Monday, May 28, 2012

Testing times?

A couple of weeks ago I had the pleasure of Brian’s company. He’d been at the golf club the night before at one of their legendary social functions. These functions used to be a simple excuse for a night of bacchanalian excess, but in these times of scrutiny and accountability even the hallowed portals of the Ambridge and District are not sacred and every function must serve an higher purpose. To that end the committee had invited in someone to do a bit of “health promotion” and offer “screening” before they sat down to their fifteen course banquet with attendant wine list, port and cigars to follow and brandies after the Loyal Toast.  

If you are detecting a hint of irony here I fear it was utterly lost on Brian.

In any event the screening on offer posed us a bit of a problem. It seems that Brian was informed his test (a P.S.A. allegedly) was “high”.

And that was all.

No advice about symptoms, no suggestion of what to do next, indeed no quantifiable information on what “high” might mean in “pounds shillings and ounces” *. Apparently the same was true for a few other stalwarts of the A&D, but fortunately they will be off bemusing their own medical attendants as none of them saving Brian are registered with us.

So what to do now? Well P.S.A. is a notoriously fuzzy test at the best of times. It’s undoubtedly captured the zeitgeist of those men, like Brian, of a certain age, and many attend seeking the “reassurance” of a quick test, on the assumption that a “low” result will ward off the spectre of prostate cancer. And here we run into a few difficulties.

The test measures a chemical put into the blood by an “unhappy” prostate. The problem is the source of prostatic disquiet could be anything on a spectrum from infection through inflammation to cancer. There had been hopes a few years back that it might prove useful as a test for the latter, but the test is just too imprecise to be useful and indeed the prevailing wisdom is that the potential harm of the number of unnecessary biopsies and other procedures that would arise from using it as a screen far outweigh any benefits it might provide in identifying new cases of prostate malignancy.

Needless to say, just because the medical establishment, hampered as it is by a need to evidence practice, doesn’t view the test as a good thing, doesn’t mean, now the Djinn is out of the bottle and the movers and shakers of groups like the A&D up and down the country won’t engage the services of the 21st century equivalent of the Snake Oil salesmen of old. So it is that they end up buying in unproven services from unscrupulous predators, keen to turn a fast buck at the expense of the anxious and ill informed, all from the best of motives. But this leaves Brian with a bit of a problem. Now he’s had a “screen” and it is “high”, but he has no symptoms of prostate disease.

I’ve offered him an examination (not described here for the sake of the squeamish—fans of Billy Connoly will know what I’m talking about though) but for now he has declined. Do we repeat the test, and if so when, and what do we do if it comes back raised again.

He’s agreed to go away and think about it for a while, and knows to come back at any point if he starts developing symptoms that suggest his prostate is unhappy, but I’m not sure he won’t be back asking for a lab test at some point in any event.

*EVCHN for attribution as usual.

Friday, May 18, 2012

Brand X

Enter Jamie, from his Nike trainers to his fashionably oversized baseball cap (I’m guessing it has some other appellation, but am too unhip and disinterested to go looking—but you all know the sort) festooned with its own logo (which again I “should” know, but again can’t really be bothered enough to go looking) he is every inch (or centimetre for the younger reader) an Ad Man’s dream.

Now I know I’m old, and grumpy, and horribly uncool, but I can’t be doing with all this branding. In the good old days, when life was austere—and I mean properly austere, not the austerity-lite Dave and George are enacting, we were glad to have shoes of any sort—let alone trainers, and trousers that came to within four or five inches of the floor without having to have extra bits let in. Labels were things you cut out of the back of your jumper to stop them itching, not “accessories” to blazon every spare surface.

Well o.k. there was the year every red blooded male child hankered after a pair of hiking shoes with a compass in the heel and a “bear paw” tread, but that was essential survival gear for when you found yourself trapped behind enemy lines, a fate more common for the average eight year old back then, when the average eight year old was allowed, nay expected, to play out in all winds and weathers and states of enemy occupation… but I digress.

On this occasion Jamie (who’s closer to sixteen than eight by the way) was accompanied by a worried looking Cathy (his mum) and after a cheery Jesterly “What ho!” she prompted him to roll up a letter strewn sleeve to reveal the forearm underneath. It transpires Jamie’s forearm has a hole in it. Well more a crater than a hole—it has a base. A mainly greeny-grey rather septic looking base, with angry looking red edges all around. It’s around 2-3 millimetres deep, and self inflicted. A few nights before, Jamie and some mates had been out braving the Biblical floods getting out of their heads on scrumpy and howling at the moon (traditional country pursuits in these parts). For some reason they then decided to do a spot of branding of their own, and one by one heated a lighter to a glowing white heat before jabbing it, now unlit at least, onto their own forearm!

On the plus side, in the modern era of antibiotics the resulting sepsis can be easily treated, and the circle is no bigger than the blunt end of a pencil. On the minus side it looks deep enough that it can’t but heal with a substantial and rather ugly looking scar. Unlike the brands he’s wearing now, but will be too cool for himself in a year or two, this one will be for keeps. He says he’s not unhappy, he wasn’t “self harming” in that sense, and that it was just a “lark”, and for now I think I believe him, but I hope this isn’t the start of some new and scary trend. Somehow it feels far nastier that the present dual fetishes for piercings and ink.

Wednesday, May 02, 2012

Nice Weather....

April has been an odd month in Ambridge. For odd, read wet. Indeed were I of a superstitious nature I’d be laying in biblical quantities of wood right now, and assembling a binary menagerie. You see the Am has burst it’s banks and roams abroad the flood plains of Borsetshire like an invading army and the denizens of the quaint Am-side villages are stockpiling tinned goods and filling sand bags “just in case”.

In consequence the roads of the customary drive to work have become waterways, especially those approaching the foot of the Ambridge Escarpment. Last week I sloshed up behind a Clio that was crawling along at a sedate pace in the middle of the canal… er, road, seemingly oblivious to the tailback that was forming in short order behind me.

It transpired as they approached the rise to the aforementioned escarpment, that there was a tailback of their own in front. Or at least a tail attached to the back of a young lady mallard who had, not unreasonably, taken this particular part of the Queen’s Highway for a new tributary to our mighty river, through which she was paddling and plashing along, oblivious to the chain of four wheeled watercraft arrayed in line astern. I can’t help wondering what went through her mind as she encountered the uphill gradient of this particular watercourse though.

There have been benefits to the “wettest-April-on-record”. The lawns at Jest Acres now, at last, have a greenish hue and no longer resemble blasted and windblown tundra. Admittedly most of this greening is of mossy origin, but as you all know I’m never one to complain. And the wizened and stunted trees of the soon to be legendary Jest Orchard have finally seen fit to sprout a few green shoots and varicoloured pink and white blossoms which cling desperately to their branches for a few moments before being lashed away by the battering rains.

Just now it looks for all the world as though May is destined to continue the aquatic trend, though we are told it would need to keep up like this for months ahead if we are not to regard present conditions as a drought still. (It seems the spirit of Michael Fish is alive and well at the Met Office). Be that as it may, imagine my delight when, on approaching the escarpment this morning I espied a hastily hand painted sign reading simply, “Caution! Ducks!”