The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.
Here’s an excerpt:
The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 17,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 6 sold-out performances for that many people to see it.
The best method of cure is prevention
Though if you’re in the unfortunate position of having a back-log this is the best method that I’ve found for clearing it (it works in nearly everyone in 1-3 days).
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Three things: Standard advice, macrogol and suppositories.
Standard measures are: enough to eat (to give it a push through), enough to drink (plenty of water or clear liquids) and enough exercise (physical exercise encourages a good bowel action).
On top of this, using some medicines to help can work wonders.
Macrogol (also known as laxido). An unpleasant tasting powder. Make up with water or similar.
To clear:
Day 1 – 2 sachets, twice a day
Day 2 – 3 sachets, twice a day
Day 3 – 4 sachets, twice a day
Day 4 – 4 sachets, twice a day (most people don’t get to day four)
To keep clear: half a sachet once a day (or one sachet once a day, or half a sachet every other day. People vary with how much they will need).
Suppositories
I recommend glycerol. They can be prescribed or bought over-the-counter.
They help lubricate the poo, so it feels less like concrete and they help provide gentle irritation to the lower rectum which encourages a really efficient bowel movement.
Take a book or something to read into the lavatory (because when it works, you don’t want to have to run the length of the house).
Take the plastic wrapper off (otherwise they are scratchy and don’t work).
There are self lubricating – so hold the bullet (any way up) and wet the end under a tap.
Push it into the bottom (if it doesn’t fire across the room it is probably in far enough). A ‘rule of thumb’ is to push it into the first knuckle.
Then hold onto it for twenty minutes (to give it enough time to work and provide optimum irritation).
Then have a pleasing, dramatic bowel action. Repeat as needed. Most back-logs take about three really big actions to clear. If you are prone to them – think about what medicines you are taking, what your diet / fluid intake is like and consider talking to your doctor.
Dr Peter Windross, November 2011
Hi Kitty cats
The phoenomenon is the description of the fingers going through the red,white and blue colour changes (named after French physician Maurice Raynaud (1834–1881) – who described this)
french flag
Raynaud’s syndrome, or “Secondary Raynaud’s”, occurs secondary to a wide variety of other conditions. Remember this because secondary and syndrome both begin with an ‘S’.
Raynaud’s disease is described as an allergy to the cold (not accurate but easy to remember) – disease….don’t know of any underlying cause
It is the “R” in the CREST syndrome acronym (Calcinosis, Raynaud’s, Esophagitis, Sclerodactyly, Telangiectasia) – this syndrome thought to be a limited version of Scleroderma which can produce a mouth which looks a little like a cat’s bottom
Raynaud's
In Raynaud‘s syndrome it is important to establish the cause (here are some if the many aetiological factors):
Asymmetrical involvement and secondary skin change on examination are suggestive of secondary Raynaud’s syndrome.
Investigations are: FBC, ESR, ANA, ENA, anti-centromere antibodies and anti-Scl 70 antibodies
+ chest X-ray to exclude a cause in the lung apex (causing compression of the subclavian artery on it’s way into the arm)
Hope that was interesting
Dr B
Good morning world, how’s it going so far?
This is from the splendid post
(well written, succinct set of easy to follow rules and guidelines)
Bonus trick: Turn text into links with HTML by using the following code:
1<a href="link">text</a>For example,
1<a href="http://wordpress.com">My favorite blogging platform</a>
I rather liked that one. I’ll leave with one more quote.
Rules are there to be followed by those not smart enough to use them as guidelines
Peter Windross, 2011
Have a great day
Dr B
Hello
Today’s condition is migraine. This is a headache which affects half your head (hemi-craine), pronounced with a heavy French accent
They are distinct from cluster headaches (which also are unilateral)
The information here is largely taken from the evidence based Scottish intercollegiate guidelines (SIGN) 2008
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So they feel like a hangover, but are one sided and can have a positive family history
The rapid onset is also a feature of thunderclap headache (associated with various different intracranial bleeds) which is a red-flag feature. It is worth learning the red-flags
Helpfully the SIGN guidance says that:
“Patients who present with a pattern of recurrent episodes of sever disabling headache associated with nausea and sensitivity to light, and who have a normal neurological examination, should be considered to have migraine”
If they have a normal neuro exam, a typical history and no red-flags then further investigation is not required. So….. No
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Acute treatment is tailored to the individual patient:
Prophylaxis (this can halve the severity and frequency of episodes)
There are a whole bunch of these (beta blockers, anti-epileptics and TCADs)
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End note: if a patient gets a headache with an aura they must have their combined oral contraceptive pill stopped (COCP) – the one with oestrogen in it
This is because there is an unacceptably high risk of stroke (which can of course be fatal). This makes them an UKMEC 4 (and we know that we can only really prescribe in situations of UKMEC 1 or 2) – this guidance is from the Faculty of Sexual and Reproductive Health of the Royal College of Obstetricians and Gynaecologists (RCOG)
That’ll do for now…… I’m getting a headache
BFN
Dr B
(check out my pages on headache – history and examination, headache – red flags and the cluster headache page)
Good afternoon guys
Today’s case is cluster headache – these are headaches (one sided) which happen again and again and again (then disappear for a while) and then come back in another cluster
green, red or yellow
Cluster headaches are the commonest form of trigeminal autonomic cephalgias (TACs).
