Blood

I learnt something new today.

I do most days, mostly from nurses, but on this occasion it was after our monthly team CPD (continuing professional development) meeting. We'd rattled through a discussion of recent papers and how they should affect our practice, we noted the bias of one review and chewed over how we were doing with NICE guidance. We discussed depot olanzapine's evidence of what the pharmaceutical company report as a "post injection syndrome" and how everyone else calls it "a coma" and how this seemed bad.

It was noted that I brought a number of abstracts from British and US journals but nursing colleagues didn't. Yet they're very interested in the 10 minute discussion of each paper, grabbing the headline messages and learning points, with their "care pathways" having changed for the better over time through considering new research and reviewing what we do. A number of articles and papers have been published by us over the last year. If nurses embrace new research (in a balanced and critical way) then adopt the good bits, why aren't they sharing lots of papers at our monthly meeting?

It's all down to what's valued. Consultant Psychiatrists have time set aside each week for CPD. Nurses do not. Nurses are told what to adopt and articulate how they're not given time to provide even basic nursing care. I wonder how many nurses have time for CPD in their week? Do any have time to browse web sites, muse over abstracts, download papers and read through NICE, DoH and other advice, guidance and direction? I know of no nurses who do.

So for a hour a month we do it ourselves, rattling through a couple papers (no more than 10 minutes on each, just to distill what the issue was, what the paper shows us, the weaknesses of the paper and how we then could use it in our work) and any new guidance and obstacles to good practice.

At least this means we've a fighting chance of spotting quackery that's increasingly peddled in more mainstream literature. Like this, which I learnt of today. Live Blood Analysis (LBA). You take a spot of patients blood, both you and the patient just look at it on a big screen for 2 hours, you see stuff move and decide what this means. Such as, "Look at those moving, they must be alive, you have parasites in your blood, take this herbal medication that's expensive but look at your blood, it's so worth it."

A Dr Rubin looked at this and found no papers on LBA in the scientific literature. None. Yet there were 2.5 million hits on Google. Interesting. Someone's advertising and making a lot of money from this LBA thingy. So, does LBA work? Is the scientific community elitist and simply ignoring a helpful diagnostic intervention? Actually, no. It's pseudoscience and doesn't work.

That's a helpful paper. I've learnt today of a new entity, Live Blood Analysis, and learnt of rigorous review of LBA which found it to be so much stuff and nonsense. Which is worth knowing.

Should I charitably tag this post as "Complimentary Therapy" or should I generate a new tag of "Fraud" I wonder . . .

Homeopathy

A number of people, indeed most, will look at options of self management, which is a good thing. Some will be desparate and try things which have little benefit. But hey, what's to lose. Some will be even more desparate and try things that have little benefit but cost money. Hmmm.

Complementary Therapy has had bad press, because much of it that is useful is understated (since it's obvious and now mainstream rather than "complementary" to maintstream practice) so it's the more extreme claims that are pushed. Which invariably aren't valid.

The bottom line is that sensible people try stuff and find it doesn't work very well.

"Herbal medicine has been around for thousands of years, indeed it has, and then we tested it all and then the stuff that worked became 'medicine' and the rest of it is just a nice bowl of soup and some pot pouri."

"Well, science knows it doesn't know everything, otherwise it'd stop."

"I'm sorry if you're into homeopathy; it's water! How often does it need to be said, it's just water!" and, "The great thing about homeopathy is you can't overdose on it. Well you could fucking drown!"

Not very politially correct at all, but pretty darn amusing :

Quackery

There are many flaws in the NHS. Oh so very many. But to my mind, both the ideology and delivery of care are better than other models I've seen (which are even more flawed).

If you (or your health insurance company) pay for you to be referred and see and receive care from a Consultant Psychiatrist, what do you get from that?

One lady got not a Consultant Psychiatrist, but an hour for a new patient assessment by a member of the Consultant's team, then 15 to 20 minutes with the Consultant Psychiatrist at the end of this.

You can argue the toss over whether this is good practice or not.

What I find hard to argue is the choice of individual initially seeing this new patient (instead of the Consultant Psychiatrist), the patient being a 38 year old lady with significant past psychiatric needs, necessitating ongoing psychiatric care.

The lady was assessed through her new patient referral to a Consultant Psychiatrist by . . . an Energy Healer.

You couldn't make it up. Read about it here.

Quack quack quack.

Complementary Therapy

I work as a psychiatrist. Having trained as a GP and delivering all liaison psychiatry, I've a bent towards folk presenting with physical comorbidity. In my patch if you're physically unwell and have mental health problems, it's common that someone refers you to my door, or invites me to a case conference to throw in my 2p worth.

It was at just such a fortnightly meeting at the local district general hospital that I was delighted by the succinct, acerbic quip 'bout local independent practitioners.

A young lady had long term back pain, with a degree of sacroiliac and hip pain. Practical treatment had been of some benefit, but the crunch was that she'd knackered joints and a frenetic lifestyle/busy family so couldn't pace herself at a comfortable level. She'd seen a someone about her back between appointments (a chiropracter) who I'd not known, so when the Consultant was describing her care over the last month and mentioned this name, and I asked who this clinician was, it was with great candor that a physio chirped up, "Oh, he's the local quack. Rub you anywhere if you cross his palm with silver."
The lady was no better from seeing him. Apparently, few folk ever are. Ho hum.

