Muddles & models

‘The New York Times’ takes no prisoners in its assessment of the EU’s response to Covid-19, writes Maurice Gueret, as he steps out on some new treatments

Predictive muddle

Irish reverence for the European Union has soared to religious heights in recent years. The more our cranky neighbours on the bigger island yearned to pull away, the tighter our bonds with the continent grew. Criticism of how the EU performed in the pandemic has been non-existent. Brussels had the worst figures in the world. Italy was brought to its knees. France’s only saving grace is that its death rate remained below that of the UK. ‘The New York Times’, not slow to deride the American response to Covid-19, turned its binoculars on Europe recently. They gave a hefty suppository to a continent that once boasted of perfect proofing against future pandemics. They excoriated European leaders for building their pandemic plans on a ‘litany of miscalculations and false assumptions’. Thousands of pages of national planning turned out to be little more than ‘exercises in bureaucratic busy work’. Our predictive modelers didn’t escape. The paper quoted a lab chief with real experience of previous animal outbreaks who said they are more muddlers than modelers. He suggested future epidemic planning should involve locking up predictive modelers at the first opportunity.

My right foot

The collagen sheets binding the muscles, nerves and blood vessels under the sole of my right foot are acting up. Putting a foot to the floor feels like walking on hot coal. Plantar fasciitis came back with a vengeance this summer. It first surfaced a few years ago and I took the advice of an old pal in the casualty world who suggested I get down to the chemist for a €25 pair of orthotic insoles. These worked a treat, but the problem resurfaced in recent months, and this time, the moulded inserts didn’t work.

The pain has been quite severe, especially putting the foot to the floor first thing in the morning. It’s not exactly renal colic or childbirth, but emitting an occasional piercing scream does alert fellow house dwellers to this hidden disability.

It’s not helped by playing a lot of golf, or by weight gain induced by biscuit overdose and lockdown wine. Colleagues have been great once again. Daily exercises and foot stretches are now the fashionable treatment. I have rescued tennis and golf balls from the garden shed and rolling both under the soles of the foot is playing a large role in my rehabilitation. An old emergency medicine pal in the sunny south-east tells me it breaks down adhesions between the layers of fascia. Other doctors on Twitter suggested I place some golf balls or round food tins in the freezer, and roll the foot over the chilled tins for 10 minutes twice a day, which allows soothing and stretching at the same time. Sole soup, anyone?

Robot repair

The British Medical Journal published an interesting study in July on the best way to treat an abdominal hernia. In my junior days, there was a mixture of the old open surgery with scalpel, stitches and scar and the newfangled laparoscopic tummy surgery where a surgeon inserts a telescope and patch to do the work. Fewer sutures were needed, with an earlier discharge from hospital and back to normal life. This new paper looked at about 120 cases of ventral hernia surgery, with half repaired by laparoscope and the others using trendy novel robotic surgery. There was precious little difference in outcome. But robotic repair significantly increased the cost and doubled the amount of time needed in the operating theatre. Patients repaired by robot stayed in hospital just as long as laparoscoped ones. No doubt our intrepid hospital accountants are taking careful notes.