Approaching 50, and i'd like to know if i'm healthy or not?
17 April 2012, 10:02 AM
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Approaching 50, and i'd like to know if i'm healthy or not?
Is there anything i can do. At present you only go to the doctor if you are ill, but i'd like some sort of middle age "MOT". Does the NHS provide anything.
Something more comprehensive than testing your blood pressure.
Something more comprehensive than testing your blood pressure.
17 April 2012, 10:37 AM
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Surely if you feel well then what does it matter?
A bloke at work recently had a stroke while playing footy. aged 53! Very healthy and active too...Live and enjoy, you never know whats around the corner and you don't always want to know!
A bloke at work recently had a stroke while playing footy. aged 53! Very healthy and active too...Live and enjoy, you never know whats around the corner and you don't always want to know!
17 April 2012, 01:12 PM
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Checking BP is worthwhile. Do you smoke? Are you overweight? Do you exercise? Do you take too much alcohol? If you have no other illnesses or symptoms, then there is no evidence based screening I would recommend beyond that, most other so called "MOT" testing is garbage aimed at the worried well, especially if you can take money off them for it. Despite the odd story of someone getting a rare treatable tumour diagnosed early on a whole body scan, it is generally considered apart from those that sell such things to be a random fishing expedition which has not been shown to give good value for money and may even do more harm than good. Any reassurance is likely false and short term only.
Women get offered breast screening from 50. Men and women over 45 are offered BP checks every 5 years.
If you want to get more into the value (or otherwise) of screening, you can check http://en.wikipedia.org/wiki/Screening_(medicine)
I expect in future there will be more screening for type 2 diabetes and high cholesterol since these especially in combination with other risks are both dangerous and silent.
PSA testing can reduce mortality from prostate cancer, but the latest data I saw was that you had to do 50 prostatectomies to save 1 life from prostate cancer, and you couldn't tell which one in advance you were going to save. The morbidity from the other 49 such as incontinence and impotence would not be welcomed.
Isolated high cholesterol in a well 50 year old is a moot point too, the "number needed to treat" is high.
Scanning with one modality such as CT has a low pickup rate for cancers in the asymptomatic.
It hasn't been possible to devise a screening programme for smokers to try to pick up early lung cancers. Plain CXR misses many that are mediastinal or too early, and many lung cancers arise in between screening tests.
Bottom line is just because a screen can be offered it doesn't mean it is of proven benefit or value for money. Sometimes it takes longer to explain all the above to someone convinced they want an "MOT" than to just do it for them.
Women get offered breast screening from 50. Men and women over 45 are offered BP checks every 5 years.
If you want to get more into the value (or otherwise) of screening, you can check http://en.wikipedia.org/wiki/Screening_(medicine)
I expect in future there will be more screening for type 2 diabetes and high cholesterol since these especially in combination with other risks are both dangerous and silent.
PSA testing can reduce mortality from prostate cancer, but the latest data I saw was that you had to do 50 prostatectomies to save 1 life from prostate cancer, and you couldn't tell which one in advance you were going to save. The morbidity from the other 49 such as incontinence and impotence would not be welcomed.
Isolated high cholesterol in a well 50 year old is a moot point too, the "number needed to treat" is high.
Scanning with one modality such as CT has a low pickup rate for cancers in the asymptomatic.
It hasn't been possible to devise a screening programme for smokers to try to pick up early lung cancers. Plain CXR misses many that are mediastinal or too early, and many lung cancers arise in between screening tests.
Bottom line is just because a screen can be offered it doesn't mean it is of proven benefit or value for money. Sometimes it takes longer to explain all the above to someone convinced they want an "MOT" than to just do it for them.
Last edited by john banks; 17 April 2012 at 01:18 PM.
17 April 2012, 01:18 PM
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I got blood pressure looked at after got back from Zambia, booked it before we went for reasons stated above,and cos I was there anyway for malaria advice
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Last edited by dpb; 17 April 2012 at 01:19 PM.
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17 April 2012, 02:02 PM
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Checking BP is worthwhile. Do you smoke? Are you overweight? Do you exercise? Do you take too much alcohol? If you have no other illnesses or symptoms, then there is no evidence based screening I would recommend beyond that, most other so called "MOT" testing is garbage aimed at the worried well, especially if you can take money off them for it. Despite the odd story of someone getting a rare treatable tumour diagnosed early on a whole body scan, it is generally considered apart from those that sell such things to be a random fishing expedition which has not been shown to give good value for money and may even do more harm than good. Any reassurance is likely false and short term only.
