Old Lad

A journey through old age

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  • Classics

    I’ve never been a fanatic over cars. I was never one of these people who drooled over high performance motors. To me a car was a necessary item to be able to travel from A to B, preferably in comfort and with good load carrying capacity. My favourite car was the Volvo 240 Estate car -not a glamorous looking vehicle but it did the job for the family plus dog. Any form of motor sport watching cars go round and round a track is a form of purgatory! So why in the twilight of my years have I just bought a Classic car? Its a 1979 nutmeg brown Triumph dolomite 1300 for those who like the technical details.

    The official reason I bought it was for my grandson who is a petrol head, and who is going to make a career in motor engineering, having just secured an apprenticeship with a company called M Sport which builds rally cars. But to my surprise, I have now become hooked on classic cars. I think its another manifestation of the nostalgia germ that infects us Oldies. I learnt to drive in a Ford Anglia – you may remember those , they had an angled rear windscreen. This was our first family car in the 1960s – my Dad only passed a driving test when I was about 12. This car transported a family of four plus dog, but when I see one now it looks tiny and I wonder how we all fitted in! The Dolomite similarly looks small now but my memory of it at the time is that it was quite a reasonable sized car. Its interesting to read the sales blurb for this particular model which boasts “luxury extras” such as a walnut dashboard, carpets, windscreen washers, a wing mirror on the driver’s door, carpets and front seat belts!

    During this summer my grand son and I have taken it to a couple of classic and vintage car shows. This has been fascinating and enjoyable in equal measure. It soon becomes apparent that the majority of the classic car owners are of a mature age, and when you turn up they are incredibly friendly. So what are we all trying to re-create with a classic car. The nostalgia thing certainly. There’s a certain simplicity under the bonnet with an engine that can be worked on as opposed to being plugged into a computer. (So far I have drawn the line at polishing bits of the engine but there are those who do). There’s also the challenge of driving a vehicle without aids such as power steering or servo assisted brakes – Steering after an hour or two provides a good upper body workout and you return to a style of anticipatory driving to take account of braking distances. The Dolomite always provokes interest if I go shopping or go to a petrol station and inevitably somebody will come over for a look. we had an emotional encounter at one of the car shows with a man who disclosed that the exact model was his first ever company car and could he have a photo with it.

    I suppose the attraction of a classic car is its another manifestation of another of the features of growing older and painting a picture of our past where we can gloss over reality – such as the fact that the car is not that comfortable and getting in and out of it is not as easy as my present car with its higher seating. I think classic and vintage cars represent a yearning for a gentler less frantic age – or maybe that’s a myth too. But its a bit of fun. And in your seventies you need a bit of Fun.

  • Life is Risky

    There seems to be more anxious people about than when I was younger – or perhaps that’s just the rose tinted spectacles of old age! However I do think that now that we have 24 hour rolling news, multi media churning out scare stories, and a type of journalism that does not believe in treating news in measured tones, its not surprising that people are generally more anxious. Or as my Gran would say – “On top Note”! Open the daily paper or watch the news on TV and you will believe that the country is going to hell in a hand cart. For example according to today’s paper we are heading for civil disturbance, nuclear conflict, penury from financial mismanagement and the effects of eating and drinking the wrong things!

    A notable feature of life as I have grown older has been the rise of Risk Management. One of my annual delights is to dress up as Santa Claus and be driven round the streets on a sleigh by my local Rotary Club. It delights children as we roll up outside their door and we collect a fair bit of money for charity. Now however this simple activity has to be preceded by a written Risk Assessment document. So this contains such gems as Santa being asked to hold a baby for a photograph. Perceived risk – Santa drops baby. Mitigating factor – no holding babies, parents to stand next to Santa with Baby! And so the document goes on identifying the most unlikely outcomes and gradually squeezing the joy out of the event. Who demands this – why the Insurers of course. In the public sector and particularly the NHS Risk assessments abound but they don’t seem to contribute to notable improvements in service. But the risk assessments provide a comfort blanket for managers.

