Tell me ..I forget Involve me... I learn

If you are passing through Waterloo Station in the next few weeks and a swarthy bunch of middle aged men looking suspiciously like Middle Eastern secret agents suddenly pop up and do a swift rendition of Row Row Row Your Boat, clattering coconut shells in accompaniment, then I can notch up another milestone in my medical career.  

Mystified ?  Just practice the singalong and I'll explain ..

I've taken two days off for education - Continuing Professional Development (CPD) being an essential part of every doctors remit these days.

We have to collect as least 250 CPD points over 5 years which can be quite a tall order.  Ideally I would give priority to clinical courses - updates on disease areas like "The latest thoughts on treating pneumonia in the Crimean War Veteran" or "Screening tests for dye allergy in women who enjoy a blue rinse" but courses can be expensive  - a weeks salary for a days course - so free courses laid on by the Deanery have a certain appeal.   I wasn't particularly looking forward to this one but it offered 10 free CPD points, so I gave up a day and a half of my "spare" (writing) time to go. And, suprisingly, it was very good (thanks to a great teaching team including Dr Simon Cooper, a consultant physician working with the elderly in Taunton). 

Based on Confucius's words :

Tell me - I forget

Show me - I may remember

Involve me  - I learn

.. we were shown how to teach effectively by involving our students using all sorts of techniques, one of which was a 10 minute "micro-teach" session that we all had to try out.

Choose something non-medical to teach was the advice. I could have got them making a nice cocktail but 10 in the morning seemed a little early for Death in the Afternoon, and most of you know my kitchen skills are dangerously limited. More importantly the rest of my group, who I was to teach, consisted of overseas doctors, predominantly middle aged Muslim men well versed in surgical microsuction in the middle ear or the challenges inherent in replacing a hip joint.  It was hard to guage what other interestes or knowledge they might have but undoubtedly mid-morning alcohol was not a good idea. 

So in a sudden brain wave I decided to teach them how to perform as a Flash Band  

("Why ???" you are no doubt immediately rising in your chair to wonder - the tutor examining me thought much the same - and assumed my microteach was

doomed from the start.)

Fearless, I made my pitch. First I introduced the concept - none of them had a clue so I used my ipad to demonstrate with a YouTube clip or two : 

A flash mob song ?

A Flash Dance ?

or even a flash freeze ?

  

Suitably impressed with the idea, we then spent a minute brainstorming what we would need :   

SINGERS

INSTRUMENTS

LYRIC SHEETS OR MUSIC

  

plus a Bandleader/Conductor .. and a big heap of guts !!


By now I was sweating and shaking - would they understand what to do... could they play the simple percussion instruments I had borrowed from my children...  would they even sing in front of their colleagues ?

To my astonishment, the guys delivered - with enthusiasm and gusto !! We had a couple of shaky verses at the start (my poor direction), a brief hiccup as I rearranged them into pairs when they looked nervous about singing alone, and then we took the world of rivers and rowing boats by storm.   Forget scalpels and stethoscopes, these doctors have new skills, so watch out Waterloo ! 

Quite how I (and they) are going to put this to further practice in the hospital isn't quite clear though ..     

Shock news from the hospital : part 1: There is no "Critical List"



Muamba still on the "critical list" ? 

An update on the radio this morning cautiously warned us that while Bolton midfielder Fabrice Muamba, who collapsed in the middle of a game last week, is showing signs of improvement in a London hospital, he remains on the critical list.

Mysterious.

What is he doing lurking on something that is no more than a figment of a hack's imagination?  He's not going to get better hanging round there.

Journalists and novelists love to think that beady-eyed administrators clutching clipboards wander the hospital wards looking for people whose pale skin and sunken eyes hint at imminent collapse of their kidneys or heart, and so who deserve to be added to

 the "critical list" .. 

  

.. that instead of getting on with the mundane business of treating patients, nurses or doctors spend their time continually weighing up heart rates, blood urea levels or CURB scores before ringing up Joe in the office to say "yeah, put him on the list, guys.." 

  

And what would the hospital do with such a list ?

Use it to drum up publicity about in the local paper about the heavy demands

on the hospital's hardworking healthcare team and how threatened budget cuts would mean a speedy demise for those on The List ? 

Wave it in front of litigation lawyers  ?

Reassure relatives that their loved one has a special place in the hospital's daily bulletin ?

   

I don't know of a hospital anywhere in the country which has a "critical list"

There is NO critical list. Get over it.  

Music that stirs the spleen is good for transplants

Keep your transplants strong !

Few would deny that music has a fundamental affect on humans. It can reduce stress, enhance relaxation, and provide a distraction from pain. Don't ask me to explain the exact mechanisms just yet because the link isn't well understood, although there is some evidence that music may act on part of the autonomic nervous system - the nervous system which acts automatically to regulate the bodily functions that we have no conscious control over, including digestion.

But now new research suggests it may reach far deeper into the physiology of the body, stirring the spleen into helpful action.

Research from Japan published in the Journal of Cardiothoracic Surgery this week demonstrates that music can reduce rejection of heart transplants by influencing the immune system.  I pause here to point out that the study was in mice, so interpretation for humans needs care. But even so, the scientists found that certain types of music increased the time before the transplanted organs failed. There were lower levels of the chemical messages that the immune system generates during rejection such as interleukin-2 (IL-2) and interferon gamma (IFN-y), and higher levels of protective anti-inflammatory chemicals IL-4 and IL-10, as well as increased numbers of  specialised CD4+CD25+ lymphocytes - cells which regulate the immune response.  They pinpointed the source of this proection to the spleen.

