“The Pill Go Round”

A recent report by Professor Sarah Harper of the Oxford Institute of Population Ageing, highlights the fact that we are too quick to use pills to solve our medical problems rather than making lifestyle changes.

I have written about this in my Pilly Galore blogs (click in the TAG CLOUD on “PILLS” to find them).

A follow-up article in the Daily Telegraph dated 19th March 2012, gives an excellent perspective on this, from a GP’s point of view – it’s written by Max Pemberton.   He outlines some of the issues as:-

  • “Patients want to feel their problem has been listened to and feel shortchanged if they don’t get a prescription”
  • “There are a growing number of drugs for everyday conditions such as high blood pressure or high cholesterol and consequently these get used as treatment”
  • Taking one drug can lead to having to take another and another”

Doctor Pemberton illustrates his point using his experience with an 80-year-old patient who was rather like Pilly Galore in her implicit faith in doctors.  I’ll call her “Unlucky Mabel” and you will see why as her story unfolds.

Unlucky Mabel had trouble sleeping, so she went to her GP and was given a sleeping pill.  It should have been called a “sleeper pill” because it had lots of unintended consequences:-

  • One side effect was incontinence so Unlucky Mabel got a pill for that too;
  • Another problem was constipation and Unlucky Mabel got two more drugs for that;
  • Blurred vision was a third added benefit of the sleeping pill but not to worry, Unlucky Mabel got eye drops for that.

Then Unlucky Mabel got really unlucky, when she was drowsy from her sleeping pills, she had a fall and broke her hip.   After the operation to mend her fracture, Unlucky Mabel got pills to strengthen her bones and more pills for the heartburn those pills caused.

You could not make this story up if you tried so I am grateful to Doctor Pemberton for telling it.

There again, from my own experience, this story is not so unusual.  Many older people take a cocktail of pills every day.   In our quick-fix go-away Health Service, a pill is the every day answer to a thousand problems.   I am sure every GP’s practice has its “Unlucky Mabel” stories.

Look on the good side, although Unlucky Mabel had a bad year, her treatment kept a great many health professionals employed :-

  • Researching the drugs to cure Unlucky Mabel’s sleeping problem,  and her incontinence,  and her constipation,  and her blurred vision,  and later on her weak bones  and her heartburn.
  • Marketing of the drugs to doctors who have to travel to far off medical centres of excellence like Mauritius or Honolulu, where they are told of the virtues of all these new drugs and that occasionally, they have a few side effects.
  • Dispensing the pills through GP’s, practice nurses, locum doctors and all the people employed in high street chemists.
  • And if all else fails, the NHS and all its consultants, registrars, junior doctors, nurses, auxiliaries and managers are all there to pick Unlucky Mabel up.
  • Finally, there are the researchers in universities who are able, with great hindsight and more distant objectivity, to see what those more wrapped up in Unlucky Mabel treatment can’t.

What a pity no-one asked Unlucky Mabel!

WHY CAN’T YOU SLEEP ?

Posted in N.H.S. | Tagged | 1 Comment

“Shinkansen Bullet Train”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see earlier blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Half-way through our holiday we travel from Tokyo to Kyoto on the renowned the bullet train.   Our luggage had been sent ahead the previous day  —  there is no room, or more especially, boarding time for messing around with luggage on the Shinkansen !   After our first day encounter with the super efficiency of Japanese Railways ( See the blog by clicking on the Archive  dated April 5 2012 ) we did not dare be late for the train.   So we set off  to Shinagawa station at 9.30am to catch the 11.56 am train   —   Hakari Express116 coach 12 seats 6A and 6C  —  with Mr J.R.’s instructions still ringing in our ears from 5 days before.   There was no-way we were going to let him down by missing the train. 

  The station is vast and the Shinkensen has it’s own set of platforms.   So we start by heading for the Information Office, for some easy turn-left, turn-right, up-the-escalator, turn-right, turn-left directions.   I think we got lost after the second turn-right, still we retraced our steps and they seemed  pleased to see us at the Information Office again 🙂    Next time we listen more carefully and do exactly as we were told.   Then we arrive at the ticket barrier and remembering  Mr JR’s instructions,  ” men are better than machines”, we don’t use the ticket machines.

