So here we are – Christmas proper is upon us and I have to drive to the Isle of Wight to see the kids and lots of their aunties, uncles and cousins. I’ve got over the disappointment of the rather exciting clinical trial I was lined up for but, at the last minute, couldn’t join.
So it was back to the chemo for another full cycle with another equally exciting-sounding clinical trial waiting in the wings. Which meant that the chemo would run right through the Christmas period, and explains why my consultant, the ever-amazing Dr Starling, was a bit nervous about my trip to the Isle of Wight. No suggestion that the NHS there wouldn’t be able to deal with any acute needs – like an infection needing intravenous antibiotics within hours – but well and truly outside the embrace of the London Cancer Network, should anything more sophisticated be needed. Anyhow, she relented and off I went to the land that time forgot…
25 December
The big day has arrived. Ordinarily, on these big bash-type Christmases – this time it was 19 people – I’d help out with roasting the turkey and the traditional rib of beef, which usually meant getting up very early indeed. But the effects of the chemo were, unfortunately, very much in evidence. I’d found that the first two days after every infusion – usually on a Thursday – are OK but on Sundays and Mondays, I am the most fatigued. I guess you could call it Sod’s law. So I help out with the meat but can’t lift it out of the oven and have to sit down every 10 minutes.
Presents are chaos, as always, but the undoubted star of the show is a video my boys made for me featuring contributions from much-loved friends, family and colleagues all over the world. Actually, I’m welling up even as I write about it now.
Anyhow, my favourite meal of the year, Christmas dinner with all the trimmings, beckons. I take a forkful and guess what? Wet cardboard! As well as giving me fatigue, split fingernails and a sore mouth, the chemo has destroyed by ability to taste most things and reduced my appetite so severely that, over the Christmas week, I lose nearly two kilos. But it’s a real disappointment not to be able to taste the moist turkey, rare roast beef and sprouts – overdone, just as I like them – and roast potatoes covered in lots of top-class gravy. As I say – Sod’s law strikes again!
26 December
It’s Monday and Eddie Mair is, unexpectedly, presenting the PM programme on Radio 4, and he’s asked me if I’ll consider doing one of our regular interview sessions – albeit on Boxing day and via a pretty shaky Wi-Fi setup at the house on the Isle of Wight. As transmission time approaches, the other 18 people in the house disappear and the chat with Eddie goes ahead via Skype and the dodgy WiFi. Only as the broadcast ends does it become clear why the whole house has gone quiet – they’re all listening to it go out live. Cue much merriment!
28 December
This being Wednesday, it’s Media Show day on Radio 4. This year it’s an extended interview with Piers Morgan. I think Piers is a really interesting character who has ended up in some pretty interesting places – and who has probably achieved his childhood ambition of becoming Britain’s best-known journalist. Anyhow, I think the interview plumbs depths not usually seen and is well worth a whole half-hour. Given Piers’s millions of Twitter followers, the social media response to the show is huge.
Piers Morgan’s millions of Twitter followers generated a huge response to The Media Show on 28 December. Photograph: Mike Marsland/WireImage
31 December
New Year’s Eve. Treatment went well on Thursday but it’s now Saturday, so I’m feeling it a bit. To try to avoid the evening rush, we decide to go for lunch at Roka on Charlotte Street in central London. It’s an Asian-fusion restaurant and I eat as much as I can, which brings on another frequent side-effect of treatment – stomach discomfort. Which then starts moving up into my chest area. We leave the restaurant hoping a brief walk might see it off. It doesn’t and a call to the 24-hour Marsden Macmillan helpline leads to the instruction to dial 999 immediately in case I’m having a heart attack or pulmonary embolism. So I do. And despite everything we hear about the NHS’s problems, I have barely finished talking to the controller when we see the flashing blue lights coming up the street.
The ambulance crew are great and decide a visit to University College Hospital A&E is in order. The staff there couldn’t be more helpful, especially with the New Year’s Eve alcohol deluge building.
After blood tests, ECGs and waiting for the results of a second test, I am discharged around 2am, pretty sure that, whatever it was, it wasn’t a heart attack. But have you ever tried getting a cab at that time on New Year’s Day in central London? Have to take a crowded free tube. Poor old Dr Starling would have a fit if she knew.
3 January 2017
Happy new year! I’m back at the Royal Marsden. First, a CT scan will reveal whether the chemo is having any effect on the cancer and its offshoots – and whether it has spread. Then blood tests (after 10 months of treatment, my veins are nearly shot and my hands and arms are now really rather like pincushions). And then there’s the critical question of whether to stick with the chemo or sign up for the new trial with immunotherapy drugs.
Dr Starling arrives with the scan and I can tell she’s not unhappy. Unlike the last time, when the news was all bad, this time the chemo has been working and my cancer is stable and has not spread anywhere else, along with some promising signs of shrinkage and reduced density – which I don’t really understand but Dr S was particularly pleased about – in the liver metastases.
So what about the trial? It’s new and prestigious – with only 120 participants at 50 centres across the world – which I guess means I’ll be lucky to get on it. We discuss the options and agree that the trial – which at the very least will give me access to Nivolumab (the immunotherapy drug that AA Gill probably didn’t get soon enough) – is the best option..
So I sign the consent forms and the system goes into overdrive. A new endoscopy to collect fresh biopsies from my tumour, blood tests and a full medical exam are all scheduled in no time at all, with the aim of starting the new treatment in about a week.
The thing about times like new year, and especially Christmas, for me is they make you wonder if you’ll ever see another. But here I am, in a new year I wasn’t certain I’d see, embarking on a revolutionary treatment – which may not work but, if it does, opens up huge possibilities. So my resolution for 2017? Not to waste any of it.
After four days of in-patient treatment – intensive rehydration, intravenous antibiotics and two units of blood, not to mention so many blood tests that “find the vein” became an almost full-time staff pastime – I’m feeling much better. So now back at the Royal Marsden [specialist cancer treatment hospital] for blood tests ahead of what I hope will be more chemotherapy treatment on Thursday.
And good news! Blood pressure’s up and stable; platelets and white blood cells all well within safe range – so all clear for treatment. This is quite a relief, and I’m sure I’m not the only cancer patient – or physician, for that matter – who feels this, but having to miss treatments is frustrating and a bit of a worry. The fear being that as treatments are skipped, the cancer and its offshoots will regain ground, thus making them harder to treat further down the line. Anyhow, none of that this week!
Thursday 17 November
Having missed a week of treatment, whereas this should’ve been a double drug week – paclitaxel on the NHS, and ramucirumab up in the private patients’ “suite” – in fact, as we’re in what is in effect now week two in the cycle, it’s NHS paclitaxel only.
Infusion goes well – once they’d found a vein for the cannula (the rather clever device through which infusions are delivered into veins). With the cold cap applied I still live in hope that I won’t lose my hair. And what a relief to have actually got another round of treatment!
Friday 18 November
In Manchester today for an appearance on BBC Breakfast’s sofa at an outside broadcast they’re doing to mark the end of a series of reports on cancer – one of which, as I think I mentioned before, featured me and a conversation with my old friend Nick Robinson about how to discuss cancer with family, friends and the world beyond. The programme came from the Maggie’s centre at the Christie hospital. Maggie’s centres are there for people with cancer – and others affected by it: carers, family, friends etc – to drop in for help, advice or just a chat.
It was heartening to meet other people living with cancer – and a great coming-together moment when the presenter tried to tell three of us we had “terminal” cancer, which was met with a good humoured but unanimous raspberry. The only certainties in life are, as they say, death and taxes, and so it is when you’ve got cancer. I might have weeks, months, years or even a full lifespan ahead of me. I know I’ve got advanced cancer and well recognise that changes the odds considerably – but I’m not out yet and neither were any of my fellow contributors.
I was asked one question, though, which really made me think. Why had I decided to be so public about my cancer? Which as I sat in the Maggie’s centre did make me think about how privileged my position is compared with so many others with cancer diagnoses.
First, I’m a journalist and so have a way of approaching my own disease which interests and engages me as a story in its own right and – as any journalist will attest – once you’ve got a story, the urge to tell it is almost irresistible. Second, I have access to ways of telling it both on the radio and in print. And third, I’m not 35 and still building a career or in the dating game or running my own business where I’m the key business winner. Who would want to tell a prospective boss or date or client about a diagnosis like mine? Nor am I facing a relationship breakdown by revealing all – you don’t exactly make yourself an investment by telling people you’ve got cancer.
For me, by contrast, there is virtually no downside. I suppose what I’ve realised is that for many people, that’s just not the case. So there is a long way to go in terms of society in general coming to terms with the realities of cancer – after all, Cancer Research statistics suggest that one in two of us will get it at some point in our lives.
Tuesday 22 November
Back to the Marsden today for blood tests ahead of treatment on Thursday – I hope! I’ve been feeling generally OK, although pesky kidney stones have been back. Unfortunately, the tests show that my platelet count has dropped again and so has the level of the white blood cells – critically important to fighting infections.
