A new friend?

Back in January I wrote about an absent friend. Since that time I have seen my old friend Ray a couple of times more, once at home, and later at the surgery, and on both occasions the absence remained a palpable thing. The guide dog Ray had lost was a big personality. When the two of them came in they were always the centre of attention. We kidded Ray it was all down to his chiseled good looks ("One of my friends says I look like Clint Eastwood"), but he and we knew his new found animal magnetism was easily 80% canine. Loosing the big rock-star dog that had been his ten year companion left Ray diminished and contracted his horizons far more than either of us expected it might.

And so it was with some trepidation that I viewed the screen message earlier this week that announced Ray plus "one other" were waiting to be seen. When I went to collect them, instead of the huge, golden maned, long haired Labrador of yore, Ray was escorted by a docile, jet black, short haired shade of a dog. Instead of bounce and slobber I was greeted with equanimity. We processed down the corridor to my office in a far more stately and reserved manner than we had been used to, and once in, the new guide settled himself quietly at his master's feet and watched me cautiously to gauge my intentions and figure out if I was to be trusted.

By the time we were done I think we had achieved a modus vivendi, and I should still be allowed to care for his master for the time being, and on the way back out of the office the carriage of the hound had a more familiar cast to it, and in reception a small flock of admirers began to gather. And again the majority of their attention fell upon the dog. I'm not sure this one will quite achieve rock-star status, but, eleven years on, his quiet efficiency will probably suit Ray better, and it is already clear that he,Ray, is moving on at last.

I was left wondering to what extent this shadow-dog communes with his forebear (or perhaps that should be foredog). I certainly got the impression at points during our consultation that older, more familiar eyes were gazing up from that long dark face.

Perhaps there is something in this reincarnation thing, or perhaps I'm just making a new friend after all....

If the CD player wasn't broken I'd have been listening to Lou Reed.

Once or twice a year you get a perfect morning. Today was one such. The school run was taken by my better half. So I got to head for the surgery a half hour earlier than normal, and today that half hour was especially blessed.

The sun had climbed just high enough not to be dazzling as I headed east out of Borchester, bleaching a near cloudless sky to the faintest blue-white. This in turn was mirrored by the soft blanket of autumn mist that hugged the base of the Ambridge escarpment. Dew drops scattered the field like tiny diamonds, and climbing the escarpment the sunlight pierced the woods at just the right angle to halo the turning leaves in shimmering gold.

What made the ride in all the better was that, being that little bit earlier, I had the route pretty much all to myself right up to the outskirts of Ambridge itself, so that despite apparently dawdling along taking in the sights I was still in early enough to have had a hot steaming Java and a couple of Hob Nobs before returning to the fray.

May you all be so blessed this morning and every morning.

(Needless to say after such a promising start karma blessed me with a morning of Flu’ jabs and crusty toenails—but somehow the residual bonhomie refuses to quite go away).

Grace under pressure.

Around a year ago Grace started to complain of tummy pain. This was before she came to Ambridge. After a few weeks she was unwell enough to need a hospital visit, and there they found a pelvic mass, around the size of a mid term pregnancy. Only trouble was that Grace was pushing seventy years of age and was long past her menopause.

In pretty short order she was told she had ovarian carcinoma. Then that she had inoperable ovarian carcinoma. Then that she had inoperable ovarian carcinoma that was not responding to chemotherapy. At some point in that process she ended up relocating to Ambridge and joined Dr Neighbour’s list.

She has in Dr Neighbour an excellent GP. She also has the input of the best available local Oncologists and Mc Millan Nurses. She also has the Ambridge District Nurse A team on her case. She has little or no pain and has no fears for the future, taking each day on it’s merits, but she has no illusions that this will be her final illness. Lately she has been a bit queasy, and has begun to feel what we English like to euphemistically call “a bit bunged up”. The usual array of laxatives isn’t helping much and neither this past week has repeated enemata from the aforementioned A team.

And so it fell to me as duty doc, a day or two ago, to call on her mid afternoon, to see if we should be trying harder to get things moving. The duty had been a bit busy, so no time for the usual lunch on the hoof for your humble narrator. I needed to examine her abdomen, so she gamely struggled upstairs to get on the bed (one simply does not submit to examinations of that sort on the settee) despite the evident effort it was costing her. I was keen to rule out intestinal obstruction, and as I leant over her “bump” to apply the stethoscope, to my eternal shame, it was my tum and not hers that did the rumbling.

In the end the exam did not reveal immediate concerns and we agreed there was no need for an urgent admission, though a quick Xray of her abdomen might be a good idea to rule out a sub-acute obstruction (believe it or not a fairly precise surgical definition that would have signs evident on said Xray). As a result I arranged for her to go for the pictures that afternoon, and in the event they were clear and we have pulled back from the purgatives and enemata and reassured her that a little feeling of fullness can be expected simply as a consequence of the mass in her tummy, but that so long as it causes no pain and no nasty vomiting she need not fear it.

In the end as happy an outcome as we could have hoped for in the circumstances, and Grace was effusive in her thanks for me not wanting to admit her. And in the midst of all this, as I was arranging for her to pop in for the films to be taken she politely wondered if she might offer me a cup of tea and a sandwich.

Hard to swallow?

Young George is just over one year old. For the past few months he has had an increasingly healthy appetite for solids and is visibly thriving. Or so he was until a few weeks ago. After a couple of weeks of gradual loss of appetite he suddenly stopped eating altogether, and mum and dad began to worry. After three days of nothing but fluids, and diminishing demand even for these, coupled with that most alarming symptom of all, a complete refusal to eat chocolate*, he had put the wind up them both and so they attended, with a still happy and smiling young George in tow.

So far, despite his total lack of enthusiasm for solids the lad was holding his own pretty well, with no signs of rapid weight loss and no real dehydration. He was vomiting after all solids though, and so had really given up trying, and so long as mum and dad allowed him not to eat he was happy, only becoming fractious when they tried to make him.

His tummy was quite soft and not at all tender. There was no worry about constipation or diarrhoea, and on the day I examined him my tummy was gurgling more than his… one of us was definitely in need of chocolate!

Overall he really didn’t seem too bad, but mum and dad were not going to take happily to this suggestion. In reality it appeared little George was suffering a bit of “reflux” with acid flowing backwards from the stomach into the lower reaches of the oesophagus causing heartburn and hence vomiting.

After some discussion his worried parents agreed to my evidently insane suggestion that we try spiking his bottles with an antacid preparation that just might do the trick, before we considered referring him on to the paediatricians. It helped a bit that I have looked after mum since she was little older that her son is now, so with a slight reluctance she and her husband agreed to try my alchemy for a week or so before pressing the panic button.

Two weeks on they came back, all three beaming contentedly, to request some more sachets of the antacid. Young George is back wolfing down everything that’s put in front of him, and most particularly he’s back on the chocolate. There can be no better sign that a toddler is on the mend.

*Regular readers will already be aware that this writer believes Chocolate worthy of it’s own food group and of that food group’s obvious preeminence over all the others.**

** except perhaps the Vodka / Bourbon group that is….