Search results for "medicine "

The ballad of adverse reactions

Author: joe

Wednesday, 29 October, 2008 - 11:21

It has - I'm sure you'll agree - a cathartic, trance-like beauty.

Unexplained wheezing, shortness of breath, skin rash, itching, bruising, facial swelling. Headache, dizziness, vertigo, tinnitus, fluid retention, visual disturbances, sensitivity to light, blistering or flaking of the skin. Abdominal pain, nausea, constipation, diarrhoea, peptic ulcers, bleeding in the stomach. Blood in the urine, kidney damage, liver damage, thrombocytopenia.

Upset stomach, diarrhoea. Rash. Itch. Swollen face, breathing problems. Thrush. Staining of the teeth. Inflammation of the kidney. Hyperactivity, dizziness, headache, convulsions. Crystals in the urine, cloudy urine. Diarrhoea with bleeding. Dark or pale urine or faeces. Jaundice.

Constipation, confusion, drowsiness. Skin rash, nausea, sweating, facial flushing, dry mouth, blurred or double vision, dizziness, malaise, tiredness, headache, anorexia, vertigo, slow or rapid heartbeat, breathing difficulties, problems passing urine, convulsions, hallucinations, nightmares, uncontrolled muscle movement or rigidity, mental depression, stomach cramps. Swelling, itching, difficulty in breathing.

Dryness or irritation of nose or throat. Nose bleed. Rash, swelling of face lips or tongue. Difficulty breathing. Pain in eyes or blurred vision. Nasal damage, septal perforation. Feeling unwell.

Abdominal discomfort or pain, nausea, stomach ulcer, vomit containing blood or brown grit, black tarry stools, worsening of existing bowel disease. Unusual bruising or bleeding, fever, sore throat, mouth ulcers, extreme pallor or weakness. Worsening of asthma, unexplained wheezing, shortness of breath, swelling of the face or tongue, collapse. Hives, itching, blistering, peeling of the skin. Heart attack or stroke. Jaundice. Pale stools or dark urine. Less or more urine than normal, cloudy urine, bloody urine, back pain, swelling of the legs. Severe headache, neck stiffness, disorientation, sensitivity to light.

Drowsiness, nausea, breathing difficulties, low blood pressure, dizziness, fainting, vomiting, a sensation that your surroundings are spinning either up or down or from side to side, headache, dry mouth, sweating, reddening or flushing of the face, fast or slow heartbeat, palpitations. Low body temperature, hallucination, general feeling of restlessness, uneasiness or of being unwell, mood changes, pinpoint pupils, rashes, itching, nettle rash, reduced sex drive, impotence, abdominal and back pain, problems passing urine and constipation. Impaction of the faeces, incontinence, unexplained diarrhoea, abdominal pain, obstruction of the intestine.

Swelling of the hands, feet, ankles, face, lips or throat, difficulty breathing or swallowing, itching of the skin, nettle rash. Blisters or bleeding of the lips, eyes, nose, mouth or genitals. Severe blistering rash, skin peeling off to reveal large areas of raw, exposed skin over the body. Inflammation of the liver, jaundice, tiredness, fever. Kidney problems, difficulty in urinating. Reddening or blistering of skin. Abnormal bruising or bleeding. Persistent diarrhoea or vomiting. Breast swelling or impotence. Headaches, dizziness, tiredness, a general feeling of being unwell, diarrhoea, constipation, stomach pain, nausea, vomiting, dry or sore mouth or throat, rash, itching, hair thinning, sensitivity to light, muscle or joint pain, depression, swelling of the hands or feet, pins and needles, blurred vision, changes in the way things taste, vertigo, confusion, hallucinations.

Nausea, vomiting, stomach pain, diarrhoea, pins and needles, headache, joint pain, muscle pain, loss of muscle tissue, raised liver enzymes, jaundice, severe or fatal liver disorder, kidney problems, kidney failure, rashes, difficulty in breathing, fainting, swelling of the face and throat, itching, skin eruptions, ulceration of the mouth, lips and skin, toxic epidermal necrolysis, sloughing of the skin. Impaired taste and smell, discoloured teeth, swelling or darkening of the tongue, sore mouth, oral thrush. Dizziness, loss of bearings, tinnitus, insomnia, hallucinations, nightmares, confusion, change in sense of reality and panicking. Low blood sugar, mood and behavioural disorder, unexpected bruising, blood thinning. Eye inflammation, changes in heart rhythm, inflammation of the pancreas, convulsions, hearing loss.

Categories: medicine, ailment, sickness, side-effect, health,
Comments: 1

Narrative-based anti-medicine

Author: joe

Friday, 25 July, 2008 - 02:52

I had almost forgotten about it. Friends had more or less stopped asking after my sinus pain. My daily medication had reached efficacy to the point of barely noticeable routine. The symptoms were ongoing but receding into forgettable habit. I had few expectations from my appointment with the sinus consultant today, but in the back of my mind I hoped that he would move decisively and more treatment - maybe an operation? - would arrive in the foreseeable future such that I could finally move on with my life. My hopes were not high - my hopes were modest and manageable.