Women get offered breast screening from 50. Men and women over 45 are offered BP checks every 5 years.
If you want to get more into the value (or otherwise) of screening, you can check http://en.wikipedia.org/wiki/Screening_(medicine)
I expect in future there will be more screening for type 2 diabetes and high cholesterol since these especially in combination with other risks are both dangerous and silent.
PSA testing can reduce mortality from prostate cancer, but the latest data I saw was that you had to do 50 prostatectomies to save 1 life from prostate cancer, and you couldn't tell which one in advance you were going to save. The morbidity from the other 49 such as incontinence and impotence would not be welcomed.
Isolated high cholesterol in a well 50 year old is a moot point too, the "number needed to treat" is high.
Scanning with one modality such as CT has a low pickup rate for cancers in the asymptomatic.
It hasn't been possible to devise a screening programme for smokers to try to pick up early lung cancers. Plain CXR misses many that are mediastinal or too early, and many lung cancers arise in between screening tests.
Bottom line is just because a screen can be offered it doesn't mean it is of proven benefit or value for money. Sometimes it takes longer to explain all the above to someone convinced they want an "MOT" than to just do it for them.
Women get offered breast screening from 50. Men and women over 45 are offered BP checks every 5 years.
If you want to get more into the value (or otherwise) of screening, you can check http://en.wikipedia.org/wiki/Screening_(medicine)
I expect in future there will be more screening for type 2 diabetes and high cholesterol since these especially in combination with other risks are both dangerous and silent.
PSA testing can reduce mortality from prostate cancer, but the latest data I saw was that you had to do 50 prostatectomies to save 1 life from prostate cancer, and you couldn't tell which one in advance you were going to save. The morbidity from the other 49 such as incontinence and impotence would not be welcomed.
Isolated high cholesterol in a well 50 year old is a moot point too, the "number needed to treat" is high.
Scanning with one modality such as CT has a low pickup rate for cancers in the asymptomatic.
It hasn't been possible to devise a screening programme for smokers to try to pick up early lung cancers. Plain CXR misses many that are mediastinal or too early, and many lung cancers arise in between screening tests.
Bottom line is just because a screen can be offered it doesn't mean it is of proven benefit or value for money. Sometimes it takes longer to explain all the above to someone convinced they want an "MOT" than to just do it for them.
Brain scan checking for tumors, heart scan checking for furried clogging of the arteries, lung scans checking for cancers, blood tests for cholestoral, sexual health screening, cancerous mole checks, the list is endless. Surely there are companies out there that offer all this?
You catch furring of the arteries early enough, surely you stop yourself from having a heart attack with a change in lifestyle? Im not a medical professor like you but I would rather catch something early? For heart attack patients, isnt the normal procedure post heart attack to inject the arteries with a special dye, scan the arteries and see where any blockages are or where any are likely to be? Heart disease is a big killer, surely these kinds of tests could be done prior not post heart attack?
Or is it much simpler just to measure cholestoral? Low reading = good heart?
All a bit of a minefield, but I like the idea of these health check MOT's if they were to go in depth like this. How old is the Queen and her fella for example? Just fortunate with age or are they having regular MOT's keeping them alive longer
17 April 2012, 02:49 PM
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"Brain scan checking for tumors"
How many cells before you detect on a scan? Usually they are metastases from somewhere else. OTOH, scan normal people and you find all sorts of things in their head that you wish you'd never found, like collections of fragile blood vessels that may bleed if you do nothing and will probably bleed if you do.
"heart scan checking for furried clogging of the arteries"
Doesn't show on most scans, angiogram is required. It is an invasive procedure carrying a lot of x-ray exposure, a cannula in your chest or groin or arm, and a risk of anapylaxis to the dye.
"lung scans checking for cancers"
They don't work, see earlier note about smokers.
"blood tests for cholestoral"
See below.
"sexual health screening"
Chlamydia screening is useful, but less so in 50 year olds.
"cancerous mole checks"
Lots of dermatofibromas get removed
"the list is endless"
it is of things you can make worse by meddling.
"Surely there are companies out there that offer all this?"
Of course there are, doesn't mean that the benefits are proven.
"You catch furring of the arteries early enough, surely you stop yourself from having a heart attack with a change in lifestyle?"
How to detect - see earlier reply. Change your lifestyle anyway.
"Im not a medical professor like you but I would rather catch something early?"
