TikTok is a social network for sharing user-generated videos, mostly of people lip-synching to popular songs. Like most people aged over 20 I had only heard of it through my kids but it seems to have exploded in popularity over the COVID-19 lockdown. It allows sharing of 15s or 60s videos and whereas lots of them are fun and challenge based, it struck me that 60s was the perfect length of time to share short patient explanation videos. I'll try and keep them as factual, serious and gimmick free as possible but please have a look, see what you think, comment if you like but don't challenge me to a TikTok dance video challenge, it wouldn't be pretty!
My links are here to vids - and also on the 'T' sharing button on the social media buttons on the footer page below
I have been working with Claire, Emma and Helen - the fantastic team at Facilitate Expert Solutions for about 18 months. Claire also runs a Barrister Practice Management Company and brings her skills from the world of law to medicolegal expert practice. The team run my diary, invoice, bill and reconcile and are generally life-savers. I was recently asked to write a piece for the quarterly newsletter and have put pen to paper on some of my thoughts about the use of Social Media in medicolegal practice. I have attached the pdf of the newsletter below.
Please do consider getting on touch with Claire and the team if you are looking for a top notch, first rate practice management solution https://facilitateexpertsolutions.co.uk/
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Informative video by my Wythenshawe colleague Professor Ashley Woodcock in the cough clinic.
Why do we cough? What are thre reasons and what can we do to reduce it?
This is a really common condition. You probably remember having sore throats and infections as a child and being told that ‘your glands are up’. We all have about 100 lymph glands in the neck that are usually the size of a pea and increase and decrease in size if and when we have infections. Any lumps in the neck that come up and stay up, however, and any lumps that are bigger than 1cm in size definitely need looking at. I run a neck lump clinic at Wythenshawe Hospital on Wednesday mornings with my x-ray doctor colleagues and we do a one-stop clinic where we can see you, have a look in your mouth and nose and also put a small (4mm) camera in the nose to have a look at the back of the throat and voice box (bit of an odd feeling but doesn’t really hurt). We can get an ultrasound scan on the same day and if this does not look normal we can do a needle test to get an idea as to what the lump is.
I am really glad to reassure the majority of patients that we see that their neck lumps are benign and nothing to worry about but some people do have lumps that need further treatment. I commonly see thyroid lumps that can be benign and left alone as well as thyroid cancers that do need surgery to remove. We sometimes see lumps that arise from the saliva glands and again most of these can be left alone. We also see some lumps that are cancers that have spread from other parts of the head and neck and need further treatment, sometimes with more extensive surgery or radiotherapy.
Further posts to follow about these conditions in detail but the most important take home is that if you notice a lump in your neck get your GP to refer you to ENT on the two week wait pathway where you will be seen urgently
Bond Solon - Meetings between experts Course
Part of the medicolegal process is the discussion between experts. The role of the expert in medicolegal cases is to provide expert advice to the Court. The expert for a claimant should not try to prove negligence or error and likewise the expert for the defendant should not aim to disprove it. Nevertheless, there are times when experts will disagree and this workshop outlined the CPR rules on discussions between experts as well as highlighting some salient practical tips.
It is an honour to have been invited to be the ENT speciality representative for the Spire Cheshire MAC. The MAC exisits to provide advice to the Hospital Director on matters relating to the safe, efficient and ethical medical use of the hospital as well as being instrumental in providing quality assurance on all aspects of healthcare. I look forward to participating in this group in the following years. #patientsafety #quality
This article is from the Journal of the American Medical Association and is an excellent overview of post-op thyroglobulin monitoring
JAMA Patient Page
March 26, 2019Thyroglobulin for Monitoring for Thyroid Cancer Recurrence
Alan N. Peiris, MD, PhD, FRCP(Lond)1,2; Dillon Medlock, BS2; Meredith Gavin, BS2
Author Affiliations Article Information
JAMA. 2019;321(12):1228. doi:10.1001/jama.2019.0803
Some thyroid cancers can come back after removal, so monitoring for recurrence is important.