    One area that has increased is in producing risk measurements for individual diseases. This of course is based on the mantra that Prevention is Better than cure. The problem here is that much of this practice is based on the science of epidemiology, which looks at overall populations rather than individuals. Let me give you an example. The population of Finland has generally lower levels of heart disease and this has been attributed partly to genetic factors and partly to a diet rich in oily fish like herrings. So the message promulgated from the research in Finland is that a diet rich in oily fish may prevent you from getting a heart attack.. However the sting in the tale is that if you stuff yourself with oily fish there is no guarantee that you will not have a heart attack. If your whole village ate lots of oily fish then the overall number of heart attacks might fall but its not possible to know if you will be one of the lucky ones. The only areas where prevention works tend to be where there is a direct individual risk. So stopping smoking will prevent lung cancer because we know that the carcinogens in tobacco will induce cancers to form. Also the various screening programmes such as bowel screening will improve early diagnosis and prevent deaths.

    Journalists of course love reporting medical research that purports to show a link between certain activities or treatments and the chances of disease or death. What you need to know when making a calculation of what this means for you is to look at how the risk is being described. Which is where I jump on my hobby horse about the difference between relative risk and absolute risk. Lets take an unlikely example. Researchers decide that there is a problem of people developing brittle finger nails. Say the rate in the population is 5% of people having brittle nails – i.e. 5 in a hundred. The research shows that those who use a certain brand of nail varnish have a 7% chance of brittle nails – i.e 7 in a hundred. The relative risk will be reported as a 40% increased risk(2 being 40% of 5) but the absolute risk is actually an extra 2 in a hundred – i.e.2%. You can bet your bottom dollar that the press will report the 40% figure which of course sounds alarming to women rather than saying you actually only have a 2% extra chance of having brittle nails. So which figure do you think generates the anxiety? It happens all the time. So next time you read a story about the risk of this disease or that or which wonder drug is being introduced see if you can find the absolute risk.

    The thing that becomes apparent as you become an Old Lad is that life is a risky business and the best we can do is just relax and be careful, and not get anxious about things we cannot do much about. I suggest the Winnie the Pooh approach. There is a story that Piglet and Pooh are wandering through the woods and a storm is brewing with high winds shaking the trees. Piglet who is naturally nervous says to Pooh – “Oh dear, suppose the wind blows over a tree and it falls on us, whatever will we do”. And as they walk on Pooh says in his laid back way – “Well suppose it doesn’t”!

  • General Practice

    So what do you think about GPs these days. That’s a question I am constantly asked seeing I was in the business for quite a long time. Despite the fact that I have not practised for 10 years I still get stopped in the street or the supermarket for a quick ad hoc consultation. In a way its quite flattering that people still recognise me. But here’s a question. Do you know who your GP is and would you recognise them in the street. My hunch is that the answer may well be No and No. Ten years ago just before I hung up the stethoscope I suggested to a colleague that UK General Practice would not last more than a decade. My opinion now is that I was right and it is steadily being reinforced as I enter the world of being a patient – it happens to all us Old Lads!

    Why did I become a GP? I started my career wanting to be a Specialist – Rheumatology as it happened – but the thing about being a specialist is that you end up seeing the same conditions over and over again. I liked variety and the challenge of making a diagnosis from first principles. I also was influenced as a boy by watching Dr Finlay’s Casebook and was in thrall to Andrew Cruickshank’s portrayal of Dr Cameron. There was something attractive about being part of a community. And so it was when I joined my first practice. Because we did our own nights on call it was a condition to live in the practice area. My children went to the local schools, we shopped amongst our practice population and gradually over time I developed a deep knowledge of families and their relationships, the places they worked and got used to being recognised and consulted informally. In the 1970s and 80’s general practice training and education came of age and as I moved into teaching in practice we began to emphasise the benefit of this community approach. We also taught the skills of face to face consultation which involved not only a wide knowledge of medicine but the skills which are demonstrated in the Sherlock Holmes stories- the value of observation and the “Non Verbals” as we called it. The workload was heavy and at times arduous but the satisfaction of a “good” consultation with the correct diagnosis and a satisfied customer kept the enthusiasm going. Computerisation came and brought enormous improvements in record keeping but the trick was to not let the screen dominate the conversation.