Great idea, reality is more complex.
"For heart attack patients, isnt the normal procedure post heart attack to inject the arteries with a special dye, scan the arteries and see where any blockages are or where any are likely to be? Heart disease is a big killer, surely these kinds of tests could be done prior not post heart attack?"
See reply above, it is quite invasive and in well people you would very possibly do more harm from x-ray irradiation and reactions to the dye.
"Or is it much simpler just to measure cholestoral? Low reading = good heart?"
No. Lots of people with normal cholesterol have MIs.
"All a bit of a minefield, but I like the idea of these health check MOT's if they were to go in depth like this."
Often an illusion.
"How old is the Queen and her fella for example? Just fortunate with age or are they having regular MOT's keeping them alive longer"
Genetics, luck and to some degree good medical care.
--
I'm all for appropriate and evidence based screening, but just because something seems a good idea doesn't mean it is worth doing unless there is evidence for it.
How many cells before you detect on a scan? Usually they are metastases from somewhere else. OTOH, scan normal people and you find all sorts of things in their head that you wish you'd never found, like collections of fragile blood vessels that may bleed if you do nothing and will probably bleed if you do.
"heart scan checking for furried clogging of the arteries"
Doesn't show on most scans, angiogram is required. It is an invasive procedure carrying a lot of x-ray exposure, a cannula in your chest or groin or arm, and a risk of anapylaxis to the dye.
"lung scans checking for cancers"
They don't work, see earlier note about smokers.
"blood tests for cholestoral"
See below.
"sexual health screening"
Chlamydia screening is useful, but less so in 50 year olds.
"cancerous mole checks"
Lots of dermatofibromas get removed
"the list is endless"
it is of things you can make worse by meddling.
"Surely there are companies out there that offer all this?"
Of course there are, doesn't mean that the benefits are proven.
"You catch furring of the arteries early enough, surely you stop yourself from having a heart attack with a change in lifestyle?"
How to detect - see earlier reply. Change your lifestyle anyway.
"Im not a medical professor like you but I would rather catch something early?"
Great idea, reality is more complex.
"For heart attack patients, isnt the normal procedure post heart attack to inject the arteries with a special dye, scan the arteries and see where any blockages are or where any are likely to be? Heart disease is a big killer, surely these kinds of tests could be done prior not post heart attack?"
See reply above, it is quite invasive and in well people you would very possibly do more harm from x-ray irradiation and reactions to the dye.
"Or is it much simpler just to measure cholestoral? Low reading = good heart?"
No. Lots of people with normal cholesterol have MIs.
"All a bit of a minefield, but I like the idea of these health check MOT's if they were to go in depth like this."
Often an illusion.
"How old is the Queen and her fella for example? Just fortunate with age or are they having regular MOT's keeping them alive longer"
Genetics, luck and to some degree good medical care.
--
I'm all for appropriate and evidence based screening, but just because something seems a good idea doesn't mean it is worth doing unless there is evidence for it.
17 April 2012, 03:01 PM
#11
Just as an aside, in my line of work there is no mass x-ray screening for tumours / cysts of the jaws as you would statistically cause more disease from the mass dose of x-rays the population would get.
Also the false positives (invasive treatent for nothing actually there) would have more morbidity than leaving things as they were.......
Small x-rays looking for decay at say 2 yearly intervals is OK though
Shaun
Also the false positives (invasive treatent for nothing actually there) would have more morbidity than leaving things as they were.......
Small x-rays looking for decay at say 2 yearly intervals is OK though
Shaun
17 April 2012, 03:46 PM
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Thanks for the replies, and thanks John for such a detailed post. At the moment, as far as i can tell, my health is good. I guess what i was looking for is like when you go to the dentist and he says, this-this and this is good, this you ned to do a bit more. It seems its not a simple as that.
17 April 2012, 04:08 PM
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without reading above
a full blood work assessment is a great indicator. it can be used for so many things from free testosterone/ldl-hdl ratios, liver enzyme levels, kidney function
the list can be huge and would be my first port of call.
a full blood work assessment is a great indicator. it can be used for so many things from free testosterone/ldl-hdl ratios, liver enzyme levels, kidney function
the list can be huge and would be my first port of call.