In spite of our muddled wanderings, the station is organised, spotlessly clean and well provided with food shops offering a huge variety of boxed take-away suchi snacks.   The newsagents are full of manga comics and sudoku puzzles, but no English newspapers.  Nearer the platform, each coach has it’s own waiting room including a Starbucks and a row of computer terminals.

The platform has clear signs  —-  all in Japanese.   Once again they are sparkle- clean, to the point where you can sit on the floor  without getting your coat dirty.   This young mother wth her baby had no problem finding a space to sit, although seats might be a good inovation for old men with dogy western knees.

Trains arrive and depart every few minutes from each platform.  A few minutes before your train is due to arrive —  but not too soon in case you get swept off to Okinawa — you line up in a little marked box.   The train stops exactly at your marked carriage point.   All the train doors open automatically.     A quick ‘squirt’ of passengers spill from Coach 12, then with a short intake of breath the train ‘sucks’ on-board the line-up of new passengers in the box marked 12, which includes me and Tom.    A guards whistle and off we go, in less than two minutes, —-but it didn’t feel rushed.

The carriage is five seats wide with a larger than UK style central aisle.   So the trains must be wider than the UK.   All the seats are reserved in advance.   Soon up to 200 miles an hour, we speed through lots of tunnels and built up areas, almost all the way from Tokyo to Kyoto.   Small two storey detached houses interspersed with office blocks and industry.   A flat plain, bordered on one side with a range of heavily forested mountains,  the coast line is never far away on the other side.   Certainly you get the sense that this is a nation squeezed into a very small island.   Building space is in short supply.

 Add the jam-packed trains and crowded Tokyo streets, and just maybe you can begin understand the masks ???????

Sony, Panasonic, Suzuki, Toshiba, Nikon, Mitsubishi – flash by the window like railway ticker tape.     Global Japanese names dotted about in relatively small factories and office buildings.

First stop after an hour at Tokyo Hashi.   At the sound of a “bing bong”, a few people get up and put on their coats,  all are standing in the aisle when the train arrives.   All off in a 20 second ‘squirt’.   All new passengers on in another 20 second ‘suck’.   Train leaves in one minute 40 seconds.

Quarter of an hour later, next stop Nagoya.      Another one minute 40 second stop.

One unusual thing is that every member of the train staff, from the coffee lady to the ticket collector, as they walk through the carriage , stop as they exit the coach, turn around to face the passengers and bow their head – even if no one is looking.

Our final stop, all passengers due to get off are already in the aisle again.   No rocking about on this train, or abrupt stops.   After an announcement in excellent English, Tom and I are duely ‘squirted off’ at Kyoto.

Posted in SMILES | Tagged | 1 Comment

“Green T Makes U P”

As I start to think about packing for a long-awaited trip to Japan, I came across an interesting study by Tokyo University.  Their researchers followed the health care of 14,000 elderly people and related it to their diets over a three-year period.

We have all heard how much longer Japanese people live and the assumption that this may be linked to how much fish they eat.  So I am looking forward to consuming lots of sushi while I am there.

This new study picked up on a new issue – Green Tea.  They found that those who drank at least 5 cups of green tea a day, were more physically active and 33% less likely to develop a disability.

I have been a lifetime tea drinker, but I only started drinking Green Tea a year ago when I met a delegation from the Chinese Government who brought with them their own consignment of Green Tea.  I was instantly converted and have only drunk Lapsang Souchong Tea ever since.

I can honestly say I am a lot more mobile, I am running back and forth to the loo all day.

Indeed, if the Chinese talked to the Japanese, they could perhaps explain the reason behind the Tokyo University research findings.

GREEN TEA MAKES U P

Posted in SMILES | 2 Comments

“Living in the Present”

The growing number of older people with dementia is making societies all over the world reach for straws of solutions   —–    in health care services that are drowning under the pressure of struggling to cope with ageing populations.

Over the past two years, I have written about the pills and potions that lay claim to helping slow down the relentless advance of the disease (click on dementia under TOPICS for previous posts).

The NHS has almost completely given up on long-term care of dementia patients and by default handed the task over to the private sector.   Residential care homes have become the out of sight, out of mind warehouses for the majority of elderly people with the later stages of dementia.   Numerous reports testify to the low quality of care that is provided to most residents by a largely untrained and low paid workforce (click on “NEGLECT SHAMES BRITAIN” in the TAG CLOUD).

As a society, we have a  ‘hopeless’  view of dementia.   This desolate outlook  negatively colours our whole view of the ageing population.

