Thursday, May 29, 2014

Dolphin Song: A Children's book!

Reading Dolphin Song to grand kids

Martine is just getting used to her new life on the game reserve with her grandmother and the white giraffe, Jemmy, when she must go away. Her class is going on a trip—an ocean voyage to watch the sardine run, a spectacular natural phenomenon off the coast of South Africa. But the exciting adventure takes a dramatic turn when Martine and several of her classmates are thrown overboard into shark-infested waters! They are saved by a pod of dolphins and end up marooned on a deserted island. Now the castaways must learn to work together, not only to survive but to help the dolphins who are now in peril.

A reprint:

Tasmania: Whales & Dolphins-Mother & Baby

The scene of a mass whale and dolphin stranding on King Island
Photographer: John Nievaart of Naracoopa Holiday units

“We see dolphins and whales beaching and dying for reasons we do not understand and men make all the effort to save them and nearly all the time fail.” The Cockroach Catcher

Jemma Blomhoff with her 4 months old daughter Jordyn on her back cares for this dolphin
Photographer: JAY TOWN

Someday Jordyn Blomhoff who was only 4 months old could tell her friends: I was there saving a dolphin. Would being taken to save whales and dolphins at 4 months of age appear on the new DSM or ICD code?

"When I heard, I grabbed some buckets. Jordyn was still in her pyjamas," said Ms Blomhoff, her mother.

Keeping cool
Photographer: John Nievaart of Naracoopa Holiday units

"They told us to find one [animal] and stick to it. Ours was a dolphin. We just tipped water over him continuously. When the water was on his face he would lift his face and open his blowhole as if he was really enjoying it.

"They took him to the water in the carrier and when they put him back, he went silly. They had to hold him so he could get some strength back. He was lifting his tail. It was excellent. So it had a happy ending." From Tasmania’s paper 
The Mercury

Others are not so lucky.
It has been a horror summer for Tasmanian whale strandings.

Pilot whales stranded on Seven Mile beach.
Photo: Peter Lord

On November 22, 64 long-fined pilot whales stranded at Stanley in the state's northwest. Eleven were rescued.

The rugged coast of Tasmania which claimed the lives of 155 whales.
Photo: The Examiner Newspaper

On November 29, 155 long-finned pilot whales died south of Arthur River on the West Coast and 32 were saved.
And in January, 48 sperm whales -- the huge species mythologised in the novel Moby-Dick -- died on a sandbar near Smithton in the state's North-West.
Some strandings have been linked to naval sonar activity. In 2005 the Royal Australian Navy said it would avoid areas where whales were known to be stranding.
There is still so little we know about the natural world and the last words go to Sir Peter Scott:

Photographer: JAY TOWN

Whales and other marine mammals rely on their hearing for life's most basic functions, such as orientation and communication. Sound is how they find food, find friends, find a mate, and find their way through the world every day.
So when a sound thousands of times more powerful than a jet engine fills their ears, the results can be devastating -- and even deadly.
This is the reality that whales and other marine mammals face because of human-caused noise in the ocean, whether it's the sound of airguns used in oil exploration or subs and ships emitting sonar. Manmade sound waves can drown out the noises that marine mammals rely on for their very survival, causing serious injury and even death.

"We shan't save all we should like to,
but we shall save a great deal more than if we had never tried."

Sir Peter Scott (1909-89)
WWF founder 1961

Nature Posts

A unique picture book consisting of 20 beautiful 9 x7 in. full bleed photos by the author of: corals, turtles, anhinga, blue tang, file fish, butterfly fish, cleaner shrimp, pompano, barracuda, flounder, star fish, and sting ray. A first of the kind tale of aquatic creatures in child-speak. A good introduction of nature to a young child, especially good as a follow-up to a visit to the aquarium; plus two pages of detailed companion

A coffee table quality photobook for a special child, introducing wild life in Africa. Photos of the animals (impala, nyala, kudu, wildebeest, warthog, gruffalo, zebra, rhinoceros, waterbuck, hippopotamus, giraffe, buffalo, elephant, saddlebilled stock) were taken by the author himself during safari trips in Africa.