17 April 2012, 05:37 PM
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its ldl/hdl ratios that are importnt
combined wth high blood pressure can lead to heart ttacks if arteries have plaque build up/swelling.
but youll never get a definitive answer
just an educated guess.
like i said a blood test is the best place to start, as you get older your body generally looses the ablilty to maintain hormone balances - and in later lafe you can clearly see t, old omen with facial hair, old men with t*ts - obv aging has all these effects and more.
but things like kidney function, liver enzyme assessment, blood lipids, b.p ect can all easilt be check along with estrogen levels ec ect - its fairly quick and simple and ill post later a full list of what to ask doc for.
genetics will larlgey dictate your health - along with diet/lifestyle, but certainly no harm in checking along the way.
combined wth high blood pressure can lead to heart ttacks if arteries have plaque build up/swelling.
but youll never get a definitive answer
just an educated guess.
like i said a blood test is the best place to start, as you get older your body generally looses the ablilty to maintain hormone balances - and in later lafe you can clearly see t, old omen with facial hair, old men with t*ts - obv aging has all these effects and more.
but things like kidney function, liver enzyme assessment, blood lipids, b.p ect can all easilt be check along with estrogen levels ec ect - its fairly quick and simple and ill post later a full list of what to ask doc for.
genetics will larlgey dictate your health - along with diet/lifestyle, but certainly no harm in checking along the way.
17 April 2012, 05:47 PM
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Well at 52, and maybe due to go on a extended high altitude walk, I popped in my gp's had a bp test 4bloods and a resting ecg, all ok , so can a least start some exercise with a slightly clearer mind.
17 April 2012, 06:07 PM
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17 April 2012, 07:15 PM
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Blood tests don't say you are healthy though. Patients love them, but they put far too much faith in them.
You can have an MI at 50 and have normal cholesterol.
You can have lost 90% of your kidneys and have normal "renal function".
You have have liver failure and have normal "liver function tests".
You can have a normal ECG and have severe coronary artery disease that will kill you tomorrow.
Screening tests, and tests generally, need evidence.
You can have an MI at 50 and have normal cholesterol.
You can have lost 90% of your kidneys and have normal "renal function".
You have have liver failure and have normal "liver function tests".
You can have a normal ECG and have severe coronary artery disease that will kill you tomorrow.
Screening tests, and tests generally, need evidence.
17 April 2012, 07:33 PM
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Every year i have an MOT at the quacks
quick lifestyle chat, weight & choloesterol check, and the mandatory bloods
only thing that came back last year was that i have gilberts disease
Non life threatening, but need to be aware of
worth doing even if its a wake up call about weight etc
Mart
quick lifestyle chat, weight & choloesterol check, and the mandatory bloods
only thing that came back last year was that i have gilberts disease
Non life threatening, but need to be aware of
worth doing even if its a wake up call about weight etc
Mart
17 April 2012, 08:10 PM
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Blood tests don't say you are healthy though. Patients love them, but they put far too much faith in them.
You can have an MI at 50 and have normal cholesterol.
You can have lost 90% of your kidneys and have normal "renal function".
You have have liver failure and have normal "liver function tests".
You can have a normal ECG and have severe coronary artery disease that will kill you tomorrow.
Screening tests, and tests generally, need evidence.
You can have an MI at 50 and have normal cholesterol.
You can have lost 90% of your kidneys and have normal "renal function".
You have have liver failure and have normal "liver function tests".
You can have a normal ECG and have severe coronary artery disease that will kill you tomorrow.
Screening tests, and tests generally, need evidence.
its all educated guessess
which is about as good a place to be.
a look back at your family history and understand family genetics, can help. and a realisation and underatnding of nutrition/excersise
but even still, anyone could drop dead tomorow
a blood test is free, easy to get done, and CAN highlight possible issues
no-ones ever going to be able to predict your future
17 April 2012, 08:29 PM
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How strange... Only booked myself a "well man" check today at the local docs.... Lived in the town for 17 yrs , never been to the docs... Lol... I'm 42, i read in our local town paper that they were offering over 40's well man checks.
Phoned up to book, itself a trial involving several attempts and 10 min 'all our operators are busy' messages (you could be dead by the time they answer the phone!) i'm booked in in a couple of weeks.
Told the lady on the phone that i havent been to the docs for over 20 yrs... She laughed and said lucky you!
Phoned up to book, itself a trial involving several attempts and 10 min 'all our operators are busy' messages (you could be dead by the time they answer the phone!) i'm booked in in a couple of weeks.
Told the lady on the phone that i havent been to the docs for over 20 yrs... She laughed and said lucky you!
