Sunday, 17 June 2007

The sun has got his hat on, but little Jimmy has not.

Every year between the end of May and the start of June it happens. We have the first patient of the year presenting us with a very sunburnt child of a varying age. Today's baby-mother had decided that her baby needed an, I quote "healthy tan." Quite why you would expect a child to need a tan of any description I know not. I surmise from the fact that this three-month-old child had pierced ears that it may be fashion related. I'm not sure how long the poor little fellow had been roasting in the sun- long enough that he was bright red and blistered. I referred him on to the out-of-hours service as he did not look very well at all. I imagine he'd need a little more than aftersun.

Tans seem to be in fashion at the moment. At the turn of the century it was fashionable to be pale and interesting. Having a tan at that point in time meant that you worked outside, not something to be aspired towards. When Coco Chanel made tanning fashionable, in the 1920s, foreign travel was prohibitively expensive. Having a tan meant you could afford to travel abroad. Now that you can fly on Easyjet to the south of France for £3 maybe that will change. The poor man can now as easily afford that golden glow as the rich man.

I will spend the next few months in silent amusement dispensing prescriptions to elaborately sunburnt patients. I think I'll stick to maintaining my programmer's tan
Many of my patients do not seem to understand the SPF system. Theoretically, if you apply it as recommended, a sun preparation with an SPF of ten means you can stay out for ten times as long as you can without sunscreen before you have problems. So, if you follow that logic, someone that normally burns in half an hour could stay out for 50x0.5=25 hours . Possibly not that useful on Earth where it'll be nighttime by that point. You are not really going to get a benefit in using anything with an SPF of higher than 15-20. Plus, higher SPF preparations tend to contain a higher concentration of UV filters and these can cause skin problems in some patients.
Using sunscreen has been shown to prevent squamous cell skin cancer. The evidence for the effect of sunscreen use in preventing melanoma, however, is mixed. Sunscreens that block both ultraviolet A (UV-A) and ultraviolet B (UV-B) light may be more effective in preventing squamous cell cancer than those that block only UV-B light. However, people who use sunscreen alone could increase their risk for melanoma if they increase the time they spend in the sun.

UV exposure increases the risk for skin cancer among people with all skin types, but especially fair-skinned people. Those who sunburn readily and tan poorly, namely those with red or blond hair and fair skin that freckles or burns easily, are at highest risk for developing skin cancer and would benefit most from sun protection behaviors. The incidence of melanoma among whites is 20 times higher than it is among black-skinned people
Observational studies indicate that intermittent or intense sun exposure is a greater risk factor for melanoma than chronic exposure. These studies support the hypothesis that preventing sunburn, especially in childhood, may reduce the lifetime risk for melanoma. So, "Little Jimmy" and his day in the sun today may cause problems for far longer than his parents might think. If you really need a tan then I advise you to get one out of a bottle and not from the sun or a sunbed. If you must venture outdoors then wear a big hat and don't sit outside in the sun between 10:00 and 16:00. Or, you could just sit inside and read blogs, that should work too. More information here.

Wednesday, 13 June 2007

Mild Dyslexia

I agree with NHS Blog Doctor on this.

“She’s very intelligent, doctor, but she is dyslexic.” I struggle with this concept. A layman’s definition of intelligence – and I happily admit to being a layman on this – is “the ability to understand and process information.” Just as it is no longer acceptable for children to fail exams, it is no longer acceptable to label them as being of lower intelligence. Instead, we sub-divide intelligence into a number of categories and look at each one individually. Let us suppose that Amanda is very poor at analysing data presented to her in words and is labelled as dyslexic. Surely this means that one area of her intelligence is poor or, in to put it in simple terms, she is not as intelligent as she might be.Because we have the label “dyslexia” Amanda will be given extra time for her GCSEs. Why do we not identify all children who are, for whatever reason, less intelligent and give them all extra time to do their exams? Indeed, taking this to the logical conclusion, we could assess all children’s global intelligence and give them examination times inversely proportional to their IQ.Why not?Whyshould it just be middle-class Amanda who gets preferential treatment?What happens to all these children with “mild” dyslexia when they leave school? Will they be prepared for the realities of life? You do not get “extra time” in the real world.

I used to be surprised at the number of people who told me that "Jimmy is very intelligent but he cannot read very well, that's why he has thirty minutes extra in exams" Surely the two are intertwined? If you cannot read and process information, then you aren't going to be "intelligent". I even know a pharmacist who tried to get extra time in his qualification exam owing to being dyslexic. It seemed to pass him by that in practice, working in the real-world, he would not get an extra thirty minutes to dispense a patient's prescription! Nice try though.

Monday, 11 June 2007

Prostatitis. Maybe stick to Trimethoprim?

