Your Bike hates you.

Divorce it and get a younger model.

Sancho – sorry – I meant the thing most recently discussed in the thread… homeopathy.

Trusts application of charges to non eu patients is uneven.

no

Sancho as the bloke who will get sued if I get it wrong… Yes…

And having used translation services a lot more when I worked in Australia, I know we are not the only country who sees this as important.

Ok a few simple points

1) Just because it is TJ doesn’t mean he is wrong.
2) I do however dislike the labelling of posters and posts as Rascist or Bullying because they are allegations which are both damaging and impossible to effectively refute.
3) Having said which – I definitely inferred a whiff of probably unconscious racism in McBoo’s first post when I saw it – my interpretation – may be wrong – I’m a Guardianista after all.

4) Lastly – the important one. As a doc working in the NHS (and not needing translation services often) I have a duty to do the best I can to diagnose and treat patients correctly. Sometimes I need a stethoscope to listen to their heart, sometimes I need a translator to listen to their story. Take either away and I cannot do the job properly, and will miss diagnoses and waste money and time. Pragmatically it makes sense to have access to free-to-patient translation services

Sancho – you’ve made me agree with TJ…

There is a certain irony in residents of a country where people are getting worse at speaking others’ languages, and yet are themselves travelling more, complaining about the cost of translators…

and those deaf and blind people… don’t they just waste money by requiring extra resources to allow communication with them… 🙄

“smug self-serving immature git fails to see point” shock horror

My father is a pompous boring twit who places his own interests above those close to him.

So I guess I am doomed. One of my real horrors.

When I see him in the mirror, or hear him in the things I say, it really isn’t good. And the last time I saw him (my choice) was when he was about my age.

Or 160 as above including remote, cable, a hydraulic system, etc etc etc….

fine fragments of parmesan/grana and thinly sliced small chillis scattered over the top FTW…

I’m in the hot-griddle and up to 2 mins a side brigade.

Steak is, like pork chops, one of those things where you really get to see if your Butcher gets decent meat from decent animals.

Looks like variant of the Edinburgh defence here to me.

OP used “behind me” in the original post, and didn’t seem upset by what had happened. Either a troll or the OP did lock the gate. Not good either way…

Got a Giant contact switch with remote for £150… seems good so far. Came from Roe Valley – now showing as £160 and out of stock.

OK – some medical input – and from someone who used to prescribe a lot of HRT (above average by a long way) until the evidence changed… And for the sake of argument I am going to state this pretty unambiguously – but there are nuances.

1) Anyone who is having a really premature (pre aged 40) menopause should have it tested/treated asap.
2) Above that it gets more tricky… the blood tests are not brilliant and I have seen people with blood tests suggesting they are totally menopausal having regular periods restarting a year later.
3) If you do have bleeding after more than a year period-free with menopausal symptoms – seek help. It isn’t always good…
4) In people with a menopause at a normal age HRT is no longer recommended as a first line preventative medication for osteoporosis, and does actually increase your risk of heart disease in year 1. After that the increased risk of breast cancer and endometrial cancer on HRT (google Womens Health Initiative Trial or see here http://www.nhlbi.nih.gov/whi/whi_faq.htm ) means that manufacturers have generally changed their licenses to say for-short-term-use-only.
5) This isn’t surprising. When we treat people with breast cancer – one of the first things we do is mess with their oestrogen and receptors. And the Breast Cancer risk after 5 years HRT is significant. We are likely to see a surge in prostate cancer if the current trendiness of testosterone for the male menopause continues, for the same reasons.
6) HRT does not get rid of the menopause. It postpones it. Most women are going to get symptoms if they stop HRT at age 50, 60 or 75…
7) So there is no simple safe and effective solution for women with menopause symptoms above the age of 50, below that I might be tempted to prescribe HRT aged 40 plus up to the age of 50, and definitely suggest it below that age.
8} Don’t believe any one who tells you there is a simple safe solution
9) And don’t blame Drs just because they cannot safely “fix” something which is -for most- a natural ageing event in women – which can be very unpleasant and really make life difficult, but is not an “illness”.

Not funny 🙁

Might lead to a secret relationship being blown, or a delay in meeting or visiting someone etc etc

we get the politicians we deserve

Oh come on… This forum is populated by IT professionals (virgins) and the middle-aged (eg me) .

Then you give convincing evidence that you have two women – perhaps road-tested by mates but hey… – who might be up for playing hide-the-sausage…

We live our lives vicariously through you…

So we need updates, pictures, swab reports and details…

FWIW – I think you should go for it.

Derek. Agreed that those are needed too.

Did a year of gassing back in the day. Had to intubation a couple in the past 20 years, one lived, one didn’t
‘Now we’d use a laryngeal mask. Put one down 4 days ago in anger. But only get involved in a resus every 2 years or so now.

I’d certainly step aside for a paramedic to take charge.

Ok for the record – and we are not exceptional locally

8000 patients
4.5 GPs
3 ECGs
1 Defib
5 Spirometers
8 Pulse Oximeters
2 Event monitors
3 CABP Machines

etc etc etc

And we need this stuff to work well and in an upto date fashion.