17 April 2012, 09:18 PM
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I'm not going to argue too much with a blood test as I don't in the surgery either, much to the dismay of my laboratory colleagues who are concerned about the appropriateness of tests and their cost. A lot of tests I do are for reassurance, because the patient wants to come away with something like a prescription or a blood test to make them feel validated, even when you can try to devote more time and insight into a reasoned explanation, if a test is what they want, no matter how useless, that is what they get as they are the tax paying customer 
Doing tests is therapeutic in its own right and is a placebo effect, and also a useful delaying tactic when you know the condition is most likely to be self limiting and only very rarely would a blood result alter your management or be a surprise.
However, when you introduce the false positives and false negatives, the cost effectiveness, the "normal range" that includes 95% with an enforced Gaussian distribution, and the sheer bad science of throwing inappropriate tests around, it really is a waste of time screening the worried well just because it is fashionable. If you're a private company and can make money from it, fair enough. I can't remember the last time when a fishing expedition yielded something useful in any of my worried well/asymptomatic patients. If there is relevant family or personal history, or symptoms, that is where the attention should be paid.
Otherwise, national screening programmes that are evidence based should be developed rather than a random scattergun approach of tests to people that ask for them not understanding their indiciations and limitations.
I didn't mention the bowel screening programme, our area was a pilot for it. That is also worthwhile.
A lot of stuff is simple advice about contraception, sexually transmitted infection, pre-pregnancy counselling, alcohol, smoking, exercise, diet. But it seems too simple to people that want tests even to the detriment of these basics.
Doing tests is therapeutic in its own right and is a placebo effect, and also a useful delaying tactic when you know the condition is most likely to be self limiting and only very rarely would a blood result alter your management or be a surprise.However, when you introduce the false positives and false negatives, the cost effectiveness, the "normal range" that includes 95% with an enforced Gaussian distribution, and the sheer bad science of throwing inappropriate tests around, it really is a waste of time screening the worried well just because it is fashionable. If you're a private company and can make money from it, fair enough. I can't remember the last time when a fishing expedition yielded something useful in any of my worried well/asymptomatic patients. If there is relevant family or personal history, or symptoms, that is where the attention should be paid.
Otherwise, national screening programmes that are evidence based should be developed rather than a random scattergun approach of tests to people that ask for them not understanding their indiciations and limitations.
I didn't mention the bowel screening programme, our area was a pilot for it. That is also worthwhile.
A lot of stuff is simple advice about contraception, sexually transmitted infection, pre-pregnancy counselling, alcohol, smoking, exercise, diet. But it seems too simple to people that want tests even to the detriment of these basics.
Last edited by john banks; 17 April 2012 at 09:21 PM.
18 April 2012, 03:06 PM
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john i agree with some, but disagree with other points of yours.
using blood tests to try and diagnose health issues isnt the way forward,
we all know all levels vary, day to day, and even by the hour, cortisol levels can change very quickly. liver enzymes can vary depending on food consumed/excersise/smoking ect ect ect
theres a whole load of avriables and a single blood test just captures that tiny moment in time.
which is why id recommend several tests and using mean results as a general indicator.
the placebo effect you mention is true and in itself can have positive effects on health.
again id reinforce an understanding of family genetics if people are worried and seek appropriate tests.
but there is a definatley a place for blood tests, it CAN be a very useful tool. aslong as the patient understands what it actually is and is not dis-illusioned into thinking within normal ranges on results means a clean bill of health.
i dont know in what capacity you work, or did work, but imo thats the job of the GP to explain and educate the patient.
goodness knows, no-one else in the country is trying to educate the massess apart from the media, and we all know how thats going!
i take on your point some just want a bit of paper with numbers or a prescription, when really theres an underlying issue that may need investigating down another route, and atleast your trying to explain to the patient what is actually the best move - trying to educate, but like you say some just wont listen.
using blood tests to try and diagnose health issues isnt the way forward,
we all know all levels vary, day to day, and even by the hour, cortisol levels can change very quickly. liver enzymes can vary depending on food consumed/excersise/smoking ect ect ect
theres a whole load of avriables and a single blood test just captures that tiny moment in time.
which is why id recommend several tests and using mean results as a general indicator.
the placebo effect you mention is true and in itself can have positive effects on health.
again id reinforce an understanding of family genetics if people are worried and seek appropriate tests.
but there is a definatley a place for blood tests, it CAN be a very useful tool. aslong as the patient understands what it actually is and is not dis-illusioned into thinking within normal ranges on results means a clean bill of health.
i dont know in what capacity you work, or did work, but imo thats the job of the GP to explain and educate the patient.
goodness knows, no-one else in the country is trying to educate the massess apart from the media, and we all know how thats going!
i take on your point some just want a bit of paper with numbers or a prescription, when really theres an underlying issue that may need investigating down another route, and atleast your trying to explain to the patient what is actually the best move - trying to educate, but like you say some just wont listen.
