Dr James Le Fanu: 22 March
It is not unusual for those admitted to hospital nowadays to see a dozen or more doctors. This reflects, in part, the ever-increasing drive towards specialisation, but it is also the inevitable (and undesirable) consequence of the European Directive limiting the number of hours worked by junior doctors.
So it would seem very unlikely that yet another ‘medical opinion’ would make much of a difference one way or another – but apparently not. Dr Graham Ellis, writing in the British Medical Journal, reports that those in their 70s and over who are lucky enough to be assessed by a physician specialising in the ‘care of the elderly’ (previously known as geriatricians) are more likely to be ‘doing well’ a year later, alive and living in their own home with no evidence of cognitive decline.
‘Significantly more older patients are likely to survive admission to hospital and return home if they undergo a comprehensive geriatric assessment,’ Dr Ellis writes.
The reason is simple enough. The geriatrician is the last of the old-fashioned breed of general physicians skilled at untangling complex and interrelated medical problems, taking a broader view of patients’ best interests and ensuring they are not taking too many pills.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Bristol writing on behalf of her husband who, for the last six months, has been troubled by vivid nightmares during which he twitches and kicks.
On a couple of occasions she has been the unfortunate recipient of this thrashing about, receiving a thump in the back and more recently a punch in the eye. He is quite unaware of this sleep behaviour, always wakes easily and, when asked, can often remember what his dream was about. ‘The punch in the eye was him inside a boxing ring!’ she writes.
The husband consulted his doctor, who put him on the sleeping tablet zopiclone – though he has never had any problems falling or staying asleep – which has had no significant effect on his night-time traumas.
These nightmares and nocturnal thrashings are due to a condition with the long-winded name of Rapid Eye Movement Sleep Behaviour Disorder. The ‘rapid eye movements’ refer to the stage of sleep associated with dreaming, when the eyes move rapidly from side to side. The cause is not known, but it may be an early sign of Parkinson’s disease.
Dr Antonio Culebras of the New York College of Medicine, writing in the Clinical Handbook Of Sleep Disorders, elaborates on the condition: ‘These are quasiintentional motor activities that might be an attempt to enact the dream content, which is frequently violent, vivid and confrontational. Treatment with the drug clonazepam is highly effective in almost 90 per cent of cases.’
drjames@lady.co.uk
A former headmaster at an approved school described his experience of lettuce’s effect on the unruly boys under his care: ‘My charges between the ages of 15 and 16 were in dormitories of about 20 boys. The morning after a rather difficult “lights out”, with their complaining about being unable to sleep, the school cook suggested that the traditional remedy was to give them a lettuce leaf to eat. On my next evening shift, I raided the pantry for the biggest lettuce leaves I could find and dished them out to the poor sleepers. They really seemed to work.’
So it would seem very unlikely that yet another ‘medical opinion’ would make much of a difference one way or another – but apparently not. Dr Graham Ellis, writing in the British Medical Journal, reports that those in their 70s and over who are lucky enough to be assessed by a physician specialising in the ‘care of the elderly’ (previously known as geriatricians) are more likely to be ‘doing well’ a year later, alive and living in their own home with no evidence of cognitive decline.
‘Significantly more older patients are likely to survive admission to hospital and return home if they undergo a comprehensive geriatric assessment,’ Dr Ellis writes.
The reason is simple enough. The geriatrician is the last of the old-fashioned breed of general physicians skilled at untangling complex and interrelated medical problems, taking a broader view of patients’ best interests and ensuring they are not taking too many pills.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Bristol writing on behalf of her husband who, for the last six months, has been troubled by vivid nightmares during which he twitches and kicks.
On a couple of occasions she has been the unfortunate recipient of this thrashing about, receiving a thump in the back and more recently a punch in the eye. He is quite unaware of this sleep behaviour, always wakes easily and, when asked, can often remember what his dream was about. ‘The punch in the eye was him inside a boxing ring!’ she writes.
The husband consulted his doctor, who put him on the sleeping tablet zopiclone – though he has never had any problems falling or staying asleep – which has had no significant effect on his night-time traumas.
These nightmares and nocturnal thrashings are due to a condition with the long-winded name of Rapid Eye Movement Sleep Behaviour Disorder. The ‘rapid eye movements’ refer to the stage of sleep associated with dreaming, when the eyes move rapidly from side to side. The cause is not known, but it may be an early sign of Parkinson’s disease.
Dr Antonio Culebras of the New York College of Medicine, writing in the Clinical Handbook Of Sleep Disorders, elaborates on the condition: ‘These are quasiintentional motor activities that might be an attempt to enact the dream content, which is frequently violent, vivid and confrontational. Treatment with the drug clonazepam is highly effective in almost 90 per cent of cases.’
drjames@lady.co.uk
Lights out with lettuce
The juice of the wild lettuce (Lactuca virosa) was at one time widely used in France as a sedative and ‘herbal anaesthetic’ for minor operations.A former headmaster at an approved school described his experience of lettuce’s effect on the unruly boys under his care: ‘My charges between the ages of 15 and 16 were in dormitories of about 20 boys. The morning after a rather difficult “lights out”, with their complaining about being unable to sleep, the school cook suggested that the traditional remedy was to give them a lettuce leaf to eat. On my next evening shift, I raided the pantry for the biggest lettuce leaves I could find and dished them out to the poor sleepers. They really seemed to work.’