Sarah Burnett-Moore

Sarah Burnett-Moore is a consultant radiologist in London

Let’s all have a mid-life crisis together…

By Sarah Burnett-Moore - 18th February 2010 10:20 am

I don’t think I’ll get to the age of 94. I don’t want to live in Bournemouth and smell of wee. So, I am a little overdue for a mid-life crisis (unless getting tattoos, and a husband ten years younger, counts).

Instead of a crisis, I’m going to get me a mid-life check, oh indeedy. There’s even a tool on the internet to help you, kindly provided by the government, and you know how much I love those institutions. I tell you what, let’s do it together…

A few details about me, what would I like to be called? Your Majesty. Date of birth, choose the gender of my virtual GP. So far, so good. I am in excellent health, I eat my five portions of fruit and veg a day (wine is made from fruit after all), and I have someone I can trust with my worries and problems (dear reader that is you).

I did no exercise at all last week (now starts the slippery slide), my waist is 30 inches, I weigh 68kg (please don’t nag me about mixing my units, looking at the scales was enough chastisement), and I am five foot five, or five eleven in the Jimmy’s.

I’m not a carer (surprise, surprise I hear you cry), I don’t take drugs, not entertaining ones anyway, and I gave up smoking 28 years ago. More than half way there now. I drink a fair bit on a proper night out, but I’ve been with the same - long-suffering - bloke for seven years. I am not depressed, stressed, or pessimessed (sorry, it’s the reverse of being an optimist, with artistic license).

Despite the salt my BP is normal, I have no history of cardiovascular disease, and I am not chronically ill. Save your comments for the end, please.

Some demographic questions, to make sure they are hitting a cross-section of the community…and voila!

The results…Smiley faces for eating, emotional wellbeing and weight. Bored faces for smoking and alcohol, advice on where to go if I’m tempted to fall off my 28 year smoking bandwagon, and a suggestion to drink more water at parties.

Do these people not know what fish do in water? Finally, a downright grimace for exercise. OK Guvnor, you’ve got me banged to rights on that one. I’m off to join a gym.

Let me know how you get on with the check!

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A (salt) mine of information during awareness week

By Sarah Burnett-Moore - 11th February 2010 11:12 am

It’s National Salt Awareness Week. I’m already quite aware of salt, it tastes great, and it even looks pretty, particularly those fancy hand harvested varieties. I cook with it, and I add it to food. I don’t have high blood pressure or a family history of heart disease, so can anyone convince me that this is bad for me?

In the interest of research I had a look at the ironically named ‘CASH’ website, Consensus Action on Salt and Health. Someone has gone to a lot of effort to come up with that acronym, shame they didn’t go to the same effort to proofread the web copy. It’s riddled with spelling mistakes, atrocious grammar, and sentences that go: “The supermarkets and the food industry claim that no-one ever told them they want foods with less salt and unless consumers demand it, they don’t see a need to change.”

How reassuring that this is the language of peers and professors. You may think I’m being overly picky here, but I don’t think this online amateurism is going to win any hearts or minds. I would offer to rewrite it for them, but there is no ‘Contact Us’ information.

But back to the science, salt is going to give me high blood pressure, left ventricular hypertrophy, stomach cancer, proteinuria, osteoporosis, asthma, fluid retention and obesity. I’ve looked at the ‘evidence’ on the website, which is largely postulates and propositions. The evidence is poorly referenced, the references are mostly written by the 22 expert scientific members who comprise the committee. There are confounding variables all over the place, does salt make me fat? Or is it the chips I am liberally sprinkling it on?

But how much salt is too much? The recommended level is between three to six grammes, which is a teaspoonful. As I don’t eat any prepackaged or processed food, I can safely say that my level is well within allowed limits, despite my culinary penchant. I might be packing an extra couple of kilos, but I have the bone density of an elephant, and the blood pressure of a 20 year old. So far I seem to be getting away with it. 