18 April 2012, 05:41 PM
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I'm a GP. I'm not sure what points you don't agree on. The internet has democratised medical knowledge and increased awareness, but it has also resulted in patients who become inappropriately wedded to a test, procedure, diagnosis or treatment, and they often don't have the background scientific knowledge that (most) medical students have to be able to understand, criticise and weigh their new found information. I'm delighted to give a rationale behind my opinion and decisions, but it is difficult when the person receiving the explanation doesn't have the ability to understand it, yet thinks they know better. You think you have their understanding and then it is betrayed by a checking question or them still being fixed to their original (incorrect) notion.
Outwith the context of research, or sports training, there are very few mainstream blood tests that benefit from being repeated on the basis that they were a single time sample, and even fewer if they were inappropriate in the first place.
The few I can think of which I commonly use:
Glucose should be fasting and repeated two hours after a glucose load to do a glucose tolerance test (but that will probably be replaced by glycated Hb)
Progesterone should be on day 21 of the menstrual cycle to establish ovulation
Drug levels for those with short half lives or particular peak levels after ingestion should be monitored in a range of time from the last dose (eg lithium, digoxin)
Other drug and disease monitoring should be periodic at evidence based intervals to screen for complications/disease progression
LDL levels should be fasting
Cholesterol levels for long term management should be delayed 6 weeks after an MI
Short synacthen tests we don't do as we don't have regular and fast enough transport to the lab, but they are time sensitive
If it is the wrong test for the wrong person, it doesn't matter how many times you do it and when. There are many times when repeating a normal test (previously done for reassurance) is still totally inappropriate and the lab will automatically reject some repeat requests within a certain time if they are expensive and not evidence based.
Good medicine can be measured in many ways, but a lot of quality markers can be related to low levels of (inappropriate) intervention rather than high levels. Defensive medicine in the US has a lot to answer for, which is why the good old NHS despite being slow for routine stuff and sometimes disgusting in its neglect of the vulnerable, gives very good value for money indeed, far surpassing most other systems when you compare outcomes and budget.
I am trying very hard not to produce another generation with "thick files". The trouble is some worried well will present symptoms that press certain buttons a doctor cannot ignore, resulting in inappropriate investigations and procedures.
Then others will ask for "MOTs", when really they need to take their car to the garage and deal with the elephant in the room which is their lifestyle.
Outwith the context of research, or sports training, there are very few mainstream blood tests that benefit from being repeated on the basis that they were a single time sample, and even fewer if they were inappropriate in the first place.
The few I can think of which I commonly use:
Glucose should be fasting and repeated two hours after a glucose load to do a glucose tolerance test (but that will probably be replaced by glycated Hb)
Progesterone should be on day 21 of the menstrual cycle to establish ovulation
Drug levels for those with short half lives or particular peak levels after ingestion should be monitored in a range of time from the last dose (eg lithium, digoxin)
Other drug and disease monitoring should be periodic at evidence based intervals to screen for complications/disease progression
LDL levels should be fasting
Cholesterol levels for long term management should be delayed 6 weeks after an MI
Short synacthen tests we don't do as we don't have regular and fast enough transport to the lab, but they are time sensitive
If it is the wrong test for the wrong person, it doesn't matter how many times you do it and when. There are many times when repeating a normal test (previously done for reassurance) is still totally inappropriate and the lab will automatically reject some repeat requests within a certain time if they are expensive and not evidence based.
Good medicine can be measured in many ways, but a lot of quality markers can be related to low levels of (inappropriate) intervention rather than high levels. Defensive medicine in the US has a lot to answer for, which is why the good old NHS despite being slow for routine stuff and sometimes disgusting in its neglect of the vulnerable, gives very good value for money indeed, far surpassing most other systems when you compare outcomes and budget.
I am trying very hard not to produce another generation with "thick files". The trouble is some worried well will present symptoms that press certain buttons a doctor cannot ignore, resulting in inappropriate investigations and procedures.
Then others will ask for "MOTs", when really they need to take their car to the garage and deal with the elephant in the room which is their lifestyle.