Did find out the laryngoscope was u/s last week though 😳

That is just awful. Totally unacceptable.

gunner that’s largely a crock…

1) Diabetes sometimes presents with repeated infections – not usually bruising. Think Leukaemia, Thrombocytopenia etc etc by all means… but capillary fragility and “senile Purpura” does also occur with age…. Usually not pre 60 though.

2) REM sleep does not last 4 hours a night… 2 hrs a night max.

3) People who are sleep deprived in experiments for several days, rapidly get back to normality with relatively few hours additional sleep. The “sleep is necessary to process chemicals” theory is totally unproven. There are other good “memory processing” or “evolutionary advantage” models.

4) Sleep deprivation has been shown to be harmful. How much of that is about disruption of circadian rhythms as in shift work or how much is because poor health (COPD, OSA, Depression etc) often leads to sleep deprivation, I’d be interested to know. Do you have any evidence?

Thats p1sspoor…

Ton result mate.

Woody must be that you are responding too slowly 😉

I’m in a nice place but just north of a deprived downwardly-mobile town with a fair amount of drug abuse and refugees. Ten years ago I was the bloke who put in the bid which got the Sussex Cardiac Collaborative later the local Cardiac network going.. At that stage we surveyed equipment and there were a couple of very small practices who did not have ECGs, so we bought them for them.

It beggars belief that any GP would not have a decent ECG machine these days. The NICE guidelines on angina make it clear you MUST do an ECG immediately when you see a patient with a new presentAion of chest pain.

I am totally embarassed to hear any GP does not have one.

Wisepranker – that’s awful….

Yes – you need it if you ever have kids, or want anyone with kids to buy it.

errr… 2wheels1guy

I don’t know any GP surgeries which do not have at least one ECG machine. I haven’t heard of anyone being sent up to a hospital by a GP for an ECG for about 20 years.

In this case Ton the key question is whether knowing you are in AF is going to change your management tonight?

If you are breathless, or have chest tightness, or the rate of the pulse you can feel is 140 or greater or just feel ill, phone 999 now.

If those do not apply, and you are not on warfarin, and you are sure the AF started in the last 24-48 hours, and you might be considered for cardioversion (DC Shock) again, you need to go to A&E now.

If you are on Warfarin, and are not breathless/ill/having chest discomfort, and your rate appears to be 120 or less, this can wait till tomorrow.

The warfarin question is because there is a 48 hour window of opportunity from onset of AF for cardioversion without warfarin. After that you need to be on it, and if you are on it there is no hurry.

Usual T&Cs apply… who knows if I am even a Dr…. But given how long you left it the first time… if in doubt, sort it now.

A nice 3-4 inches is fine. The equivalent of powder to skiing…

I like it

Depends what for…

Now if it is a 5 day faecal fat collection….

What I’d do is ring the surgery at 0830 tomorrow morning and ask them for a precise weight of stool needed… 😉

Serious answer – it doesn’t seem to matter much, A quarter the container is plenty for most tests.

U is wicked fast so U is da best… 🙄

Which trails do you help maintain?

I really dislike it when people are stroppy and OTT about an MTB trail without rolling their sleeves up and doing something about it…

It is an off-road trail – not a manicured tarmac covered cycle path – if you find it dangerous – go slower… 😉

Yes, this crime deserves as many investigators as it takes. The future freedom of our media, quality of our journalism and personal privacy are threatened by this issue.

Next.

40 was a walk in the park

Try 50…

But I sleep as long as I want 6 out of 7 nights, life is good, and I am heavy but fit. The impending need for reading glasses is a pain, and one of my cars is insured by Saga… but life is pretty good… Hangovers suck more though.

The Grim Reaper is getting closer and closer, and whilst I am sure I will be skiing at 80, I can see MTBing may only have another 5-10 years.

I’m looking for one too…

some pron to keep you going

http://www.ihaveasoul.co.uk/

Spot on. Looking at 3% down last year, a further 5% this year and 5% next year. And thats before adjustment for inflation. Plus our pensions (which are not final salary) screwed with. Increased workload and being blamed for everything. I know a lot of GPs retiring a year or two earlier than they had planned. There is a workforce crisis coming soon. And you Z11 know eff all.

Car yes

Mountain Bike no

So funding – as I said to TJ – has increased, and waiting lists and customer satisfaction have improved etc etc etc. And the way pensions have been handled is a huge demotivator.

But that is to miss the core issue here which is why some hospitals/wards seem bad, and others with similar funding seem good. Anyone listening to some of the patients stories on the radio today would hear things that mirror things patients have told me. Often the care is excellent. But sometimes patients do seem to be getting in the way of ward staff members chatting and having tea. And often there are unacceptable bureaucratic snafus with appointments and investigations…

There do seem to be teams and units which are good at learning, and some where the patients seem to be perveiced as a nuisance.

In order for the plane not to move forwards the treadmill will need to generate a force on the plane equal to and opposite to that produced by the thrust of the engines. This would mean that right from the start of take off thrust being applied (and I think TOGA thrust can be spooled upto in 2-3 seconds) the friction of the wheels rotation to transmit this force would need to be huge. This might be possible in a model plane with low take off speed and small wheels and iffy bearings but for a full sized commercial plane it isn’t going to happen .

… but you don’t really get either of those things on Later… we did get the Civil Wars, and Little Roy and I think she looked a bit out of her league compared with them. Peter Gabriel is a bit marmite I guess.