Nuclear war

Hi,

Today I saw a lady who had become obsessed with the fear that we might have a nuclear holocaust this year. What do you do with this situation? I tried to explain that it is unlikely, but I couldn't say that it certainly won't happen. What with all these problems in Ukraine and the Middle East, she told me that perhaps I should be more worried and left.

Perhaps she is right!

Fertility

Hi,

Really tough consultation today. A 44 year old lady had been coming to our practice for a few years trying to get pregnant. She had got a text asking her to make an appointment with a doctor about her recent blood test results, and came in to see me

Due to her age, she wasn't eligible for NHS assisted contraception during the last few years, and had been in and out of the surgery getting blood tests, trying to stop smoking and reduce her weight in order to improve her fertility. The blood results she had come in to hear about from me showed that she was going through the menopause and couldn't have children now. 

This was terrible news to break to her, as she really wanted a child. I think she had been in denial for some time, though, as she hadn't had a period in about 6 months. I spent over an hour talking with her while she alternated between crying and shouting at me - she felt that we had let her down and let her time run out. Being exposed to that raw emotion was scary, and I was aware that towards the end I had 5 people waiting to see me in the waiting room who could hear all the shouting and sobbing coming from the room. 

Being a GP can be emotionally draining, especially when you are questioning whether your team may be in the wrong...

CBBC skills

Hi,

On Friday one of my patients was a 3 year old kid who had come in with an ear infection. After having a chat with the parents and a playful examination of the kid I reassured them and went to send them home. The mum was really impressed - she told me that her child was usually really shy of the doctors and wouldn't let them examine hum at all.

For a moment, I was secretly smug. I am the child whisperer! She quickly deflated my bubble and explained that it was probably because I looked like one of the 'silly CBBC presenters' and wasn't scary like those 'other older strict doctors'...

Well, as long as the kid doesn't vomit on me, I will take it...

Dr google

Hi,

A patient came in today with calf pain he had had for a week after falling off of his bike. After a google to come up with the possible causes for this, he was adamant that he had acute compartment syndrome. This is a medical emergency where the trauma to the limb causes so much swelling it cuts off the blood supply, meaning the tissue becomes more damaged and inflamed due to to the lack of blood. A vicious circle. His leg looked completely normal.

It took me a very long time to try and convince him that Dr google was not in an ideal position to assess his leg, and if he did have acute compartment syndrome his leg would have destroyed itself by now. After 30 minutes of my time he left to try some paracetamol and rest.

Benign Paroxysmal Positional Vertigo

Hi, 

Had a rewarding experience today in GP world - a lady came in complaining of severe dizziness for the last month or so, and I managed to diagnose and treat the condition in about 10 minutes, leaving a very satisfied and surprised patient!

When patients complain of dizziness, it is important to find out what they mean by this - importantly separating out the symptoms of vertigo (feeling like the world is whirling around, like you have just stepped off of a fast merry-go-round)

Not all fun and games

She had these vertigo symptoms when looking up to do her mascara, and when turning over in bed. This is very suggestive of a disease called Benign Paroxysmal Positional Vertigo (BPPV) where there are little crystals in your ears which keep the fluid moving after you stop your head from turning, making it feel as though you are still moving/spinning.

A simple test for this is known as the Dix-Hallpike test, and simple involves having them sit on a couch looking at 45 degrees to one side, then rapidly lying them down - this makes them feel very dizzy and makes their eyes spin in circles (rotational nystagmus). A potential risk of this manoeuvre is you make the patient feel so poorly that they then vomit on you. fortunately this did not happen here!

Because this condition is due to the crystals in the inner ear, it can easily be cured by putting the patients head through a series of different positions (known as Eply manoeuvre). This basically shakes the crystals out of the inner ear and cures the problem.

This is exactly what I did - aided in part by good ol' Wikipedia on my phone by the bedside as I had never done these moves before. It worked wonderfully, these problems which had ruined this patients life for a month were gone after a few minutes of turning around and about. She was able to walk out of the practice cured and happy, very grateful for what I had done. It made my day, being able to cure someone with your bare hands (and the not-insignificant power of Wikipedia!)