor] can get a clear picture of what's going on and then look at options to take action. 

 

12 hours ago, iL Dottore said:

.... There is absolutely NO excuse for not listening to the concerns of the patient. Perhaps the concerns are unwarranted, but it is a doctor's job to also reassure his or her patients when their concern are unfounded (and explain why).  
 

In my view a good doctor takes his time and listens very carefully to his patient on what they are saying, how they are describing what they are experiencing and – sometimes more importantly – what they are not saying!  ... 

 

I wish we'd had someone with your approach deal with her case. Chances are we'd both still be here and in reasonable health... I know people can actually make themselves sick through worry. Some (justified) reassurance can do wonders for a patient's outlook, I suspect you'll have seen that yourself more than a few times. 

 

Your second paragraph sounds a bit like the skill of a good writer or film director - knowing how best to tell the story and from whose angle. And knowing what to leave out/to the reader's imagination is often harder than knowing what to include. 

 

 

I have posted previously on ERs about my own health problems - I'll not go on at length again now but sadly what I said in yesterday's post was not the only time the NHS has let my 'family circle' down. Partner, both parents, uncle and me - dead or disabled, all from things which should - according to official stats - be curable. Which is why I thoroughly agree about the desperate need for change and have followed Flavio's comments on ERs about alternate health care systems with interest. 

 

After the initial botch the NHS made of me I did try private medicine as @polybear mentions he'd try if it was necessary. One thing to mention - private healthcare does not cover all procedures. A consultant/specialist may help you negotiate the maze of the NHS but with some more specialist operations they either can't or won't handle these themselves in private hospitals, at least the regional ones. I wonder if you push hard enough they would find someone/somewhere in London or overseas who would - for a cost - do the necessary? 

 

One specific query for Night Mailers - is there a publicly available UK list of consultants by specialism indicating their expertise? The way for instance schools are rated by exam results? Come the autumn I will be looking for someone to have another go at improving things, so if there's such a source indicating who is brilliant/can work miracles (and preferably not too far away!) as opposed to the 'merely' competent, it would be very useful. 

[jjb1970]

17 minutes ago, Northmoor said:

Grumpy old man alert:

https://www.bbc.co.uk/news/articles/c5y83kj3wg2o

 

So now (some) people expect to be congratulated for being able to sit and stare out of a window for a few hours?  While it would come under their heading of "stimuation" I never found it difficult to pass the time on a long journey with a thing they're probably unaware of, called a book.

 

Muppets.  I thought the comments from the medical professionals to be very pertinent.

 

I like some music on my phone and some good books. Sitting staring at the seat ahead for 13 hours, eschewing sleep or any distractions, would strike me as a warning sign that someone might have psychological issues than something to admire or celebrate.

[jjb1970]

One of my weaknesses is Chinese cinema, admittedly it's not for everyone but I enjoy it. So one of the things I enjoy about Chinese airlines is the in-flight movies. Ditto Korean Airlines.

[Northmoor]

5 minutes ago, jjb1970 said:

One of my weaknesses is Chinese cinema, admittedly it's not for everyone but I enjoy it. So one of the things I enjoy about Chinese airlines is the in-flight movies. Ditto Korean Airlines.

My experience of China Southern Airlines just over 20 years ago was, err, "interesting" in what might be described as cultural differences.  My neighbour completed his in-light meal with a loud and rather odorous belch, while based on his actions (and those of about a quarter of the passengers), the Mandarin element of the safety video appeared to say, "Immediately upon landing, passengers are requested to unfasten their seatbelts, climb over the person next to them and remove all items from the overhead luggage compartments as quickly as possible.  Prizes will be awarded to the winners".

[polybear]

55 minutes ago, Northmoor said:

Grumpy old man alert:

https://www.bbc.co.uk/news/articles/c5y83kj3wg2o

 

So now (some) people expect to be congratulated for being able to sit and stare out of a window for a few hours?  While it would come under their heading of "stimuation" I never found it difficult to pass the time on a long journey with a thing they're probably unaware of, called a book.

 

Muppets.  I thought the comments from the medical professionals to be very pertinent.

 

If I were sat next to such a person I'd be worried.....