My consultant, Dr Starling, appears even more fed up and disappointed than me, especially because there are some very early signs – no symptoms from the main tumour at all, improved liver function and other markers showing positive – that might suggest the new regime is working on the cancer. Trouble is, it might also be rendering me unable to safely receive it. Consultant wondering – but really hoping not – whether I might be in the 2% of people (yes, 2%) to whom the drug paclitaxel appears to do this. Naturally I am with her on this!
So treatment on Thursday now looking unlikely. More self-injections to promote white blood cell production prescribed, and more blood tests (we really are running out of veins) booked for early Thursday morning …
Wednesday 23 November
Up at 6.15 to prepare for The Media Show. But, to be honest, the kidney stones are killing me, the medication can make one a bit dopey, and I’m feeling pretty fatigued. So 7am speak to producer, who takes the news brilliantly well and sets out to find a stand-in presenter. I always feel bad doing this but BBC Radio has been really brilliant about it, and I guess if I did present a programme and made a hash of it I’d feel quite a lot worse.
Thursday 24 November
Back at the Marsden. Blood results not great so definitely no treatment today. Another date missed and more of the frustration and underlying issues to worry about. But a platelet infusion later and it’s onwards and upwards!
Friday 25 November
Months ago I agreed to a request from the Media Society – and the London Press Club and the Royal Television Society – to consider participating in an evening looking at my career. Flattering and hard to turn down in many ways but weirdly like an invitation to my own wake. With the help of BBC Radio they managed to get the historic Radio Theatre at Broadcasting House, home to so many BBC comedies and performances. And the event is tonight!
It is framed as an interview between me and Roger Bolton, presenter of Radio 4’s Feedback but a TV executive of many, many years’ experience who once upon a time as editor of Nationwide gave me my first proper job in telly. Well, 300 guests and a packed Radio Theatre beckoned – and, I should say, with every likelihood of a £2,000-plus donation to the Marsden charity. But what had I let myself in for?
Back at the Marsden again, the platelet count had improved but there was no significant movement on the white blood cells and the amazing Dr Starling was actively worrying about whether I should even do the Radio Theatre event. Ultimately she relents, and with a very strict set of instructions – get a cab there and back, stay away from anybody with a cough or cold, and if you get a temperature or even feel just really off, call the emergency helpline immediately – gives me her blessing.
Audience reaction was truly amazing and utterly humbling. As wakes go, it’ll be one to remember – which I trust I will for many years to come!
To donate to Maggie’s centres, visit maggiescentres.org
It’s another big week for me and my cancer (aren’t they all?), but it’s Wednesday so it’s Media Show day, and things are really hotting up before the US election. We’ve got a good show. I’ve managed to persuade Piers Morgan – as one of the few British journalists who actually knows Donald Trump – to speak to us from his car while he’s filming in Florida for ITV. And he’s really interesting about what the media have and, critically, haven’t understood about the Donald. Piers is also one of the people from the worlds of journalism and broadcasting – many of whom if I’m honest I really can’t claim to know especially well – who’ve come forward to make my life easier (whether they know this or not) by offering good wishes and positive thoughts. And if my experience is anything to go by, if you know anyone with a cancer diagnosis – don’t hesitate – just drop them a line to let them know you’re thinking of them. Genuinely appreciated all!
The show went well, I think, but I’m still suffering from occasionally quite acute fatigue – I blame the radiotherapy, as I didn’t get anything like this in the course of seven cycles of heavy-duty chemo. Also since the radiotherapy, I’m really only able to sleep on my back (earplugs, earplugs, my kingdom for a pair of earplugs, can I hear despairing partners muttering?). The doctors reckon this might be because of the impact of the radiotherapy on my diaphragm, which might’ve been “clipped” by the high-energy x-ray beams.
Anyhow, all’s well with the back-sleeping malarkey except that at around five on Thursday morning I get the first signs of an unmistakable – and potentially very painful – condition. Kidney stones! I was first diagnosed with them more than 25 years ago and every now and again since a new one would get stuck in my kidney and kick off a bout of “renal colic” – the name given to the excruciating pain that can come with them. This time a couple of painkillers see it off – but stand by, if you can face it, for what happened a few days later…
Thursday 3 November
My first day on the new treatment – paclitaxel and ramucirumab (the one I’m having to pay for) and my first visit to what one of the nurses laughingly described as “business class”, otherwise known as the PPMDU (private patients medical day unit). So at 9am there I am being shown into the unit, discreetly hidden from the regular NHS day unit I’ll be visiting later for my paclitaxel infusion – and guess what? It looked very similar to its NHS equivalent; and while we’re on the subject of business class, the seats were actually identical! Staff were great, of course, and I got my first dose of the very expensive (£12,000 plus per cycle) ramucirumab, which the NHS currently won’t finance.
The treatment was first class and, as I’ve previously indicated, I’ve no problem with the principle that I should pay for it, as the NHS should be protected from additional unfunded treatment costs I choose to avail myself of – but I still struggle with the Royal Marsden taking a 20% markup simply to supply an already very expensive drug – which, by the way, is already standard treatment as part of second-line chemotherapy for my cancer in the US – and charging a private patient’s day rate as a whole day for a treatment that takes just over an hour. I’ve taken to calling it my very own “cash for treatment” scandal. I hope they’re putting the money to good use, which is perhaps something worth looking into.
Anyhow, having received my ramucirumab, I was escorted back downstairs to rejoin the rest of the human race in the NHS MDU. And do you know, aside from having identical seats to “upstairs”, I think there might actually be more space down here? But time to get reacquainted with the “cold cap”. This, as its name suggests, is a rubber cap attached to a refrigeration system that rapidly cools the wearer’s head, thus reducing the risk of hair loss that some chemotherapy drugs otherwise more or less guarantee. It doesn’t work for everyone, but it really worked for me over seven cycles of chemo.
And to be honest, a few quizzical looks from other patients more used to seeing women using it and the endurance test that is the first 20 minutes of wearing it as it literally freezes your scalp (think ice-cream brain freeze and multiply by 10) was a very small price to pay. Of course I’d forgotten how hard it would be and very nearly took it off. But in the end the name of the new machines they now have at the Marsden, Paxmans – true! – and a well-timed traquiliser from the staff got me though it. And, so far, I still have hair – on my head.
Saturday 5 November
Today would turn out to be one of the most difficult since I was diagnosed back in March – and none of it to do with my cancer or its metastases directly. For a start, I have been suffering with constipation (thousands of cancer patients do) which, once it gets to 5 or 6 days – as it has for me – can become almost painfully uncomfortable. Then there was the discomfort under my right ribs – put down to my liver playing up or, more likely, another hangover from the radiotherapy. And to cap it all was the recurring renal colic from my age-old kidney stones and their appalling sense of timing. And here’s the twist. The painkillers – co-codamol, a mixture of paracetamol and codeine – tend to work less effectively over time but, critically, make you more constipated!
To cut a long story short, Saturday was a bit of a perfect storm: in increasing discomfort and waiting until enough time had elapsed to allow me to take more painkillers which a) no longer quite do the job; and b) make the you-know-what worse. As a result, I can’t leave the house and have no desire to eat or drink. And it’s the latter that’s set to provide the biggest twist of all …
Tuesday 8 November
Due at Marsden for pre-chemo blood tests preparatory to the next dose of new chemo due Thursday. By now, after such a dreadful weekend, I can add extreme fatigue to my list of ailments – shower, dress and have to sit down, slightly breathless, for a rest. Blood tests show sharply declining level of platelets, which means no chemo for me unless they recover. Doctor also spots that my blood pressure is pretty low – and I get light-headed when standing up and so prescribes intravenous fluids to help.
Wednesday 9 November
Up at six, looking forward to Radio 4 Media Show today. Unfortunately, same thing happens – extreme fatigue and dizzy when I stand up. Decide Media Show might not be possible – the BBC, by the way, have been nothing but support itself over the course of my cancer travails. Return to hospital for more IV fluids. I think these are probably the longer-term consequences of the radiotherapy taking my appetite for food, and critically, drink away, and my simply not drinking enough for far too long
Thursday 10 November
Back to Marsden to see whether platelet levels have improved sufficiently for treatment to proceed. Not only have they gone down further – something my consultant Dr Starling and her team are unsure of the cause of – but my blood pressure’s up and down like a yo-yo.
As a result, I was admitted as an in-patient to the Marsden to try to get these things sorted out and see what might be done with my kidney stones, which are still giving me gyp!
And three days later, as I write – intravenous fluids and antibiotics and a host of new medications later – that’s where I still am.
PS: the ward staff are great and the food’s not bad at all.
The corollary also holds, however, whereby the adverse effects of drugs can be turned to therapeutic benefit in some really different – and difficult to treat – problem than that for which they were initially prescribed. Hence, the propensity for cancer chemotherapy to lead to serious nausea and vomiting proved a significant limiting aspect in its tolerability right up until the introduction, 20 many years ago, of the drug Ondansetron, which blocked the action of the chemical serotonin, which plays an important function in controlling the motility of the gut.
