Saturday Submissions – With Dr. Liam Farrell

It’s a day late, I know, I know, I’m sorry – (It will be worth it, promise!) I haven’t been well in the last few weeks, I completely forgot all about Saturday Submissions last week and then I do it a day late this week, oh dear! I can do better than this, surely!!

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This week I speak to Dr. Liam Farrell, yes, a real doctor, or at least used to be a family GP, now better known as an award winning columnist and broadcaster. You can find Liam over on Twitter as @drlfarrell.

 

Why presentations are best served rare

We are doctors; we do terrible things to people. They come into the surgery like healthy folk and go out as patients. If they’re really unlucky we confine them to an institution where the occupants are routinely left immobile, deprived of sleep, fed a diet that is tasteless and nutritionally marginal, and experience the de-humanizing indignity of being half-naked all the time.

‏The average age of a patient in general practice is 75 years old.. Many have multiple diagnoses, and their care is incredibly complex, and above all requires more of our time. But our time is in increasingly short supply, so much of it wasted on the worried well and on health promotion. If we reckon on 15 mins per consultation, a family doctor with 2500 patients would spend 7.4 hours per day to deliver all recommended preventive care and 10.6 hrs per day to deliver all recommended chronic care.

‏This leaves a generous 6 hours every day for those pesky acutely ill patients, sick certs, insurance and passport and DLA forms, paperwork, eating, sleeping, banging our heads against the wall in sheer frustration, toileting and reproducing. But what is never understood, by patients, the general public, the media, bureaucrats, managers or politicians, is the huge numbers of people family doctors see who aren’t sick, and who have nothing wrong with them; this really can’t be comprehended unless you sit in with a family doctor for a whole surgery. A huge part of our job is telling people what they don’t have. Unfortunately, ‘nothing wrong with you’ is a retrospective diagnosis and can only be made after the consultation.

As the threshold for attending healthcare services grows ever lower, there are more and more worried well, too much screening and over-treatment. It becomes harder and harder to pick out the really sick person from amongst the ranks of the worried well; when you are looking for a needle in a haystack, the last thing you need is more hay. There is consequently not enough time and resources to the really sick; so everyone loses, especially those with hard to recognise rare diseases.

As The Fat Man said in The House of God, when a medical student hears hoof-beats outside a window, he thinks it’s a zebra.

Which might be true, of course, in certain circumstances – if you were in practice in the Serengeti, for example (curiously, I was once in the Serengeti, heard hoof-beats outside my window, peered through the early morning mist and saw only an old cow).
A medical axiom used to be that common things are common and uncommon presentations of common diseases are more common than common presentations of uncommon diseases. But this is now known to be misleading. Taken all together, rare diseases, and rare variants of common diseases, are not uncommon. And diagnosing rare diseases is very difficult; it’s not as if there is a are disease specialist we can refer patients to.

I do have some hard-earned experience. As an intern, I saw a young lad in casualty. He had fainted at a disco (yes, it was that long ago, Saturday Night Fever was quite fashionable. Old age is creeping up on me, not sure why but fairly sure it’s up to no good) and he had a few unusual skin lesions and a labile BP.

These days, I doubt if I would be able to recognise a phaeochromocytoma ( a rare tumour of the adrenal glands) if one walked up and assaulted me with a blunt speculum (I’ve been flogged into apathy by too many URTIs and sick certs, rare and interesting diseases only present to other doctors), but I was young then, fresh and sharp and so hip, I could hardly see over my pelvis.

I wrote ‘possible neurofibromatosis?’, ‘possible phaeo?’ on the chart and admitted the young man to the ward. I was too green to realise the importance of hoarding unusual cases to myself, for my own advancement, and sure enough, the rumour spread around the hospital as fast as an epidemic of flaming gonorrhoea.

Later, when I went to check up on my patient, I found him buried under a tide of medical students, SHOs and research registrars, all keen for a piece of the glory, all ordering 24-hour urines, all dreaming of a case report for the peer-reviewed journals and another notch on their CVs.

‘Help me, doc,’ he said, desperately, ‘they’re suffocating me.’ I whipped away the students, but the others were far above me in the hierarchy and I could offer little succour.

‘Sorry, pal,’ I said. ‘It’s a common complication of uncommon diseases.’

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Thank you so very much to Liam for providing todays Saturday Submissions!
What did you think of his post?
Do you relate as a medical Zebra?

Please leave a comment and let Liam know what you think, be sure to check out his Twitter Link and make a new connection! 🙂

——— Wanna Be Part of Saturday Submissions?———-

All you have to do is tell us a little about yourself and write a blog post (Any Wordcount) in relation to your chronic illness, or how a relation/friend/patient with an illness affects or interacts with you, etc. all welcome!

