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