Feel relieved that it isn't 1949? I'm sure you can still get these on Ebay. I think I'd prefer a 28-day-course of Trimethoprim 200mg bd.

The wire plugged into an electrical socket, presumably! I'd prefer not to have shoddy 1940s-era electrical items around my bottom. Nice that they offer a 30-day trial. Now that's customer service.


Hat-tip Theo Spark

Thursday, 7 June 2007

OTC Xenical?

as seen on Pharmalot.

The group also charges that Alli, which is a version of Roche’s Xenical prescription med, has minimal effectiveness, potentially harmful side effects and “uncertain risks.” These include orange undies caused by oily stools, which Glaxo acknowledges should prompt some consumers to take extra undies to work, just in case

I am not sure when OTC Xenical will arrive here in the United Kingdom. I have no doubt that there will be a huge demand for it. Be prepared for weeks of breathless coverage in the health pages of desperate tabloids such as The Daily Mail, articles on Daytime television.

And who will the patients who come in for it? They'll be the patients who are mildly overweight at best. In my experience the genuinely overweight and obese do not come in for slimming products, at least in the pharmacies where I work. Maybe one reaches the point of no return when one reaches a BMI of 35+? Maybe the patient is too busy eating cakes to come into the pharmacy?

It's the same with weight loss medication on prescription. We very rarely dispense it to the grossly overweight, we only tend to get prescriptions for those patients who are a "little bit tubby." Well tubby and persuasive/tubby and friendly with the doctor.

By the way, you now the perfect excuse to take an extra pair of pants to work, how useful! Probably best if you make them an orange pair.

Tuesday, 5 June 2007


Interesting post from Kevin, M.D. I have not yet had a "proper" stalker, and that isn't a challenge!

I've been tagged

I've been tagged. by Lola

Eight things you really don't want to know about me

  1. I used to have an invisible friend called Bimbo.

  2. I have an irrational fear that obese people will lick me like a lollipop.

  3. I only buy things in square containers so that they will stack easily.

  4. I have four slightly different versions of Blackhawk Down on DVD, which is a film I don't even like that much.

  5. I find people that believe in any sort of God profoundly suspect.

  6. I would rather spend a day at work, with no pay, than a day shopping. The Internet is your friend, why would you need to visit a shop? Hey, I'm a bloke, it doesn't matter if my clothes do not really fit.

  7. I make secret, imaginary lives in my head for the people I see around me.

  8. I got married at the same venue as the guy who played Joey in Friends. But not at the same time, that would have been weird!

In my own way of dealing with chain mails, I will not pass it on. But thanks for forwarding it to me.


From Crooked Brains:-

A woman was out golfing one day when she hit the ball into the woods. She went into the woods to look for it and found a frog in a trap.
The frog said to her, "If you release me from this trap, I will grant you three wishes."The woman freed the frog, and the frog said, "Thank you, but I failed to mention that there was a condition to your wishes. Whatever you wish for, your husband will get Ten times of that The woman said, "That's okay."
For her first wish, she wanted to be the most beautiful woman in the world.The frog warned her, "You do realize that this wish will also make your husband the most handsome man in the world, an Adonis whom women will flock to".The woman replied, "That's okay, because I will be the most beautiful Woman and he will have eyes only for me." So, KAZAM-she's the most beautiful Woman in the world!
For her second wish, she wanted to be the richest woman in the world. The frog said, That will make your husband the richest man in the world and he will be ten times richer than you.The woman said, "That's okay, because what's mine is his and what's his is mine."So, KAZAM-she's the richest woman in the world!
The frog then inquired about her third wish, and she answered, "I'd like a mild heart attack!!"
Moral of the story: Women are clever. Don't mess with them.

Attention female readers: This is the end of the joke for you, Stop here and continue feeling good…….The man had a heart attack ten times milder than his wife!!!

Moral of the story: Women are really dumb but think they're really smart.Let them continue to think that way and just enjoy the show.

PS: If you are a woman and are still reading this, it only goes to show that women never listen!!! that is why you read it even after our advise to stop!

Preventative medicine

Nice post from Scienceroll. Fortunately a majority of my patients are doing these things already, of their own accord. Then again, fifteen item prescriptions for diabetic patients probably keep me in work! We really can't have people being too healthy :)

Saturday, 2 June 2007

Stupid names (part four)

Chinnelle. Yes, try and figure that one out. It is either a phonetic spelling of Chanel (as if Chanel isn't classy enough to use as a first name- no comment!) or possibly someone who really cannot spell.

But, it would be worth fourteen points if you could use it in Scrabble, so life is not all bad.

I know, I know, It's not professional to mock patient's first names, but it is one good way to reduce stress when in the middle of a stressful day.