 

 

 

[jjb1970]

21 minutes ago, Northmoor said:

My experience of China Southern Airlines just over 20 years ago was, err, "interesting" in what might be described as cultural differences.  My neighbour completed his in-light meal with a loud and rather odorous belch, while based on his actions (and those of about a quarter of the passengers), the Mandarin element of the safety video appeared to say, "Immediately upon landing, passengers are requested to unfasten their seatbelts, climb over the person next to them and remove all items from the overhead luggage compartments as quickly as possible.  Prizes will be awarded to the winners".

 

Indonesia is like that too, also trying to drag ridiculous amounts of stuff into the cabin.

 

A few weeks ago I  flew Air China Frankfurt - Beijing and one of the flight attendants reminded me of YouTube Uncle Roger and his ex-wife Auntie Helen, it was comical and splendid entertainment. She was a product of the Air China cloning program (I.e stunning) but she seems to have missed the training day that addressed customer service......good fun though.

[iL Dottore]

17 minutes ago, The White Rabbit said:

That sounds both very sensible from a medical perspective and a good way of maintaining doctor-patient trust/confidence. You are the one around all the time and most familiar with symptoms and behaviour, whether we're talking about yourself, a child, parent or even - down the vets - your pet. The [doctor]/vet is the one (hopefully anyway!) with the specialist knowledge but lacks the familiarity of the individual - what's good/bad, usual/not etc.. If you can both work together, hopefully the [doctor] can get a clear picture of what's going on and then look at options to take action. 

Very wise words.

In maintaining a good patient-doctor relationship it’s also advisable to admit mistakes (we’re only human) explain why the mistake was made (“I’m sorry Mr PB that we didn’t catch this earlier, but the test results and your symptomatology were consistent with baked bean deprivation and not cake deprivation as the latest tests have shown”) and tell the patient what you will do to address the issue (“we will now put you on an ultra high cake intake diet to correct the deficiency” ). A study or two done in America (I think by an insurance company that specialises in malpractice insurance) found that doctors who were honest about mistakes and said they would correct them had happier patients and were less likely to be sued for malpractice – unlike those who admitted no mistake. An impressive finding when you consider that the US is the birthplace of the ambulance chasing lawyer.

28 minutes ago, The White Rabbit said:

One specific query for Night Mailers - is there a publicly available UK list of consultants by specialism indicating their expertise? The way for instance schools are rated by exam results? Come the autumn I will be looking for someone to have another go at improving things, so if there's such a source indicating who is brilliant/can work miracles (and preferably not too far away!) as opposed to the 'merely' competent, it would be very useful. 

Let me see what I can find (although it might be few days) Obviously, specialist medical societies – such as ASCO (American Society for Clinical Oncology) - will have a list of its members and their specialties. How accessible these lists are varies from society to society, knowing what specialty is most suitable for dealing with what ails you is the first step and then you drill down from there.

 

Assessing the competence and ability of a clinician is a very complex process with many pitfalls. When we are setting up a clinical trial, a clinician’s CV is always demanded and reviewed. We don’t really look at where they went to medical school, let alone look at their exam results (although if their CV indicates they got their medical degree at the Poly Bear School of Medicine and Pizza Making this would warrant some deeper investigation) more important are the number of publications they have authored (as primary author or as co-author), the number of clinical trials they have been involved in and what sort of of professional societies and various working groups they are involved in. Anyone who is on a working group (or is chairing a working group) that sets the gold standard for certain treatments or the management of a specific disease is clearly going to be someone who knows what the hell he/she is doing. However, all this applies to academic medicine, but can be helpful outside of the academic environment.

 

A few words about “Health Tourism” it is big business and mostly – but not always – involves going from a high medical cost country to a low medical cost country. A lot depends on what needs to be treated. There have been more than a few stories published in the press about people from the UK travelling to the US to get specialised treatment for their child that is not available on the NHS (or elsewhere in the world, for that matter).  But most “health tourists” head east for their treatment. This company deals with “medical tourism” and some of the prices (and especially some of the locations chosen) are quite interesting indeed https://medigence.com/hospitals/orthopedics/total-knee-replacement-ul/switzerland

 

Surprisingly, Switzerland gets a share of health tourists - often people coming to take advantage of the superb orthopaedic surgery available in Switzerland (orthopaedic surgeons in training in Switzerland have plenty, and I mean plenty of opportunities to practice and refine their skills with the constant and abundant supply of winter sports enthusiasts who regularly underestimate their abilities as sportsmen and women*). The orthopaedic surgical practice that installed my prostheses are also the orthopaedic surgeons that take care of the local football club players, and when a football club entrusts a multi million pound player into the care of an orthopaedic surgeon, you know that surgeon will be top notch! 