“My mother had been unwell for a number of years, however there was no purpose to suppose her death was imminent,” writes a lady from Shropshire. “One night, I awoke all of a sudden to discover her standing at the foot of my bed.” The telegram confirming her mother’s death arrived that following morning, the timing coinciding with her apparition in the bedroom.
The maternal telepathic intuition of a son’s death in wartime gives a variation on this theme, as Peter Hindes reports. The 22-year-previous son of his following door neighbour was killed whilst navigating a Lancaster bomber on his 86th mission over Germany. “She told us that at the time of his death in the early hours of Sunday morning, she was awoken from sleep to hear him shouting for support from his bedroom.” She went to investigate but identified his area empty.
These are, of course, just anecdotes. But Pulitzer prize-winner Deborah Hunt acknowledges in Ghost Hunters – her 2007 background of the scientific investigation of such supernatural phenomenon by such luminaries as William James and Henry Sidgwick – their findings are a lot much more persuasive than is typically recognised. She began as a sceptic, but ahead of extended, “I could feel the hinges of my brain, nearly virtually, creaking apart to make space for new ideas”.
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The gentleman, as featured last week, with severe bladder soreness for an hour right after (but never ever although) passing urine has prompted numerous further reviews, similarly unexplained, regardless of thorough investigation. None the less, a couple of readers declare that the soothing properties of pearl barley water (“rather gloopy and not to everyone’s taste”) helps to minimise the intensity of the soreness, as does consuming camomile herbal tea 3 instances everyday the energetic ingredient is bisabolah, which has anti-inflammatory properties.
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Lastly, my thanks to a self-styled “old wife” for passing on her personal encounter of a conventional remedy for the agonising nocturnal cramps to which the two she and her husband have been martyrs in current months. She managed with some problems to obtain two huge magnets from her regional farrier, who uses them to collect up utilized nails when shoeing horses. Considering that placing them in the marital bed, neither have had “a single twinge”.
E mail healthcare concerns confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Answers will be published online each and every Friday at telegraph.co.uk/well being
‘Making it up as he goes along? That just does not sound like Dave.’ Photograph: Getty
• Huge information from PM Dave, who faces the dilemma of making an attempt to lift the nasty celebration stain from his Conservatives with no generating the celebration seem to be so politically proper that all of the crusty varieties defect to Ukip. There have been targeted initiatives aimed at lifting the Tory minority ethnic vote above the sixteen% of 2010 – making flights to the Caribbean low-cost by amending air passenger tax and a promise from Theresa May possibly to appear again at disparities in end and search. Still, there is a mountain to climb and every single little will aid. Dave discovered time this week to seem on the black music and speak internet radio station Colourful, and when it was place to him that the government may oblige organizations to disclose to the world the ethnic composition of their workforces, he did not bat the concept away. “I will certainly seem at the notion,” he said encouragingly. “I am satisfied to search at concepts for a lot more transparency.” Some recommend he was just currying favour, and that the possibilities of him forcing a lot more monitoring and reporting on enterprise is really quite unlikely, but we have been shouting them down, for currently there is as well a lot cynicism. Producing it up as he goes along? That just isn’t going to sound like Dave.
• There will be transparency inside of our hospitals, says Jeremy Hunt, meanwhile. But isn’t going to the principle also require embedding in Whitehall itself? Government is not exactly blabbermouthed when it comes to discussing its very own failings. Consider the personal computer techniques. We throw many millions at private contractors, but it by no means quite goes to plan. This kind of has been the situation not too long ago with 3 government departments the place tinkering meant that workers could not get electronic mail, open documents or use the scanners. The irritations lasted up to 4 weeks and raised pressure levels to new heights. “If the buildings weren’t sealed, the pavements would be littered with pc gear,” one toiler told us. Lessons have been discovered, a Whitehall spokesman told the FT. But will the firms be hit with swingeing penalties, on the basis that private companies reap the income but bear the hazards? Will not hold your breath.
• The great and great pitched up at the London School of Economics, exactly where acting and would-be chair of the BBC Trust Diane Coyle set out her stall this week. Observers say she impressed. Later, at the exclusive reception with the BBC glitterati from Lord Hall downwards, the black and minority count appeared significantly less extraordinary. Just a handful from a group numbering 60 or so. The all-new diversity drive is much essential at the Beeb.
• Coyle convinced many doubters, but she did not search very at house with the technical side of her presentation. She struggled with easy replay of video and had to phone on the skills of a nearby helper. He was not much greater. They misplaced the vital powerpoint slide evaluating Walford in EastEnders to Walthamstow in true life. The perils of public speaking but specifically irritating for Coyle probably, the wife of the BBC’s technological innovation correspondent, Rory Cellan-Jones.
• For all these unlucky candidates who failed to be elected in final month’s neighborhood council elections, the opportunity to serve presents itself (the prospect of fame can wait). The Elections Centre at Plymouth University, run by Professor Colin Rallings, has invited all 17,000 candidates, regardless of whether they won or misplaced, to take part in a particular survey. For all that indicator up, there is possibility of a reward following random choice, 3 respondents will get Marks & Spencer gift vouchers. Those who lost won’t even have to declare them.
• Finally, though Colin Firth jilted Paddington Bear, claiming that he could not discover the correct voice to do the character justice, other people have trod that path with out self-doubt. In his memoir My Life, David Jason tells of arriving at a voiceover studio and encountering the excellent Sir Michael Hordern. “I said ‘Sir Michael – what are you carrying out right here?’” Sir Michael was unapologetic. “‘What am I carrying out here? My dear boy,’ he stated. ‘I am carrying out what you are performing. I am currently being a vocal whore.’”
They come in ones and twos, sometimes a lot more. Some of the individuals have fresh bullet holes or machete wounds other people have wounds that have been neglected for days due to the fact of an inability to attain the hospital. Some are innocents caught in the crossfire, some the very ones who shoot.
And as is most typically the situation in civil conflicts, the majority of patients are not the ones immediately wounded but individuals who suffer the consequences of the disruptions of an previously-feeble health technique: intestinal perforations from typhoid fever pregnancies challenging by arrested labour significant skin and muscle infections that have spilled more than into the bloodstream, foremost to septic shock.
The Bangui General Hospital is a single of three primary hospitals working in the Central African Republic’s capital, with its population of some 1 million folks. Built in the 1960s by the Moroccan government, the big complex sits a few miles in one route from the relative peace of the Oubangui river, and in the other course from the chaos of Bangui’s violence-torn PK5 and PK12 neighbourhoods.
It is from the latter two locations that practically all of Bangui’s Muslim citizens have fled or been evacuated in the past few months as sectarian violence amongst Muslims and Christians threatens to tear the nation apart. Most have continued on to the north-west of the nation, or to neighbouring Chad or Cameroon.
I am part of a skeleton staff of expatriate physicians, nurses and support staff from Médecins Sans Frontières that functions with Central African physicians and nurses to give emergency space and surgical care at the hospital, although other teams focus on outreach in refugee camps and mobile clinics across the nation. From the hospital’s rooftop we peer across the city.
A flock of birds floats languidly across the sky, the crimson glow of the sun setting behind the unlit spotlight towers of the main soccer stadium. The peaceful scene belies the spasmodic chaos below. At evening we hear scattered gunfire and grenade explosions in the distance and wonder how a lot of patients will come, and when.
Muslim in the P12 district of Bangui put together to flee the violence. Photograph: Eric Feferberg/AFP/Getty Pictures
A 23 yr-previous lady arrives one particular early morning, her body riddled with bullet holes. Numerous slugs have blasted via her limbs, shattering bones. Despite our ideal efforts, her gaping chest wounds portend a death that can’t be averted by restricted surgical capacity. I wonder – no more here than back house in the US – what prospects people to violence. The human physique is not meant to be torn apart by bullets.
Spasms of violence grip this country, whilst in the background regular societal structures unravel. Thirteen percent of the population is internally displaced, schoolrooms are usually empty and crops go unplanted.
A yr in the past, the overt violence in the capital was possibly worse aid workers who have been here described dead bodies lining the streets on the way to the hospital and extrajudicial killings happening everyday across the city, some even outdoors the paediatric ward down the street.
And what now? Regardless of the presence of some two,000 French troops and 6,000 members of an African Union-led peacekeeping force, the Central African Republic appears to teeter on the brink.
The UN just lately approved the deployment of 12,000 extra troops and police to support maintain buy, but they are not due to arrive right up until September. Meanwhile, the disorder in this former French colony continues.
While the war-wounded might be the most visible victims, the true and lasting tragedy could lay in the consequences of worsening malnutrition, estimated to impact in excess of two million citizens, many of them young children. A society broken at the centre is fraying ever much more at the edges.
A rebel fighter in the Central African Republic smokes during a patrol, near to the border with the DRC. Photograph: Goran Tomasevic/Reuters
From the northern village of Boguila, near to the Chadian border, information of the slaying of 16 civilians, like three Médecins Sans Frontières nationwide staff, chills our hearts and rattles nerves.
