Rude health: Fleshy earlobes
There are plenty of good puncture sites for blood tests to ooze from, writes Maurice Gueret, and he is all ears for a new one
Nobody likes to be a pin cushion, but some folks are martyrs to the cause of blood-letting. Diabetics and patients taking the blood-thinning drug called warfarin are well used to having their skin punctured. Or so we would think.
A retired children's doctor who was on warfarin to prevent his blood from clotting wrote to the British Medical Journal recently to tell them how fed up he was with the pain of having fingers pricked. He had a remedy and asked his GP's nurse to swap sites and take a regular blood sample from his ear lobe instead. She did this and his problem was solved. Auricular phlebotomy is quite acceptable to the World Health Organisation whose guidelines on drawing blood say that small samples make be taken from the fleshy part of the ear, particularly in screenings and when large numbers need to be tested. Or when doctor and nurse haven't time to sit down and hold your hand!
When minute blood samples are required, a full needle in the arm is not necessary. A quick stabbing with a spiked lancet will do. The clinical name for a pin-prick blood test is a capillary puncture. The sites that can be used sound a bit like a certain party song - ears, fingers, heels and toes. Heels are usually chosen only in newborn infants. Toes are a bit sensitive and the blood-taker could also risk receiving a kick. Earlobes have very few capillaries (the tiniest blood vessels) and with few nerve endings too are quite resistant to pain. This is especially so in older patients who find fingers a bit sensitive in advancing age.
Waiting room survey
It's time for our annual Waiting Room Survey, so in the coming weeks I'd love to hear from readers about the best and worst of waiting rooms you are asked to inhabit. Doctors, dentists, hospitals, counsellors and physiotherapists - I want your reports about them all. Are you subjected to Cash in the Attic or Flog It on the practice television? Does your healer pipe out country and western music? How healthy are the plants? What's the oldest magazine? Any interesting leaflets? Good cartoons on the wall? Rudely written notices? Is there a good box of tissues handy? We won't do any naming, shaming, or whistleblower identification, so anonymity of visitors and hosts is guaranteed! I'd just like a selection of observations on the Irish waiting-room experience. Please do get writing to me at email@example.com or at PO Box 5049, Dublin 6W.
Growing up in 1970s Ireland, you became aware that there were two types of Irish homes. Those with multi-channel televisions and those with a solitary channel from Donnybrook and something in Welsh. I was one of the lucky ones and favourite summertime viewing for boys in multi-channel land were five-day-long test matches in cricket on the BBC. When a game of anything lasts a full five days, including hours off for rain delays, the role of the commentator is greatly magnified. Our favourite was former Australian captain Richie Benaud, a maestro of moderation amidst the stumps, the bats and the monotony in between. He died from complications of skin cancer last month at the fair age of 84. Older generations in Australia have the highest incidence of skin cancer in the world. Migration of more fair- skinned races to a hot outdoor country you see. They know risk avoidance better now than they did in Richie's day. There has been plenty of commentary about Benaud's acumen in spinning balls and his legendary commentating, but not so much about the skin cancer that ended his life. The site of his lesions, on the forehead, scalp and neck, would suggest that sun exposure in early life played a role. As a child, Benaud's own cricketing hero, Keith Miller, never wore a cap. Richie followed his example. It was rumoured that Benaud's barnet was once sponsored by Brylcreem and that part of the deal involved keeping a full head of hair on view. When asked to comment on this, Benaud said mischievously that he was not going to say anything on the matter and was certainly not going to reveal how much he was paid! It's difficult always to pinpoint exact causes of an individual's illness in medicine but I was interested to read that as a teenager Benaud was struck on the head just over the right eye whilst batting for New South Wales. And it took an extraordinary 28 X-rays of a crater in his forehead to determine that he had fractured his skull. Now that's some exposure.
Though I wouldn't necessarily want to live with him, I'm a great fan of Kerry hotelier and television presenter Francis Brennan. He is not afraid of his own opinions and can be a master of tact. He might have made an excellent general practitioner had his mother guided him that way. I recall a television interview in which he was asked how he might handle a particularly smelly staff member in the workplace. Francis spoke about his 'compliment sandwich' where he would praise the person to high heavens for a job well done, whisper some quick and sensible advice about soap and personal hygiene and then change the subject to finish with another flourish of praise and promise for the future. Great common sense in that approach and it came to mind the other day when doctors were advised not to mention the level of obesity they see in every patient, but to focus instead on their activity levels. Doctors might ask 15-stoners if they have ever considered walking a poodle. For 18-stoners change the breed to labrador. And for 20 stone and upwards try the giant schnauzer, great Dane or Irish wolfhound. Or all three on a lead together!
Dr Maurice Gueret is editor of the 'Irish Medical Directory'