The thyroid gland is located in the lower front part of the neck above the breastbone and regulates metabolism through production of thyroid hormones (T3 and T4). Thyroid cancer is a malignant tumor of the thyroid gland. Papillary and follicular thyroid cancers are the most common types, and are known as differentiated thyroid cancers because they process iodine similarly to normal thyroid tissue. Surgery is the initial treatment for papillary or follicular thyroid cancers.
After initial treatment, long-term monitoring is needed to check for recurrence of the cancer. This is done by repeat ultrasound examinations of the neck, radioactive scanning, and measuring thyroglobulin levels in the blood.
Thyroglobulin is a protein made by the follicular cells of the thyroid gland. It is used by the thyroid gland to produce T3 and T4. The normal value for thyroglobulin is 3 to 40 nanograms per milliliter in a healthy patient. If a patient’s thyroglobulin level is found to be increasing after all of the thyroid gland has been removed, the patient may have a recurrence of a differentiated thyroid cancer. Very high levels of thyroglobulin may suggest metastatic or recurrent disease. About one-fourth of patients who have thyroid cancer have antibodies to thyroglobulin. Antibodies should be checked along with thyroglobulin because if they are present, they could interfere with measurement of thyroglobulin. Thyroglobulin levels after a lobectomy (removal of half of the thyroid gland) should correlate with the size of the thyroid gland remaining after surgery. Falsely high values of thyroglobulin can occur after a partial thyroidectomy because the remaining thyroid gland can increase in size. Following thyroid gland removal, radioactive iodine ablation (destruction) of residual thyroid tissue maybe done to reduce chance of recurrence and to make monitoring of thyroglobulin more reliable.
How Is Thyroglobulin Measured?
Thyroglobulin is measured using enzyme-linked immunosorbent assay (ELISA). The accuracy of the test depends on how strong the binding is between thyroglobulin and the antibody used. If a thyroglobulin value seems abnormal, the ELISA test should be done again to ensure the results are accurate. There are other tests for thyroglobulin; the results of tests depend on which type of test was done. When comparing test results, it is important that tests were the same type and done in the same laboratory.
Thyroglobulin levels should be measured every 3 to 6 months for 2 years after thyroidectomy and every 6 to 12 months after that. Depending on an individual patient’s circumstances, the amount of testing may differ. If thyroglobulin levels are increasing, the cancer may have returned. When a thyroglobulin level is increased, testing should be done more frequently. When levels are decreasing, the cancer is probably receding. When there is a cancer recurrence, thyroglobulin levels can be suppressed at the same time that levels of thyroglobulin antibodies increase.
For More Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Conflict of Interest Disclosures: None reported.
Sources: American Thyroid Association
Holsinger FC, Ramaswamy U, Cabanillas ME, et al. Measuring the extent of total thyroidectomy for differentiated thyroid carcinoma using radioactive iodine imaging. JAMA Otolaryngol Head Neck Surg. 2014;140(5):410-415. doi:10.1001/jamaoto.2014.264
This week I was down in London to attend the Royal Marsden update in the management of Thyroid Cancer. This was hosted by Dr Kate Newbold and was excellent.
There were talks on the role of biomarkers in the diagnosis and potential prognosis of thyroid cancer and discussions about the role of as well as the management of potential side effects of tyrosine kinase inhibitors. These new drugs block the growth of certain cancer cells and in thyroid cancer that is no longer responding to radio-iodine treatment they have become a game-changer.
The day ended with a panel discussion on the management of difficult cases. All in all an excellent course and now back to put it all into practice.
This podcast is from a while ago and summarise a systematic review that I undertook for the Cochrane Collaboration looking at the benefit of masking devices for tinnitus. It is, hopefully, a useful introduction into what tinnitus is and how it can be treated. The bottom line is that masking devices are probably better than no treatment at all and there is no harm associated with their use.
Link to the full study here: