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Doctor's Consultation  by Dr. Iain Corness

 

The Go-Go dancer’s knee

While thinking about joint pains, there is an old orthopedic surgeon’s joke which goes: “What’s a nice joint like you doing in a girl like this?” However our joints certainly give us lots of problems, especially as we get older.
The joints to give us the most worries are knees, ankles, fingers, shoulders and hips in around that order. All of them are joints you use and need frequently.
For many of the joints it is a simple case of wearing them out. This is especially so with the weight bearing joints as the knees, ankles and hips. In the perfect body scenario, your joints are designed to last you about 80 years, hold your bottom off the ground for 80 years and move smoothly for 80 years. Overload these joints and they wear out quicker. Consequently, if they have become knackered by the time you are 55 then you have another 25 years of aching joints to look forward to. Of course, the quickest way to wear out your poor old joints is to be overweight.
In the past week I have had a couple of people come to see me to ask about their pains. However, this is not surprising, as pain is often the presenting symptom for many illnesses and physical conditions. For example, the symptom of a fractured rib is pain on deep breathing, coughing or sudden movement.
In fact, our skeletons are responsible for many of our pains. Fractures and degenerative conditions such as osteoarthritis are certainly high in the list of likely suspects. Gout, which produces an arthritis in the joint in the big toe gives exquisite pain - just ask anyone who has had it!
Is it not possible to be pain-free, in today’s Android world? Unfortunately, the chemicals that are strong enough to mask the pain are also strong enough to render your brain inoperative when taken over a long period.
I do also realize that there are times when you want “temporary” respite from pain. The footballer with a fractured finger can have local anesthetic injected into the fracture so that he can do the two 45 minutes halves plus injury time and penalty shootout. That’s it. Not tablets for the next three weeks!
So why do we have “pain”? Pain is actually inbuilt into our systems for an important purpose. Damage control! Pain is what stops us damaging our bodies even further than they are damaged already. Let’s go back to the broken rib scenario. Most fractured ribs are “cracks” along the long axis of the bone, not a complete break right through, so that the ends are flapping around in the breeze. The pain stops the unfortunate person from doing too much and breaking it totally right through. Pain has a protective influence. With the person who has joint pains or gout, the purpose of the pain is to stop further damage to an already “crumbling” joint or one filled with sharp crystals. Pain makes you rest it, so that it can heal. When you stop to think about it, pain is good for us.
However, there are also chronic pain situations, and these are harder to deal with. Particularly when the pain is coming from a permanently damaged skeleton, or from a condition we cannot “cure”. This is where pain management comes in, and it is a fairly skillful region of medicine, let me assure you. Practitioners in this have to really understand what the patient is going through. What happens is that we (or you) have to maximize an ability of the body’s nervous system known as “attenuation”. This is where the nervous system receives so much pain stimuli that eventually the pain receptors “give up” through the overuse. However, getting to that stage is a long and painful road itself.
Chemical assistance is needed, but it is not just a case of taking big dose analgesics. In actual fact, much of the work in this area is with taking agents to slow down nerve transmission and other agents such as anti-inflammatories, which work with pain killers to make them more potent at a lower dose (so the brain doesn’t get mussed up)! It’s not easy.


In response to some medical attacks

It has always been the case where people like to throw stones at conventional clinical medicine. Claims of over-servicing, over-prescribing and downright fraudulent practices are thrown about, citing someone whose uncle/friend/mother (delete that which is inappropriate) suffered at the hands of “bad” doctors.
Now, there are certainly some “bad” doctors out there, just as there are “bad” lawyers, “bad” real estate agents, “bad” mechanics and just about any profession you would like to think of. But they’re not all “bad”.
And me? I am a conventionally trained British/Australian style medical practitioner who has spent a lifetime practicing EBM, otherwise known as Evidence Based Medicine. Practices that have been proven to work. Call it “good” medicine, if you like.
I am proud of my training. Six years at an Australian university that had a good name, and still does, despite undergraduates like me attempting to besmirch it during the aforementioned six years. I am also proud of my final exams taken in the Royal Colleges of Physicians and Surgeons in London. I have the honor to have my name listed in the ‘great book’ with luminaries such as Hunter, Jenner and Lister. I am also indebted to my tutors during the 12 months of ‘pre-registration’, where you apply your knowledge under the supervision of accredited specialists. An arduous road, but one that is a safeguard for you, the general public.
Another safeguard is called ‘peer review’ which medical doctors have to undergo. The ‘powers that be’ are also ensuring that we keep up to date with a process called Continuous Medical Education (CME). That medical education continues through to today, with CME lectures being attended by my hospital’s doctors, and myself. Fortunately for me, the slides are in English, even though sometimes the lecture is not.
Those ‘powers that be’ also try to ensure that we prescribe drugs that are efficacious, that have been tested, and the evidence points to this. It is not anecdotal evidence, but true scientific evidence shown by research in many countries, with hundreds of thousands of patients. It is following that type of evidence, that I can recommend with all good faith, that 100 mg of aspirin a day is “good” medicine. I also know that if you are prescribed a ‘statin’ drug it will lower your cholesterol levels. They have been tested. And these days, very rigorously indeed.
I am also the first to admit that we have sometimes managed to get it wrong. The Thalidomide story still has living examples of this. However, the medical world-wide network is cohesive enough to ensure that this drug was withdrawn. It is the checks and balances system that has kept western medicine afloat. This is not to be equated with the checks and balances system that has been incorrectly applied in the banking industry that sees the institutions on the brink of sinking!
I am often asked my opinion on “alternative” medicine, and all its diverse areas of ‘specialization’. I try to avoid direct confrontation over this. If devotees have found that they can diagnose tumors by looking at patient’s auras through their third eye in the middle of their foreheads, then I am genuinely pleased, in fact delighted, provided that they have subjected the method to scientific scrutiny.
If various groups can actually cure cancer, epilepsy, halitosis or lock-jaw by inserting dandelions into a fundamental orifice, then again I am delighted. This is a medical break-through, but as such, must be subjected to medical scrutiny. If the method stands true scientific examination (not to be confused with anecdotal ‘evidence’) then it will be adopted by everyone, complete with thanks to those clever people who picked the dandelions in the first place. After all, penicillin was tripped over, not designed. But it has had a very rigorous scientific scrutiny since.
As far as the majority of ‘folk’ remedies is concerned, I work on the principle that if you ‘think’ it is doing you good, then it probably is. But don’t ask me to endorse something that has not been scientifically tested.
When the ‘alternative’ group spends more time proving their methods, instead of complaining about non-acceptance, EBM practitioners will give them more credence.


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The Go-Go dancer’s knee

In response to some medical attacks