    So when and why did what I perceive as the slow death of general practice start. Its difficult to put a precise date on it but several factors seem to have come together. First there has been a demographic shift with more and more talented women entering general practice but bringing a desire for part time working. The latest figures suggest that 80% of GPs now work part time. The removal of the requirement to be on call at night meant that doctors no longer needed to live in the practice area so could commute, and the community identity began to be lost. Continuity of care began to decline before the pandemic. When I retired from active practice I worked as a medical adviser in the Tribunal Service and we often had to request a print out of a person’s medical record. These almost universally showed a pattern of multiple consultations with a multiple number of people and no clear plans for follow up, the onus being on the patient to arrange a further consultation. The pandemic necessitated a dramatic reduction in face to face consultations and greater use of telephone doctoring, and this has never recovered. There is now great dissatisfaction amongst the population about the difficulty in getting to see a GP. In mitigation of my colleagues they have actually been encouraged by the NHS to adopt methods which make the process of seeing a GP less straightforward. The old mythical “Dragon at the Gate” (Receptionist) has been replaced by the internet! The practice I am now a patient with ( which happens to be my old practice) has adopted the model called Total Triage. So if I want to start the process of a consultation I first have to fill in an online form stating my case. were I not computer literate and resorted to the old fashioned method of ringing the surgery or calling in, a receptionist would fill the on line form in for me! This on line form then goes to a triage centre where a decision is taken as to who I will see – not necessarily a doctor – rather than who I want to see. If a consultation is deemed necessary there is a 50:50 chance it will be by telephone. And quite probably with somebody I have never met!

    These new ways of working are said to be extra efficient and as the jargon has it “Make the best use of resources”. Perhaps in these days of social media, WhatsApp, the next generation will be quite happy. But we have lost the personal touch. GPs have become anonymous figures working in episodic medicine rather than forming any relationship with patients. Worryingly face to face consultation skills and the ability to elicit physical signs of disease may well decline and telephone consultation is high risk. The knowledge of a patient’s circumstances that I used to get on home visits has all but gone – in fact many practices have a home visiting team of nurses or paramedics

    Does any of this matter. I leave it to you to judge but sadly my style of general practice aint coming back. Which makes me sad because looking back on a deeply fulfilling career I have had to admit that I would not like to be a GP now.

  • Stuff

    I am regularly told as I get older that I should undertake “Decluttering”. I take this to mean that I should get rid of what my family refer to as “Stuff”. Having lived in the house for 40 years there is a considerable amount of stuff about. We all have it and it seems to have some meaning for us. I remember though that when I worked as a GP I became quite philosophical about people’s belongings. Before I explain I need to digress for younger readers. I was of an era when GPs visited people in their own homes. Difficult to believe now I know, and we also got out of bed at night to visit them! What made me philosophical about “Stuff” was the occasions when I would be asked to go to a home where a person had just died. I would stand in the bedroom and look around and realise that the person’s belongings no longer meant anything, even though in life they were probably precious – a demonstration of the adage that “You can’t take it with you”

    There were occasions of wry humour at times. I still have a vivid memory of being called to a house late one night where an old man who lived alone had died. I was met by his two sisters, both in their seventies, who ushered me into the bedroom. As I did the necessary brief examination to confirm death, there was a whispered conversation at the foot of the bed. Eventually one of the sisters asked me if I could remove the brother’s false teeth. I explained that this was best left to the undertaker and wondered why they wanted them. The explanation was that they were brand new and one of the sisters felt that they might be a good replacement for hers! What you would now call recycling I suppose.