Unprovoked, and taking place throughout an armed robbery at a well being outpost clearly marked as a Médecins Sans Frontières facility, the killings have sparked a debate within the organisation, utilized as it is to working in challenging situations. Médecins Sans Frontières made a decision to decrease its pursuits during Central African Republic in protest for a quick time, though the function at the hospital continues unabated.
Final week, a 35-12 months-previous female in her 10th pregnancy arrives in the emergency room in shock, barely coherent. The shape of her swollen abdomen suggests a ruptured uterus and she is rushed to the operating space. The eight-month-old foetus has perished and the mother’s life hangs by a thread as we perform an emergency hysterectomy.
Uterine rupture occurs up to ten occasions more frequently in least-produced nations than it does in the most-developed nations. It can be a last blow right after the domino result of having several pregnancies, limited pre-natal care and obstructed labour with impaired entry to well being care services. Up to 90% of girls with uterine rupture die, as will this patient in a couple of hours.
There is too little that we can do, also late. The patient’s mom waits outside and receives the news, translated from French to Sango and back, with an unmoving face. A short while later on, as daylight breaks and the sounds of roosters and the waking hospital fills the grounds, I observe as she carries away the wrapped physique of her unborn grandson. She disappears behind a cement column painted a rusty red, bare feet padding along the floor. It ought not finish like this…and nevertheless it does.
David Rothstein is a paediatric surgeon at the Lady and Children’s Hospital of Buffalo. He started operating with Médecins Sans Frontières in 2007 in northern Sri Lanka and has made month-extended journeys for MSF each 12 months because, working in Chad, Nigeria, Democratic Republic of Congo and the Central African Republic
The initial issues the 12-yr-outdated boy with diabetes with recurring bouts of unexplained stomach ache. The culprit, suggest several, could be foods intolerance and, in particular, sensitivity to wheat or gluten, but also onions and the sugar substitute sorbitol, which is a widespread ingredient of diabetic meals.
Two readers report that their child’s signs and symptoms had been eventually discovered to be due to appendicitis. “We have been convinced my daughter had a grumbling appendix, but had been advised there is no this kind of point,” writes a mother of yet another twelve-year-old who knowledgeable 6 months of agonising abdomen pains. “The surgeons did ultimately operate, and the problem turned out to be her appendix, which was unusually lengthy and tucked behind her bowel.”
A number of readers describe this as a function of their irritable bowel syndrome, but it could also apparently be a symptom of the inflammatory condition microscopic (or lymphocytic) colitis, which can only be diagnosed with a bowel biopsy, and diverticulitis. There are reviews of sustained improvement by excluding milk and other dairy products and coffee from the diet program. Individuals who have had their gallbladder removed in the past might be aided by taking the wonder drug cholysteramine, which has featured in this column before.
Lastly, this may be a unusual side result of the common diuretic frusemide, and importantly, a reminder from a reader that any unexplained change in bowel habit requires even more investigation: “My late husband had the exact same difficulty that he ignored at initial, but he was ultimately found to have a tumour in the colon.”
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Last but not least, my thanks to a reader for passing on his serendipitously found treatment for possessing to rise numerous occasions a evening to pass urine, necessitated by his enlarged prostate. He is troubled by back pain, for which his physiotherapist advised lying on the floor and thrusting his pelvis in the direction of the ceiling 40 occasions. On a single event, woken by the “urge” at 3am, he did his 40 thrusts and inside a number of minutes was ready to fully empty his bladder. He then slept uninterruptedly till morning.
Electronic mail healthcare concerns confidentially to Dr James LeFanu at drjames@telegraph.co.united kingdom. Answers will be published on the Telegraph site each Friday, at telegraph.co.united kingdom/overall health
After recovered, the bottle was stored in the pantry “for emergencies only”, this kind of as a get together, in which a spoonful of the elixir “made it a doddle”. When the bottle was completed, her mom returned for a repeat prescription. The medical professional had, nevertheless, moved on and his successor regretted he was unable to comply with her request, for, after consulting the records, the substances included amphetamines.
The report of unexplained bouts of stomach discomfort in the twelve-yr-old grandson with diabetes, as featured in the column final week, has prompted a reader to create that, as a youthful boy, her diabetic son (now aged 32) had intermittent, “awful stomach pains and cramps”, lasting up to a day, and of this kind of severity as to make him sick. They have been sooner or later attributed by the paediatric advisor at the Royal Berkshire Hospital to the exciting condition recognized as abdominal migraine, due, it is presumed, to the exact same mechanism as classical migraine: of an alteration in blood movement to the tissues. It disappeared right after puberty.
Alternatively, about one particular in ten kids with diabetes also have coeliac illness triggered by sensitivity to gluten. This proved to be the explanation for yet another boy who, for the very best part of two years, was woken by severe abdominal discomfort pretty much each night. His mother and father placed him on a gluten-free diet and “almost immediately” his attacks ceased, only to relapse if he inadvertently ate a gluten-containing foodstuff.
Nonetheless, it is required to recognise that kids (specially boys) in the pre-teenage many years are prone to the syndrome Recurrent Abdominal Soreness (RAP), for which no result in is recognized, and which in some evolves into Irritable Bowel Syndrome.
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This week’s conundrum comes courtesy of Mr N A from Leeds, puzzled by why his first, normal bowel movement of the day need to be followed an hour later by the “urgent” need to have for a even more evacuation – “much looser, practically liquid at times”. This, for clear motives, can be most inconvenient, and he needs to know whether any individual with a comparable knowledge may well know of a preventive remedy.
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Lastly, my thanks to a reader for passing on a simple but efficient treatment for easing the agonizing muscle spasms in the decrease back, induced by arthritis of the lumbar spine. He had spent substantial sums on different kinds of osteopathic manipulation, right up until suggested by a wellness service physiotherapist that he must practise normal do-it-by yourself massage by lying on the floor for many minutes a day with a tennis ball positioned at the primary internet site of the discomfort. This would exert just the appropriate sum of stress on the knot formed by the muscles in spasm, causing them to unwind.
“This is definitely no panacea, but has provided a lot more relief than my prior expensive therapies – and all for the cost of a tennis ball,” he writes. And not even that, as the tennis ball he utilizes was identified by his dog when out on their every day stroll.
Electronic mail health-related concerns confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Solutions will be published on The Telegraph website every single Friday at telegraph.co.united kingdom/wellness
At 1 time, psychiatrists produced a distinction between two kinds of depressive sickness: melancholia, a significant, protracted, often lifelong gloominess of the spirit and the a lot more widespread “reactive” depression, whose comparable but less severe symptoms are normally in response to an adverse daily life occasion, such as unemployment, marital breakdown or bereavement. Back in 1980, the American Psychiatric Association abolished this distinction in favour of seeing depression on a continuum, more significant in some than other individuals, but usually responsive to medicine.
Subsequent, Prof Shorter argues that psychiatrists were also readily seduced by claims that Prozac-like medicines have a particular mechanism of action, bettering mood by boosting the ranges of serotonin in the brain. In reality, scientific understanding of the role of transmitters in mental sickness was, and remains, “trivial”.
“The complete Prozac story is a cautionary tale,” says Prof Shorter. “When it comes to both diagnosis and treatment, the early approaches are very typically far better.”
Dizzy at springtime
The conundrum featured in this column of the lady whose mild vertigo when lying down or turning in excess of in bed is exacerbated close to the spring equinox has prompted the notion that this have to be due to adjustments in strain in the middle ear – for which there are two attainable explanations.
The very first would be a hayfever-variety allergy, the place sensitivity to pollens in late March brings about narrowing of the Eustachian tube at the back of the throat, stopping fluid draining from the middle ear and adversely affecting balance.
Up coming, readers level out that the climate is typically unsettled at this time of year (therefore March “coming in like a lion and going out like a lamb”). The fall in barometric pressure in the days prior to a storm, for illustration, would result in the fluid in the middle ear to increase, with comparable consequences.
Mystery abdomen discomfort
This week’s health-related query comes courtesy of Mr HJ from Leeds, creating on behalf of his 12-12 months-old grandson, who has Sort 1 diabetes. This is effectively-managed on his present insulin regime, but for months he has been troubled by a consistent abdominal ache of this kind of severity as to wake him at evening, affecting his schooling due to exhaustion.
The typical scans and X-rays have failed to determine a cause and he has been labelled as possessing “chronic non-natural abdominal pain”, with the implications that the difficulty is psychological rather than physical. This obviously can not be the case. Does any person, he wonders, have a suggestion as to what may well be amiss?
E-mail healthcare concerns confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Answers will be published every Friday, at telegraph.co.united kingdom/overall health
The Royal College’s report neither cites Prof Turner-Warwick’s paper nor discusses these two unstable kinds of asthma, which are often resistant to treatment and thus a major contributory element to the concern it addresses. This surprising omission would, one particular may think, invalidate its sensationalist conclusion that conscientious medical doctors are to blame for these deaths.