The French cook with significant amounts of salt, yet their incidence of many of the above diseases is far lower than ours. It’s not because they use Fleur de Sel either, because as the CASH website points out: rock salt isn’t “any different from common salt just because it’s mor (sic) expensive.” Imagine how many Michelin stars Alain Ducasse would have if he stopped using salt.

So for the time being I am not going to worry, especially after one of the tabloids carried a headline this week saying that there wasn’t enough salt…It seems such a waste to spread it on the roads, but it does make for gourmet snow.

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HDr’s bloggers expose more than their souls

By Sarah Burnett-Moore - 3rd February 2010 10:31 am

Acute calcific tendonitis. A medical misnomer if ever I’ve heard one, it is not cute at all. Although becoming a patient surely renders the toughest of docs more empathetic, sometimes it goes too far.

So far I’ve clocked up a laparoscopy, a knee arthroscopy, two LETZ, an excision of Morton’s neuroma, a mastectomy, reconstruction, and various prosthetic swappings, but last week nature dealt a cruel blow…

You probably imagine that my Hospital Dr fee for ranting about cyclists and vegetarians funds my Jimmy Choo habit, and well it might, if they were in very poor nick, and I bought them on eBay. In fact, gasp, I have a day job.

It’s a great job, sometimes I get to stick needles into premiership footballers, and I think there’s at least one woman out there who would pay me handsomely so to do. The majority of my therapeutic interventions, however, is injecting subacromial spaces, and needling supraspinatus calcific deposits. That’s the background out of the way, back to the drama.

Ten days ago, I spent five hours shooting sixteen shrieking twelve year olds. In a photographic sense, you understand, although the alternative seemed more attractive as the afternoon went on. Sunday morning, I woke up with a niggly right shoulder, and by Monday I could not abduct my arm at all. I had some impingement bursitis injected over fifteen years ago, and had not had a days trouble with it subsequently, but this was a totally different level of pain.

You have read the catalogue of operations, and I have had two children, but I can safely say that this was the worst pain I have ever experienced. Monday afternoon I got an x-ray on it, as the non-professional would say.

There, nestling in the musculotendonous junction of infraspinatus, were three foci of calcification, each about the size of an ibuprofen tablet, which is ironic, as anti-inflammatories did sod all for the pain. Another sleepless night, and finally I can understand why the pain drives some patients to casualty.

I spent a good proportion of the night figuring out how I might be able to inject it, to no avail. Tuesday lunchtime I saw Andrew, the orthopaedic surgeon. To my enormous relief, he thought an injection wouldn’t do the job, although he did ask me if I had considered trying to do it myself. It’s not that I don’t trust my colleagues…

So, last Wednesday, I had an arthroscopic subacromial decompression and removal of the calcium. Even immediately post-op, it hurt less than before. The next day Andrew came to tell me how much fun the operation had been. Click on this link and have a look yourself. 

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Widgets hold the key to future healthiness

By Sarah Burnett-Moore - 3rd January 2010 2:00 pm

Along with nearly 27 million other Britons, I have been making my New Year resolutions.

Determined not to be amongst the 40% who fail within the first month, I decided to make them along NHS guidelines. They even have tools for your desktop or smartphone, and you’ve got to love a widget…

I am going to share them with you, because then I will have to stick with them, won’t I?

Firstly, I am going to give up smoking. Apparently I’ll look less wrinkly, smell nice, save loads of money, feel better, and live longer. I started the widget, and entered the number of ciggies I have a day. Bingo, I’m now a non-smoker, I’ve managed 47 minutes so far! This resolution malarky is going to be a piece of wee wee, particularly as I don’t even smoke.

Next I am going to lose weight (important now that I’ve given up a non-existent nicotine habit) and get fitter. The keep active tool suggests I should become a volunteer, I wonder how that works? I need to do 30 minutes of activity every day - knitting - that covers that. 

