Category Archives: death

The world – divided or united?


Where are we at in 2017. Have we learnt anything from our existence up to now?

What is life? What is quality of life? Who are humans? What is power?

From the year dot – and who really knows when exactly that was, humans have lived on earth and by definition had to co-exist. We have grouped ourselves into various different groupings. We have fought wars. We have progressed in many ways and regressed in others.

There are places on earth where justice exists and there are places where it does not. Most of us would prefer to live/be born where there is an inkling of justice and freedom?

So many people were convinced that Trump would not actually become president. They laughed scoffed and said it would never ever happen. It did.

Now here we are in 2017 in a fairly regressed place – I believe. Where one person signs into being orders that blanketly prevent movement of “free” people categorising them by a set of rules. Abortion is bad – terrible and to be frowned upon but living people who are living in a war-torn unjust places are even worse, cursed and must remain that way with no redemption? And America – the once – free world is now becoming an insular, inward focused country with walls around it. No boogy men or women allowed in. Are you really that narrow minded ? Mr Trump? The message preached sounds really quite extraordinary, quite two-faced, quite astonishing.

As the CNN reporter put it – americans risk of being killed in america by any one of these nations so called terrorists is a very very small number with the total counted up to now being zero.

However countries that provide profit to Mr Trump (whose citizens may be more dangerous) seem to be fine for the moment (don’t hold your breath though).

I wonder where this is all headed. In about 2 weeks a brand new landscape opens up across America – no longer the free world. No longer an american dream. No longer.

And yet there is support against Trump worldwide ?

I really wish that the way I see things is perhaps not the way they are – can someone point out a positive here? Is Trump actually doing a good thing? A thing I can not see?

On giving birth and what I have learnt


I believe that from the moment of conception something changes inside of you. Something that you can not quite put your finger on and something that eventually is what one might call motherhood. That in itself is a whole dimension of complicated intertwined emotion and a whole lot more.

From the moment I knew that I was essentially a “mom” I was changed and I wanted only the very very best for this little creature growing inside of me who was body, spirit, soul.

This, combined with hormones (and they were certainly not friendly to me) was a complicated mix of “stuff” to deal with.

I knew that conception is natural. I knew that for 1000s of years women delivered babies at home. I also knew the flip side (being a doctor) and that many things can and do go wrong. This was not a good combo for me personally.

I delivered two babies naturally with epidurals that only worked on one side (both times – apparently I have a filament). The first time was with a “doula” and quite an elating experience. The second was without  (you can read my birth story for reason , I still wish I had had one rather). The second time around I was 39 and things really just never actually

went according to plan.

Long story short I had a near-death and out of body experience. The pain I had AFTER delivering was something I never ever wish to experience again. Despite being a doctor and complaining of pain I was treated unkindly (to say the least)(there are many other phrases I could use). I was eventually resuscitated and taken to theatre. It was unpleasant mildly put. I was not even able to really bond with my little for at least 48 hours. All of this could have been prevented. Recently I had surgery and realised that I had actually ruptured my uterus with the birth (this healed miraculously by itself). There are many miracles that happen every day. I thank God for mine.

I am writing this in part as catharsis and in part to women out there at large.

Lessons I have learnt :

1.) If you are in pain – you really are in pain and don’t let anyone tell you that you are not. Pain is nature’s loud speaker and it should NEVER be ignored. Only the patient knows if they are in pain regardless of how loud (or not) they scream.

2.) Pain (extreme pain ) always means that there is something not right and it needs to be figured out and fixed. It can be ignored however the risk of death or damage is high.

3.) When you are over the age of 35 it may be better to cut your losses and have a caesarian section – provisor – if all goes 100% to plan at dates (term) and your labour progresses as it should by all means go for it. However if one requires induction, long labour etc have a caesarian section.

4.) Miracles do happen but medical science is very clever now make sure your “carers” do all they can in terms of what we know to date.

 

 

 

 

 

Statins are NOT satan, indeed the contrary!


satan2statins2Ok, so I am not Tim Noakes, neither am I a professor of medicine – though I have listened over the past 20 years to many of them and do on an ongoing basis. They as a whole (generalisation) tend to speak from journals and science. Science these days has to be proven quite well.