                 It is essential that we turn this unspoken grumble into a smile.

Therefore, any attempt to do so should be looked on positively.    That is why when I recently wrote about a new project in Switzerland, which is a planned village for people with dementia, I wished them well.  (See “Living in the Past” in the ARCHIVE 16 February 2012).

Collectively we need all the help we can get to find better ways of providing for the challenge this difficult disease presents to ageing societies.    Therefore it was particularly interesting to read in The Times,  31st March 2012, of a village in Holland which inspired the Swiss project.   The project is in Hogeweg, which was opened in 2009 and accommodates 152 residents with dementia, who live communally in small group homes.   It has a range of facilities which include a restaurant, a shop and traffic free village streets.   More importantly they have a host of trained staff and volunteers.   The village cost £16m of mainly state funded money to build and it then  around £50,000 a year to look after each resident.   So this option is certainly not cheap and probably therefore cannot be easily replicated.    However, the most important question is “does it improve the lives of the residents?”   To this the answer would seem to be yes – certainly if you judge it by the demand for places – although this may well come from relatives looking for respite for themselves as much as for the residents.

The reported response from Jeremy Hughes, the Chief Executive of the UK Alzheimer’s Society, was understandably cautious and disapointingly sceptical.   He focussed on the need not to deceive dementia patients.    I think that is a somewhat simplistic view.   We subject dementia sufferers to huge indignities in the care we currently provide for them, which go well beyond a few little white lies.

Perhaps the lesson to be drawn out of all of this is that for residents with dementia and their relatives to have better lives, they need more support from properly trained staff and an active life in familiar surroundings.

To this end, taking residents to an artificial environment and grouping them with other confused residents may not be the most obvious thing to do.    Though it may be the only answer for some residents who live alone or are in in the later stages of dementia.

I wonder are we confusing dementia sufferers by taking them away from a world in which they had anchor points in an earlier life ?    Is that is why they so easily lapse back into the past ?    Surely it is better to continue to look forward, by building on a lifetime of their own experience and skills.

Then allow people with dementia to live in the present.

Posted in Dementia | 2 Comments

“Move to the Country” 3

Two years ago I wrote a blog recommending you move to Dorset if you want to live longer.    See May 28 2010, in the Archive.

I must apologise to anyone who took me seriously and moved.   A more upto date study by actuaries Towers Watson has now suggested that Hinton St. George in Somerset is the best place to live if you want the longest life expectancy.  A man of  65 could expect to live until 88.7 and his wife of the same age will live on until she is 91.6.

The downside is that you will be living among lots of barristers, teachers and vicars, who all seem to enjoy long lives.  Still the pub quizes should be good.

Isn’t it amazing how statistics can be so useful in helping us live our lives.  I am sorry though if you have to move again, but it may give you a few more years.

For anyone reading this who lives in Bootle, you are predicted to live 5.5 years less.   So if you can afford the move to Somerset and are good at pub quizes, I should get on with it without delay.

Posted in SMILES | Tagged | 1 Comment

“A Shopping Experience”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see earlier blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Takashimaya is an upmarket department store in Kyoto.   We went there to see a Marc Chagall exhibition.   Not exactly the normal way to use valuable retail floor space !    Since we were directed to the “exhibition hall” it is evidently in frequent use for this cultural purpose.   The gallery was well attended and not full of shopping bag carrying temporarily diverted customers.

As lunchtime was approaching, we went to the food department with counter after counter of unrecognisable delicacies.   As you pass by each section, the assistants shout a high-pitched “welcome” at you, like fruit and veg market stall holders in the UK.   Walking by the fresh delicatessen counter which had about ten assistants, set them all off in unison.  Clucking like a coup of squawking chickens.

We finally found the Sushi bar and expected to go in and be able to select one or two samples of food for a light lunch.   First problem was the door again – we could not see in, so when we entered we were surprised to find ourselves in a tiny room with a counter only big enough for a dozen seats —  with a white aproned chef and only one waitress.   Next problem – the menu was all in Japanese – no pictures and no English speakers.    So we pointed at the mid priced set meal and hoped for the best.    We were not disappointed – individual bowl after bowl of food was placed before us.

It was all interesting, although we had no idea what most of it was.    After about an hour and ten courses, we were presented with a plate with one real chilled strawberry and a quarter of grapefruit which turned out to be delicious jelly.    This looked like the last course, but we were only certain when the people at the end of the counter got up and left.