To lose weight after Christmas (although spending the festive season in Marrakech has left me in slight negative equity anyway), I will walk 10,000 steps a day. With my pedometer on me at all times, I shall stride 6.6km on a daily basis. The dogs will be delighted, and after three months, I’ll be just south of Selkirk.

I will also eat healthily. The supermarket healthy swap widget has removed the freshly squeezed orange from my trolley, and replaced it with a carton of Tropicana. Eh? The family will eat healthily too. New guidelines suggest that children should only be allowed solids if they can sit up with good head control, and accurately reach for a banana. So I’m going to have to go back to breastfeeding my son, after he’s had a few pints of cider.

Although that nice Professor Donaldson won’t let him have any until the end of February, when he gets to fifteen.

Talking of alcohol, I will stick to the daily recommended level of two to three units for women, and, no, I won’t save them all up for Saturday night because I know that is BAD for you. 

I will drink my 123 mls of anti-oxidant Merlot all in one go. I will also take careful note of my mental state, the widget says I am unhealthily stressed at work, and that I am depressed. If anything is making me depressed it’s these NHS tools.

Finally, I promise not to upstage Bob Bury (our new blogger). That’s one resolution I will stick to.

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A list of reasons why cycling is bad for you…

By Sarah Burnett-Moore - 3rd December 2009 12:01 am

A report, by the University of Surrey, in today’s BMJ confirms that cycling is proportionally more dangerous than driving.  

Apparently in a collision between 70kg of flesh and bone, 9kg of flimsy metal, and two tonnes of people carrier, the cyclist will come off worse. I wonder how much that study cost, to make a statement of the bleeding obvious.

But whose fault are these accidents? In Guildford, it is possible to conceive of a Miss Marple style cyclist, in 1930’s garb, wearing a perky little hat, with a proper ‘Ladies bike’ with a basket on the front…unfortunately city centres are full of lycra-clad fascists. These fools seem to think that they have to ride their bikes like an eco-warrior in a Mad Max film.

In the space of one week, I have seen the following transgressions:

1. Cycling the wrong way down a one way street.

2. Cycling the wrong way down a cycle lane.

3. Not actually using a perfectly good cycle lane.

4. Cycling on the wrong side of a main road.

5. Cycling through a red light, then swearing at the motorist who had right of way.

6. Jumping on and off the pavement repeatedly, scattering pedestrians.

7. Cycling with the MP3 player on full blast.

8. Cycling and talking on the mobile (Professor of Vascular Surgery, you know who you are).

9. Gratuitously abusing motorists, or thumping their cars because you ‘disapprove’ of their gas guzzling nature - for which read, jealous that they can’t afford a new 4×4.

Feel free to add your own to the list. Worse still, half of these idiots don’t wear a helmet, and some operate the Darwinian principle of cycling carrying a helpless toddler as a potential additional victim.

It’s fine to go round taking the moral high ground about saving the planet, and getting fit, but when are cyclists going to start thinking about sensible road use?

Stuff like one way streets, and traffic lights are there for a reason, which is TO PROTECT YOU.

Cyclists are not licensed or insured, and therefore almost impossible to identify and prosecute for dangerous driving, unless they are sufficiently injured to hang around the scene. But, I suppose the victims of dangerous cycling, apart from a few old biddies who get knocked over on the pavement, are pretty much exclusively the cyclists themselves.

So wise up you two-wheeled warriors - cycle safety is for your own good, not mine.

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SOBs must temper their acronym obsession

By Sarah Burnett-Moore - 11th November 2009 2:23 pm

I had to get a second opinion for an ankle MRI last week, it’s not something I do often, but this one had me foxed.

Don’t get me wrong, I could interpret the images well enough, but I could not make head nor tail of the request. It read: “?? TCJ or TNJ. Probable TCC. ? PPV deviate.” If this means something to you, then I’ll accept intellectual defeat, but I felt like Dan Brown’s symbology expert, Robert Langdon, faced with a Masonic puzzle.

