Dementia

 Next week is Dementia awareness week.

 I hate dementia. It's a horrible illness that strips us of our dignity and makes families lose their loved ones. It causes a huge burden in caring and as yet has little in the way of help or cure.

Dementia is an area that divides the medical profession. From Professor June Andrews statement that GPs should be sued for failing to diagnose dementia to the more pragmatic Dr Gavin Francis who was amongst a group of doctors who described the 'cash for diagnosis' policy on dementia and reaching new levels of absurdity. (this was a brief contract that offered GPs a sum of money for each new diagnosis of dementia they made)

 All doctors are agreed that dementia is a very significant and emotive diagnosis. The division arises from the thought that diagnosing the illness early is of benefit.

 There are a few drugs now available in the UK that are licensed to slow the progression of Alzheimers type dementia. The problem is they don't really have a clinically significant effect and have a high risk of side effects. One evidence review of multiple studies suggested that dementia medications showed a 2.8 point less deterioration in the ADAS-Cog dementia score after six months compared to placebo. Bearing in mind this is on a scale of 0-70 that's not going to make a huge difference in quality of life. It's also worth noting that there is very little published evidence out there comparing beyond 6 months.

 There are some reasons that make it worth seeing your doctor early if you have concerns about your memory. First of all there are a host of investigations to rule out other causes, B12 deficiency, underactive thyroid and depression can all mimic dementia. And some dementia is caused by vascular disease in which case it is worth treating blood pressure and cholesterol.

 Being diagnosed early can help with planning too. Facing the thought that you may one day not be fit to make decisions about your life is a hard subject to broach, but naming a medical and financial power of attorney is a much more straightforward process while you still have that ability.

 When considering something like this, I ask myself what I would want if I was the patient, or their relative. I don't know that I would want to face the diagnosis at an early stage, and I definitely would not take dementia medication as I currently feel the impact of side effects greatly outweighs the benefits in disease progression. However if they ever come up with something more effective, I would reconsider.

 What I would do is take up the offer of investigations, just in case there was a treatable cause. I would want to plan with my family the best option for future care, any financial considerations and sadly inform the DVLA (this is compulsory if you have been diagnosed with dementia).

 I would follow any lifestyle advice that may help slow progression and I would support any causes that help support carers for people with dementia and research into the illness.

 http://www.alzheimers.org.uk/
http://www.alzheimersresearchuk.org/

 What I am planning to do, and hope other people take up the cause. Is make a special date for considering dementia on the 25th May. (okay it's after next week, but bear with me)
 I am a huge, huge fan of Terry Pratchett. His books taught me more about the joys and frailties of human life than any degree or course. Anyone who has read 'Night Watch' will recall the revolutions of the 'Glorious 25th May'.
 So come the 25th May, change your profile picture to a sprig of Lilac. 'Wear the lilac' for dementia in memory of Sir Terry, and donate to his JustGiving site which is raising money for RICE

 https://www.justgiving.com/Terry-Pratchett

10 Things I didn't study at medical school (but people expect me to know)

(Image from cequejenpense.com)

 As a GP I love to help people. Sometimes that is treating their medical condition, sometimes it's giving lifestyle advice to prevent illness and sometimes it is just providing a sympathetic ear.
 What often amazes me is the amazing diversity of things we get asked about. We cover a huge amount of medicine and are expected to know about pretty much every speciality, but there are some things I just have to approach with a bit of common sense or a baffled shrug of my shoulders.
 I often think the position of GP has replaced that of the local priest, wiseperson or family elders and we are often approached for some bizarre problems that aren't really appropriate. Here are a few of the more frequent offences.


1. Financial.

 I cannot tell you if you should sell your second house or who you should allocate as your power of attorney. I graduated with a shedload of debt and bought my tiny house in 2004 on a 100% mortgage. I'm really not clued up about financial advice, except to say don't do what I did. Please get a qualified, independent financial advisor, not me.