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Prolonged reside the ‘queen of poisons’
The limited efficacy of, and daytime sedation soon after taking, medicines for the treatment of neuropathic pain, lately talked about in this column, has prompted a reader to report his encounter with the homeopathic treatment aconite, the “Queen of poisons”, which in big doses “causes nearly instantaneous death” – but is a lot favoured by practitioners as a remedy for sciatica, trigeminal neuralgia and related complaints.
“I have in no way actually believed in homeopathic treatments,” he writes, but he was impressed by aconite’s effectiveness when taken as two tablets every single two hours, in suppressing the “deep, electric-shock-kind pain in my feet”. His signs and symptoms gradually worsened (“at evening, I felt as if a sparkler was exploding beneath my toes”), warranting therapy with the anti-epileptic drug carbamazepine, but the aconite he still finds assists to control exacerbations: “This is no placebo effect.”
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Mystery blurring
The girl whose near-sight, initially impaired 1st issue in the morning (so she is unable to go through her copy of The Every day Telegraph), improves later in the day, has prompted a couple of achievable explanations. First, this can be a side-impact of the beta-blocker eye drops timolol, prescribed for decreasing the raised intra-ocular pressure of glaucoma.
Subsequent – and importantly, since it is not broadly recognised – this transient visual blurring is a characteristic signal of Fuchs’ Corneal Endothelial Dystrophy (FCED), named after the Austrian ophthalmologist who first described it. The blurring is due to swelling of the cornea with fluid while asleep, which slowly evaporates during the day – a method that can be facilitated by directing the warm air of a hairdryer, held at arm’s length, at the encounter.
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A quesion of timing
Lastly, a more suggestion on politely but firmly rebuffing those unsolicited dementia-screening interrogations. Just lately, when going to his nearby practice, 1 of our much more senior and distinguished columnists was requested to “answer a handful of questions” – starting up with “the date of the present year”.
“That depends on what calendar yr you are employing,” he responded. “By the Islamic calendar, it is 1434”.
E-mail health-related queries confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Solutions will be published on the Telegraph web site each and every Friday, at telegraph.co.uk/overall health
Their signs and symptoms, rather, are a mixture of depression, anxiety, side results of medicine and preceding brain damage – some of which are treatable but can be overlooked if the patient has been (incorrectly) diagnosed as getting dementia. It also appears the numbers progressing to much more severe varieties of cognitive impairment are significantly reduced than previously supposed, raising doubts about the utility of diagnosis in the 1st location. Christopher Maycock, a retired household medical doctor “at risk of an unsolicited GP dementia assessment” intends, when asked to title the current Prime Minister, to reply “Disraeli” – a tactic that others may possibly want to adopt.
As for the red tonic, yet another reader vividly remembers getting taken by his mom to the family members physician who, at the end of the consultation, emerged from his dispensary with a bottle, instructing him to take two teaspoons each morning: “It was lovely.” Not too long ago his brother-in-law introduced him to the energising drink sarsaparilla that has, reputedly, a selection of medicinal uses. “My first mouthful distinctly reminded me of that red tonic dispensed 50 years previously,” he reports.
The most potent of these hidden components, nonetheless, was that stand-by of murder novels, the poison strychnine. At a minuscule dose (one twenty-fifth of a grain) it was claimed to “increase the speed of impulses in the nervous system”.
The nearest modern day equivalent to these tonics, it is advised, may be a glass of Mackeson’s ale.
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The reader’s account of “excruciating and agonising pains” in the reduce jaw, spreading down to the neck, arm and chest, has prompted even more plausible explanations.
A couple of readers recommend this may possibly be oesophageal spasm, that can often be relieved by a slug of alcohol (which relaxes the muscle groups) or the burp-inducing effects of fizzy lemonade. The spasm itself is generally brought on by acid reflux and so people often impacted would advantage from the preventive effects of an acid suppressant drug this kind of as omeprazole.
The additional probability is that the ache may possibly be induced by clenching of the jaw muscle tissue at evening (bruxism), which can be prevented by sporting a mouth guard.
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This week’s healthcare curiosity comes courtesy of Mrs FD of Leeds, who has been troubled by mild vertigo on and off for numerous many years, especially when lying down or turning more than in bed. The dizziness is a lot more marked at the time of the equinoxes in late March and September, when day time and night are of roughly equal duration – following which she improves again. Could there be, she wonders, some cosmic explanation?
Electronic mail health care queries confidentially to Dr James LeFanu at drjames@telegraph.co.united kingdom. Answers will be published every single Friday, at telegraph.co.uk/well being
Their signs and symptoms, rather, are a mixture of depression, anxiety, side results of medicine and preceding brain injury – some of which are treatable but can be ignored if the patient has been (incorrectly) diagnosed as getting dementia. It also appears the numbers progressing to far more significant varieties of cognitive impairment are significantly reduced than previously supposed, raising doubts about the utility of diagnosis in the 1st place. Christopher Maycock, a retired family members medical professional “at danger of an unsolicited GP dementia assessment” intends, when asked to identify the present Prime Minister, to reply “Disraeli” – a tactic that other individuals might want to adopt.
As for the red tonic, one more reader vividly remembers getting taken by his mom to the loved ones doctor who, at the finish of the consultation, emerged from his dispensary with a bottle, instructing him to consider two teaspoons each morning: “It was wonderful.” Just lately his brother-in-law introduced him to the energising drink sarsaparilla that has, reputedly, a variety of medicinal utilizes. “My very first mouthful distinctly reminded me of that red tonic dispensed 50 many years previously,” he reports.
The most potent of individuals hidden elements, even so, was that stand-by of murder novels, the poison strychnine. At a minuscule dose (a single twenty-fifth of a grain) it was claimed to “increase the speed of impulses in the nervous system”.
The nearest modern equivalent to these tonics, it is advised, may well be a glass of Mackeson’s ale.
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The reader’s account of “excruciating and agonising pains” in the decrease jaw, spreading down to the neck, arm and chest, has prompted more plausible explanations.
A couple of readers recommend this might be oesophageal spasm, that can usually be relieved by a slug of alcohol (which relaxes the muscle tissues) or the burp-inducing effects of fizzy lemonade. The spasm itself is generally brought on by acid reflux and so these regularly impacted would advantage from the preventive results of an acid suppressant drug this kind of as omeprazole.
The additional possibility is that the soreness could be induced by clenching of the jaw muscles at evening (bruxism), which can be prevented by sporting a mouth guard.
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This week’s medical curiosity comes courtesy of Mrs FD of Leeds, who has been troubled by mild vertigo on and off for numerous years, specially when lying down or turning more than in bed. The dizziness is more marked at the time of the equinoxes in late March and September, when day time and night are of roughly equal duration – soon after which she improves once again. Could there be, she wonders, some cosmic explanation?
Electronic mail healthcare inquiries confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Answers will be published each and every Friday, at telegraph.co.united kingdom/well being
He was at first handled with gabapentin 3 occasions every day to excellent effect, particularly at night, though this resulted in daytime sedation and dizziness. Accordingly, he was switched to the more pricey pregabalin, with the morning dose decreased to minimise the dizziness – but this led to “breakthrough” ache during the day. This was countered by adding in the antidepressant duloxetine, which initially triggered nausea, though this settled and the dose was increased.
The curiosity of the lady for whom speaking – specially on the telephone – leads to her to build a blocked nose is most likely caused by persistent hyperventilation, otherwise identified as Carbon Dioxide Syndrome, suggests Sally Gething, a practitioner of the Russian breathing approach Buteyko.
The explanation is as follows. We routinely breathe about 5l of air per minute at rest, which for these with hyperventilation can rise threefold when speaking, causing the concentration of carbon dioxide in the entire body to fall. This in turn constricts the smooth muscle in the nasal passages – hence the blocked-nose sensation. This sort of difficulty is apparently acquainted to Buteyko practitioners and can be avoided by adopting their breathing approaches. For a lot more details, go to www.buteyko.co.united kingdom.
Impaired vision
This week’s health-related query comes courtesy of Mrs PB from Suffolk who, for the previous number of weeks, has identified that for the initial hour or so following waking, she has difficulty in reading a newspaper. This can be improved by washing her eyes in warm water. Her distance vision is unimpaired. She has no indications of conjunctivitis, but her eyes do feel a bit sore in the direction of the finish of the day. Her optician are not able to explain this uncommon symptom and she would be more than grateful for any ideas.
Just the tonic
Ultimately, Harry Leeming, who writes a regular column for Useful Wireless, receives “all kinds of odd questions” that fall inside of his discipline of skills. He wonders whether any individual may well be able to clarify the following. Back in the Forties, those who felt under par would visit their household doctor (or the panel physician of pre-NHS days) requesting a “tonic”, and they would be dispensed a bottle of coloured liquid.
“They had been convinced this created them truly feel a great deal much better and that some tonics have been better than other individuals,” says Mr Leeming. He suspects this to be a situation of mind above matter but would be interested to uncover out what the ingredients may have been. Now aged 76, he occasionally feels a bit under par and wonders whether there is anything he should be taking.