Luckily I deciphered it, and saved the world - sorry I mean wrote the report - and no, I am not going to put you out of your personal misery.

I think this is a generational thing. A patient recently told me that a young doctor didn’t know the term Heberden’s node, but they bat the acronyms out like Brian Lara. As far I was aware, the main virtue of an acronym is that you can insult patients without them noticing, although many, such as GOMER (Get Out Of My Emergency Room) and AMFYOYO (Adios Mother Fucker You’re On You’re Own), are in the public domain thanks to programmes like ER.

We all know that NAD really stands for Not Actually Done, but here’s a few new ones…

SNEFS, SubNormal Even For Suffolk. That had me LMAO (sorry), I’m almost disappointed I don’t work at Ipswich General. Well not really, obviously, but I’d love to write that on a report. Or PIP, Pyjama Induced Paralysis, the syndrome where perfectly mobile patients lose the use of their legs due to a disease process called ‘admission’.

Don’t you love it when a ward patient is wheeled up 20 minutes late for a procedure, then leaps with alacrity out of the chair, and bounds onto the couch with the enthusiasm of a Cocker Spaniel puppy. However, my favourite acronym of the week is ART, Assuming Room Temperature.

So helloooo, orthopaedic surgeons, you know who you are, if you’re going to use an acronym, at least make it funny. Take 24 hours to think about it while I’m summoned to The Vatican by helicopter…

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“An advisor is an expert who gives advice”

By Sarah Burnett-Moore - 2nd November 2009 12:15 am

We live in an era of honesty, and evidence-based medicine, yet it now seems that if you tell the truth, and provide evidence, you’ll get sacked from your role as a government Tsar.

Poor Professor David Nutt, head of the Advisory Council on the Misuse of Drugs, was dumped by e-mail for pointing out some hard truths about not so hard drugs. He spoke against reclassifying cannabis as a B class drug, and pointing out that you are nearly ninety times more likely to die from alcohol, than ecstasy, and that tobacco is the biggest cause of premature death.

Of course I am not calling for alcohol or tobacco to be banned, and neither would the government, imagine the tax revenue they would lose. But I am asking for a sense of proportion about recreational drug use.

Quote of the week from Alan Johnson: “You cannot have a chief advisor…campaigning against government decisions.” The last time I looked in the dictionary (seven seconds ago, gotta love the iPhone) an advisor is ‘an expert who gives advice’. Advice doesn’t have to be taken, picture a child approaching the fire, you could advise him not to put his hand in it, and how would you feel if he rejected your advice?

It seems both stupid, and expensive, to set up committees, and appoint Drug Tsars (not to be confused with Colombian oligarchs), just to take no bloody notice whatsoever of their recommendations. As Nutt said today, Gordon Brown is making statements which are totally outside his expertise.

Mind you, if Gordon Brown confined his statements to areas within his expertise, he’d have bog all to say. And, while we’re on areas of expertise, anyone noticed that the rest of the world is out of a recession and we’re still stuffed.

In yet another example of a clash of ministerial policies, the home secretary is, in fact, giving tacit approval to alcohol, whereas the health watchdogs have found a spectacularly easy target.

The latest alcohol clampdown is on the high end supermarket recession busting tactic of offering a main course, side dish, and pudding, all for £10 for two people. “What a great idea, we’ll have a lovely cheap meal in, instead of nipping to the pub for supper.” I hear you say. Well, apparently it’s not a great idea, it’s fuelling middle aged, middle class alcohol abuse, and the gurus want the promotions axed.

When us middle classes aren’t craving the latest Apple products, or outdoing each other at obscure cheese, we’re getting utterly drunk, and creating havoc by falling asleep in front of our boxed sets of Lost. We’re pictured in the papers having shouting matches with our dogs, falling into bed with our clothes on, and flashing our socks. No, they must be getting me, and my friends, seriously being confused with feral youth.

I am sick of being a soft target for ridiculous policies.  