I would like to convince readers that the NHS is worth saving so for a limited time I am offering an electronic version free to any medical blogger, nurses and doctors that worked in the NHS and other health care systems totally free. Please drop me a note to my email address <cockroachcatcher (at) gmail (dot) com >or through COMMENTS.

Sunday, May 25, 2014

....MRSA & Antibiotics: Doctors or Vets???

©2010 Am An Zhang

Do we continue to blame the doctors when animals are given antibiotic to help them grow?

Germany:  Der Spiegel 'Bigger Profits than Cocaine Dealers'

"Some veterinarians' profit margins are bigger than those of cocaine dealers," says Nicki Schirm, who has been a veterinarian in the state of Hesse for more than 25 years. When a veterinarian finds a sick chick among 20,000 other chicks, he treats the discovery as justification to preventively treat the entire flock with antibiotics, says Rupert Ebner, a veterinarian from the Bavarian city of Ingolstadt. "Nowadays, flock or herd health monitoring is the code name for the generous administration of drugs," says Ebner. In many cases, he adds, fake diagnoses are used to provide a justification for the use of antibiotics.

In large veterinary practices, profits from the sale of drugs can account for up to 80 percent of revenues. This is mainly due to the volume discounts offered by the pharmaceutical industry and the sweet privilege known as the right to dispense -- a special provision for the pharmaceutical monopoly. For more than 150 years, veterinarians have been allowed to both prescribe and sell medications -- with almost no supervision whatsoever.

Some 900 tons of antibiotics were fed to animals in Germany in 2010. This is 116 tons more than in 2005, and more than three times as much as the entire German population takes annually. Pharmaceutical producers were required to report their 2011 sales of veterinary drugs by the end of March. A number of companies did not comply, prompting the Federal Office of Consumer Protection and Food Safety to request the information in writing.

According to The Union of Concerned Scientists:
Microbial Drug Resistance 13(1):69-76.Akwar et al. 2007.
Risk factors for antimicrobial resistance among fecal Escherichia coli from residents on forty-three swine farms.
"Akwar et al. found that people living and working on swine farms where antibiotics were used in feed had increased chances of carrying resistant E. coli. In some cases, the risk of resistance for the farm workers was higher than if they had taken antibiotics themselves. Once farm workers are colonized by resistant bacteria they can transfer them to family members and others in their community."

The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancment of weight gain. In business terms it is the conversion ratio of feed to weight that matters. The Obama government may well be taking steps to control it due to the rising incidents of Hospital Infections. Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!

It may therefore require more than "washing hands" if we do not want more outbreaks like this and other ones.

About 70 percent of all antibiotics used in the United States are given to healthy farm animals.

That is scary!

The Obama administration is at last taking on the ever powerful farming industry-good luck!
The New York Times leader today:

Farms and Antibiotics

July 24, 2009 New York Times
"The Union of Concerned Scientists estimates that 70 percent of the antibiotics used in this country are fed to farm animals. These animals do not receive these drugs the way humans do — as discrete short-term doses. Agricultural antibiotics are a regular feed supplement intended to increase growth and lessen the chance of infection in crowded, industrial farms.

"These practices are putting both humans and animals increasingly at risk. In an environment where antibiotics are omnipresent, as they are in industrial agriculture, antibiotic-resistant strains of diseases quickly develop, reducing the effectiveness of common drugs like penicillin and tetracycline.
"Despite that danger, the Food and Drug Administration had been reluctant to restrict routine agricultural use of antibiotics. The F.D.A.’s principal deputy commissioner, Dr. Joshua Sharfstein, signaled a welcome change in direction recently, testifying on behalf of a new bill, the Preservation of Antibiotics for Medical Treatment Act. It would allow veterinarians to prescribe antibiotics to treat individual animals or prevent disease, but it would sharply restrict the routine feeding of antibiotics to farm animals — the practice most closely associated with the development of drug-resistant pathogens.
"The legislation is drawing strong opposition from the farm lobby since the restrictions would make it much harder for industrial farms to crowd thousands of animals together in confined, inhumane and unhealthy quarters. But the current practice is dangerously self-defeating: treating more and more animals with less and less effective drugs and in turn creating resistant strains of disease that persist in the soil and water. Congress should stop this now before an entire class of drugs becomes useless."