Last edited by john banks; 18 April 2012 at 05:44 PM.
18 April 2012, 06:20 PM
#26
I think in short if your body is fubared, then its fubared.
You or anyone else no matter how professional won't know until it gets to the point where it says "I've had enough". Pain is a main indicator, collapsing on the floor into a twitching mess probably means its pretty urgent (or you're drunk).
Although I'd like a brain MRI scan...I'm pretty certain something isn't quite right in here
You or anyone else no matter how professional won't know until it gets to the point where it says "I've had enough". Pain is a main indicator, collapsing on the floor into a twitching mess probably means its pretty urgent (or you're drunk).
Although I'd like a brain MRI scan...I'm pretty certain something isn't quite right in here
18 April 2012, 09:22 PM
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john, serious question because it really is internet folklore about the amount of time GP basic trainig is spend on endocrinology (sp)
be it right or wrong it would be great if you could clarify - as your directly involved in some form of medicinal training, but in a GP's training period, of 4 years im maybe mistakely informed? something like 4 weeks spent teaching students on endocrine and related issues
would be fantastic if you can rubbish or clarify this commonly spouted myth/truth.
my own personal experience and its most probably wrong is GP's are there to prescribe anti-biotics or refer you to a specialist - i understand thats greatly insulting as there will be so much more invovlement in areas i couldnt even comprehend. and background learning and teaching im not aware of.
youll probably have guessed my points come from a sport related background, where hormone manipulation is common place, but at same time the people invovlved tend to have a massively greater understanding of the role of hormones/nutrition and excersise - be that aerobic or anerobic.
i have ten years plus in"internet" mythology background regarding anabolic/androgenic steroids, and its fairly easy nowto differentiate btween truth and fiction to a certain extent
but some clarification on my paoints above can mean i can pass on genuine info to interested parties
ive seen local goverment publications, at needle excahnges nd clinins and to be nice to them they are wildy innacurrate, misleading and downright dangerous in some instances.
i coach a lot of athletes and only like to pass on accurate info, most of which ive accrued myself over the past ten years
be nice to hear a non biased veiw point
be it right or wrong it would be great if you could clarify - as your directly involved in some form of medicinal training, but in a GP's training period, of 4 years im maybe mistakely informed? something like 4 weeks spent teaching students on endocrine and related issues
would be fantastic if you can rubbish or clarify this commonly spouted myth/truth.
my own personal experience and its most probably wrong is GP's are there to prescribe anti-biotics or refer you to a specialist - i understand thats greatly insulting as there will be so much more invovlement in areas i couldnt even comprehend. and background learning and teaching im not aware of.
youll probably have guessed my points come from a sport related background, where hormone manipulation is common place, but at same time the people invovlved tend to have a massively greater understanding of the role of hormones/nutrition and excersise - be that aerobic or anerobic.
i have ten years plus in"internet" mythology background regarding anabolic/androgenic steroids, and its fairly easy nowto differentiate btween truth and fiction to a certain extent
but some clarification on my paoints above can mean i can pass on genuine info to interested parties
ive seen local goverment publications, at needle excahnges nd clinins and to be nice to them they are wildy innacurrate, misleading and downright dangerous in some instances.
i coach a lot of athletes and only like to pass on accurate info, most of which ive accrued myself over the past ten years
be nice to hear a non biased veiw point
18 April 2012, 10:26 PM
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Understanding PCT
PCT, what does it mean?
Post Cycle Therapy.
What does it do?
It returns your Hypothalamus, Pituitary, Testicular, Axis (HPTA) back to producing its own endogenous testosterone production.
How long does it last?
Good question but in my opinion the normal 21 to 30 days protocol is too short unless suppression of the HPTA is minor.
Ok, you produce about 7 mg of testosterone a day or around 49 mg a week on average, some more, some less (usually older guys).
So, you go on a cycle of lets say 500mg of testosterone a week or about 10 times your natural production. The body sees this as too much testosterone and will lower production of testosterone to try to maintain homeostasis (balance). The body loves homeostasis.
Testosterone in a man gets converted into two other hormones; one of those hormones is DHT (dihydrotestosterone) this is done by an enzyme called 5-alpha-reductace. DHT is actually about 3-5 times more androgenic than testosterone.
The other hormone it gets converted to is estradiol (E2), this is a strong estrogen but from now on we will just refer to it as estrogen, even though there are 3 different kinds of estrogen. Testosterone gets converted into estrogen by another enzyme called aromatase. The conversion is called aromatization.