Everything went out of whack as soon as I entered the consultant's office. There, in the room, was not the doctor I had seen before, and was expecting to see now, but someone I had never met before. Almost immediately I involuntarily hit a wall of stupor when she asked me why I had come all the way to Andover - such a long way from where I lived - for my appointment. I stared at the wall, utterly unable to answer: "it's not my choice," I said. She looked over my notes. "Well, Dr N- is one of the country's leading sinus doctor, so your specialist has refered you to him," she said. I know this. She knows this. Why are you asking me? The nurse came in and shortly asked the same question. The doctor repeats the Dr-N-leading-country-sinus mantra. I have come all this way, and it is a waste of my time. I know this too.

She says she will examine me with a rigid scope. The nurse enters the next room, but it transpires the doctor intends to examine me here now, not next door. "I thought you were going to make him walk!" the nurse says. Just then, the doctor inserts a spray tube into my nose and I get a hit of cocaine-like dullness. The liquid drips out of my nose and onto my T-shirt. She notices and asks the nurse to pass me a tissue. The anaesthetic liquid has already dripped onto my T-shirt, and she is wielding the scope. It is a metal rod, cut at an angle at the end, with a light shining from it. She inserts it into one of my nostrils, and I excruciate for a few seconds as she twists it through my sinus. I can barely breathe - I am dying for her to remove this intrusion into my head. My eye muscles crush around it as I sense it nearing my interior being; my eye is closed, but the light illuminates my head and my eye sees a redness from within itself. She swaps to the other nostril.

"Aaargh!!!", I recoil as the scope scrapes the tender insides of my nose and my head jerks back. She is displeased - the over-sensitive insides of my inflamed sinuses are a fault, and I feel bad for feeling the pain. She complains that when I scrunch up my nose and eyes, she can't move the scope. I am a defect patient, whose pain will not allow her to examine me. I don't even know her name. She finishes as I wipe my tears onto a gauze tissue already damp with anaesthetic spray and snot. I really don't even know who this woman is. "You mustn't eat or drink for two hours". Of course she can't have known that I skipped lunch in order to get here on time, because she has not even asked me for my permission to enter my head with a shining metal rod in the very places where I have intense pain.

In the closing exchanges of the appointment, between the doctor and the nurse and me, I gather myself and command my polite composed voice to ask about timescales and locations. She says I must see Dr N - of course, I thought I had come today to see Dr N. I don't care where the appointment is, as long as it is soon... "Dr N has some annual leave coming up, so it may be a few weeks." Why am I even here? "Okay," I say. I leave the room, walk into the sunshine, go back to the car, and am not quite overwhelmed by the urge to cry. Instead I drive for an hour-and-a-half feeling frustrated, and somehow manage to get home without crashing, while the cocaine numbness thaws in my throat.

Worst of all, of course, I constantly tell myself that there are people worse off than myself, and that I shouldn't complain, because doctors and nurses deal with very sick people who are very ill and dying and I'm lucky that all I have is constant but manageable pain in the front of my head where my being is. Anything short of life-threatening peril is, in the over-stretched world of public health care, irrelevant.

So, in short, today's brief experience of care in the NHS left me feeling angry, bitter, and frustrated, but also guilty for my self-indulgence in thinking I might expect anything more.

Categories: medicine, NHS, treatment, sinusitis, guilt,
Comments: 0

Placebo prozac

Author: joe

Sunday, 09 March, 2008 - 17:29

SSRIs are no better than placebo at treating depression in the majority of cases. It's been a couple of weeks since this story broke, but it was infinitely fascinating, and for a while I was amazed that no-one seemed to be examining the weird reflexive problem that breaking the story itself seemed to present. Placebo (in my limited understanding) works because patients believe they are being treated - and presumably the improvement in the psychological state of the patient has physiological benefits. But then if the national media tells everyone that even though the pills they take are actual 'medicines' as defined by NICE and the pharma-industry (rather than sugar-pills), actually the benefit they're getting is really only a placebo, doesn't that mean that you remove the efficacy of even the placebo (because now everyone knows their benefits are 'only' psychological)?

As the author of the report, (and by the way, isn't the PLOS open access peer-review journal an awesome thing), Irving Kirsch, stated on the Channel 4 News coverage:

one of the core characteristics of depression is a sense of hopelessness, and anything that combats that, and instils a sense of hope is going to help people feel better.

Doesn't the coverage of this report tell those patients that their hope is illusory? I know that about 10 years ago I enquired about a stop-smoking trial. The researcher taking applications said that the trial would use a placebo, and that half of the participants would be given a glucose sweet, while the other half would be given a 'placebo'. I mentioned that I had heard that glucose sweets helped to combat the physical symptoms of nicotine withdrawal because they mitigated the drop in blood sugar levels, and had tried it before (with obviously limited success). At this point, of course, the researcher said I couldn't take part because, since I had used glucose sweets before, I would be able to tell whether I was being given the sweets or the placebo, rendering my participation in the trial meaningless.

