SCREEN TEST

A health check isn’t a bar­gain, says Mau­rice Gueret, if it misses out key tests. And he re­veals the strong­est hand­shake in surgery

Sunday Independent (Ireland) - Life - - HEALTH - Dr Mau­rice Gueret is a GP and edi­tor of the ‘Ir­ish Med­i­cal Directory’. Email mgueret@imd.ie and fol­low him on Twit­ter @mau­ricegueret

My health in­sur­ers, the Vhi, have been in touch to of­fer a “Screen Ex­tra” check-up for an as­ton­ish­ingly low €125, re­duced from €425, which they say is the full cost. Test­ing takes place at their new med­i­cal cen­tre on Har­court Street in Dublin and you pay as you book, so a credit card is needed and the name of your GP, to whom a copy of your re­port can be sent. Sounds like a rel­a­tively cheap op­tion, which the Vhi are rec­om­mend­ing you take ev­ery two years, but closer ex­am­i­na­tion of the ac­tual pack­age re­veals some omis­sions that I might have ex­pected com­pre­hen­sive screen­ing op­er­a­tions to in­clude. There is no chest X-ray for in­stance, handy for pick­ing up lung le­sions that stetho­scopes and blow­ing ma­chines tend to miss. Nor is there an ex­er­cise heart test — an elec­tro­car­dio­graph (ECG) read­ing while you per­spire on a tread­mill can be a lot more in­for­ma­tive that one taken ly­ing on the couch. To be fair to the VHI Well­ness sec­tion, they do point out that the ECG is not a di­ag­nos­tic test on the heart, but rather a mea­sure of its elec­tri­cal func­tions. I would haz­ard a guess that medics are a lot more aware than their pa­tients of the lim­i­ta­tions of ECG ma­chines. Con­tin­u­ing our se­ries on or­thopaedic ail­ments, to­day we look at the com­mon Colles frac­ture, named af­ter the Kilkenny sur­geon, Abra­ham Colles, who so en­thralled his stu­dents and col­leagues, that they reg­u­larly gave him stand­ing ova­tions af­ter lec­tures. The Colles frac­ture af­fects the wrist and rarely af­fects any­body un­der the age of 50. It usu­ally oc­curs fol­low­ing an ev­ery­day trip or fall where an out­stretched hand is rushed to the ground to pre­vent an­other part of the body land­ing there first. The lower end of the wrist’s ra­dius bone snaps and the two bro­ken ends of the bone are driven into one an­other. Though the wrist swells and can­not move, there is of­ten sur­pris­ingly lit­tle pain. If the fall is par­tic­u­larly heavy, or the bone is par­tic­u­larly weak, the two ends of the bone ‘dis­place', which means that one end tends to ride up over the other. This causes an ob­vi­ous hump or ‘din­ner-fork' de­for­mity at the wrist and may well re­quire ma­nip­u­la­tion, where the bone ends are ‘re­duced' or pressed back into align­ment be­fore the ap­pli­ca­tion of a plas­ter. Re­duc­ing a Colles frac­ture is not a pain-free pro­ce­dure and usu­ally re­quires anaes­the­sia, ei­ther gen­eral or re­gional. An as­sis­tant holds the pa­tient's up­per arm, while the sur­geon grasps the in­jured hand as if he was about to shake it. Firm trac­tion is then ex­erted along the length of the limb in or­der that the dis­placed bit of ra­dius bone can be slot­ted back into place. You will note that or­thopaedic sur­geons tend to have large hands and firm hand­shakes. Care­ful and reg­u­lar fol­low-up of the en­cased wrist is nec­es­sary at a frac­ture clinic, but most pa­tients can ex­pect to be plas­ter-free within six weeks. Phys­io­ther­apy can then be a use­ful ad­junct to treat­ment, es­pe­cially if the grip strength of the af­fected hand is re­duced. Full heal­ing is the norm, but recog­nised com­pli­ca­tions in­clude mal-union (per­sis­tent de­for­mity), dif­fi­culty mov­ing the thumb, chronic pain and stiff­ness. Colles breaks in the wrist are very com­mon, ac­count­ing for about one in ev­ery eight cases in a frac­ture clinic. They are more com­mon in women, es­pe­cially those who have been through the menopause, thin­ning of the bone (os­teo­poro­sis) be­ing a com­mon cul­prit. A sin­cere thanks to the reader who, on read­ing my re­cent piece on Zam-Buk oint­ment, sent me a tub of the fa­mous balm in the post. This cen­tury-old rem­edy is re­mem­bered by many of you. A for­mer ex­ec­u­tive with May Roberts, the com­pany that dis­trib­uted it here, sent me some ad­ver­tis­ing ma­te­rial which showed that it also came in sup­pos­i­tory form. You needn't send me those ones. The prod­uct is no longer avail­able through the usual chan­nels here, but I did hear that it was avail­able in one named eth­nic shop in Dublin city cen­tre, but I haven't had time yet to in­ves­ti­gate. A Trin­ity med­i­cal grad­u­ate, who has done won­der­ful med­i­cal work in Africa, also wrote to me on the sub­ject. She re­mem­bers that her aunt, who was born in 1903, be­lieved that Zam-Buk could cure any­thing. The doc­tor has a tin with an ex­piry date of 2006 and she be­lieves that the name de­rives from the Latin name sam­bu­cus, for the com­mon el­der tree and that it once had a com­po­nent that de­rived from the el­der bush. I have heard many sug­ges­tions as to how it got its name, but this is the most sen­si­ble and per­haps most likely I have heard yet. A reader tells me how she was stung by a wasp in the dy­ing days of sum­mer. It was the first such event in many years, but it rekin­dled mem­o­ries of child­hood be­cause her en­tire fam­ily re­acted rather badly to th­ese stings. She re­mem­bers as a child us­ing a laun­dry ac­cou­trement, Reckitt's Blue Bags, on stings with ex­cel­lent re­sults and asked me to write about what it was that made them so ef­fec­tive. Grow­ing up in Rath­farn­ham, I knew the Reckitt name well, aside from know­ing they were the man­u­fac­tur­ers of Det­tol, Ster­adent and Bon­jela. They had a small fac­tory in the Dublin foothills on the site of an old mill, over the Owen­do­her River that runs near Edmondstown Golf Club. It's still stand­ing to­day, with its orig­i­nal name Reckitt & Sons Ltd chis­elled in stone, but is no longer op­er­at­ing. The ‘blue bags' that pre­vented washed laun­dry from yel­low­ing, were made from the mid 19th Cen­tury by Reckitts in the UK, a com­pany that be­gan as starch pro­duc­ers. The blue bags con­tained noth­ing more than bak­ing soda and a new ul­tra­ma­rine colour­ing im­ported from France. It was the bak­ing soda, be­ing al­ka­line, that soothed acidic stings like those from wasps or hor­nets.

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