Neglect

Today I had someone who has maggotsssss in their groin. In A&E, she is profoundly in shock (as in medical term meaning - hypotensive and tachycardic), severely dehydrated and septic, coated in her own faeces and urine and she has maggots brewing in her groin which is drenched in candidiasis. (and this is not the therapeutic maggot; this is infestation)

And she lives with her child.

The nurse said to me," How could this person do that to her own mother?".

Its hard to say. I think I will wait until what the social service found in their investigation before drawing my verdict. From what I heard so far, I don't think she is a tolerant person and very aggressive and violent towards her social worker.

Very sad indeed it comes to this.

Dementia and Hospital Stay

Marah la pulak aku dgr this survey from Alzheimer's Society.

Do they really think that we don't want to discharge our dementia patients ASAP? Lots of them have no carer, no one to bother to help caring after them, which is why they stay and occupy our hospital and intermediate care bed so we can help sort out the social, their care package and living circumstances and activates government funding. They already medically ok for discharges agessss ago.

You see, don't just read the headlines. A lot of good work go unnoticed.

PCC

Today is the first I handled Prothrombin Complex Concentrate. Had this lady with INR > 10 and endometrial cancer, bleeding per vagina, bleeding per rectum, melaena, haematemesis and in congestive cardiac failure and pretty much our last shot. God bless her.

Once issued by consultant haematologist, I collect, mixed them, administer, complete all their paper works. This precious stuff is for doctors only, even the staff at transfusion will not help me calculate the flow rate for slow iv injection.

Expensive stuff. I can't remember how much it costs, I knew it is a least a few thousands pound per vial.

Should I medicalised this blog?

Suddenly I feel I should write more medical stuffs in this blog; you know, things like the gold standard treatment for certain diseases etc...? Perhaps too boring, no? Probably because I feel too content to write anything else?

Let me just talk about my experiences in Diabetes, esp with this not-exactly new drug called exenatide.

I mean, pure biology exploitation and how you see it is interpreted in clinical practices. It comes from the poisonous lizard found in North America, which eat only about 4 times per year. A bit complicated to explain, this incretin-mimetic effects, but it has something to do with hibernation.

It doesn't always work for everyone, but when it works, it works wonders. I achieved weight loss and better diabetes control. I mean, some of them even come off insulin completely and we can give it to HGV driver. For those who don't know, in the UK, once you go on insulin, you are no longer allowed to driver heavy good vehicle, and license revoked, which means loss of employment, and obviously, this is a massive issue for one's life.

p/s; Comel sungguh ikan2x barbs saya. Lots to learn about aquarium rupanya. New hubster obsession, tido dekat dgn ikan lagi. Comel betul.

Equity

Woohoo!

It looks like the equity of the house has increased? The developer is selling our house type GBP 6000 more than its value back in 1 1/2 year ago. In the current economic climate, I supposed that is good. Not that I am thinking of selling; I do love our little green energy saving house (well, I do try my bit with the recycling etc..).

This is nice

It gives me a good glow of nice feeling when one of the cardiology SpRs told me her boss gives me a compliment about me and the cardiology team is looking forward to my coming to them. Its nice being remembered for being good.

(Her boss and I used to work together at the local cardiology interventional centre.)

(Yes, I am like Elliott Reid of Scrubs, full of my neuroses)

Medical Jokes

Please ignore it if you don't think its funny.

In a conference, three doctors are talking about PCC and medical emergencies. One of them is a haematologist, one of them is an Obs and Gynae and one of the is Accident and Emergency Consultant. They are talking about the use of PCC.

Turn out they are not in synch with each other.

Haematologist : PCC ~ prothrombin complex concentrate
Obs & Gynae : PCC ~ post-coital contraception...hahahaha

Bleeding emergencies eh?

P/S: PCC (prothrombin complex concentrate) is a bloody fantastic stuff to stop major bleeding post warfarin. Intriguing stuff, apparently some minority Aussie emergency medic did use PCC to stop massive bleeding eg: in road traffic accident even for people not on warfarin. Well, kinda remind me of that factor VII people stock up during TT race (not usually use anyway).