FAR FROM SWELL

I dealt last week with the nail infection called paronychia and promised to look today at another finger (or toe) condition called the whitlow. I recall a patient, prone to malapropisms, once claiming to have a “winslow” on her finger. She had been thinking, no doubt, of The Winslow Boy and that stolen postal order. A whitlow, sometimes called a felon, is an infection of the pulp at the far end of the finger. It's the second most common infection of the hand (after paronychia), accounting for about 25 per cent of all cases. Digits most commonly affected are the thumb and index finger. Swelling and dull pain are initial symptoms but, on the second or third night, serious throbbing starts, which can interfere with sleep. If untreated, pus continues to build up under the skin and you may see a little pimple or white point at the centre of the abscess. Antibiotics and a poultice in the early phase may hinder the infection, but often a lancing or a small operation to remove all the slough is necessary. The cause is usually bacterial, sometimes fungal, and there is a distinct type of whitlow called the herpetic whitlow, which is caused by the cold sore herpes virus. Symptoms of this are as above, but with a burning sensation and tiny little skin blisters or vesicles around the affected area. Resolution is often spontaneous but, sometimes, an antiviral medication is needed. Hospital food is back on the agenda. Bill writes about some recent experiences. We'll start with the good ones. A long stay of some months in the Mater public hospital left a benevolent impression. He says the food was very good and the catering staff were lovely. He also reports from Our Lady's Hospice in Harold's Cross, where a relative has been staying. Excellent canteen, he says, where staff, visitors and patients who are able, can meet for lunch or dinner. He said the food is first-class, as is the fare served on the hospice wards. Bill's direct experience of private wards in St James's Hospital is not so good. He has been in and out, and describes the food as being of variable standard. It's sad to hear about this sort of thing. Perhaps the ratings’ people at Trip Advisor might consider including hospitals as well as hotels. If you have any interesting experiences, happy or otherwise, about hospital food, please do get in touch at mgueret@imd.ie I'm loathe to criticise the Irish Heart Foundation, as they do a lot of good work. But do they really need to issue budgetary advice asking the Minister for Finance to remove the zero tax rate from croissants and chocolate spread? Surely there are bigger issues for a Heart Foundation to fry? I'd like to hear their opinion on whether cardiac stents are being overused in the treatment of coronary artery disease, and whether doctors can be motivated by financial concerns to overuse them? The New York

Times carried a fascinating article on this over the summer but, to date, the debate doesn't seem to have reached these shores. I think it's kind of more important than the jam doughnuts, banoffi pie and Jaffa Cakes all mentioned in the recent Irish Heart Foundation press release. And the Royal College of Physicians are also spending an awful lot of time on lifestyle advice these days. Last month, it was press releases on alcoholic beverages; this month, it's the grub on your table. I'd like to hear more of their opinions about improving medical services for people who actually are ill, rather than implicating individual lifestyle as culpable for almost every illness known to man. Do they consider it unhealthy that sick children wait for a full year to see paediatric tummy specialists? How about four-year waits for old people to see joint specialists? Earlier this month, they hosted a public meeting on exercise, diet and alcohol with the unfortunate title of Your Health — You Are What You Choose. I have met thousands of patients over the years who have not had the good fortune of perfect health and they certainly did not choose to be ill. Nor can it be said with anything like certainty that most of the diseases they had were anything to do with lifestyle. If anything, the opposite is true. Family history and a barely explored genetic lottery of life are kingpins of illness causation and nobody should tell you otherwise. When you do get sick, you deserve early diagnosis, quick treatment and access to the best of first, and sometimes second, opinions. I'd like to see more of this sort of health promotion from our distinguished colleges. Nagging by press release is just too easy. I have been writing to more than a thousand dentists around the country this month to obtain entries for the next edition of the Irish Medical Directory. We have neglected to include tooth-pullers and gum-cutters in recent years and hope to remedy this in next year's edition. What struck me, when making out a database of addresses, was how the nomenclature of dental clinics has changed. No longer is it Dr Crown at the Village Dental Surgery. It's all-American now, with the emphasis on pearly gnashers and washing-powder whiteness. There's an Ivory Surgery, the All Smiles Clinic and Fresh Breath Rooms. I got a laugh from seeing one simply called The Bridge Dental Surgery, but my favourite was a surgery in Cahir, Co Tipperary, which is the wonderfully named ConfiDental. Thankfully, we have still to come across the Floss and Gloss, Crowning Glory or The Tooth Booth. If you have any more suggestions for good names for dental clinics, I'm all cavities at mgueret@imd.ie or you can write to me at PO Box 5049, Dublin 6W.