Friday, November 27, 2015

Anorexia & Bulimia: Breast Implants & Abuse!

©2008 Am Ang Zhang
      That Chris’ mother should have been the patient was obvious from the first time I met her. She indeed saw a psychiatrist before moving from Dorset. She had been hospitalised for Anorexia Nervosa.
      She was cured. She got married. Then she had Chris.
      If she did not tell me, I never would have guessed she had Anorexia Nervosa.
      At first I did not even know how I knew.
      “She was a very good looking woman,” my secretary told me one day, “she hasn’t got a bad figure either.”
      Doctors are not supposed to notice these things and if they do they have to keep it to themselves.
      That was the discordance. She had a good figure. Many recovered anorectics cannot maintain a nice balanced figure and I am quite sure it is to do with the various hormonal upsets from the extreme dieting, a sort of gonadotrophin stimulating hormone problem.
      She did have fertility treatment in order to have Chris. She would feed me with information now and again.  Perhaps that had something to do with it.
      Chris was difficult, but no more than the average single parent child. His father had long since disappeared.
      Was Chris’ behaviour one of the reasons she consulted me?
      She was one of those mothers with lots of questions, and I am one of those psychiatrists who wanted parents to find their own answers.
      In psychiatry knowing the answer is no guarantee to a cure. In fact it is the same in many branches of medicine as we still have so many incurable diseases. Parents do want to have the answer and of course in the commercial world there are now doctors that cater for that desire. A nice label, be it ADHD, Bipolar, Autism or Asperger.  As long as there is a technical sounding name people are happy. If you can have a specific drug, so much the better.  If not you may get special education, benefits or both.
      As long as it has nothing to do with “upbringing”.
      But upbringing could be trans-generational.  What happens to one generation can have an impact on the next generation.
      Many parents want to look at the here and now and a quick fix answer.
      One day mother told me, “I am bulimic!”
      Then she took out some capsules and said that she could not have those as she could not have an orgasm.  She had been seeing an adult psychiatrist but came to me for the problems she found too embarrassing to discuss with her own psychiatrist.
      She had a new boy friend who was much older than she was and he was a pilot.
      She wanted me to see him to explain about the side effect of her medication.
      “I am taking 60 mg.” she told me.
      I did wonder, as the 20 mg dosage might have been less problematic.
      I declined the request and she was rather disappointed. She accepted my reasoning – I did not initiate the treatment.
      Three weeks later she told me she broke up with him.
      Then she told me she normally could not have an orgasm unless she imagined she was having sex with an older man. She then thought it might work with having an older boyfriend.
      As I listened mother decided to tell me more.
      She had been abused by her father from about the age of twelve and the awful thing for her was that she actually enjoyed the sexual side of things. It was an abuse she found hard to come to terms with. She could not hate her father because when she came out of hospital after her Anorexia, she had no breasts to speak of. Her father paid for implants, twice.
      When Chris’s father left he bought a house for them.
      He paid for her private treatment for Bulimia.
      Worst of all, she had to imagine her father whenever she made love to have any chance of an orgasm.
      No. She had never told anyone else before.

                                                                                                 From The Cockroach Catcher 

You may also want to read about  Amanda.

 .............What an outcome. I had spent so much time with this girl and this was in the end what happened. She said one day she would be in a mental hospital like her father, but she hoped to kill herself before then.

         I no longer remember Amanda as a severe anorectic but rather a very talented artist who suffered serious abuse. Yet in a society which prides itself in social care, she did not become a famous artist with a high income, telling all about her history of abuse in front of a famous chat show host. Nor did she become a movie star telling all after drug and alcohol rehab.

         Instead she was on benefits and I am struggling hard to find something uplifting to end this story. It has taught me one thing: Anorexia Nervosa may be just a manifestation.

Anorexia Nervosa Posts

Jun 29, 2011
Cape Floristic Region (CFR) of South Africa
 ©Am Ang Zhang 2005
South Africa reminds me of my Anorexia Nervosa patient.

In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:

Mar 01, 2008
This is not about Stephen Hawking's famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge ...
Mar 19, 2011
Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private clinics springing up for the sole purpose of admitting anorectic patients and ...