    As I get older my stuff feels more important largely I suppose because it is by way of a memory bank to the life I shared with my late wife. One of our traditions for example was when we travelled to foreign places (or some places in the UK)we would always try to buy a Christmas tree decoration. So each year when the tree was erected it became a visible reminder of travels and places. Interestingly we always found something distinctive even in the several Islamic countries that we visited.

    There is a scientific justification for hanging on to stuff as we get older, particularly if you want to preserve memory. The British Psychological Society recommends Reminiscence Therapy as an activity to deal with mental health problems such as Memory Loss, early Dementia or Depression. Reminiscence therapy is an activity which involves remembering and retelling memories from your past and events from your life aided by looking at materials from a particular time. So in a session of Reminiscence Therapy conversation can be about childhood, school days and work life, family holidays or events. It is thought to exercise the part of the brain concerned with memory and well being. And it is thought to give improved cognitive function and improved quality of life It is even recommended in the NICE guideline for the management of Dementia as an intervention to promote cognition and independence.

    There is of course a subtle difference between collecting stuff and hoarding. I have never been one for retaining string or brown paper from parcels, or ten years worth of old magazines. Although I do have a healthy collection of strong elastic bands dropped by the postman! Hoarding is about keeping hold of things “just in case it comes in useful” as my Gran used to say. Stuff has usually been actively acquired at a certain point in life. So I am hanging on to my “Stuff” – the pictures, the trinkets, the ceramics etc. as a preventive health measure as the Old Age journey continues. Yes I can declutter some things – a good place to start is probably the “man drawer” full of old phone chargers, USB cables and sundry earphones. And now that we stream a lot of entertainment I probably don’t need all the DVDs or for that matter a DVD player, which looks like it will be going the way of VHS video recorders. But most of my Stuff is a comfort blanket. Although I know that full well when I am no more my children will be on the phone to the local house clearance experts! Hang on to your “Stuff”.

  • Whisky

    I never used to like whisky. My only experience of it when a child was as a relief for toothache. Hold a piece of cotton wool soaked in whisky against the offending tooth to deaden the pain. But the taste – ugh! This of course was one of my Gran’s remedies. Growing up in the 1950s alcohol was a rare thing to have in the house and usually only at Christmas. My Gran would buy a bottle of sherry, a bottle of port and a bottle of whisky, and it was not unusual for these to last virtually until next Christmas. And wine had not yet been invented!

    So now in my seventies I like whisky particularly single malts. The whole whisky experience is surrounded by hype and marketing but there is still something mystical about the whole process of making whisky and obtaining the subtle differences in flavours. As the years have gone by I have learnt to distinguish tastes by the variety of casks the spirit has been matured in, the effect of peat smoke in the roasting of he barley. I have a bottle in front of me (Aberlour 12 year old as it happens) and on the bottle it says that it has been matured in American Oak and sherry casks and is rich and citrusy. Other bottles describe flavours of vanilla or baked fruit and the taste of the sea. But I struggle to experience some of these. Which is a good lead into one of the features of becoming an Old Lad – the fact that the sense of taste changes with age.

    Like many people I experienced Covid but didn’t have the loss of sense of smell or taste. But I do find that many things I once enjoyed now appear bland and uninteresting. I liked avocados but now the trendy snack of “Smashed avocado on Sourdough toast” (Why smashed and not mashed by the way) is pretty tasteless. I need stronger tasting cheeses and have climbed up the ladder of cheddars from farmhouse to extra mature. I was out for dinner recently and decided to go for the Sunday Roast as an option. On the plate when it came was roast beef, roast and mash potatoes, roasted carrots and roasted parsnips together with a Yorkshire Pudding. Not only was it a beige meal, tome it tasted like a beige meal.

