I saw a report on the BBC today about heroin addicts in the US seeking treatment abroad for their addiction with a novel (and illegal) psychoactive drug, Ibogaine. It’s a fascinating story – the patient goes in with a long-term and devastating addiction, experiences a day or two of vivid, often insightful, hallucinations, and in many cases, leaves no-longer dependent. Unfortunately further roll-out of this treatment has been hampered by both legal/financial issues, and a worry about unexplained fatalities, and there’s an increasing body of evidence that this drug can cause cardiac arrythmias, leading to arrest.
I remember well the day when we admitted someone with Ibogaine-induced-cardiac arrythmias.
I quote from the case report:
“A 39-year-old man was brought to hospital after suffering 3 seizures”. “Approximately 3 h later, the patient had an episode of self-limiting pulseless polymorphic VT. He was moved to the resuscitation area where he went on to have 7 additional episodes of polymorphic VT that were successfully terminated with electrical cardioversion.”
Depending on your existing level of medical experience, that sentence is either mildly interesting, or something that makes you go “OOEEERRRGH”.
It was pretty “OOEEERRGH” at the time. I remember vividly standing in our admissions unit (with no background other than the fact he’d been admitted with seizures), looking through his triage notes, and watching the cardiac monitor above him go doo de dooo de dooo (as I imagine cardiac monitors do when they have nothing to report) ‘WEEEEEEEEEEEEE!’ as the screen filled with cardiac badness and the patient suddenly looked a bit crap.
Image: Polymorphic VT, AKA Cardiac Badness in similar form to that encountered in this case. Source: EKG World Encyclopedia http://cme.med.mcgill.ca/php/index.php , courtesy of Michael Rosengarten BEng, MD.McGill
This great Christmas BMJ article considers whether portrayal of general practice in Peppa Pig raises patient expectation and encourages inappropriate use of primary care services.
In the spirit of the article, I would like to suggest an improved Peppa Pig episode that could be used to convey more realistic expectations, encourage safe self-management and use primary care services more effectively .
Previously : Case study 2: George catches a cold (quoted in the article)
Parents call Dr Brown Bear on a Saturday regarding an 18 month old piglet with a 2 minute history of coryzal symptoms after playing outside without his rain hat.
Dr Brown Bear telephone triages and makes an urgent home visit.
After examining the throat, he diagnoses an upper respiratory tract infection and advises bed rest and warm milk. Symptoms resolve within 12 hours.
New : George catches a cold (more realistic suggestion )
George Pig has a fever and is grumpy as hell. Mummy Pig knows the score from previous experience. She checks the NHS website just to be sure, and notes George has none of the concerning signs that would suggest she needs to seek further medical advice.
She goes to the local pharmacy and has a constructive conversation with the pharmacist, and is given some pink medicine for George Pig. She goes home and attempts to syringe some pink medicine into George Pig’s mouth until roughly equal quantities of medicine have gone into George, on the carpet and in Mummy Pig’s face. George Pig is eventually only placated by bottle and daddy’s smartphone, and doesn’t want to sleep for more than 20 minutes at a time unless he is in Mummy Pig’s arms and being rocked.
A lovely little case report has just come out in AAC, about a patient with pretty terminal multidrug-resistant Acinetobacter baumanii infection being treated with a cocktail of bacteria-destroying phages.
I like to hear little radio reports from planet phage every now and then, as I do get asked about them quite a lot when talking antibiotic apocalypses.
It’s well worth a read for those who want a quick insight, as it’s like a microcosm of the phage therapy world all in one patient – all the hopes, limitations, concerns, all in a very nicely written article.
Clever science? tick. Phages being inactivated by the patient’s own body? tick. Development of resistance by the bacteria? tick. But also… possible clinical effect in someone with few options, and an excellent discussion about synergy between phages and antibiotics, Which I think boils down to ‘if you hit it with enough things simultaneously it goes down eventually’.
Someone on twitter suggested that if we described the threat of antibiotic resistance in terms of Game of Thrones, it might be easier to grab attention and understand. I mean, it’s all in the news about how resistant superbugs are going to kill us all…
So here we go: (Massive spoilers for GoT warning)
White Walkers = near-unkillable superbugs
So for a long time, bad guys could be killed with sharp, pointy things, and heavy, smashy things. Like bacteria can be killed with antibiotics. Only some people/things/bugs have managed to change and can no longer be killed by sharpness or smashing or even the strongest antibiotics. This is bad. Modern life sort of depends on us being able to kill things that want to kill us. If we can’t, it’s a bit of a game over, really.
But right now, they seem like they’re a long way away, and they only affect wildlings/ other people you don’t really care about but read about in the Daily Mail.
“It is hard not to feel a sense of awe of the ingenuity of the bacterial machine in surviving human intervention, as you see it revealed in DNA sequencing; findings that are beautiful in their science, and often deeply concerning in their potential consequences.”
How Whole Genome Sequencing technology is helping us understand and respond to antimicrobial resistance – our article for Angle Journal is available here:
When I talk to my hospital colleagues, and my patients, about antibiotics, overuse, and resistance, there is certainly no lack of awareness. Unprompted I frequently get told exactly what the problem is.
There’s one answer I rarely get.
“I’m probably part of the problem, and I am changing what I am doing, to do my bit”.
Is this reflected in what is said online?