Jun 17, 2008
Anorexia Nervosa comes to mind and this is one of the conditions that have for want of a better word captured the imagination of sufferers and public alike. I have already posted an earlier blog on its brief history. ...
Feb 23, 2010
This is not about Stephen Hawking's famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge ...
Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting ...
Feb 21, 2010
Anorexia Nervosa: Chirac & Faustian Pact. Reading a new book sometimes brings you the unexpected. In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, ...
Feb 29, 2008
Anorexia Nervosa: a cult? I have long recognised that Anorexia Nervosa is really only a symptom, like a headache, for which there is no “one-size-fits-all” cure.
Jun 08, 2011
... to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. ...
Jul 20, 2009
Edward Burne-Jones.
Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.

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Email: cockroachcatcher (at) gmail (dot) com.

Thursday, November 26, 2015

Anorexia Nervosa & Medical Ethics: Letting a patient die?

©Am Ang Zhang 2005

Can a patient be allowed to die? 
Can a seventeen year old patient be allowed to die?
Can a seventeen year old Anorexia Nervosa patient be allowed to die?

Are we not supposed to save lives?

Could doctors be held to ransom? By?

Here is a Play: Let Her Die!

The Players:

The parents:
Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

Too often there is this bizarre desire by some parents to make sure that if they cannot do it, no one else should either. We need to recognise it early enough. We are doomed otherwise, and so is the patient.

The patient: Nicola
It was really quite painful to sit there and talk to someone who looked worse than the worst they showed from Auswitz. Why could Nicola not realise that if she wanted any man to like her she would need to look a lot better, which involved doubling her weight for starters.

The Doctors:
Dr Hillman:

This was a family given up even by Dr Hillman, my most fervent supporter of family therapy. Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

The Consultant:
        I did not go round looking like a hippie or pretending that I liked the music the teenagers listened to. I told them to me it was trash. I did not pierce my ear or have a tattoo. I certainly did not wear trainers to work.
        In short, you do not have to gain respect by becoming like them or worse, by pretending that you are like them.

The Experts:
I spent one session with them and agreed with Dr Hillman. They were good. We looked like a bunch of amateurs dealing with professionals. None of the family therapy tricks work, Minuchin or Haley.

The NHS Trust & GMC

To me, suspension on full pay is a risk every doctor takes nowadays, as the basis is no longer limited to bad practice. It is no longer a reflection on whether you are good or bad clinically. Many psychiatrists are no longer prepared to use techniques that might upset their patients or parents of their patients.

The Main Action:

A family meeting was called and it lasted only a few minutes.
          I was in top form.

          “Nicola has been eating but after two months has not put on any weight. I cannot see any reason for her to continue to stay here. She might as well do the eating at home. She can then sort out for herself why she is not gaining weight without the pressure from us.”
          I tried to put it in the calmest way possible.
          “You mean you will let her die?” Father sounded a bit annoyed.

        With that father got up and left the room without saying another word.

          “What do I do now? You have upset him!” said mother.
          Good, something got to him at last, but I did not say it.
Nicola gave a wry smile to me as if to say, “You found me out.”
          She turned to mum, “Let’s pack and leave this dump.”
          We all kept still.
Six months later, one of the nurses bumped into Nicola in a nearby town. She was kicked out by father and moved in with another ex-anorectic. She was with a boy friend. More importantly she was wearing a very sexy dress to show off her then very good figure.
          She did not die.

                                           Based on an extract from my book The Cockroach Catcher

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US


Dr No said...
CC - Dr No rather suspected that if you didn't turn up and comment on badmed, then you were probably doing a post of your own!

Dr No reads the moral of your post as less is more, ie the more doctors try to control patients (admission, section, forced feeding), the more the patient resists. Do the opposite (patient can go home, even die if the want to) and the patient still resists - in Nicola's case by gaining weight...even if she did do so rather rapidly...and, of course, having a spook for a dad is enough to put anyone on edge...

E's case (the one recently in the news) is very different. She was almost twice N's age, very different family by the sound of things, significant co-morbdities and a long history of failed forced feeding attempts (albeit with one early success). She was, if such a concept is meaningful, in end-stage anorexia nervosa.

