Sunday 21 January 2018

Rude health: Of Mice and Men

The latest research on ankle injuries amongst North Carolina's rodent population has Maurice Gueret pricking up his ears

A sprained ankle may not be so benign and may require physiotherapy.
A sprained ankle may not be so benign and may require physiotherapy.

Just as I was recovering (very nicely, thank you) from that black, swollen limb I sustained on a Portuguese footpath, came the news from an American university that a sprained ankle may have lifelong consequences. A number of studies from a professor in North Carolina hint that a single sprained ankle can alter how you move for life. She recruited 20 college students who were prone to sprains and attached them to a pedometer to see how well they moved compared with peers. They did badly, taking an average of 2,000 fewer steps per day.

Previous research at the university involved surgically snipping the ankle ligaments of young adult mice and allowing them to heal. The mice never quite made the rodent Olympics, as they didn't fully recover their speed. The message is that ankle sprains are not as benign as we thought. If you do come a cropper on the street, limping along to your chartered physiotherapist might be the best idea. And if the doctor says that you are obese, use these three words to impress him - chronic ankle instability.


Some doctors place funny signs around the waiting room and surgery. There was one I knew who had a sign saying that if you couldn't afford his fees for a cure, he could touch up the X-rays for a lower charge. It was a joke, but some patients didn't get it, so he took it down. A doctor who works on a busy part of town close to pubs, a chipper and a stadium, recently had a sign outside her front door saying "Please don't put your litter here - this is a doctor's surgery". The sign is gone now, but was up for about a fortnight. I am still trying to figure it out. Perhaps it's only veterinary surgeries that know how to deal with litters!

Digital toilets

A care home in England was recently criticised for calling its residents by their first names without checking with them in advance. Not a hanging offence, but the BBC gave the story plenty of welly by requesting an interview with the care group's director-of-something-or-other. I listened intently, as it's a topic that interests me.

A very jolly lady came on the radio to apologise profusely for the oversight, and to state that all staff have now been brought fully up-to-date on the policy of asking residents how they would like to be addressed. To show what a wonderful care group they are, she told millions of listeners that all their care homes have now installed the very latest in digital Japanese toilets. And with that, everything went straight down the pan, the story dried up and the care group and their patients emerged smelling of roses.

Public and private

Public and private medicine seem to happily co-exist in Ireland. But nobody is ever quite clear who the major beneficiaries are - whether it is doctors, patients or the various businesses that inhabit healthcare. In Britain, the demarcations are stronger. Most doctors who worked in the public service rarely crossed over into private medicine, but that is beginning to change.

One who looked at both sides of the coin was GP and writer Dr Gavin Francis, and he didn't like what he saw. Writing in the Guardian literary review last month, he told some uncomfortable stories of what he witnessed. There was a pharmacy sending a percentage of dispensing fees, which were collected from patients, back to the clinic that prescribed in the first place. He wrote about on-call NHS consultants who could not be contacted because they were doing private work.

He noticed during his time in general practice that scans, arthroscopies and follow-up appointments were all more lavishly recommended when the patient was paying. He wrote about the case of a private tonsillectomy on a young boy that went badly, an operation that would not have been done in the first place by the National Health Service. He wrote about how private mental-health companies refer patients back to the NHS if they become complex, suicidal or unprofitable. Irish doctors are in the unusual position in that many might sympathise or even recognise some of these criticisms, yet, when they get sick themselves, they will often be first in line to stay out of the public system and use their private health insurance.

It's safe to say that no country on Earth has found the perfect system, but we are all guilty of spending too much time criticising the public service and not nearly enough scrutinising the private.

Human body book

The first book I ever had on how to examine a human body had 16 pages on the ear. I don't have that luxury here, and anyway, there is only so much you want to know on your Sunday about what gives human ear-wax its peculiar taste. The ears have two major functions, being twin organs of hearing and balance. In a doctor's surgery, six main ear complaints arise - deafness, discharge and dizziness, followed by pain, tinnitus (unwanted noise) and foreign bodies, such as beads in children's ears.

The outer part of the ear, known as the pinna, is made up of cartilage and is not commonly of much medical interest. The more important parts of the ear are well hidden, down a long canal and behind the membrane of a drum. Wax in the canal would be the main cause of temporary deafness, and a peek down the auriscope will confirm whether extraction or syringing is needed. A good listener in medical school will know what direction to pull ears to open up the canal and avoid trauma from the narrow light source. In adults, the ear is best usually lifted slightly upwards and backwards to give the best view. I'd like to keep hold of your ears a bit longer, so we'll return to them for more next week.

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

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