Unilateral pain in the distribution of the trigeminal nerve
Pain is always unilateral in cluster headaches
Same sided autonomic features:
Agitation is common
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Done
ciao
Dr B
(check out my pages on headache – history and examination, headache – red flags and the migraine one)
Hi world
A little piece on how to approach headaches
Please also take a look at the red flags not to miss and a look at cluster headaches and the migraine review
As with all things in medicine – history followed by the examination (then investigations – simple then special, like CT)
my head hurts (so does mine)
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The point of the history is to find out everything there is to know about the headache. The clues you look for are those features which will help you determine the most likely underlying cause. Migraine, cluster headache, sub-arachnoid haemorrhage, chronic subdural, tension like headache, etc. all have characteristic qualities which you can bring out in the history. Sir William Osler said…..
“Listen to your patient, he is telling you the diagnosis”
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papilloedema
Cranial nerves (learn them and their examination, get it slick in 3 minutes – it’s an afternoon well spent which will stand you in good stead throughout your career – and you’ll look cleverer than the students around you 
)
Fundoscopy to look for papilloedema, severe hypertensive changes or clues like diabetic retinopathy
BP – malignant hypertension is important and can be missed
Pain in the neck – can be the joints (arthritic), the discs (can prolapse and press on both the spinal cord and nerve roots) and the muscles (probably the commonest cause of headache is tension held in the occipital insertion of trapezius causing pains which radiate over the top of the head – better posture, less stress, a heat pack and a good massage from a lovely therapist are the best cures)
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Ok, those are the salient features
TTFN
Dr B
Hi y’all
Today is headache day. Here are a few pointers on how to approach a headache. Avoidance is probably best
But lest the reading in your favourite neurological tome be too headache-o-genic (I’ll admit I made that word up) then here is a brief guide…
It is based on the best evidence I could find:
Headaches – SIGN guidance 2008
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(migraine, tension headaches, cluster headaches)
(neoplasms, drug induced, infection)
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The red flags are often talked about. These are what you spot which makes you think (or should do): I want this patient to see someone -else / -cleverer than / -a long way from here
(in case they -die / -sue / -don’t get better / -get better before I can share this fascinating case and an opportunity to teach my colleagues and demonstrate my superior clinical acumen…. maybe)
There are fourteen of those and they are fairly obvious if you uncover them. They are all meant to ring an alarm bell. Until you learn them (which will probably take many many patient histories of practice) – simply print off the list as a checklist and use with the patient – impress them with your resourcefulness (they won’t know it because you like me get brain block sometime – don’t worry about this, it is a common phoenomenon amongst budding doctors)
That’s enough for now
Take care
Dr B
(check out my pages on headache – history and examination, cluster headaches and the migraine one)
Hello world
Today I want to have a little look at getting cross
I’ve noticed that when I get cross I can get cross at the world in general, the particular circumstances of why the universe is against me today, other people, animals and inanimate objects
Nothing unusual so far I hope
Animals and other people: my girlfriend get cross at the cats for bringing their muddy paws in and walking over the (well chosen I’ll admit) cream sofa – my response is to tease her and say they’re behaving like ‘animals‘
They are just that: animals, in the same way children are childish and stupid people in your way are just that (not evil, just stupid). It’s not their fault
muddy paws
Few people try to make to angry / sad / frustrated – most are just trying to do the best they can with what they’ve got (mental, physical and emotional resources) – it’s not their fault if they can’t see the world your way, you actually appear the same way to them – so it’s hardly surprising if occasionally we butt heads with people we meet. The trick is to realise that that is all that it is and the world would be a bit weird if it and all the people in it conformed to your every whim anyway
The universe is against me: is it? really?
It may seem like that and that is a good time to stop, take a deep breath and realise that to quote the Baz Luhrman song (wear sunscreen)
Your choices are half chance.. and so are everyone elses
The world turns, events happen and none of these things are conspiring against you (I promise). We have pretty much free choice in most things we do and in how we choose to think moment on moment. Smile, it’s a good start.
Inanimate objects: when these are conspiring against you
Occasionally things wink in and out of existence (like car keys and mobile phones) – that was a theory my 80 year old grandmother claimed (way before our understanding of the ten dimensional universe we currently occupy was popularised by string theory). It is the only explanation for why you are looking for something and you find it in somewhere where you’ve already checked.
My favourite is when I’m running late for work and find my toothbrush in my hand despite having spent valuable minute searching in vane for the bristly plastic scrubbing device.
trans-dimensional mischief
The other theory is that is says more about your state of mind that you are blaming other things (objects are clearly not at fault) – I find it interesting that we can apply this to other people too. If someone else is clearly at fault try thinking of them as a malevolent toothbrush switching dimensions just to irk you – and consider that it may be me or how I am today which is causing this perceived friction. It makes me smile more and be a little more generous in spirit. I rarely regret that – it is often extremely helpful
Try it – go on
All the best
Dr B
Hi Guys
Today I will offer you something that was shared on a website about moods.
I’m paraphrasing and can but bow to the cleverer offerings of Michael Neill and his genius catalyst stuff and recommend his solutions cafe as well worth investigating
This bit pertains to the weather of what happens in our lives each day
My take is that when we start out in life we are beholden to the prevailing weather (if it’s raining we 
and if it’s sunny we
Maturing we are able to produce our own weather – we can generate from within us that which soothes our soul and can (on a good day at least) project this and share with our fellow humans
Weather is all very well but whether is bothers you is all a case of perspective, to take the over view the meta-picture is to see things from the point of view of the sky
The difference between weather and the sky is that if were we to transcend the meteorological phoenomena and issues we are able to see the world from the point of view of the sky (stratosphere and beyond) at which point we see weather systems moving and occurring. We see them as interesting and pretty but they just don’t really get in the way of your day or what you’re up to
Which is nice
the meta view
Have a go (it’s only a mental exercise after all)
Ciao
Dr B
within all of us we hold the key