Can a patient be allowed to die? Yes - we do it all the time.

Can a seventeen year old patient be allowed to die? Yes - we reluctantly and with great sadness do it from time to time.

Can a seventeen year old Anorexia Nervosa patient be allowed to die? Not if we can possibly help it. But anorexia nervosa is truly pernicious illness, and sometimes it defeats us all - although usually a bit later in the patient's life.

Would Dr No have discharged Nicola as you did? Almost certainly, and probably for the same reasons!
Cockroach Catcher said...
It is perhaps The Cockroach Catcher's own experience with young Anorexia Nervosa Patients that has coloured his views. There is in him a genuine feeling that doctors should be allowed to doctor pure and simple and in that sense he feels that psychiatrists should be doctors too, real doctors.

Remember the early days of treating phobia when bus loads of phobic patient from none other than the Maudsley were taken to Piccadilly Circus and dumped there. It was known as implosion therapy. then later suicidal patients were given the sharpest razor blades so that they can get on with it.

In Psychiatry, the best treatment is without doubt Placebos. But placebos only works if neither the patient nor the parents knew.

In reading DN's blog I reposted my patient where I let her die.

Well, did I or was that part of Haley/Minuchin treatment? You can decide.

No the early day psychiatrists did not mean harm to come to the Picadilly or Razor patients, but when non-doctors are involved, good luck to the said patients.

Perhaps DN;s patients was of Millennium Trilogy quality and ooops, what was the state doing?

Please let the real doctors or better still the real psychiatrist get on with their real work, if only they are allowed to remember how to give all the guidelines floating around.

The Cockroach Catcher retired partly because he sensed he would not be allowed to carry on his own doctoring ways.

Tuesday, November 24, 2015

Birds & NHS: Perfectly Safe?

Are birds safe? As safe as our NHS?

 © Am Ang Zhang 2015  

Is the NHS safe? Of course! But at a cost………..

There is little doubt that our NHS is being privatised one way or another. See Dr Grumble.

LONDON, Sept 21, 2010

Serco said on Tuesday it had won a 300 million pounds ($468.5 million) contract to provide pathological services to London's King's College Hospital NHS Trust.
Under the agreement, Kings College will join the existing joint venture between Serco and Guy's and St Thomas' NHS Trust, creating the UK's largest provider of pathological services.
The combined service will conduct more than 10 million individual tests a year for customers in the NHS and wider health sector, the support services firm said in a statement.
Serco said the deal would contribute about 110 million pounds to its revenue over the 10 years of the agreement.

Today Serco hit the news:

Serco is to be ordered to explain to the Government why it took the highly unusual step of writing to its leading suppliers to demand that they pay a blanket 2.5pc "cash rebate" on their work this year or risk losing future contracts.

Francis Maude, the Cabinet Office minister leading the Government's efficiency drive, is furious and has ordered Serco to account for its actions. "We unequivocally disagree with and are highly critical of the approach taken by Serco," said a Cabinet Office spokesman. "Francis Maude will be calling them in to explain themselves."

Do governments learn? Perhaps not:

National Express loses East Coast line
National Express is handing the East Coast rail franchise back to the Government after admitting that funding for the distressed London-to-Edinburgh network will run out towards the end of the year.

After months of attempts to renegotiate the £1.4bn contract, the company admitted yesterday that its NXEC subsidiary – which holds the franchise – has slipped £20m into the red this year and is rapidly burning through its resources. Richard Bowker, the group chief executive, will step down at the end of August.
A publicly owned company will take over East Coast operations when NXEC hits the buffers, Lord Adonis, the Secretary of State for Transport, announced yesterday. The process of finding a replacement operator from the private sector will then start at the end of 2010.

The Guardian: Metronet
The most shocking aspect of the Metronet scandal is that not enough people are sufficiently shocked. The news that the government is bailing out Transport for London to the tune of £2bn as a result of the debacle was barely covered in the national press and was mentioned on the Today programme long before the peak 8-8.30am period.