Another surprise experience behind a closed-door.

Next some gift shopping.    I went to browse in the homeware department.    I obviously looked lost after ten minutes of aimless wandering and an assistant approached and offered to help.     When it was apparent I could not speak Japanese, she apologised and fetched someone who spoke fluent English and proceeded to be my personal shopper.  Each time I selected something, she picked up the plastic label off the display and someone else came and took it them away.    When I had finished my selection, she ushered me to sit down at a table.   All my selections were already waiting neatly laid out in front of me.    I was asked to check these were the correct items and then to choose a wrapping paper and colour of ribbon.    I was just wondering how I would keep track of what was in each box, when I was asked to put the name of the intended recipient on a strip of paper.  Then all the presents were taken away.    Within five minutes they were all returned wrapped, ribboned and protected with bubble wrap with the small paper name-tag labels attached.

  A brilliant lesson in customer service !

As I left, I passed another exhibition in the store.   This time a big room sparsely filled with displays of ikebana flower arrangements.   The attendants were all ladies in Kimonos.

I could even get to like shopping if it was all done in this way 🙂

                                    THANKFULLY IT WON’T BE

Posted in SMILES | Tagged | Leave a comment

“Royokan Garden”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

The highlight of our trip to Japan was, without doubt, our stay in a traditional Japanese family hotel called a Royokan.  I will write about our experience in a separate blog but the one thing that stands out most in my mind, is the memory of the garden.

The interior of a Royokan is one of stark simplicity – sliding walls and doors.  Standard size tatame floor mats.  Uncarved tables and chairs and no other furniture.  The only interior decoration comes from a few Japanese prints on the wall, and carefully placed Origami flower arrangements.  Colours are straw, wood browns, white wall panels and ebony black furniture – all illuminated with subdued low-level lights.

The small internal garden is a complete contrast.  It contains a host of elements knitted into an intricate tableau of natural and man-made features.  Water meandering in a small stream – contrived into a waterfall, splashing over green moss on rocks, trickling through hollow bamboo shoots.  Rocks and stones of all shapes and sizes – a few rugged boulders, flat stepping-stones, round river pebbles on the banks of the stream.  Man-made stone pagodas and lanterns.  Verdant plants adding a green pallet – moss on the wet rocks.

 

Tussled uncut grass, ferns on the boundary between the waters’ edge and the rock scree.  Camelias not flowering any longer.  Just one flowering cherry clipped to leave a thin cloud of pink flowers.

A few large trees rising out of and above this small piece of heaven, all bounded by bamboo and plain off-white walls.

In the early morning after doing my Tai Chi exercise in the quiet slumber of a sleeping house – silent footsteps on a forgiving straw mat floor – I sat and watched the dawn break over this garden haven.  The babbling stream is the dawn chorus.  White, golden and speckled Koi Carp adding colour to the dark water.

Black silhouetted tree branches against the lightening, colourless sky.  Light splashes on the already moist rocks and wet leaves.  As the garden wakes, the sun breaks.  Just a slow sleepy-eyed dawn.  The cherry blossom not yet awake for a new day given the courtesy of a late awaking for her daytime glory.

The designer who put this together was a genius.  Nothing and everything new each day – timeless beauty.

A CALM PLACE TO CONTEMPLATE

Posted in SMILES | Tagged | Leave a comment

“Tidy Japanese Style”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

When I leave my hotel room each day I try to leave it tidy, but my idea of tidy falls a long way short of tidy by most people’s standards.  Certainly my wife tells me frequently enough.  That said by Japanese hotel standards I am not even close.  They do all the things that any hotel housekeeper does – replace the used towels, clean around everywhere, make the bed and put clothes back into wardrobes and draws.  Nothing unusual about any of that.

However, there are noticeable differences that go beyond that in Japan.  Immediately you walk back into your room the curtains haven’t just been drawn back, the lace shear has been evenly pleated so precisely that you assume it must have been done with a ruled template.  Similarly, in the bathroom, they haven’t just replaced all the soaps and lotions you have used, but a new variety of bath salt – “herbal” has replaced yesterday’s “citrus” – to bring you health and happiness.

Towels have been refolded and placed long on the high rail and short on the low rail.  Used dressing gown, not just hung up but expertly folded and tied with the belt as it was when we first arrived.

Tissues are all triangle tidy, as are the toilet rolls.