Dr Margaret Mellon of The Union of Concerned Scientists testified before the House Rules Committee in a hearing on H.R. 1549, the Preservation of Antibiotics for Medical Treatment Act (PAMTA).

First appeared: July 24, 2009

Related: New York Times

Hospital Infection: Quorum Sensing

Saturday, May 24, 2014

Hello Spring: BBG & Peonies!

All photos ©2014 Am Ang Zhang 

Book I recently read: superhero for grown ups! 
Flash Boys: Michael Lewis
Over the past week, a host of U.S. authorities have confirmed that they are looking into certain practices used by high-speed traders, whose strategies can involve executing thousands of trades in milliseconds. The FBI, the U.S. Securities and Exchange Commission, the U.S. Justice Department and the attorney-general of New York State all have investigations underway.
For Mr. Katsuyama, the probes are partial vindication. Several years ago, while working for Royal Bank of Canada in New York, he began to suspect something was amiss in the execution of stock trades – namely that high-speed traders were, in effect, getting a tiny sneak peek at his transactions before they could be completed.
RBC “was the perfect place to discover what we discovered,” he said. It was a firm where “choosing to do the right thing was not a hard decision.”
Mr. Katsuyama left RBC in 2012 and launched IEX’s stock trading platform last October. Its objective: creating a market where high-speed traders do not enjoy any advantages over their slower peers. For now, the IEX share of overall trading volume is minuscule, but it is growing; this week, the platform experienced its biggest day on record, with 58 million shares traded.
Sitting in a bare office overlooking the former site of the two World Trade Center towers, Mr. Katsuyama appeared slightly shell-shocked by his transformation into a semi-public figure and by the passionate responses to Flash Boys – both in support and in opposition.

Wednesday, May 21, 2014

Health Care Class Struggle: NHS & Hong Kong!

 I have always maintained that we were distracted into talking about GPs and ignore the most important aspect of Health Care in most countries: specialist care. We are fast heading towards a new class struggle: Health Care Class Struggle: Private & Dumped Public.                                 

                                    US $ 50,000 for Stent Procedure©Am Ang Zhang 2011
In most western and not so western countries the demand for Hospital Specialists (Consultants in England) has never been higher.

Check out the Mayo clinic.

A friend had a STENT procedure In Hong Kong (like the one Prince Philip had) for a reasonable US $ 50,000.  I worked out that his cardiology specialist is earning a humble $10 million a year.

You begin to get the picture that for a long time, NHS is extremely good value.

When there are not enough specialists to go round in any country money is used to ration care. Just look at Canada.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.

My friend thought it was a bargain at US$ 50,000.

What about your painful hips, the CCG may decide to impose a wait time to limit cost. So you too will pay for it. That is what my golfing friend did in Florida for a bargain US$90,000 as he paid a co-pay of 25%.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in CCGs arguing about the price of Stents or Hips.

Soon with changes in the amount of private work FT Hospitals may do, what successful, skillful and sought after Consultant would want to stay within the NHS only to have his pension contribution increased and ultimate pension reduced.

Why not be 100% private and where are FT Hospitals going to find consultants for the phantom private patients.

Private hospitals will continue to provide NHS work but more to fill in their money making gaps. Very smart management indeed.

Consultants in private hospitals are generally extremely well treated, not like the way CEOs of old NHS Hospitals used to sideline them.

In Hong Kong, private Consultants work with several private hospitals and all private hospitals knew that these are the geese that lay the golden eggs. All hospitals provide excellent facilities for them including free valet parking as time is precious.

Could this be why so few consultants are objecting to the changes? I remember one such Private Hospital in Sheffield where there is no charge for parking and there was even free Cappuccino!

What about the quality of work?

Remember, in England, NHS or Private, they are the same consultants.

Tuesday, May 20, 2014

NHS Sunset: The Last Cook.

The sun will soon be setting for our beloved NHS!!!

                                                           ©Am Ang Zhang 2012

Perhaps it is not that well known that the dismantling of our beloved NHS started long before the present government and the future does not bode well for those of us that likes to keep NHS in the public domain.

Child Psychiatric in-patient units across the country were closed some time after many adult hospitals were closed or down-sized.