Yes, of course, it's complicated and rather esoteric, but the pure bones of this scandal are quite simple and opposition politicians, the newspapers and, indeed, the public, should be making much more of a fuss about the waste of several billion pounds because of new Labour's love affair with the private finance initiative.

In July 2007, Metronet BCV and Metronet SSL, two companies set up to modernise London Underground’s infrastructure, went into administration when they became unable to meet their spending obligations. Their failure resulted in London Underground Limited (London Underground) having to buy 95 per cent of Metronet’s outstanding debt obligations from its private sector lenders in February 2008 rather than repaying this debt over the 30 years of the contract. The Department for Transport (DfT) made £1.7 billion of grant available to help London Underground do so.

The taxpayer has borne some of the direct costs of Metronet’s failure, including the unexpected upfront payment of £1.7bn. We estimate there has been a direct loss to the taxpayer of between £170m and £410m.

Ernst & Young was paid £33m for handling the administration of Metronet.

Are we aware how much those working for Metronet were earning?

More skilled labourers, such as signal technicians, cost up to £79.19 an hour, or £144,000 a year, based on a 35-hour week, although not all of this is passed on to the individual employee.

The "charge-out rates" - paid by Transport for London from fares and taxpayer subsidy - were agreed by London Underground in August last year after Metronet went into administration and remain in force. The company continues to carry out much of its track renewal and repair programme under the control of the administrator.                                               

……… Tony Travers of the London School of Economics said: "By the end of next year, £10billion will have been spent on the PPP, overwhelmingly from the public purse, and what the hell can we see for it - a few tiles at stations, a bit of re-railing. It's a terrible catalogue of failure."                    More>>>>>

18 April 2009

So last month the Treasury was forced to establish a unit whose remit replaces the "private" in PFI with "public". For long-standing critics of PFI, this bailout of £13bn worth of projects is the nadir of Brown's grand plan to protect the taxpayer from financial risk. Instead, taxpayers' money is being used by the government to subsidise the operation of many of the UK's largest PFI schemes.

"The financial crisis has highlighted a basic truth - that private finance is only a way to borrow money that will have to be repaid by the taxpayer sooner or later," says Stephen Glaister, professor of transport and infrastructure at Imperial College London. "Risk transfer has proved difficult or impossible, so the taxpayer has ended up bailing out the commercial failures of the PFI companies."

A dishonest system

He said: "It is now very clear that PFI has largely collapsed as a mechanism for funding infrastructure. This was a dishonest system of accounting, designed to hide taxpayers' liabilities. If the private sector cannot now come up with the money, and is unwilling to take the risks, we need to move to a simpler, more honest system of public investment for public projects."

……….The taxpayer, through the infrastructure finance unit - dubbed the "Treasury bank" - now lends directly to PFI projects and also to the EIB and government-owned banks. This money is then lent on by these institutions, at an increased margin, to the PFI consortiums. The consortiums build the project and charge the taxpayer a fee for the next 25 years for the provision of goods and services. In the case of one of the largest PFI schemes, the £5.5bn M25 widening scheme, banks are charging the PFI consortiums 2.5%, or 3.5% over the inter-bank lending rate. This is up to five times the rate payable before the credit crunch.

Now we know!!!

There are currently about 110 PFI projects in the pipeline, worth an estimated £13bn - all in line for a handout from the Treasury bank. This includes £3.5bn of waste treatment and environmental projects, £3.1bn of transport schemes and £2.4bn of schools projects. Among the largest of these are the M25 widening, Manchester Waste, the North Bristol NHS Trust Southmead hospital redevelopment, Bradford Building Schools for the Future, Victoria hospital Fife, North Tyneside housing and Croydon & Lewisham street lighting.

The Manchester waste scheme was rescued this week thanks to a £120m injection of senior debt from the Treasury bank and £40m of cash from nine local authorities in the Manchester area. The Department for Environment, Food and Rural Affairs also put in £125m.

In the end I am sure the NHS is safe: but at what cost to the tax payers!!!

NHS Posts:

Enemy Of The People: NHS, Internal Market & Safety Net

Local Authorities: NHS Reform & Iceland

NHS: Changes Or A Conspiracy Against The Public Interest