The very next patient had problems after a below knee amputation after trauma. Again, discussion on practical and psychosocial and pharmacological management of his care. Young bloke, bad motor bike accident, loss of job and self esteem and social life, not doing too well. He'd also seen someone to help him, an osteopath to, "get him moving again" and sort out, "back spasm" that was, "stopping him walking." The name of the osteopath was not known to me. I asked who he was. It went quiet as medical collegaues tried to think how to frame it, but a physio who knew him well interjected helpfully that he was, "A charlatan."

Clarity of information, I love it. One of the perks of working in old pit villages, people call a spade a spade. As one old man said to me today, when I was asking about diagnosis and how much he sought to know of his dementia, "Tell it like it is, lad. Just tell it like it is." Complementary therapy better deliver meaningful outcomes, because if it doesn't, local folk sure get the measure of it pretty sharpish. And to date, results in my corner are woefully shabby . . .

Bioresonance Therapy

One of my patients, who's elderly and frail, is being exploited by family and has financial hardship and has had difficulties with young drunk neighbours moving in and has had physical illnesses (fractured hip, heart attack) so, overall, has had a pretty chequered course throught this year.

I was asked to see him ostensibly because his concentration's not great.

I could see reasons why, but assessed cognition anyway. It was normal. Ropy in some areas, but understandably so, he's certainly not having problems that are sufficient to attract a diagnosis of mild cognitive impairment (MCI) or dementia.

What was of interest to me was the impact his GP had. An inquisitive soul, I always like to ask why the patient thinks they're seeing me, what they and their GP thought I could help with. It's a perk of having an hour with new patients, especially when the mental health is straightforwrd and swiftly addressed, patients can share more peripheral details that are stirring within their thoughts. This lead on to conversation 'bout the GP consultation and how helpful it had been. His GP, on chatting through with the patient what was going on and suggesting I meet up with him, also undertook some opportunistic health promotion. He's had a heart attack this year, isn't it about time to think about the cigarettes he smokes? The GP's words struck home. My patient did indeed stop smoking.

How did he do this?

He went to a private consultation where his pockets were picked. £300, if you're interested. For this, he got the most exceptional treatment I've heard someone be flannelled with for years.

The cigarettes had toxins. These were in his system. These had affected his system, which is why he wanted cigarettes. Thus, these toxins needed removing.
First, the specific packet of cigarettes he usually smokes was taken off him and taken out of the room "to be analysed." Then uninsulated wire was wrapped around each wrist and connected to a machine. Buttons were pressed. "Ooooh, you need an hour and a half on this to cleanse the toxins." Time passed. Then the explanation that, with toxins coming out, he may well smell tobacco when having a shower because, "that's the toxins coming out."

He's not smoked, it's worked for him. But I'll wager good coin it ain't the pseudoscience technobabble and spangly machine with wires and lights and buttons that's done it . . .

Wibble

Increasingly there's pressure to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in ways other than just through antipsychotics. This is a good thing. I still maintain that antipsychotics can be part of the answer for some patients some of the time, but they're not a cure when used alone.

I'm blessed to be working with nursing staff who are exceptionally good at what they do. Which isn't diagnosis or medical stuff, it's nursing care. I've a lady in permanent care, through progression of her dementia. She has become increasingly vocal (shouting out) and wandersome. We have no antishouting pill. We have no antimoving pill.

I looked at her medication and stopped some of it, which made things better. Two months on, things have progressed and again the home's struggling to cope with her. My nursing colleague visited and tried to understand why this lady was shouting and moving. Hip pain from arthritis after nonunion of a fracture could be one factor. Constipation could be another. Disorientation, through diminished insight and a lack of appreciation of what's going on, could be a factor. Thirst sometimes seems to be.

As well as spending time divining why the behaviour unfolds and what it means, the nurse also undertook some interventions at frequent intervals within the care home. Aromatherapy. Hand massage. Doll therapy.

It's all worked.

Marvellous.

Humble Pie

I am sceptical about the benefits of aromatherapy. I am not anti-complimentary therapy. Just as I am sceptical about the benefits of some drugs, the effect of some injections and the validity of a lot of cardiac surgery, so I am sceptical about aromatherapy.

You smell stuff and get better. Huh?

Some sites are nauseating in their juxtaposition of soft fluffy cuddly safeness and hard longterm pseudoscience. Would you trust this salesman? I wouldn't. Some content just riles me too much.

Several of our band 3 and band 4 staff have undertaken aromatherapy and massage courses. They've been undertaking aromatherapy and hand massage with patients who have dementia. A proportion of patients have behavioural and psychological symptoms of dementia (BPSD). As they're increasingly distraught and disoriented they find it harder to engage with the nursing staff. Confrontational and unhelpful behaviour can escalate. Medication is used to help them regain control to engage in the reality orientation processes with nursing staff. This gives me audit data showing the prevalence of lorazepam use prn (as needed) for BPSD on that day unit.
Staff didn't change. The band 3 and band 4 staff started to do aromatherapy hand massages and burn basil and whatnots. Incidence of BPSD reduced. Prevalence of lorazepam use prn reduced.

Maybe it does work on the limbic system, improving things for a wee while. Maybe it's a placebo effect. I don't know. But it seems to be useful for some of my patients, some of the time, with no significant treatment emergent adverse events.