To me, the government is too concern with short term results that they impose various changes across the board in Health Care & Education without regard to the long term consequences or costs.

After all, I have made good use of in-patient facilities to un-diagnose ADHD and that would in turn save children from unnecessary medication and the country from unjustified benefit claims.

Such units were also great training grounds for the future generation of psychiatrists and nurses. Instead, most rely on chemicals to deal with a range of childhood psychological problems.

Indeed it was a sad day when the unit closed.

From The Cockroach Catcher:

Chapter 48        The Last Cook

ne of the few things I learned working in some inpatient units was to be appreciative of the ancillary staff. What a cleaner might reveal to us was often more telling than a formal interview. It could well be that often parents were unguarded and more able to reveal things to someone like the cleaner or indeed the cook.
         I was fortunate enough to experience one of the last NHS cooks when I was Senior Registrar at an inpatient unit. The inpatient unit catered for a middle age group spanning the older children to the younger adolescents. It was one of a kind in the U.K. and indeed it was the first to start a national training course for Psychiatric nurses in inpatient care, a good three years before anywhere else.
         The unit was in the middle of town and was considered to be too far from the Hospital for catering purposes.  Instead a cook was employed to cater for the needs of the children and nursing staff.  We doctors were not supposed to eat there. But we did.  Mainly for lunch.
         If we arrived at mid-morning we used to get a nice cup of tea. But that was only since I started bringing in my own tea leaves. We also got served home-made scones and the like.
         All very homely.
         I had since wondered if our great success rate was more to do with having our own cook than all the other therapies and tit bits that we did.
         You never know as people do not really research these things.
         ……I often arrived late at lunch time after the children and nurses had eaten as morning clinics had a habit of running late. With less than ten minutes to spare, the cook would still manage to serve me a bit of some of the things she knew I preferred. Often she felt compelled to sit with me to tell me about her grandchildren or about what the government should really be doing to help the likes of her, a war widow bringing up two sons in this Naval town. I always admired the resilience shining through her stories.
         She also provided me with her down to earth views of what we should do with whichever patient that had come in. I listened. I took note.  You never know.
         Sheena was the mother of two girls we had to admit. They were both ‘soilers’ and they would never touch vegetables at home or anywhere.

         Sheena was petite, worn and a chain smoker.
         But she had two lovely looking girls.
         We knew from the start there were handling issues and most likely diet ones too.
         One of the other reasons for their admission was that by and large there were very few girl ‘soilers’.  
         It was always a good sign when a child flourished in an inpatient setting, and away from home some mothers were more capable of telling you more of what went on.  Some mothers found it easier to talk to one of the non-medical staff, perhaps the cook.
         Mothers got fed too on their visits. More often than not the children preferred their mother to go home than to stay and watch them. That was a different issue. With the money spent on cigarettes and drinks not much was left for food either for the children or the parents. I knew that if we checked for vitamin and other deficiencies we would find them, a problem that had taken Public Health a long time to wake up to. Increasing tax for cigarettes and drinks did not change people’s habit one little bit.
         With a simple routine the girls were clean in no time.   At least during the week as they all went home week-ends, when the unit was closed.
         We were at a loss as to what was going on.
         The girls would get worse over the week-end and soil. This went on for quite a while.
         Then one day the cook talked to me.
         “Sheena never stays Mondays,” she told me.
         I listened.
         “Have you noticed she is always in dark glasses on Mondays?”
         How stupid of me. Now and again I saw her at the door seeing the girls off and yes, she wore huge sunglasses.
         Sheena was not a movie star.
         I arranged to see Sheena.
         She said, “You knew.”
         I nodded.
         “But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.”
         I suggested that I should speak to him but she looked terrified.
         She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.
         She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in.  We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next?  Another violent man most likely.
         Was it such a cop-out on my part?
         Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far.  That was before Maria Colwell. 
         The unit had long since been closed.
         The last cook in the NHS retired .
The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

The Cockroach Catcher has a full review on Amazon.

While most doctors are content with taking a medical history, Zhang would listen to his secretary and cleaning staff to learn about the milieu, thus gleaning useful information that can help his patients. It reminds me of Confucian humility. Confucius says: "When three men walk together, I have a teacher among them". 

As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy). 

 Read more:
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

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