E-mail healthcare inquiries confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Solutions will be published each and every Friday, at telegraph.co.uk/well being
He was initially taken care of with gabapentin 3 instances day-to-day to great result, specifically at evening, however this resulted in daytime sedation and dizziness. Accordingly, he was switched to the far more costly pregabalin, with the morning dose lowered to minimise the dizziness – but this led to “breakthrough” ache for the duration of the day. This was countered by including in the antidepressant duloxetine, which initially brought on nausea, though this settled and the dose was increased.
The curiosity of the lady for whom talking – particularly on the telephone – brings about her to produce a blocked nose is possibly caused by chronic hyperventilation, otherwise acknowledged as Carbon Dioxide Syndrome, suggests Sally Gething, a practitioner of the Russian breathing strategy Buteyko.
The explanation is as follows. We routinely breathe approximately 5l of air per minute at rest, which for those with hyperventilation can rise threefold when speaking, triggering the concentration of carbon dioxide in the body to fall. This in flip constricts the smooth muscle in the nasal passages – hence the blocked-nose sensation. This kind of dilemma is apparently acquainted to Buteyko practitioners and can be prevented by adopting their breathing techniques. For a lot more details, go to www.buteyko.co.united kingdom.
Impaired vision
This week’s health care query comes courtesy of Mrs PB from Suffolk who, for the previous few weeks, has found that for the very first hour or so soon after waking, she has problems in reading through a newspaper. This can be improved by washing her eyes in warm water. Her distance vision is unimpaired. She has no indicators of conjunctivitis, but her eyes do come to feel a bit sore in direction of the finish of the day. Her optician are not able to describe this uncommon symptom and she would be more than grateful for any tips.
Just the tonic
Finally, Harry Leeming, who writes a regular column for Sensible Wireless, receives “all sorts of odd questions” that fall inside of his area of knowledge. He wonders regardless of whether any person may well be in a position to clarify the following. Back in the Forties, these who felt under par would check out their loved ones doctor (or the panel physician of pre-NHS days) requesting a “tonic”, and they would be dispensed a bottle of coloured liquid.
“They had been convinced this produced them feel a lot greater and that some tonics have been better than other people,” says Mr Leeming. He suspects this to be a situation of thoughts above matter but would be interested to discover out what the elements may possibly have been. Now aged 76, he often feels a bit under par and wonders whether or not there is anything he must be taking.
E-mail health-related inquiries confidentially to Dr James LeFanu at drjames@telegraph.co.united kingdom. Solutions will be published every single Friday, at telegraph.co.uk/wellness
A small waterfall on the river Usk at Llangynidr bridge. Photograph: P Tomlins/Alamy
Handful of valleys in Wales are much more verdant than that of the Usk, its river heron-sentried, swift and graceful in between banks lapidary with primrose, stitchwort and bluebell. Fallen trunks wedged high over the water bear witness to winter floods. Two sandpipers pulse and dip in time to the whistling diminuendo of their calls. A robin shrills its alarm. From the hump-backed and cut-watered medieval bridge the riverside way winds a long, engrossing mile east to the confluence pool of the Nant Cleisfer, up which impetuous moorland stream my journey lies. At the final settlement of Blaen y Cwm, abandoned to sheep and entropy now, wood sorrel’s flowering beneath mossed walls. I select a leaf, nip and chew at its apple astringency.
Ring ouzels scud ahead and larks falter skyward on ladders of song as I climb to a ford exactly where the path from Tredegar arrives from the south. The substantial plateau among Usk and Taf has prolonged fascinated me. It’s arduous terrain, deep heather pitted with hollows that mark the place underground chambers have collapsed. Some of the most tough problems in British caving lie deep beneath its surface in techniques the identified lengths of which are extended each 12 months by committed and hardy-humorous devotees of a sport in comparison to which mountaineering seems secure and effete. Also hard now for an old man like me, I consider, with a wry smile of gratitude and a host of recollections of exquisite crystal beauties that lie darkly in the rock far under my feet.
This barrier landscape of moon-like austerity amongst the wealthy nation of the Southern March and publish-industrial desolation of the mining valleys holds other resonances. Half a mile south-west of the ford at the head of the Nant Cleisfer is the Chartists’ Cave, exactly where pikes of the insurrectionists have been stored just before their 1839 attack on Newport. Far more just lately inside of the radical tradition, Aneurin Bevan and his buddies often walked up here from his Tredegar house, discussing as they went the political venture that should be his enduring legacy – the NHS, the dismantling of which we are now despairing witnesses. The three excellent stones, neglected and vandalised, that comprise his monument lie just beyond the moor at the back of Waun-y-Pound industrial estate. I would like to see our politicians walk this rough ground to it, quietly, in mindful pilgrimage.
I give my college students annoying homework assignments, the very first of which is to come into class with an elevator pitch for a proposed firm. I define the term “elevator pitch” for them as a 60 2nd description of the organization. Time period – no further explanation. I ask them not to go through up on elevator pitches, and not to observe pitch competitions on YouTube. I want them to wing it – make some thing up that they believe will be convincing.
The college students all do a excellent undesirable job – which is exactly what I want. The pitches are all flawed, but the “intelligent but wrong” encounter helps make it less complicated to do it correct a week later, soon after we have far more thoroughly defined successful ways to pitch their companies.
The most widespread blunder the college students make? Pitches that are all notion, without having context a great deal of “here it is” and no “here’s why it issues.”
The 2nd time close to, the students get it proper: they recognize difficulties that require to be solved and the folks that have the dilemma they define the market place, THEN give the notion and describe how the notion can turn into a business. All in 60 seconds.
Negative pitches leave a “who cares?” hanging on the air. Great pitches helps make us nod, cock our eyebrows and consider, “the world has been waiting for this – why did not someone feel of it just before?”
I invest in existence sciences and biotechnology, difficult problems with complex options. So it is refreshing to hear about a novel nevertheless straightforward reply to a real difficulty.
Case in point. The difficulty: autistic kids wander, and every as soon as in a even though they wander away, and they can’t discover their way back, and they cannot be found. You have witnessed the information stories.
The folks impacted: the families, support people and colleges that face the issues (along with the joys) of caring for these children.
Lauren Thierry has a answer. Lauren is the president of Independence Day, a firm that tends to make clothing specially created for autistic youngsters. Her answer to the wandering issue? Minor GPS trackers embedded in the clothing.
Why didn’t a person feel of that ahead of?
I’ve read through a whole lot about wearable engineering, but so several of the concepts are remedies in search of a dilemma. Google Google glass, smart watches, Bluetooth rings, and iPhone-linked jewelry are modern technologies, but to my primitive thoughts they do not effortlessly and simply answer the “so what” test.
“Keeping track of kids who wander away” does.
(disclosure: I have no organization connection to Independence Day Wearable Tech. I am acquainted with the company President.)
The trend of prescribing blood-thinning medicines such as warfarin as a preventive measure against strokes in those with heart rhythm atrial fibrillation, markedly increases the risk of bleeding below the skull, known as a subdural haematoma. Neurosurgeons now see as numerous as 10 circumstances per week that could require a main operation to evacuate the clot of blood pressing on the brain.
The diagnosis, readily confirmed by a CT scan, is relatively easy in those with neurological signs and symptoms following a history of trauma or a fall. But the bleeding may possibly also happen spontaneously and, as Dr Elizabeth Teale of the Leeds Institute of Overall health Sciences observes, “the clinical functions can effortlessly be misinterpreted”.
It might, for example, result in behavioural or character modifications that can mimic a psychiatric illness or dementia. The hazards of a delay in diagnosis are clear adequate, and it is now suggested that people taking warfarin (or other blood-thinning medication, such as clopidogrel) should have a prompt CT scan each time they have even a minor head injury, or build novel mental or neurological symptoms.
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The conundrum of last week’s “excruciating pains” has elicited several related accounts. “Mine also come up in either ear or lower jaw, then progress across my neck and shoulders,” writes a reader. “It is a quite unpleasant knowledge.”
The intensity of the discomfort and reasonably brief duration – lasting from 15 minutes to an hour – is also a feature of the syndrome of “cluster headaches”, prompting the suggestion that they might reply to the anti-migraine drug Sumatriptan.
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Ultimately, further to the relevance of totally emptying the bladder as a preventive measure towards recurrent cystitis, a reader commends the simple if neglected treatment of potassium citrate (pot cit). Her 1st five years of married life was blighted by significant pain on intercourse brought on by repeated bouts of cystitis – until an elderly relative advised the treatment method. “Pot cit possibly saved my marriage,” she writes.
