Sunday, November 29, 2015

Anorexia Nervosa : French Wine & Health Care!

France is famous for its wine and Health Care:


In my post on PIP implant I suggested that the French should stick to wine making: I was unfortunately wrong. They only make the labels it would seem.

In the wine worlds most dramatic news since the Austrians added anti-freeze to their winesyears ago one of the big Burgundian houses is in serious trouble.

 ©2008 Am Ang Zhang



Four directors of Maison Labouré-Roi, the 180-year-old Burgundy negociant house, have been accused of various counts of wine fraud.

…..Public Prosecutor Eric Lallement said during a press conference held in Dijon last night (13 June) that the fraud office was first alerted due to a disparity in figures between what the company was actually bottling and what it should have been, given the yields declared at harvest time. ‘It was as if the company was managing to vinify 100% of its musts, which is impossible,’ he said.

On investigating this, he said police found evidence of several specific frauds: firstly bypassing legal blending limits, affecting every level of the production from Grand Cru, Premier Cru and Village appellations, and adding table wine to wine musts to top up the ‘angel’s share’, Lallement said. He said the suspected fraud related to 500,000 bottles of wine, worth €2.7m in sales.

The second fraud detailed was over wine quality and labeling. ‘When the company needed to fulfil an order of a wine that it had run out of, it swapped labels with other wines,’ said Lallement. The magnitude of this fraud is estimated to be around 1.1m bottles.

****PIP implants manufactured by a French farm using non medical grade material: read it all here>>>>

So should they now stick to Health Care; best in the world according to WHO a few years back!
 ©2008 Am Ang Zhang




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, witch doctors. He was told to sacrifice one of his daughters if he wanted his presidency. Soon after his younger daughter, began suffering from anorexia nervosa.


So, I Googled Chirac’s daughter:



Telegraph: By Colin Randall
Published: 07 Dec 2004
President Jacques Chirac's wife has broken a 30-year silence to talk publicly about the anorexia that drove their elder daughter to try repeatedly to kill herself.


"A mother who fails with a child, who cannot bring a sick child back to health, always feels guilty," Bernadette Chirac said on French television. "And a father, too."


Laurence Chirac, now 46, was a promising medical student and worked for a short time after her studies with Samu, the emergency medical service, in Paris.


But she had suffered from an acute form of the eating disorder since she was 15, leading to several stays in hospitals and clinics.


Sixteen years ago, during her father's second presidential campaign, she was taken to hospital amid widespread rumours that she had died.


"Being famous can be harmful when one is faced with illness," Mrs Chirac said. "Confronting this kind of difficulty, you just want to hide from the gaze of others."


Laurence, whose younger sister Claude is a key member of the president's team at the Elysée, continued to suffer from the condition. In 1990 she tried to commit suicide by jumping out of the window of her fourth-floor flat.


A nurse assigned to her round-the-clock care was unable to stop Miss Chirac, who survived with a broken pelvis and head injuries.


Little has been heard of her since and Mrs Chirac said merely that she always kept the hope "pinned to my heart" that her daughter would recover.


Mrs Chirac has been the president since 1994 of a charity seeking to create better conditions for children and teenagers in hospital, enabling them to listen to or play music and play sports. She agreed to talk about her daughter on a France 3 discussion programme, “You Cannot Please Everyone”, to help publicise a new clinic for adolescents, La Maison de Solenn, funded by her charity.


"These children need some gaiety in their lives, to be able to see the sun," said Mrs Chirac,


She contrasted this ideal with the conditions in which her daughter was sometimes treated, "enclosed behind brick walls in a bedroom with a small window". She added: "That is why this mother wants to create a facility specific to adolescents' needs.

French Health Care as experienced by the President’s daughter.

We did not do too badly with our own Adolescent Psychiatric Units.


Related:


Saturday, November 28, 2015

Uluru & NHS: Killings or Savings?

Now! It is quite simple really!!!                                                                                                                                   

It is very much like  giving children the mortgage and meal money and that they buy primarily from mother, food, washing and accommodation. But then, there is no restriction on buying food from AQPs: other mothers, fish & chip shops, supermarkets and even McDonalds. What if the children sleep over at friends: is rent deducted.

They just cannot see it, can they?

  ©Am Ang Zhang 2013
It is indeed very sad to see how modern perverse incentives that were used in other institutions were used in our NHS hospitals in one part of the United KingdomEngland.

The figures are there for all to see and it is hard to believe that the very smart people that are currently running the country did not know.