Can someone please tell me that it’s not true that Trick or Treating is going to be banned, in order to reduce childhood obesity, and obviate the risk of being sued for handing over sweets? Come to think of it stopping the extraction of sweets with menaces is probably a good thing, and I would welcome being able to stay home at Hallowe’en (tucking into a cheap starter, main course, pudding and half a bottle of wine).

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Sympathy runs out for world’s fattest man

By Sarah Burnett-Moore - 21st October 2009 1:20 pm

Seventy stone is a lot. In new money, it’s 445kg, or the equivalent of 1,780 packs of lard. If you put ‘what weighs 445kg’ into a search engine, you get the following answers: a fourteen hand racehorse in tip top condition, a marble slab that nearly killed a construction worker in Canada, a fully grown musk ox and a fat bloke in Ipswich.

At that weight the ox can run at a speed of 37 miles an hour, but Mr Ipswich hasn’t even got out of bed for the past eight years.

The last time he left the house, to go to his local hospital, they removed a window, and got him out with a fork lift truck. Now he needs to be transferred to Chichester for a gastric band. He’ll be winched out the window frame, and placed in a specially adapted ambulance, at a cost of £90,000.

You may be wondering: What’s wrong with a removal truck? And why is there no bariatric surgery centre closer to home? But the real question is, not how did he get so fat, but how did he stay so fat?

I had a patient recently with a BMI of 52, small potatoes compared to this chap, but she was also bedbound. After retrieving my ultrasound probe, and indeed entire arm, from the depths of the folds of fat, I thought: “Hang on. Who’s bringing her food?”

It turns out the Suffolk sperm whale - who’s on benefits and been getting fat at our expense - had a secret accomplice. His dear old mum. For the last 2,922 days, she brought him 21,000 calories of nosh a day. That’s over 61 million calories. Which is 266,791 Mars bars, including 3,201kg of fat.

I can’t even imagine what you would have to eat in the space of a day to get to that calorific total, but it’s more than seven times normal. And yet this frail, little old lady (I picture her miniscule, bird-like) continued stuffing god knows what into her growing little lamb.

Not any more. She popped her clogs six weeks ago, and since then it has taken two carers to look after him, and draw attention to his plight.

When Winnie the Pooh got so fat on honey that he got stuck in the doorway to Rabbit’s house, his friends were sensible enough to starve him until he lost enough weight to escape. They didn’t give him even more honey. Now if small, stuffed, and indeed imaginary, farm animals have that much common sense, why don’t we.

It has got to be cheaper to set up a care unit in his own home, and take advantage of his helplessness to support him through some initial weight loss. I’d be surprised if there are even laparoscopic tools long enough to get through the layers of blubber to put the band in.

It might be useful to install a fatcam, so his predicament is available on the web, as a lesson to us all. We could then send messages of support on You Tube as we watch him shrink before our very eyes.

I’m sure one of the satellite channels could make a compelling 24/7 reality show, Really, Really, Really Big Brother, with a natty Geordie voice over. “Day 1,493 and Mr Ipswich can finally wipe his own bum.”

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Hypnosis helped lance my needle phobia

By Sarah Burnett-Moore - 13th October 2009 10:12 am

People find my needle phobia risible. When you’ve had seven operations for breast cancer, five months of chemotherapy, and two episodes of septicaemia, all in the space of two years, let me assure you it isn’t.

For most people a needle phobia isn’t a ‘live’ issue, they don’t encounter them every day like I have to. In recent years, my anxiety has got to the point where I get an embarrassing shake, even attaching the needle to the syringe, when it’s not even going to be stuck in me.

As a result I have been rationing the number of injections I could do each day, before I imagine I might explode. When you work with elite athletes, this does not look big or clever. For a number of other reasons, I had booked myself onto a Neurolinguistic Programming course last week. This is a method of using deep relaxation, or, if the word doesn’t scare you, hypnosis, to alter belief patterns and thereby behaviour.

