Wednesday 17 January 2018

Rude health: Lumps and bumps

Diagnosis of Fr Jack Hackett and the effects of meldonium on tennis rallies keep the mind of Maurice Gueret active

Russia’s Maria Sharapova took the banned drug meldonium. Photo: Reuters
Russia’s Maria Sharapova took the banned drug meldonium. Photo: Reuters
Dr Maurice Gueret

Maurice Gueret

March has been the month medics learned a bit more about meldonium. Family doctors all over the world hurried back to surgery and checked their Kardex systems to see if they had ever treated a young Russian lady by the surname Sharapova.

Ten years is a long time in the annals of medicine, when some of us cannot even remember who we saw yesterday morning. Magnesium deficiency, strange heart rhythms in teenagers, diabetes in the family and tennis elbow - just the sort of thing that might set off a doctor's alarm bells. Luckily for Irish GPs, they are off the hook. The drug meldonium has never been licensed here - indeed, its Latvian manufacturers have never sought one. It was primarily put to use for treatment of angina and heart attacks in unpronounceable countries that never vote for us at Eurovision. But little was known about it outside Eastern Europe, other than the fact that some well-known cyclists and middle-distance runners were growing fond of it. Now that we know a bit more, the allure of amateur sport is  a lot more attractive than the professional one.

They are listening to me in England. The National Health Service has announced plans to build 10 towns that include 'dementia-friendly streets'. You will know that I am no fan of farming urban grannies out to the mountains and bogs, when they have been used to streetscapes for all of their lives. I have nothing against the countryside, but when tax incentives are used to encourage developers to build modern nursing homes, there needs to be some mechanism to ensure that cheap, out-of-the-way land isn't always the chosen site. It's not all good news. The so-called 'healthy towns' are also going to go in for fast-food bans and having to walk everywhere. I get a little worried when health chiefs start talking about 'embedding a healthy-living ethos'. But the proposal to keep older people in their communities is very welcome, even if they have to drive outside town for the odd Big Mac.

The recent death of Frank Kelly robbed Ireland and the world of a very funny man. I'm old enough to remember his incarnations before Father Jack, but it was as the alcoholic priest in Father Ted that the comic actor endeared himself to a whole new generation. Indeed, for children, the monosyllabic Father Jack was the absolute star of every show. The topic of priests of the church and their fondness for alcohol receives scant attention. It is one of those taboos that we all know about, but we rarely speak its name. The novelist Graham Greene did broach the subject back in 1940 with his famous book The Power and the Glory. Greene's anti-hero was a 'whiskey priest' who had once fathered a child and was forced to go on the run in rural Mexico, drinking and ministering on his way. Few official figures exist for problem drinking in religious populations, but the fact that special segregated treatment services exist in many countries, suggests that the problem is recognised, if somewhat hidden. Like doctors, priests become quite expert at hiding their alcoholic demons, so that when attention is sought, the problems can be quite advanced. I don't think we were ever told of Father Jack's precise diagnosis, but psychiatrists might argue the finer points of whether he had elements of mental confusion and wobbly gait from Wernicke's encephalopathy, or the impaired speech, confabulation and irritability of Korsakoff syndrome. What was clear to all, even to the untrained eye of Father Dougal McGuire, was that Jack's curse was a five-letter word.

God knows what sign they would have put up over Father Jack's bed if he was ever in hospital. I visited a ward recently and was surprised to see a big sign over one of the beds not just with the patient's name and treating consultant, but prominently announcing the name of a disease she was suffering from. There it was in bold capitals - DIABETIC. No chance of privacy at that hospital, was my first thought. Especially when the ward had six beds, though it looked barely big enough for four. My second thought was that the word 'diabetic' probably referred to the diet the patient was to get. Perhaps other patients in the hospital had COELIAC, LACTOSE INTOLERANT or CUSTARD & JELLY pasted over their beds. Maybe there are bigger issues to fry with the chips at our hospitals, but when individual confidentiality doesn't extend to notices that all visitors can plainly read, one has to wonder if some hospitals ever consider better ways of doing things.

The hospital in question received a nice new emergency department recently. It had once been rumoured to be due for downgrading, but having a senior minister at cabinet has kept it safe from the death knell of hospital groupings. It is also being helped by a whopping four-euro car-park fee if you feel like visiting your nearest and dearest for just 30 minutes. I'll have more to say about hospital car parking next week. Not every institution has been so lucky to stay off the casualty list. The recent election had plenty of politicians stirring up feelings about their parish hospitals. A common pledge was that their election would stop the local casualty unit being turned into a 'lumps and bumps clinic'. All of which only goes to give lumps and bumps a bad name. I will remind senior politicians of all parties that lumps are no less important than bumps. Either can do away with you just as quickly as a yawning electorate.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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