2. Employment issues.

 The number of patients I saw with employment issues grew hugely in the last few years. Both in private and public sector jobs. Now occasionally, when someone is really struggling with stress and is unable to work it is appropriate to be signed off work. However most of the time this can worsen the problem and the people to approach are your union or ACAS. I don't know much about employment law and I certainly can't intervene on your behalf to stop your boss being a bully, or to make them re-instate the annual leave that you booked but has now been cancelled, or to stop them putting you on night shifts.

3. Marriage guidance.

 Well I've been married for 12 years, but I don't think that qualifies me in any way to advise you on whether you should stay with your husband or leave him for your lover. Or indeed if you should stay with your horrible partner because you don't want to move out of your house. And I'm not going to get involved in any custody bickering either, please just put the needs of your children first and act like adults in all this.


4. Education.

 If your child is struggling at school you need to talk to the teacher, and keep talking to them. I cannot magically get your child assigned to the most popular school in the area, and I will not support you in keeping your child at home because they are unhappy at school. If you want to home school them then you need to go through the appropriate channels.

5. Dentistry.

 I've had a dental infection and the pain was horrendous, so I sympathise, I really do. But that doesn't mean it's right for me to give you antibiotics. Dental problems need to see a dentist. 111 can let you know the contact details for the emergency service if you are not registered with one. I can just about name the teeth and that's pretty much the full extent of any dental training I had. There have been cases of patients getting severe illnesses due to partly treated their dental infections with GP antibiotics and not getting the abscess treated properly, so however much you don't like dentists, or their fees, I'm not going to collude with you on this one.

6. First aid.

 Now I will offer first aid to anyone in the vicinity who needs it. However, to my amazement we weren't taught any first aid at medical school except CPR. Luckily a few years with the Red Cross in my youth covered most of that. And being a mother to 4 boys has been a crash course in the rest. But it really is something I think should be covered in medical school.

7. Alternative Medicine.

 Now I'm going to risk offending here because I think most 'alternative' medicine is a crock of smelly stuff. At best I think there are some well meaning individuals out there who love to use an extended placebo effect to make people feel a bit better, at worst  think there are a bunch of callous charlatans who mislead and take advantage of vulnerable people in the name of profit.
 So please don't ask me if I approve of your homeopathic remedy, or if I will sign a waiver form to say it's safe for you to have Hopi ear candles or cupping. If you practitioner is at all qualified and knowledgeable they will be able to tell you themselves if it is appropriate and above all take responsibility for it rather than passing the buck to me.
 I cannot tell you if herbal remedies are safe to take because they are not tested. Herbal remedies are classified as supplements, not medicines so do not have to go through the rigorous trials of effectiveness and safety that drugs go through. Until they have to do this, I'm not endorsing any of them.


8. Weight loss.

 Now I'd like to think I have some knowledge of how to lose weight, having managed it myself to a certain extent. Medical school actually covers very little in the way of healthy eating. We get a brief module on cholesterol and various important vitamins and minerals, then we're turfed out into the real world and expected to dole out advice.
 There are a few sources of good information out there, but I've heard some really terrible advice given out by GPs, and like normal humans we can get carried away with the latest trends. It is a very hard area to carry out evidence based medicine and good studies are few and hard to carry out.
 Weight loss is a very individual path,  My advice would be to know where you are going wrong; log your food and drink intake and be honest; you will need to invest time and effort to see success, and anything that offers miracle results without significant work is going to be a scam.

9. Hair and beauty stuff.

 When most girls were experimenting with hair and make up I was studying, or working in a factory saving money for college. As a result I don't have a clue about make up, in fact if anyone could teach me how to do that upper eyelid eyeliner thing I'd be forever grateful. So if you come to me and ask if I think you should have various beauty treatments, or how to make your hair shinier, I'm going to be less help than your hairdresser.

10. Fortune-telling.

 Just room for one final pet peeve. I am often approached by patients who want to know if their cold will progress into tonsillitis, or a chest infection. As they're going on holiday, or have exams, or it's Christmas. I would love to be able to tell the future, I'd be off to buy a winning lottery ticket and handing in my resignation. But sadly this is not the case and I will just have to work hard to earn a living like the majority of the population.

 So before you come to see us, have a think about if it's something covered in a medical curriculum. Because if not you're just getting the same advice you could get from your next door neighbour.