Electronic mail medical queries confidentially to Dr James LeFanu at drjames@telegraph.co.united kingdom. Solutions will be published each and every Friday, at telegraph.co.united kingdom/overall health
Next, their findings are contradicted by independent surveys that discover that muscular aches and pains are a hundred times more frequent than these reported in the clinical trials, although a series of even more difficulties are not even described – decreased energy, exertional fatigue, depression, memory reduction, insomnia, diminished libido, etc, and so forth. It is only to be expected that the drug firms must be reticent about this kind of issues. And it is surely of curiosity, as I go through by means of the HealthInsightUK.org, that the arrangements among Big Pharma and academic institutions specifically exclude entry to the original information on which the claims for the security of statins are based mostly.
This most current examine does not make me a convert to their wider use.
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The “miracle cure” of a 3-month program of the antibiotic Erythromycin for chronic catarrh, as not too long ago featured in this column, has prompted many exciting feedback. Professor Tony Narula of London’s St Mary’s Hospital reviews this regime has not too long ago been endorsed by the European Group of ENT experts. Subsequent, for the many in whom there is an allergic element to the chronic inflammation of the lining of the nose, it can be valuable to mix the regular treatment of a steroid nasal spray with an antihistamine, both taken orally or as a spray (Rhinolast), even though the addition of the asthma drug Montelukast confers further benefit.
Last but not least, there is the instructive knowledge of a reader whose 20-year background of persistent rhinitis and sinusitis culminated in her completely dropping her sense of smell and taste in her early forties. An MRI scan unveiled huge nasal polyps that had been removed by ENT professional Carl Philpott, of Excellent Yarmouth Hospital, with a three-hour method acknowledged as “computer-assisted sinus surgery”. “I left the hospital the subsequent day and inside of the week my sense of smell had returned,” she writes. “It is an delight to be capable to take pleasure in food – and nature – again.”
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The couple no longer capable to value the joys of mountain climbing and cliff walking, getting both designed a fear of heights, would, many readers suggest, advantage from a handful of sessions with a clinical hypnotherapist. The vertiginous sensations induced by peering in excess of a precipice, climbing a ladder or even descending an open stairwell are, it is claimed, an exaggerated kind of a typical survival instinct to stay away from probably hazardous conditions. It is attainable, utilising hypnosis in a secure atmosphere, to think about the encounter of strolling along a clifftop – hence desensitising people afflicted to the fears and physical sensations this can cause.
Alternatively, if a lot more dramatically, a reader from North Yorkshire claims that on a recent visit to New Zealand he cured himself of his dread of heights following participating in a 400-ft bunjee jump.
This year, it so happens, marks the 60th anniversary of the first successful kidney transplant, when American surgeon Joseph Murray eliminated a kidney from Ronald Herrick and transplanted it into his identical twin brother Richard, then in the terminal stages of renal failure from the progressive inflammatory problem glomerulonephritis. His new kidney functioned immediately and inside of a couple of weeks he was effectively ample to be discharged from hospital, promptly marrying the nurse who had looked following him in the recovery room soon after his operation.
Just lately retired doctor Dr Chris Burns-Cox, an altruistic donor when he was 72, has set up a charity, Give a Kidney, to motivate other individuals. This has grow to be a sensible prospect for many largely due to another health-related marvel – keyhole surgical treatment – that permits the surgeon to get rid of the kidney by means of a small incision in the flank. “Donation is no big deal for the donor, but a significant one for the recipient,” Dr Burns-Cox observes, anticipating a time when “the days of suffering and even dying on a waiting list for a kidney transplant will be over”.
Mystery smell
The frustrating knowledge of the gentleman, as featured final week, who finds that cooking the family supper brings about him temporarily to get rid of his sense of smell has prompted an fascinating suggestion from a former surgeon at St Bartholomew’s Hospital, Mr J Buchanan. He proposes really plausibly this might be relevant to the heat of the kitchen stove or cooker aggravating some lower-grade catarrhal irritation of the nose and sinuses – therefore diminishing the perception of smell as mediated through the olfactory nerve.
This is really distinct from the scenario with the gentleman who can nevertheless appreciate the bouquet of his fine wines (consequently the olfactory nerve have to be intact) but finds they taste “disgusting”. This would imply some disturbance of the nerves accountable for relaying sensation from one or other of the 4 types of taste buds (sweet, sour, salt or bitter) at the back of the tongue.
Canine fury
This week’s health care query comes courtesy of Mrs CM of Kent, writing on behalf of her husband, 78. He is “a sort person often fond of cats and dogs”, but lately, when strolling to the neighborhood village, the dogs he has encountered have had to be held back, snapping and growling, by their owners and he has twice been “nipped”. She wonders whether or not the canines may probably be sensing some chemical of 1 or other of the a number of prescription drugs he will take and would be more than interested to hear of any similar knowledge.
Summer digestion
Lastly, my thanks to a reader for passing on her most fascinating treatment for heartburn and acid reflux, prompted by her observation that she is much much less troubled by her symptoms in the summer season compared to the winter months.
She speculated that this might be relevant to the truth that during the summer she goes swimming most days and that plying up and down the pool performing the breaststroke might strengthen her diaphragm, providing it a tighter grip on the oesophagus and thus avoiding the upward reflux of acid from the abdomen. Accordingly, since Christmas she has taken to incorporating into her hold-match regime the practice of simulating the very same muscular movements as people involved in doing the breaststroke. “I have not been troubled by heartburn given that,” she writes.
Email medical concerns confidentially to Dr James LeFanu at drjames@telegraph.co.united kingdom. Answers will be published each and every Friday, at telegraph.co.uk/well being
Today I had a tonic-clonic seizure, the textbook hey-look-at-me-I’m-epileptic kind of seizure, with convulsions, teeth-gnashing, groaning – all the big boys!
It started, as it always does, with the rising feeling – a sickness and despair coming from my toes, like the feeling of nightmares – crawling all up my body and paralysing me so that I couldn’t call for help. Then the dread closed in all around me and everything went fuzzy and unreal.
The seizure’s never the worst bit, though. The worst bit’s when I come to and I see the faces of the people I love. It must be pretty horrific for them to see me all twisted and spitting like that. After every seizure my body mends me, but the guilt is always the last thing to heal.
Soon I felt weightless and kind of euphoric, like I was really stoned. Then the tiredness came. Seriously, nothing can lift the exhaustion once it’s there. It makes my bones feel like they’re too heavy for my body.
Usually after a big seizure I need to sleep all day, but today was different. Today Matt made me get up and go into the sitting room of the house we share in London, where he placed me in front of his photography lights. I sat there, too tired to speak, and he took this photo.
I’m exhausted and the left side of my face tingles where I burst some superficial blood vessels under the skin, but I feel kind of hopeful, now. I’m thinking this could be the start of something.
30 August 2012
I’m fucking scared. I’ve had so many tonic-clonic seizures in the past two weeks – like, ten or more; sometimes twice a day. They come in clusters and this is the worst cluster I’ve had in a very long time.
It probably goes without saying that I can’t work. Occasionally I do a bit of modelling – it’s a hobby I really love and I try to do it whenever I can. But right now I can’t even think about it. My speech is slurred and I’m so tired I can barely move; with every shoot I miss, my confidence takes a beating.
Maybe it’s just the exhaustion talking here, but I really feel like I can’t cope any more. The seizures are now so frequent they’ve left no space for me. What’s the point of being here? What’s the point of taking my epilepsy medication?
Even as I write these words I know that any second the switch could flick in my retarded brain and the epilepsy could take away my dignity and threaten my life and frighten the people I love. And the guilt. It just gets worse and worse. I’m so very, very sorry. Talk about a clusterfuck. Just before Matt took this photo, he asked me to think about how I was feeling, and uncontrollably, I began to cry. I haven’t told anyone yet, because I feel so ashamed of myself, but for the past few days I’ve been having suicidal thoughts.
13 September 2012
I’m out of the other side of the tonic-clonic cluster now, thank goodness, and I managed to get through it without confessing the extent of my depression to Matt. But the epilepsy’s still getting me down in lots of little ways. You see, this condition isn’t just about writhing on the floor in response to flashing lights (contrary to popular belief, only a small percentage of sufferers have this type of photosensitive epilepsy).
There are other kinds of seizure, like the one Matt caught me having in this photo. I just zoned out and ‘disappeared’ for a moment, hence my highly attractive, saggy-jawed zombie face. Sexy, right? Little seizures like this happen pretty often, and for those few seconds I’m not thinking anything, not a sausage. I only know I’ve had one when I miss a juicy bit of gossip in a conversation, or if I’m welcomed back to planet Earth by a fellow human saying my name. In a way this photo is funny. Now I finally see why my friends and family have called me Space Cadet and Dolly Daydream for so long. But in a way it intensifies my sadness. The tonics didn’t start until I was about 19 but I’ve been having these zombie seizures all my life. Why didn’t the doctors recognise them as epilepsy? Looking into these vacant, goggle eyes, I wonder how different things would be now if I’d been diagnosed when I was a child.
9 November 2012
Shortly before Matt took this photo, we’d had a huge argument; that’s why I look so exhausted. It was just petty, domestic stuff, blown out of hand. We’d been packing to leave London for his Nan’s 80th birthday party when we started needling at each other, and then, before long – BOOM – we were at each other’s throats.