The co-creator of this technique is a scientist called Richard Bandler, who is a self-confessed nut-job in the nicest possible way. He is the man who cured a Jesus loonie by turning up on Good Friday with a seven foot crucifix, some nails and a hammer. After 20 minutes the bloke was insisting that he wasn’t Jesus.

Well, Richard likes to demonstrate his techniques on problems that amuse him, so I guessed that he might find my particular problem entertaining. Wednesday morning, I was summoned to the stage, and asked how I knew to be nervous around needles, as opposed to a chip.

I suggested that I knew needles could hurt, whereas chips didn’t. Richard then explained to me at great length how you could kill someone with a chip. Believe me, if anyone could kill someone with a chip, it would be him. Oh, and he also explained how to kill someone with a slice of chocolate cake.

Within seconds, he had me laughing at myself for my irrational fear, and that was before the ‘hypnotic’ part. I can’t say that I felt any more hypnotised than relaxed, but I opened my eyes to be confronted with a syringe and needle, that Richard then insisted I stuck in him, to prove that I wasn’t going to wobble. I knew he was enough of a psycho to let me do it, so I indulged my best polarity responder (ornery bitch) behaviour and refused. “Scared?” he asked.

“No,” I replied. “That’s technically assault. And I don’t know what’s in the syringe.” It hadn’t occurred to him that I could have stuck the needle in, without depressing the plunger. That battle I won.

The acid test was today. The patient needed a sub-acromial injection. She walked in and told me that she had been researching me on the internet. Whoa, that’s a good way to make your doctor feel confident! She then proceeded to tell me how anxious she was, and told all her horror stories of previous injections.

Needle-ss (hey, I can even make jokes now) to say, in the middle of this stuff, she didn’t notice I’d injected her, and I felt as confident around needles as the Tailor of Gloucester.

Maybe there is a little bit of magic out there after all.

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Where’s a pharma pen when you need one?

By Sarah Burnett-Moore - 18th September 2009 4:53 pm

I sincerely believe that the National Health and Safety fairies are running amok. Their tiny wings are flapping as fast as a hummingbird and creating chaos in every hospital in which I work. How do I know this? Simple. Biros.

Face it, we work in an industry where the staple item of pay is a pharmaceutically enhanced Bic. Reps hand out literally trillions of the ruddy things on a weekly basis. Well, not literally. So how come I can never, ever find a biro when I need one. There is never one in the reporting room, or ultrasound, or CT, or…I could go on, but I expect you get the picture. 

Now, you may be asking me, “Sarah, in this pacsologically advanced age, why do you need a biro?” Well get this, it’s for writing things, like signing reports, or jotting down telephone numbers, or writing down latin stuff to bamboozle the patients.

You might argue that there is no point allowing biro access to a doctor, since no-one is going to read the output anyway, but I still need one. My handwriting is, at the same time, beautiful, but totally illegible, but who knows when I might need to perform an emergency tracheotomy?

OK, it’s not happened in 29 years but I live in hope. My husband tried the “Surely a doctor always has a pen” line, but I shot that one down in flames (I didn’t have a pen, but I did have a lighter).

I don’t have a pen because A. I am a big, grown up, consultant, so I don’t have a white coat (try convincing a tabloid reporter trying to take your photo of that - but that’s another story…) and B. because I am a ‘girl,’ my clothes do not contain pen-friendly pockets. Ergo: I. Need. A. Pen.

The nurses and radiographers are allowed them, so I have to go cap-in- hand, begging for brief usage, but they are always snatched back before I can sneak off with them. The reception staff have them too, but they watch every pen stroke with the accuracy of a hawk. If I try to finagle a Front Desk pen, I am confronted with a headmistressy dressing down, and have to promise not to do it again.

I can only conclude that ‘Da Management’ thinks that doctors are so stressed, we may develop biro-rage, and stab a patient, or more importantly, one of them, in the eye. Come to think of it, I can never find a pair of scissors when I want to run with them either.  

Strangely, they still let us play with needles…

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