But what seems to be critical is the type of music.  So if you are the sort of person who likes those gentle wafty wave noises or tinkling of silver bells in the breeze - the sort of New Age thing you can pick up in the local craft shop, or just a touch of Ambient, you may want to think again. I'm sorry,

Mr Eno         

.... and Mr Schulze 

but these toons simply don't get your spleen going enough.   Open your lugholes to something else and try a bit of Verdi or an Ode to Joy (the choral part of Beethoven's 9th). 

The Japanese team found that opera and classical music could both affect the immune system but single frequency monotones and new age music did not. They admitted they hadn't tried Screamo, Dubstep, Gospel or Punk so clearly lots more interesting research is needed.

But for now get loud and get venting your spleen !!

Perhaps they just need better songs ....

NNNNnnggggnnnn ... 

I've tried, really I have..
I'm all for older musicians ..  (big time !)
I'm happy to champion causes related to the elderly..
I treat and write about dementia (watch the shortest one closely...)

But I just can't quite go here.....

and even this is a struggle...

Hitting the highs with High Intensity Interval Training

Two weeks since I watched Michael Mosley on BBC's Horizon tell me that just a few minutes of high intensity exercising (going as hard and fast as I possibly could, to get my heart rate up to around 90% max) would shake my metabolism into a higher gear, and I am astonished at the results.  In just two weeks I'm feeling fitter and shedding weight faster than I ever have before. 

I'm doing it to improve my sugar metabolism and try to dodge my high family risk of Type II Diabetes but as I am dieting too it is already working very effectively to help me lose weight - especially the high-risk central "apple-shaped" obesity.  

Its changing all long standing teaching  Its painful to beat my heart rate up to about 150 and stay there for a minute before resting and then trying again, but not impossible (especially on my old pal, the X-trainer) and much more bearable than hours of slower slog.

here's one of the original papers  on it from Australia and some more research on the topic. .. and here   Lack of time is no longer an excuse as this slightly old report tells.. 

Keep watching this space
 .. maybe now the sun is coming out, one of these would be nice...  (helmets are there to keep bird woo off presumably ?

NB * Get your doctor to check you about before you try if you have any risk of heart disease or other health problems

A beautiful tribute by a son to his father's last years

http://www.dayswithmyfather.com/#/0

Guess we could try running the Indian Railways instead ?

 

http://www.economist.com/blogs/dailychart/2011/09/employment

Is 68 too old to teach ?

Teachers are busy debating an NUT ad which they say suggests that 68 is too old to be working in schools. Hear what they have to say at :
http://community.tes.co.uk/forums/t/558534.aspx?s_cid=Mon_news_COM

The general feeling seems to be that individuals should have a right to carry on working in their teaching role at this age, if they so want to, although most hope they will have been able to pack up work by then.

Isn't this a waste of one of the most valuable contributions that older people can make to society -  to help pass on the huge wisdom and knowledge they have acquired over the years ?

Bearing in mind that at 65 many people will still have 20-30 years of life ahead of them (average lifespan of women in Surrey is now nearly 95  - and rising..) we are going to have to accept, like it or not, that complete retirement for all work or contribution to society needs to be pushed back further into later life (unless illness or disability intervenes). 

About 10,000 people in the UK today are already over 100, but its estimated that 10 million people alive at the moment will reach 100 (17% of the population).  The numbers speak for themselves, and the age of 68 starts to look more like it's still part of mid life.  If you are going to reach 100, you probably still need to be working in some shape or form at 68.  And the majority of 68 year olds today are still fairly spritely.   Of course, many will have gone past the ability to manage heavy manual work (although we once had builders come in to extend our house and the guys digging the foundation were a 58 year old and his 81 year old father !) but perhaps a couple of hours 2 or 3 days a week teaching would be an achievable contribution to society. In Denmark, retirement has become a gradual process, slowly giving up a day a week at a time, over a period of several years.

Its time to take a different view of the years previously held as the start of retirement, and we need to find productive roles for those towards the end of mid life.  

 

Tales from The Departure Lounge 2

One of my patients has turned a corner - the wrong one - and she is now dying, very slowly.  I think I've posted on a similar case about a year ago, and like that patient, no food or liquid has passed her lips for 8 days now (although mouth care keeps her lips moist). She's very peaceful lying in bad, semiconcious, but her family are distressed by the idea that we are not feeding her, giving her drinks (We can't just pour them down her) or giving her intravenous fluids. Nothing for 8 days. Its a basic human instinct to want to nurture with food and drink - and even harder to accept a loved one is dying.   I should add that breakdown of body fat in this starvation situation liberates water and combined with a switching off of metabolism, water needs are much reduced. Of course, you can't ask an unconcious person what its like to not take any fluid (although she is not showing any signs of distress – we are managing her on the Liverpool Care Pathway for the Dying.) A study from Oregon of 106 terminally ill patients in hospice programmes who chose to discontinue food and fluids with the conscious intention of hastening death found that most reported a high degree of peace and comfort - 90% were thought to have achieved what is described as a "good" death. In the end I guess that even is she is not suffering, its a long slow haul for her loved ones around her bed. 

N Engl J Med 2003; 349: 359-65

 

http://www.nejm.org/doi/full/10.1056/NEJMsa035086#t=articleDiscussion

Blueberry brain-treats

What should you be eating to protect your brain and nervous system as you get older? Here's the research evidence summarised in 10 short slides - I recommend you read them at the link below (and then go out and get a salmon salad and some berries for lunch)

Brain food !