Even my toothbrush, toothpaste and razor have been repositioned with all the other items to match the alignment of the sink basin.

It makes you want to keep the room tidy yourself.

MAYBE THAT’S THE LESSON

P.S.

It does not stop there  —-  all hotel corridors are spotless and clutter-free  — except for the occasional decorative item.  Here are some examples :-

This last one is something really special 🙂

Posted in SMILES | Tagged | 1 Comment

“A Guided Tokyo Tour”

This is one of a series of blogs which describe my trip to Japan in April 2012.  To see further blogs in the series, click on “Japan Odyssey” in the Tag Cloud.

Like our hotel door to 16th floor lobby experience, we emerge from the underground into the light of a Shinto Shrine.

Our Meewa guide turns out to have an encyclopedic knowledge of the Meiji Shrine.   The park was built near the beginning of the 20th century with trees planted by 10,000 volunteers.    90 years on it is one of the three largest man-made forests in the world.    The others being the Bois du Boulogne in Paris and Central Park in New York.    We enter through a massive wooden gate constructed with two single cedar tree posts brought from Hong Kong.

One of the first things we saw on the pathway leading up to the Shrine, were offerings to the many Gods.  There are 180 Shinto Gods and judging by the wall of Saki barrels that were left for them, they must have been heavy drinkers.

As we walk up the wide paths through the wonderland of specimen trees, we occasionally pass a be-masked fellow wanderer, surely missing the point of this fresh air lung in the city.    On the approach to the Shrine, the path widens and is framed by an advertising hording sized gallery depicting the history of the park.    Even the people with masks stop to admire them, but they still don’t take their masks off.

At the next turn in the path, a man with a rake has a Forth Bridge job of raking flat the loose gravel scuffed up by all the visitors.    He shows no sign of concern about new visitors approaching his freshly levelled work, more like pride that they can walk on a smooth leafless path.    His job is to keep the path looking today as it did on the day he first started in the job.    Change is in the hands of the God of the Seasons.

Before we were able to enter the Shrine, we had to cleanse ourselves of any impure thoughts.  There is a small washing place and Meewa shows us the ritual of washing our left hand first, then our right hand, then cupping water into our cleaned right hand and swilling our mouth.  I don’t know if it worked but we tried.

After this, there are no more photographs as you weren’t allowed to film inside the Shrine.

The Japan Odyssey continues as we emerge into the more commercial world of Tokyo again but with one final surprise just outside the entrance.  I saw in the distance a familiar building which was locked way back in my mind from my early architectural training.  A building designed by Kenzo Tange for the 1964 Olympic Games in Tokyo.  This swimming pool design was so outstanding that it instantly brought back the impression it had made on me all those 38 years ago.

Posted in SMILES | Tagged | Leave a comment

“Grumble Day or Smile Day”

How you feel when you wake up in the morning can often determine your outlook for the rest of the day.  Today I am in London for a meeting, staying in a modest no-frills backstreet hotel.

As usual, in my slow start early morning daze, I stumble and fumble my way through shaving, showering and dressing.  Too early yet to form an impression of the day.

Somehow I navigate my way down the lift and through unsigned corridors to the restaurant for breakfast.  A smile from the waitress, seated and tea-ordered, my new day begins.

     NO SAUCER  😦 my cup on a not-quite formica table.  American style economy without American style bountiful breakfasts, and make-my-day smily service.

My more modest two poached eggs on brown toast arrives,  — with extra toast that will be cold when I get to eat it   😦

Then the background music plays Roxette’s “It must have been love”  🙂   That rescues a smile and evokes memories of great times in the early 1990 days of ExtraCare.  Driving around the Midlands opening shiny new nursing homes and recruiting lots of fresh-faced, eyes wide-open, new-job staff.  Singing to the car stereo as I went.  As the song says, “It must have been love, but it’s over now”.

                                HAPPY MEMORIES   🙂   🙂   🙂

Maybe this hotel is not so bad after all.  Ten flavours of yoghurt, a variety of French croissants, ham and other cold meats, and fresh fruit from all over the world – apples, oranges, bananas, pineapple and strawberries in February 🙂

Now to finish with my cold toast and little jars of jam – raspberry jam, apricot jam, strawberry jam, blueberry jam……….BUT

                NO MARMALADE  😦  😦  😦

Posted in GRUMBLES | Tagged | 3 Comments