You can include photos (preferably your own, if found online be sure to add links to where you found them)

Be sure to add links to your social media accounts so people can link back to you OR You can write it anonymously if you like just be sure to put your details in the email so I can respond to you personally 🙂

You can send your submissions to: irishpotsies@gmail.com

Looking for Guest Bloggers Please!

guest-blogging

 

Hi folks,

I am still on the lookout for guest posters for this little bloggie, I would appreciate hearing back from anyone with or in contact with a chronic illness. Patients, Partners, Family, Friends, Carers, Therapists, Doctors, anyone who would like to take part. If you know of anyone who might like to, please share this with them, thank you!

It can be completely anonymous or open, whichever you prefer, please just follow the steps below to take part and I really look forward to hearing from you 🙂

Also, a very BIG Thank You to those who have submitted something already, I hugely appreciate the efforts, thank you 🙂

——— Wanna Be Part of Guest Blog Submissions?———-

All you have to do is tell us a little about yourself and write a blog post (Any Wordcount) in relation to your chronic illness, or how a relation/friend/patient with an illness affects or interacts with you, etc. all welcome!

You can include photos (preferably your own, if found online be sure to add links to where you found them)

Be sure to add links to your social media accounts so people can link back to you OR You can write it anonymously if you like just be sure to put your details in the email so I can respond to you personally 🙂

You can send your submissions to: irishpotsies@gmail.com

 

 

Lette 🙂

Back To work with Dysautonomia!

So yeah, Here is the blog post ye have been waiting for! 🙂

I had said it to you over on the Facebook page that I wanted to take a different direction for this little blog. I still want to raise awareness as much as I can, share my experiences and things that help, but now I have something new to share with all of you.

I am back to work with this illness, and so far, so awesome! 🙂

So I thought, hey, wouldn’t it be cool to share that experience, Irish fainting goat girl with Dysautonomia returns to work for the man in the real world, how does she get on?

Well lets find out shall we? I want to share my working experience with you while I have this condition, the positive aspects mainly and any difficulties or surprises that I encounter along the way.

For obvious reasons I am not going to say for whom I work, people close to me or know me through other social networking sites may know but I will keep that off the cards. However I can say, that I have a lovely cushty number working from home, full time for a well known company where I provide technical support via Computer and phone.

I was first diagnosed with Postural Orthostatic Tachycardia Syndrome when I was 28 back in April 2011. It came out of the blue and as I wasn’t prepared for something that debilitated and disabled me so severely at the start, I quickly found myself in a steep wallowing rut where I lacked all motivation to do anything, much less think about work.

In the summer previous to this, 2010, I had just completed a Masters of Science, of which I was very proud and worked very hard for and once finished, I wanted to pursue starting my own business in Media (Photography and Video). Then this happened and I was devastated, to say the least.

I was always someone who kept busy to some degree, I have worked since I was 16 and I knew once the Masters was finished that I had a plan.

That plan shattered around me when I got my diagnosis. Not initially mind you, I have a very positive outlook and I tried to fight the reality for as long as I could but constant relapses, catching bugs, fainting and reoccurring hospital visits soon also shattered my motivation to get anything done.

During this time especially, I have my husband to endlessly thank for the immeasurable help and encouragement that he provided. He has been my rock and my savior (no I am not religious in the least, but you know what I mean)  😉

Through one event and another, in August 2011, I decided to go ahead and start my own business anyway, with the help of my husbands amazing support I said I would at least give it a shot. I was still very ill but really didn’t want to give into the illness and anyway, who would hire me knowing I have this condition? I could barely stand up for 15 mins without passing out and falling over and breaking a bone or something (Later in 2012 I was also diagnosed with Ehlers Danlos Syndrome (EDS), so that explained all the broken bones and stuff!)

So I gave it a go and even got busy. I started getting calls from colleges to document events and Artists work, Weddings became a frequent work day and shortly afterwards even the videography started getting interest from people.

I tried and I worked and with endless help from my better half I somehow managed, but I found that I was unreliable, to just myself. I never left a client down, but in doing so, I suffered greatly. One day of photography, especially the weddings which required travel all over the country, up to and sometimes exceeding 12 hours, usually left me bed bound for up to 3 days afterwards in dire straights with severe Pots and Dysautonomia symptoms which eventually ended up being swiftly followed by being admitted to hospital and then the left overs of the job were left to my husband to clean up and get finished, and that was just unfair and happening all too often.