In the brave new world, English Hospitals (or their managers) need to perversely increase activity to survive (or collect a good bonus before moving on or going off sick). GP Commissioners (CCGs)need to reduce hospital referrals in order to achieve government imposed savings or if it is run by privateers to find profits for shareholders.

Hospitals will fail and be bought up and the privateers will be so smart that they will only run the profitable parts.

Government will be left still running the loss making services or they could be sold out to the likes of Southern Cross .


Attempts to cull hospitals are happening in various guises and sometimes such failed. Fortunately for the government, since Les Misérables, the people may march and wave banners but they don’t do revolutions anymore. So instead of culling and closing A&Es, they downgrade them. It s a bit like, we do stomach pain but not myocardial infarcts.                                                                                                                

I have written before that A&E is the one thing that upset planners, accountants and most importantly the new CCGs. There is a belief, rightly or wrongly that A&Es still have real DOCTORS, and not someone flown in from Germany or further east. Nor are they like OOH or NHS111 where the concern is about money than your survival. As I was drafting this post another hospital is being overwhelmed by high A&E attendances.

What is most worrying is that A&E will lead to more hospital admissions: perhaps unnecessary ones or god forbid, absolutely essential ones.

In the unholy war between CCGs that hold the money and the Hospitals that needed the money patients may either be denied treatments that were needed or perversely given investigations and treatments that were not. 

But wait, they dream up something new: patient must get better or hospitals will not get paid. They called it:

Outcome based commissioning          

So plan B then, from now on admit only well patients. Or those we know that will get better. Just remember that Clinton picked the hospital with poor mortality for his bypassWhy?

So mother is now not going to be paid unless the kids get As.

But, hang on some patient will die; and not every child will get As unless we fine the schools too.

Perhaps that too.

Suddenly, there is going to be some killing and surprise, surprise; it is not what you think: no, not patients. 

That would be too simple.

From the BMJ:
Kill the QOF

The QOF simply hasn’t worked. It is a bureaucratic disaster, measuring the measurable but eroding the all important immeasurable, and squandering our time, effort, and money. It has made patients of us all and turned skilled clinicians into bean counters. Incentives and centralised targets are under scrutiny throughout the public sector because targets just lead to gaming. It’s time to look away from the screen and at the patient once again. Turn off the financial life support and let this failed intervention die.

What happened? £10bn


We are entering the 10th year of the world’s largest public health experiment in EBM—the target driven QOF (Quality and Outcomes Framework). It has cost £10bn in direct payments to general practitioners, but this is just the tip of an expensive iceberg.

From 2004 to 2011 prescriptions for statins doubled, for angiotensin converting enzyme inhibitors and diabetic drugs near doubled, for antidepressants rose 60%, and for steroid inhalers rose 30%.  Polypharmacy is the norm not the exception, and research evidence validates this approach.

Statins & others:
Yet statins, for instance, are supposed to reduce heart disease by 30% within a few years. The QOF has created three million new statin users, so why has there been no demonstrable effect on heart disease trends? Also we might reasonably expect within a decade to see a change in the trajectory of UK life expectancy, but we have not. Likewise the QOF was designed to improve chronic disease management in general practice, but instead outpatient referrals have risen 5% annually, with similar rates in acute hospital admissions.

This is leading to unsustainable pressure and costs throughout the NHS. Perhaps assessing the impact of QOF is impossible because there is no control group. But we can compare UK trends with other similar countries, and there is no evidence that UK healthcare is outpacing these countries.

The problem with the NHS Reform is the NHS itself. Because it is still to be funded by Taxpayers, there is much money to be made.

It would be different if we separate out Private Health Care and State provided one.

That the management consultants found out a long time ago.

No! No! No! Let Private Providers make money from the so called NHS.

Soon the government will discover that money would drain from the state to Privateers with no improvement in the actual care delivered.

The master plan is simple: a fixed amount of money is now given to CCGs who will be responsible for the delivery of health care.


Well, from now on blame the CCGsHa Ha Ha.


Hospitals are now in a risky position and that means 5% of you who might be seriously ill are too. CCGs may not want to fund the treatment you need or within the time frame that you will need. A once wonderful training ground for doctors may no longer be so wonderful. There will probably be fewer functioning hospitals and soon the once prestigious world famous hospitals will just be bitter sweet memories of a few of us.

KILLED.

Now can you see it?
©Am Ang Zhang 2013

Friday, November 27, 2015

Anorexia & Bulimia: Breast Implants & Abuse!

©2008 Am Ang Zhang
Chris
      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.


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

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.
        Impenetrable!

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

2 comments:

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.