Anyway, it was all too much. I couldn’t take it on top of everything else. I was at breaking point. So, mid-argument, I told him my secret that I wanted to die, and watched the wind get knocked from his chest.
Instantly I felt an overwhelming urge to leave, to run away. I was so ashamed. But then he held me, and the relief washed over me in waves. I felt safe. I’m so, so glad I told someone.
I have another secret that I’ll never tell him; I’ve stopped taking my epilepsy medication. It’s so stupid, I know, but I can’t help it. I don’t know why I don’t want to take it. I guess I’m just sick of it making me feel shitty, and sick of being controlled by it. No one knows this and no one can, only me.
25 November 2012
It all came out during my appointment with my epilepsy nurse the other day, when I confessed that I hadn’t been taking my tablets. I hadn’t planned to tell her but when she asked me if I had been taking my medication, I realised she just knew. Matt had come with me for moral support, and he was shocked to say the least.
After the appointment in Southampton (the town where I grew up) I was going spend a few days there with my parents while Matt went back to London. I got a taxi with him to the railway station and we were silent all the way, then he had to run for the train so we didn’t kiss goodbye or anything. All he had the chance to say was this one little exasperated sentence: ‘Your epilepsy’s got worse since you’ve been with me.’ I just stood there watching the train move into the distance.
Mum and Dad thought I should move back in with them so they could look after me; and to be honest, those few days with them were so cosy that I started to think they might be right. They were so supportive! But when I came back to London Matt was saying that we’d make it work, somehow. My parents want me to move back.
Matt wants me to stay. I’m sat in the middle of them like a freaking lemon. Matt took this photo today. I look so torn in it. I just don’t know what to do. Right now I feel like I want to run away and that I don’t want anyone trying to control me. Maybe I’d feel better if I started taking my tablets again?
3 January 2013
I’ve just got back from my first holiday abroad in ages. I went skiing in France with Matt, his mum and her husband for a Christmas break. Overall I had a marvelous time but there were some bad days. The real bummer about epilepsy is that it’s triggered by intense emotions. Like one day I got over-excited and had a seizure on the slopes. I remember very little of it but I know that I was rescued and sled down to safety by Matt and his family. I had to rest the whole of the next day. Dealing with the frustration of inactivity is a big part of learning to cope with epilepsy. Sometimes you want to go outside and climb a mountain or go on an all-day bender, but you’ve got to learn when to reel it in.
I’m back on the tablets now and my seizure activity and mood have calmed, although it took a few weeks to readjust to the meds – they seem to make me worse before they make me better. I’ve got into a good routine and haven’t missed a single tablet, I don’t think… I just can’t stand the exhaustion they bring.
Before Matt came home and took this picture, I’d sneaked on a bit of make-up. When you’re a bit special like me, you don’t get to feel like a bombshell very often, and I wanted at least one photo in the series where I didn’t look completely rough. Unfortunately, being a bit special means you often forget to do things, like take off your boyfriend’s scruffy jumper for said bombshell photo.
7 January 2013
Today was a really good day, mainly because I went to the gym. It might sound silly, but when you’re taking each day as it comes, even the tiniest of achievements can make you soar. Right now I’m tired, but extremely proud.
At the gym I did an exercise class and managed to keep up with the group for most of it. You feel kind of daft doing the moves, but then, everyone else looks pretty lame in those classes, don’t they? It was just loads of fun. I did zone out and get a bit wobbly at one point, so much so that the instructor asked if I was OK and suggested I had a time-out. But my competitive nature forced me to stay on until the end of the lesson.
I slept most of the afternoon, but got up for a photo when Matt got home. His face always lights up when he finds me in a good mood. It’s weird. Tomorrow could be entirely different, but I have days like this when I feel like I can take on the world…
3 March 2013
Sheesh! Epilepsy messes you around. Just when you think things are looking up, your body deals you another blow. I’ve been on my period for a couple of weeks now, and my epilepsy’s got worse again, which makes me think it might be linked to my menstrual cycle, somehow.
Apart from the big tonic-clonics and the zombie, zoning-out seizures, I also get these mini fits where I tightly clasp my hands together, my upper body fidgets, and my arms twitch and rock. Sometimes my head will fall to the left. It only lasts a few seconds.
When we were children my sister used to helpfully and rather endearingly inform my parents that I’d gone to ‘the bad place’ when I was having one, and the name stuck. They really aren’t too bad at all. They’re not dangerous like the full blown tonic-clonics, but now they’re becoming much more frequent and it’s starting to worry me. They’re exhausting me.
Right now I feel like this project is all too much. I’m finding it very difficult to write because I feel so lethargic. And because my emotions impact on my epilepsy, I’m now getting this sick feeling every time I try to describe how I feel. Like the illness has hollowed me out.
I’m in the bad place in this photo. I’d never seen myself having this type of seizure before, and it’s sort of thrilling to see it captured. But it’s eerie, too – coming face to face with that massive unseen part of me for the first time.
13 March 2013
I had a big seizure the other day and I made Matt cry. I’d been out modelling the day before, and in the evening I’d gone out with friends. The tiredness from that is what probably brought it on. I know it’s selfish, but I still want to go out and live my life, whatever the consequences might be.
Matt is finding it more and more difficult. I think he’s slowly coming to terms with the fact that he can’t do anything to fix my epilepsy. He’s such a motivated, ambitious person, so I can imagine how hard this is for him to accept.
We had a long, calm adult conversation about whether it might be better for the relationship if we lived apart. We still want to stay together as we both love each other very much, but it can be really tough being so close to each other all the time. I still want to be with him more than anything.
I’m very reliant on familiarity and routine, and this uncertainty about my living situation is unsettling me. Without certainty I can easily get confused and forget to take my tablets. Plus, any shift in my emotions can really impact upon my epilepsy.
15 May 2013
I’m in the middle of a cluster of seizures. I’m having loads, both big and small, and my body feels heavy from the exhaustion of this current barrage. The lethargy is really starting to do my head in. I want to keep up my gym and housework routine but I just can’t when I’m like this. Still, I’m trying my best to stay calm and allow this cluster run its course. Deal with it, Helen!
Interestingly, after the first of the big seizures in this cluster, I started to menstruate later that day, and it seems more and more likely that my seizures are linked with my sporadic periods.
When epilepsy is affected by the menstrual cycle in this way it’s called Catamenial Epilepsy – a really common subtype of the condition. Periods screw with seizures because oestrogen is a convulsant. So I’ve been having injections of progesterone (an anti-convulsant) in the hope that my periods will eventually shut down and improve my ‘time-of-the-month’ seizures.
When you’re in the middle of a cluster it’s hard to see out the other side, but I’m recovering well from each seizure, and although I’m tired, I feel safe and secure with Matt. We’ve decided to carry on living together.
18 June 2013
Realising that my epilepsy is probably linked to my menstrual cycle has given me an incredible boost. I’ve now discovered that I can have a progesterone jab more frequently in an attempt to nip my periods (and therefore perhaps a cluster of seizures) in the bud before they happen.
I’m feeling so positive at the moment. I’m experimenting with a low carbohydrate, high protein diet, as I’ve read this may help to control my energy levels. Seems good so far. Plus, I’m on top of my routine, which includes housework, gym, replying to emails and writing this diary (routine is what keeps me going). I’m even starting to have the attention span to read books again, which is just smashing. Matt and I are doing well. I’m trying to make a real effort for him now that I’m feeling a bit better, so I’ve been applying make-up and choosing my outfits to feel a bit more girly. It might sound like small stuff, but these are the little, tell-tale signs of a normal life that I’ve craved for so long.
For the first time in as long as I can remember, I feel optimistic about the future.
6 October 2013
So much has happened.
Matt broke up with me in July. I was devastated. One night while we were holidaying in the countryside I had a huge seizure – Matt said I was making demonic noises and my eyes were popping out of my skull; that it was like watching me die. I guess he couldn’t cope anymore. I miss him so much. I miss seeing his mum. I miss London and the friends I was making there.
I’ve moved in with my sister in Southampton, now. She decorated my room with pictures of friends and family, and I felt instantly safe and at home. Every day I have old friends contacting me and asking to meet up. I’m so lucky.
Despite the huge changes in my life, my health is improving. My speech is better and I’m reading more. It sounds silly, but I just can’t stop reading books! It’s such a wonderful feeling to be able to read and understand something without struggling. I’ve been researching more and more about nutrition for epilepsy, and have really upped my game. I’m now doing a ketogenic diet of high fat, moderate protein and almost no carbohydrates. This stimulates the release of ketones, which are natural anti-convulsants. It’s incredible! I can’t explain how much of a difference it’s made. I’m still making sure I take my tablets regularly, but if my progress continues I’ll see if I can lower my dosage.
I’m now hoping to start working regularly again, and I’m researching courses for study. I’m no longer ashamed of the person I am. I feel awake and everything is clear. For the first time in ages, my epilepsy is not defining me, and for the moment, at least, my life has a shape of its own.