It was tough, it broke down my motivation for wanting to succeed and I was physically, health wise, incapable of keeping up to the work when I started out.

However as time went on, I started to do a little better.

In 2012, even though I had 8 hospital admissions, my specialists finally had me on a concoction of medication that seemed to have somewhat stabilized me. Towards the end of the summer that year, I stopped eating Wheat and Gluten to see if that would help my terrible digestion and tummy issues caused by a combination of the Dysautonomia and the medication I was on to treat it!! Going gluten free was just the start of the improvements I was about to see in my health.

In October 2012 I was also diagnosed with EDS type3, which accounted for all the musculoskeletal and digestive issues I was having. Having this diagnosis helped in my understanding Dysautonomia better and allowed for a better understanding for my specialists of how my health was affected.

Armed with new medical knowledge, eating healthier and a generally more active lifestyle the end of 2012 marked a vast improvement in my health but a major drought in the Media business.

Irelands economics and Media work in general had slowed right down, making income unreliable, infrequent and financially things started to get very shaky.

Throughout christmas and the new year there was no luck in finding work and my motivation was lacking again. We also had a pretty crap christmas, but you would get over that!

Long story short, I kept trying. Handing out cv’s, sending my information to companies and hearing nothing back.

I quickly lost heart.

One morning I woke up to a mail in my inbox from the better half. He  had been up late in the office and noticed a job, working from home for a very legitimate, big name international company doing technical support within the qualification that I had.

I decided to apply in the vague hope something may come of it.

A month goes by and I hear nothing…

Suddenly I get a mail saying that I had been selected for an initial interview. Did that and successfully made it to a second interview and lastly a third. Over the course of about a month, I completed 3 interviews and was told that I would be told shortly afterwards if I had gotten the job or not.

I was so hopeful and a little scared, I wondered if I did the interviews ok as it had been so long since I had done a formal one. I thought would I be able to work a routine job at all?? I found it difficult to work for myself although in this job I wouldn’t have to be running around after bridezillas for over 12 hours!! A month went by and I heard nothing. I thought, yet another opportunity failed and passed me by.

Out of the blue I get a phone call early one morning. I was half asleep and not prepared for it.

“…I am delighted to say congratulations, you have the position. We would like you to be available to start on…”

the rest is a blur! I was both excited and a little terrified at the concept of working for someone else, the ever dreaded question in the back of my mind: Will I be able for this?

One month of fully paid training, fulltime, Monday to Friday 9 – 5:30pm started in June where we had to be trained in on every aspect of the job. There was a class of about 15 of us where we had to complete an exam at the end of each weeks training session. if we did not pass and failed an exam twice, thats it, you do not secure your contract. Some people didn’t do well and couldn’t secure their contract.

It was difficult, interesting and I actually had fun. I am delighted to say I passed all the exams, secured my contract and I am nearly at the end of my 2nd month on the job!

It has been amazing. All my work equipment was provided to my home by the company. I have a set routine to follow and I have found it amazing.

I am motivated, eating well and healthy as I have regularly assigned breaks, before I would go from one end of the day to the other and not eat properly due to a lack of routine.

I keep well hydrated as always and now my days are occupied with doing something other than staring through the screen wasting my life on Facebook if I didn’t have proper work to do!!

The only difficulty I have found so far on the job is how exhausted tired I am when I finish work every day. I know I am just sitting at the computer taking calls and giving tech support but it requires a lot of concentration and interaction on a computer platform, while I am on the phone speaking with people, trying to troubleshoot and resolve an issue and I do find it really wipes me out by the end of shift, especially if someone is being testy at the other end of the phone!

Thankfully though I am working on it. I find it is getting easier, the job, the routine, understanding different accents on the phone!! I am loving it. I have made new friends, and starting a new daily routine really seems to have helped me as a whole. 

Regularity suits me, it suits keeping this illness under control. Routine keeps meds, food, liquid intake and even toilet breaks under control. Keeping up regular exercise however has dropped since I started. Not only have I been really tired after work, but the uncharacteristic heat we have been experiencing over the last few weeks has shut my body down! I have no energy in this heat other than that, getting a new job has been amazing and helps to take my mind off the fact that there may be anything ‘wrong’ in my body or otherwise. I enjoy it, my sleeping pattern has stabilized and loooong may it last! 🙂

So this is my first ‘work’ related post, I have been living it which has been great but reading it may be boring to you, if it is, please let me know what would help. Is there anything specific you would like me to talk about in relation to working with this illness?? if so please let me know 🙂

Thank you for your time in reading this humble bloggy! 🙂