Monday, 21 March 2016

MATHS ILLEGAL - Australia's numeracy cringe

I am accused of promoting alternative approaches to disease management via social media.
Of course I do. I promote the use of maths.

Specifically I promote the used of least-squares minimisation to solve the problem of cortisol homeostasis. (with appropriate conditions on variable values) Interestingly, this gives a similar result to what some creative and successful Addison's patients have worked out by trial and error and posted online. (In contrast, look at the posts from patients on the Addison's disease Australia facebook page, complaining about their poor health, but refusing to even consider alternative treatments.) 

But when I mention this in medical circles I get stupid responses such as it not being "evidence-based" or "peer-reviewed" or "unproven" The real reason is that most doctors are so under-educated in maths the only calculus they know is a Tintin character. I'm yet to hear of any doctors in Canberra who can solve my Sudokus.

AHPRA tell me I cannot promote unproven treatments via social media. Apparently using maths doesn't count as proof.

Sunday, 20 March 2016

AHPRA is trying to kill me.

AHPRA have launched an investigation of me, alleging I take doses of medication other than those prescribed by my endocrinologist.
Of course I do. I would be dead otherwise.

It seems they are incapable of distinguishing between the footballers who used prescribed oxycodone recreationally and a patient with Addison's disease faced with a potentially fatal adrenal crisis.

My endocrinologist prescribed me 50 micrograms of Florinef a day. On occasions this was too much, and I took half that.
However, if I took that even triple that dose on a mega back country ski day, I would end up collapsed in the snow, far from medical help, dry retching uncontrollably, and unable to stand up without feeling like I was going to pass out. Or worse. I know this from my own experience.

I learned from bitter reality that prescribed doses of Florinef were either excessive, or grossly inadequate. No endocrinologist has experience with many patients who do the sort of things I do in my spare time. And the peer reviewed literature on the subject is grossly deficient. Look for yourself.

Now I have AHPRA telling me I cannot take any dose of drug of drug which has not been prescribed by my endocrinologist or GP, because it is illegal. It seems I am supposed to die from an adrenal crisis if the appropriate paperwork has not been done.

I'm wondering whether next week I should go for a long run taking only my prescribed dose and finish in Parliament House having to be carried out in an ambulance because my blood pressure is so low I can't stand up.

You saw in a previous post a bsl of 1.8; low BP might be my next project.

Half marathon 21.1km in 1:34:57

Yesterday I ran my first half marathon. Despite being very average at school sport, I placed 2nd in the over 55s (would have been 3rd if Simon had not been sick) My time was 1:34:57
How many Type 1s can do that?
How many Addison's patients?
Another victory for maths over medical dogma.

Friday, 18 March 2016

Doctors clueless about post op pain control

My friend was completely unimpressed to receive this prescription for pain relief on discharge less than 24 hours after a hernia repair.
Is there anywhere in the world apart from Canberra where this is considered acceptable practice?
Panadeine forte one tablet each morning
Endone 5 mg every 4 hours if required

The patient was completely pain free after a simple procedure under local anaesthesia, yet is prescribed 30mg of endone to take home. Have any doctors there heard of the hillbilly heroin problem?
As for the paracetamol and codeine doses...

Wednesday, 16 March 2016

Is it technically illegal for diabetics to vary their insulin doses?

I was contacted yesterday by a representative of AHPRA who informed me that I was being investigated for self-prescribing.

The evidence he cited came from my blog which shows that in varying circumstances, I alter the doses of drugs used to manage my diabetes and Addison’s disease.

He said it was the opinion of the entire AHPRA Board in Canberra that this constituted self-prescribing and was illegal.

Medical advice to a patient with Addison’s that they should not stress-dose is negligent in the extreme.

Are approaches like DAFNE, and stress-dosing of steroids in Addison’s illegal unless specifically prescribed, or are AHPRA incompetent in their interpretation of existing legislation?

Are my doctors negligent if they have not provided written advice on whether I should alter my drug doses in varying circumstances?

ps. Readers may wish to speculate on whether it is a coincidence that I received this phone call just weeks after making a submission to the current Senate Inquiry into harassment of doctors by AHPRA

Tuesday, 15 March 2016

Some doctors say I use the wrong drugs, in the wrong way, but look at my results!

National Orienteering League competition in Melbourne. While the Opens battled for world ranking points, I competed in the M50s, placing equal 4th.