 

There are many private hospitals and clinics scattered around the world that are attached to well-regarded teaching hospitals** and staffed by English speaking clinicians, nurses and medical technicians and can offer state of the art medical interventions with excellent outcomes. However, like with setting up a clinical trial, you have to do your homework. Some of these private hospitals and clinics will offer treatment packages that include flights, accommodation for one or two relatives, as well as the desired medical care for the patient. 
 

Even going to a fairly low medical cost country on a “medical package tour“ (for want of a better term) will not be inexpensive. However, the advantage will be that whatever the medical intervention is needed ir will take place earlier rather than later when that medical condition is still (probably) treatable with potentially very good outcomes (although, of course, this various and patient to patient and medical situation to medical situation).
 

* the huge number of sporting orthopaedic injuries treated in Switzerland, every year does mean that very rare injuries – such as a spiral greenstick fracture of the tibia: are seen and are treated much more frequently than elsewhere.

** for some teaching hospitals in “low medical cast“ countries, having a private clinic is definitely a win-win situation; they treat patients who need treatment and are willing to pay for it, whilst at the same time generating an income that can be used to support the poorer patients that they see in their teaching hospital.

[iL Dottore]

28 minutes ago, polybear said:

 

If I were sat next to such a person I'd be worried.....

Especially if they’re muttering to themselves and invoking the name of a deity, politician or “influencer”…

[PhilJ W]

My GP is pretty good and is very thorough but what he lacks is a bedside manner. For example he won't give test results he will just say that it's ok without any details. I'm aware that some patients would rather not know but I'm not one of them. By contrast when I went to the Hospital to see the Urologist a few months ago he asked me what my last PSA test and I replied that I had no idea, He then asked me who my GP was and when I said Dr.C****** he said that explains it and looked it up on the computer. I might add that the urologist explained the procedure (an endoscopy) and what he found (an enlarged and vascular prostate) and reassured me that there was no indication of cancer. Incidentally my GP who must be approaching 70 is about to retire or is retired as for the last six months I have been dealt with by a new doctor, young, female but only there Thursdays and Fridays.

[jjb1970]

3 minutes ago, iL Dottore said:

Especially if they’re muttering to themselves and invoking the name of a deity, politician or “influencer”…

 

It's if they're clutching a copy of the LNER Society Journal that I'd very slowly walk away, avoiding eye contact and disembark.

[iL Dottore]

1 hour ago, The White Rabbit said:

I know people can actually make themselves sick through worry….

This has only happened to me once, and I wasn’t worrying about myself. Normally, I am very sanguine about what ails me, Mrs iD and the doggies, despite knowing far too well what the possibilities could be, what are the treatments involved, and what the outcomes are likely to be. What has happened has happened and will happen cannot be changed as biology is, well, biology. Schotty has occasional bouts of faecal incontinence and – I think - is now slightly demented; whilst Lucy has episodes of diarrhoea and is now pretty much deaf as a post.

I don’t worry or fret about this, I just deal with it.

 

However, the one time where the expression “sick with worry “ was more than a saying to me was when I had to take Lucy to the vet because of some significant upper abdominal problems and the initial ultrasound (admittedly, it was done by a young and very inexperienced Vet) was inconclusive but suggested the possibility of pancreatic cancer. Not a very good diagnosis for neither human nor dog. So when I took Lucy to the vet for her follow-up ultrasound, I was – surprisingly – slightly nauseous on the way there, in other word “sick with worry”.

 

The second ultrasound, taken six weeks after the first, was equally inconclusive - which was quite reassuring. Pancreatic cancer is very aggressive in both humans and dogs and progresses very, very rapidly in dogs (weeks). The fact had that nothing had changed was a great relief.

 

Lucy continues to be happy, and although afflicted with some of the infirmities of old age is pain-free and enjoying her “senior years”.*

 

* as mentioned above, Lucy has become deaf, certainly to the point where Mrs iD notices Lucy‘s deafness. However, I don’t think Lucy is entirely deaf, because sometimes she does things that make me think “hold on a minute, is she pulling a fast one on me?  But who cares? It is what it is.