There is honestly so much rubbish on the internet from the absolute hogwash about statins to the dribble about vaccines.

LEt’s talks science and let’s talk LIFE quality and quantity.

No I am not a professor but I aim to give my patients the absolute best I can.

What do we know? We know that the diabetes/cardiovascular (another way of saying heart attacks) epidemic is growing on a log curve (if that does not shock you look up what a log curve is). It is not stopping, on the contrary it is snowballing. Why?

Multi-factorial.

What do we know from science and trials like Jupiter – these are big (100 000s) patients across continents. The long and the short is that if your number – LDL is at target (2.8 mmol/l) you will NOT have a heart attack and you will NOT have a stroke.

Now think about this for a minute, would you rather have a heart attack/stroke or would you rather have a bit of muscle ache? Not so bad if the heart attack takes you – although bad for the family. But a trainsmash if you are “maimed” by it, especially when we KNOW it is preventable.

WE have so many statin trials that it is unethical to have one arm on a statin and one arm off a statin – that’s how strong the evidence is as we KNOW the non-statin arm will have “events”.(Secondary prevention).

I am also not a huge fan of big pharma and whilst various conspiracy theories exist in this regard. This is not a conspiracy. This is indeed science.

“Statin therapy is effective at reducing cardiovascular event rates among those with prior myocardial infraction, stroke, diabetes, or overt hyperlipidemia, and current guidelines strongly recommend lipid-lowering therapy among these patient groups as an adjunct to aggressive lifestyle interventions. However, of the nearly 1.7 million heart attacks and strokes that occur annually in the United States, more than half occur among apparently healthy men and women with average or low levels of cholesterol. Thus, novel screening and treatment strategies for cardiovascular prevention are needed that can detect high vascular risk in the absence of hyperlipidemia, that are inexpensive and simple to implement in the primary care setting, and that can provide comparable or superior effectiveness compared to currently accepted approaches”. This is the opening paragraph of Jupiter. What jupiter was trying to ascertain is whether primary prevention is worth doing.

The results ? “Finally, in terms of net clinical benefit, when a composite end point of a first cardiovascular event, venous thromboembolism, or death from any cause is considered, the 5-year NNT in JUPITER was 18.13“”Current guidelines for statin therapy emphasize the need to achieve specific LDLC goals to maximize benefit. However, statins reduce hsCRP in a largely LDLC independent manner, and in the CARE,10 PROVE IT – TIMI 22,9 A to Z,11 and REVERSAL21 trials, best clinical outcomes in terms of event reduction or atherosclerotic regression were observed among those who not only reduced LDLC, but who also reduced hsCRP. Specifically, in these studies, the lowest clinical event rates were consistently seen among those who not only achieved LDLC levels <70 mg/dL, but who also achieved hsCRP levels <2 mg/L. Although these findings are consistent with laboratory evidence indicating antiinflammatory properties of statin therapy as well as current pathophysiologic understanding that atherothrombosis is a disorder of inflammation as well as hyperlipidemia, the concept “dual targets” for statin therapy remains controversial.22

“JUPITER not only confirms that men and women with elevated hsCRP and low LDLC are at substantial vascular risk, it demonstrates that statin therapy can cut that risk by half. Simplified guidelines that advocate combined lifestyle and pharmacological therapy in those groups where trial evidence clearly supports a net benefit have the potential to greatly improve patient care and public health.”

I have specifically quoted Jupiter verbatim as I am so tired of unsubstantiated claims in this regard and I would urge all the statin haters to read the science and chat to the professori of our times. The professori at large.

Statins are not the devil indeed if you are a loved one they may be the saviour. The saviour in terms of preventing a death or a person that now has to be “cared” for. The saviour of our failing medical system that does not need the added burden of cost of multiple patients with stroke and heart attack. Look up how much the average cost to medical aid (or patient if not on one) a heart attack/stroke costs in money terms. Then think about that cost in emotional/psychological terms. Then just have a little think about the vast body of science for a longer while than it takes to read some pathetic unsubstantiated claim on the vast body of internet rubbish. The choice really is yours, the answers are there if you look for them properly.

Circulation: Cardiovascular Quality and Outcomes.2009; 2: 279-285doi: 10.1161/CIRCOUTCOMES.109.868299statinsstatins2

 

 

 

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