Those doctors who say I use the wrong drugs, in the wrong doses, by the wrong method will no doubt continue to make pathetic excuses for the poor performance of their own patients, and will continue to use the same ridiculous glucose control algorithms.
If you don't learn enough maths, you can't even quantify how disadvantaged you are by your ignorance.

Beat the computer at Sudoku - just add one number

 The computer solution to this puzzle involves calculation of the position of four different numbers     ( 1, 4, 2 and 9 )  under two scenarios. How the computer determined the starting and finishing squares further complicates its solution.

Can you add a number ( not necessarily a 9 ) by a much simpler method which only involves calculating the position of two numbers?


Computer solution

Wednesday, 2 March 2016

Easier sudoku. Do this before you tackle the maths behind my previous posts.

Just add one number by the easiest method (and yes, it is really easy if you understand the pattern). The published computer solution is computationally intensive. Just why did the computer choose cells (7,6) and (2,3)?
A really big clue the benefit of innumerate lawyers and doctors - the obvious cell to work on is (3,2)
The mathematical concepts behind many of my previous posts are much more difficult than this one.
Try this one first.


Published solution method

Tuesday, 1 March 2016

How many patients died because doctors ignored drug company recommendations?

Vioxx was always a drug considered unsafe in patients in patients with renal failure, or at high risk of developing it. In 2002 the FDA implemented labelling changes to reflect the findings of the VIGOR study. The labelling changes included information about the increase in risk of cardiovascular events, including heart attack. The nature of these risks was such that they were most likely to manifest in patients already at high risk of CVS events, such as the elderly, or those with a recent neck of femur fracture (NOF).
Yet years later, a tertiary trauma hospital was still recommending routine prescription of Vioxx to a NOF patients either with or at high risk of both renal failure and cardiovascular events.
Patient often fall and break their hip because they have had a small cardiac or cerebral event, and even if their kidneys are normal before they fall, their age, dehydration, surgery and anaesthesia, blood transfusions, muscle necrosis and other factors mean they are at considerable risk of developing it. 
Look at a page from the protocol which was approved by the hospital executive, and to be followed by intern and resident doctors. Vioxx was to be prescribed regardless. 
Yet history records that doctors were extremely successful at diverting the blame for patient deaths onto the drug company, despite the fact that its product guidelines advised against the use in patients like these.

ps. note also the endone dosage recommendations. Not at all appropriate for this patient group.

Is there any other teaching hospital in the world that was stupid enough to make vioxx part of a treatment protocol for anyone, let alone high risk patients in Sept 2004? Only Canberra?

Osteoporosis prevention

Government guidelines for osteoporosis prevention state that in addition to traditional weight-bearing exercise, patients should also engage in "exercise that involves pulling forces acting on entheses (tendon insertions) of long bones, even in the very elderly. Weight bearing and resistive exercises are better for bone strength than .. exercises such as swimming and cycling."
"It should also be noted that the benefits are only maintained as long as the patients take exercise."
Note that these recommendations apply to the upper as well as the lower limbs.
I'm only 55 so I have no excuse, but very few Addison's patients seem to do much in the way of physical therapy, presumably because their doctors fail to stress its importance.

One rule of social media is that if something is not reported at all on social media it either doesn't happen or is very rare. I have read literally hundreds of posts from many forums and other sources about where Addison's patients have discussed doses and dose reduction to avoid steroid side effects, yet I can't recall a single post (apart from my own) where any arm exercise to prevent osteoporosis has been discussed.

Patients frequently report on social media that their doctor has pushed steroid dose reduction,with its consequent loss of energy and life enjoyment. Patients do report that their doctors give them drugs when their bones do get brittle.
Patients don't report that their doctor has made them aware of the recommended clinical guidelines shown above.

Medical body suggests patient with Addison's disease should NOT be taking steroids. Yes, some doctors really are that stupid.

The other day I received a phone call from AHPRA threatening me with various dire consequences if I did not forward evidence that I had been prescribed steroids. The clear implication was that I should not be taking them.
AHPRA knows full well that I have Addison's disease. I have documentary evidence of that, and I reminded them again during that phone call.
But they were insistent. They did not believe that I had a valid reason for taking steroids and requested evidence that my endocrinologist had prescribed them for me.
Addison's and other forms of adrenal insufficiency are not that rare, yet there is an appalling level of ignorance about it among senior doctors.