In fact, this is precisely the point of double-blind trials which use placebos: the researchers don't know who is getting the medicine and who the placebo; and equally, the patients don't know either. Ethically-speaking, they have to know there is a chance, because I think the procedural codes of these trials require that participants are told that some of them will receive placebo.

Of course, all of this acknowledges the fact that a patient's psychological state, their expectation, hope and optimism, has an important and measurable effect on the likelihood that their prognosis improves.

So it was interesting to see Ben Goldacre look at the topic in his unfailingly interesting column Bad Science:

Do drugs stop working if you know they are little better than a sugar pill? And do cultural factors, like our collective faith in a treatment, have a measurable effect on the benefits? On this, there has been a only tiny amount of highly tenuous research.

And in the little research that has been done on the subject, while some reports might imply that declining 'belief' in a medicine reduces its efficacy, there is also evidence that even when patients are told explicitly that they are being given a placebo, nevertheless, the treatment has a beneficial effect.

This, I suppose, gets the media off the hook for telling millions of people that their medicine is no better than sugar pills, and perhaps we'll see more in the coming years as to whether the use and efficacy of these SSRIs change. And of course, exposing the the cravenness of the pharma-industry can never be a bad thing. But it does still leave the question, what exactly is it about the change in expectation that using a placebo encourages, that works therapeutically, even when people know it is just a placebo? And, indeed, why can't I just heal my head, by believing it will be healed?

Categories: medicine, placebo, therapy, depression, pharmaceutical,
Comments: 0

Health fiction

Author: joe

Monday, 12 November, 2007 - 18:45

I considered going to the hospital carrying a copy of 'Narrative Based Medicine' by Greenhalgh and Hurwitz. My experience has become so reflexively, regressively contingent that I thought I might as well go the whole hog, and encourage the consultants and nurses, by noticing the book, to become radically self-aware of the experience they were creating around me.

Earlier in the year I registered for my PhD, which I intend to focus on the therapeutic uses of creative activity. There is evidence that people who keep journals during their treatment for serious illnesses such as cancer have a statistically significantly improved prognosis. Why might this be? Is it the case that our experiences of serious illness are such chaotic, disempowering transactions with the machine of healthcare, that the productive act of creating our own purposeful, narrativised story out of the bare, brute facts of therapy and treatment actually improves our bodies' ability to survive?

My father was diagnosed with cancer 7 years ago and died six months later. He said the process of pin-balling between consultants and treatments was frustrating precisely because doctors want to tell you as little as possible. Perhaps for good reason. Perhaps euphemism ('growths' rather than 'tumours') helps to minimise the psychological trauma. Perhaps a gradual induction into the language of primary and secondary, benign and malignant, potassium levels, morphine and death spray is a therapeutically beneficial approach, and ignorance is convalescent bliss. Perhaps knowing little, and trusting in the authority of the medicinal apparatus improves the prognosis.

"How is your hearing?" one nurse asked him. "Pardon?" he replied.

And so, as I have had constant headaches since February of this year, which usually recede only after the self-medication of Nurofen, I have been witnessing at first hand the efficiencies of the British healthcare system. And rather like a media studies student who is suddenly noticing how adverts are constructed, I can't not examine the story of illness (or lack of narrative) the actors in my performance are creating. My consultant informed first, not me, but his dictaphone, of my almost certainly necessary surgery. What surgery, I am still only able to speculate. It is sinusitis, an infection, pus in the ethmoid. Today's MRI scan of my head was olympically efficient - I arrived 15 mins early and had left the hospital by the time my appointment was supposed to take place. I, rather unnecessarily, slowed things down by asking the nurse what happened next. "Your scans go to the consultant now, and then he will contact you soon. Just turn left out of the doors."

Of course I have the problem of Einstein's observer, watching trains travelling in different directions at the speed of light. I'm in the train, and can't get out of it to look. I can't experience medicine without thinking about the experience of medicine, and I can't think about the experience without picking out the moments that are self-selected to illustrate the competing narratives that constitute the phenomenon of medical treatment.

I also can't help but think there is a certain kind of guilt associated with querying the treatment that our noble welfare-state doctors and nurses provide. One is supposed to say "mustn't grumble...", adopt the Blitz spirit, "there are people worse off than me..", "oh it's just a touch of sinusitis..." How self-indulgent to expect a consultant to spend an extra few minutes explaining the diagnosis and how the treatment will pan out, when he must dash off to start someone's heart any second now. "Remember that the appointment that you cannot attend is very valuable to someone in pain or distress" the leaflet says. Unusual, fatal, healing, fictions.

Categories: medicine, hospital, treatment, therapy, narrative, phd,
Comments: 0