    There is a reason for this. According to the Medline Plus encyclopaedia we have about 10,000 taste buds. These are programmed to sense sweet, salty, sour, bitter and a flavour called Unami – a taste linked with foods containing glutamate as in MSG used in Chinese cuisine. The number of tastebuds decreases as we age but from the age of 60 each individual taste bud shrinks. So sensitivity to the five tastes begins to decline. Ageing is also accompanied by decreased saliva production which also affects taste, as does a decline in the sense of smell. And we know that the ability to enjoy the taste of a food or drink is influenced by its smell as well.

    So when I was younger I suppose my palate could not take the relatively strong flavour of whisky but now like the spirit in the barrel my palate has matured and can tolerate and even enjoy the flavour of a good malt. So that’s all good then. The future looks like a life of Venison, strong cheeses, robust wines and beers and favourite whiskeys. This getting older could be worse!

  • Bladders

    As the journey into old age progresses its natural to think of all the things that can go wrong. Most people worry about major events like heart attacks and strokes. We can take precautions to prevent these but they are events that are often out of our hands. Day to day of course we notice odd aches and pains, a sense of not being quite as fit as before and things that once were easy aren’t any more. A wise GP of my acquaintance used to tell his patients -“Its just the newness wearing off”! However the one thing that inevitably dominates getting older is bladder function. Its a problem for men and women alike but I can only speak from a male point of view. And in subtle ways it begins to influence what we do and how we plan our lives. And its irksome!

    The first inkling I had that this bladder thing was upon me was the need to visit the bathroom once or twice a night. And sometimes it became 3 times. Its at this stage you realise what a significant advance en -suite bathrooms have become. A far cry from my childhood when the answer to a nocturnal urge to pee might well have been a chamber pot! (we did in fact have indoor bathroom facilities so were considered posh) Nothing that you do seems to affect this – restricting drinking in the evenings, restricting what you drink, its all of no avail. There are two physiological reasons behind these night time episodes. Firstly the body regulates its fluid balance via a hormone called ant-diuretic hormone (ADH) which tells the kidneys when to produce urine. Normally if you are drinking a lot through the day the ADH level will fall, and if you become dehydrated the ADH level goes up telling the kidneys to reduce urine output. Normally at night the ADH level will be higher so you don’t wee. However as we get older we produce less ADH and so through the night the kidneys produce more urine. The second problem is that wen we lie down the blood flow to the kidneys increases and this causes more urine to be produced. So getting up through the night is the new normal and the depressing fact is that there is not much you can do about it! So forget a camping holiday unless you don’t mind the rigmarole of getting out of your sleeping bag and wandering across a field to the toilet block. Holidays in hotels or guest houses are nowadays not a problem since the en-suite is usually the norm. Better than the good old days of shared bathrooms.

    Gradually the bladder begins to make its presence felt through the day. And in subtle ways begins to direct how we plan our lives not least in the way that we begin to take an interest in toilet facilities! Train travel begins to be a better option that coach travel. Being “caught short” is always at the back of your mind. This of course is not helped by the steady decline in public toilets. Its a salutary fact that in the last decade 50% of public toilets have been closed by local authorities. As we oldies are increasing in number there needs to be a radical rethink about public policy on facilities. And the stern warning posted in pubs and shops that “These toilets are for the use of customers only” doesn’t help. I can’t be the only person who in desperation has gone into a pub and bought a lemonade simply to be able to use the toilet! Perhaps we need a law similar to other European Countries that allows compels bars and cafes to make their facilities available toall

    Medically our options are limited. True there are certain conditions like Prostate enlargement or Irritable bladder syndrome that can be helped by medication but sadly in the majority of cases your bladder will change the way you behave Be prepared! A last plea to those who operate trains and planes – please avoid your facilities being “Out of Order”. Perhaps as well as punctuality league tables we should have data on how often toilet facilities are working – and refunds if they aren’t.

  • Experimenting

    Experimenting

    Finding my way around wordpress……new blog post coming soon.