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Selasa, 19 Juli 2011

A shedload of pills to combat old age

Why is everyone over a certain age expected to be on medication?

In a telling commentary on our times, Mr Andrew Brain from south London, now in his eighties, writes to tell how his family doctor, the practice nurse and an optician have each on separate occasions expressed the same astonishment (even indignation) on reviewing his medical records, “But Mr Brain, you are not on any medication!”
A pill bottle with a pile of spilled red pills against a white background
When patients take pills for one illness, it can have a knock-on effect on their health
The hazards of the “medicalisation of ageing” when everyone over a certain age is expected to be taking a fistful of pills every day are confirmed by a recent (and shocking) analysis in The Journal of the Royal Society of Medicine of over 500,000 admissions to hospital associated with Adverse Drug Reactions (as they are known) – revealing a 7 per cent increase over the past 10 years.
The dynamic behind this trend is well illustrated by another revealing remark reported by a reader started on drugs to lower his blood pressure after it was found to be “raised” on a routine visit to his local surgery. Soon after, he was also found to have a raised blood sugar leading to his being diagnosed as having diabetes.
Then he developed visual disturbances warranting being referred to the eye clinic at the local hospital, where the registrar casually remarked that both the diabetes and the visual problems are “commonly associated with blood-pressure medication”.
This might be described as the knock-on or multiplier effect where, for example, the commonly prescribed blood-pressure-lowering drug bendroflumethiazide induces diabetes, requiring treatment – as well as the prescribing of statins.
These, in turn, cause the usual muscular aches and pains leading to the prescribing of anti-inflammatory drugs that cause gastritis or irritation of the lining of the stomach, requiring yet more pills – and so on.
What to do? Mr Brain suggests that perhaps more people should follow the example of a relative, recently deceased at the age of 91, whose wife on clearing out his garden shed found “3,000 pills and a stack of uncashed prescriptions”.
* There has been a cluster of late calls on the intriguing phenomenon of work-related nightmares persisting long into retirement, with several describing how they found themselves in anxiety-inducing situations they had never experienced for real.
“I still have dreams where I have reports unwritten, meetings missed” writes a senior educational psychologist with a successful career helping children with behavioural and emotional difficulties.
And worse – as in one dream where she found herself addressing the entire staff room wearing only her underwear or being summoned to the head of her department while drunk to account for wrongly managed casework.
Meanwhile, another reader suggests an intriguing and potentially remediable explanation for some anxiety dreams. He had a habit of taking a neat dram of The Famous Grouse following his evening meal, taking his time over it and only finishing it just before retiring to bed.
Then the anxiety dreams started, “really frightening stuff”, from which he would wake with a pounding heart and profuse sweating.
It took some time for him to realise the Scotch must be the culprit in causing nocturnal palpitations that his sleeping brain then converted into those heart-pounding dream scenarios. Since making a point of finishing his whisky well before bedtime, his nightmares have ceased.
* This week’s curiosity comes courtesy of Mrs A K from Leeds whose husband develops a red mark on his forehead between the eyebrows every couple of months.
Then it gradually fades away over the next few days. “The first time it appeared, I thought he must have been wrestling with the roses,” she writes.
But its occurrence appears to be spontaneous without there being any specific external cause. She is not unduly concerned on his behalf but wonders whether anyone might know what is going on.
* Finally, the phrase “kiss it better” has a double meaning most obviously to comfort a child with a grazed or bleeding knee.
But kissing also proved most useful in removing a blue plastic disc from the nostril of a two-year-old girl – as recently described in the Journal of the Royal Naval Medical Service.
“Her head was held firmly but gently while her mother blew forcefully into her open mouth while occluding the contralateral nostril”.
This forced the plastic disc down the nostril so it could be removed with a pair of forceps. This technique apparently reduces by an impressive tenfold the need for “instrumental removal under general anaesthesia”.

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