Monday 23 April 2018

Rude health: Mourinho medicine

Doctors won't be queuing up to treat the Chelsea manager, says Maurice Gueret, nor will they bring a jug of freesias

Eva Carneiro talks to Jose Mourinho after treating Eden Hazard
Eva Carneiro talks to Jose Mourinho after treating Eden Hazard

Maurice Gueret

Doctors up and down these islands have reacted with fury, many of them ripping up their Chelsea season tickets, at the latest antics of Jose Mourinho. The Premiership season wasn't a week old when the club's manager issued a red card to team doctor Eva Carneiro, banning her from attending training, matches and the team hotel. Her crime? Running on to the pitch to examine a player who was heavily tackled towards the end of a match.

Chelsea were already down to 10 men in the game against Swansea and  Dr Eva's sojourn onto the pitch meant that the injured player had to be temporarily sidelined. In Jose's strange mind, this left the team with a vulnerable nine-man line-up trying to hang on to a 2-2 draw. The kernel of the problem was that Professor Mourinho had judged the player's injury to be nothing more than a bit of fatigue. He insisted that Dr Eva needed to understand more of the mentality of the game and less of the medicine. Just because a player rolls around looking like he has  a serious injury, doesn't mean he has one. Don't expect a rush of doctors towards the 'Special One' if he is ever found writhing on the ground.

Paracetamol prices

I was telling you recently about the huge differential in paracetamol prices between here and the UK. Northern shoppers can get them at the supermarket for two pence each, while we pay almost fifteen cent a tablet down here. UK citizens are allowed to buy two packets of 16 tablets for about 60p, whilst we are limited to a single 12-pack for about €1.60. A lot of lobbying went on when paracetamol regulations were introduced here some years ago and I fear that the pecuniary interests of the consumer were overlooked. The main reason cited for making 12 tablets the limit here for a single purchase was the danger of paracetamol overdose. But the UK allows a 32-tablet limit and there is no evidence that this has placed their population in more mortal danger than our own. What it has done is limit our market to packs of 12, which means that cheaper and larger international packs of paracetamol cannot be sold here. It also makes the management of everyday illnesses such as fevers and 'flus very difficult because sick patients have to keep replenishing supplies every couple of days. There is simply no argument against raising the allowable purchase here from a single packet of 12 to a single packet of 16. And it will save the consumer a small fortune.

Patient rights

A funny but true story has reached me from an eminent teaching hospital. A wonderful lady of 90-plus mature years was propped up in bed fasting for tests the following morning. It was the middle of a warm night. She was parched. In her own words 'off her head with thirst'. The only hydration allowed was from tiny sponges on a stick. Cute lady that she is, a little vase containing freesias caught her eye. A kind relative had left it by earlier. She took a good drink. But some busybody on the ward shouted out "She is drinking the flower water". There was consternation as the compos mentis of the dear lady was called into question. The patient refused to give up the vase until she was given a glass of water. But the battle for a mouthful of water was lost and the only effect was that she had to fast for even longer the next day so that the test could be done. But lo and behold, the following morning she felt better than she had done for ages. She wonders if it might have been the freesias. It might well have been. Either that, or standing up for the rights of patients against rigid rules.

Botanical library

All of which sent me off to my botanical library to research the provenance of these most fragrant of hospital flowers. Freesias are native to South Africa and are named after Friedrich Freese, a German physician who practiced in Kiel during the 19th Century and listed botany as a hobby. They are popular food plants only among moths and butterflies, and their scent makes them popular in candle and soap factories. Freesias are not very toxic plants, but neither do they come with a reputation of curing very much at all. Aromatherapy fanatics bang on about the properties of the plant's oil. I find its most redeeming quality is getting rid of the smell of fish and chips from the car. That and quenching a bad nocturnal thirst.

Blood pressure

We continue our journey around examination of the human body with a look today at blood pressure. I was watching some veterinary programme on television the other day and they featured hypertension in ageing cats. I cannot imagine how vets cope with pumping up tight cuffs on the paws of a sharp-clawed felines. Human blood pressure is an easier measurement. It's taken by placing a stethoscope over the brachial artery and then temporarily stopping the flow of blood down the arm by inflating a sealed bag hidden in a cuff over the upper arm. What the doctor listens for as he deflates the cuff are the Korotkoff sounds, named after a Russian surgeon who discovered the technique at 31, but died himself at 46. In simple terms the first measurement, the systolic, is when blood flow resumes and the second one, the diastolic, is when the sounds become faint. Your blood pressure is expressed as the systolic over the diastolic. Doctors can differ when it comes to deciding between a healthy blood pressure and a sick one. In our day, we were trained to believe that the systolic in an adult can be 100 plus the patient's age but the healthy diastolic should always be less than 90. I'm not so sure about cats. If in doubt, request a 24-hour monitor. If you can find one, they save a lot more lives than defibrillators.

Dr Maurice Gueret is editor of the Irish Medical Directory

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