Ok, the body will convert more testosterone into estrogen probably to try and maintain homeostasis, so the more test, the more estrogen. For most this estrogen is not a problem. But for some it will be a problem and this extra estrogen can give side effects like gynecomastia (gyno) or water retention, but one big problem is estrogens suppressive effects on Luteinizing Hormone or (LH) LH is what the pituitary gland sends as a chemical hormone to the Leydig cells in the ********* where the ********* will product testosterone. Estrogen is probably 100-200 times as suppressive as testosterone.
So when LH production stops (exogenous testosterone will do this too) the ********* will stop producing and like anything not being used will atrophy.
What does this mean?
You will get some small *****, no kidding mine have been the size of almonds without the shell.
OK, so you come off a cycle, the exogenous testosterone is tapering down and after about a couple of weeks (this is the clearance time for testosterone cypionate and enanthate) you end up with low levels of testosterone as your endogenous production has long been stopped. Now here where the problem starts. You potentially have the testosterone of a woman, and high estrogen from all that aromatization.
This can be a recipe for disaster, why? Because men need test to feel normal and not only that hard earned muscle will be eaten up by being in a catabolic environment, not to mention there is still going to be some suppression because of elevated estrogen.
I have seen big strong men carry on like crying women in this state; it is very bad, sex drive is zero, no energy, emotional, insecure, the list is long.
So, what can you do?
First of all in my opinion bringing the nuts back online is very important, the most important. This is done with the use of Human Chorionic Gonadotropin (HCG)
It basically is pregnant woman’s urine. HCG mimics LH and as we learned above that LH is the chemical hormone that stimulates the Leydig cells to produce testosterone. HCG is very strong and many times stronger than the amount of LH that the pituitary puts out.
The typical dose is anywhere around 350iu to as much as 2500iu and even in some cases more but I don’t recommend this. Best advice is to use as little as possible to achieve success at bringing the nuts back to life from their nice little vacation.
The half life of HCG is around 3 days or so, so Subcutaneous (Sub-Q) shots or Intramuscular Shots (IM) are done about Every Other Day (EOD or Every 3 Days (E3D).
If you use too much for too long desentization of the Leydig cells can happen and this is not good.
One other thing is HCG aromatizes pretty heavily. So an anti estrogen is always recommended if you shoot more than 500iu and even that if you are gyno prone would be a good idea to add an anti E.
HCG comes in tow bottles or vials and one is powder and the other is a solvent or bacteriostatic water, the water gets added to the powder and this is called reconstitution. Once HCG is mixed it must be refrigerated. In bacteriostatic water it will last around a month.
Now next we want to block the hypothalamus and pituitary gland from that excess estrogen as that in itself is suppressive.
How is this done? With a drug called Clomiphene citrate (clomid). This is really a drug to help women ovulate but it acts as a Selective Estrogen Receptor Modulator (SERM).
It occupy’s the estrogen receptors in the hypothalamus and pituitary and blocks estrogens exertion on those glands. It’s like putting a key in a lock but not turning the key. It is just occupying that space without really doing anything.
Clomid in my opinion works better than another SERM that many people use called Nolvadex. Both pretty much do the same thing but together I have found to be far superior than using any of them by themselves.
Clomid is used to test the pituitary for secondary hypogonadism, clomid @ 100mg a day after 5 to 7 days will double LH responce and increase FSH by 20% to 50%, that is huge.
Both clomid and nolva are in pill form as well as liquid form.
What these do is block estrogen. The body sees this as it is low in testosterone and estrogens suppressive effects are not there as the receptors are blocked. So it see’s this as low testosterone and low estrogen so the body turns on the hypothalamus to produce Gonadotropin Releasing Hormone (GnRH) which in turn tells the pituitary gland to produce LH and FSH (follicle stimulating hormone). FSH is another hormone that stimulates the Sertoli cells in the ********* to produce sperm.
Ok, so lets put this all together.
There are a couple of ways you can do this.
First you can take HCG in small amounts during the cycle to maintain testicular function or you can take it after the cycle is finished to start your PCT.
Either way is fine but if the cycle is very long then long use of HCG can be a problem due to the possibility of desentization of the Leydig cells.
That’s pretty much the last thing you want to do as you want your own LH production to keep the ********* producing test.
So, what you can do is wait about 2 weeks for the testosterone to clear your system or be around base levels of normal producing test and start your HCG, clomid and nolvadex all at the same time.
You don’t have to worry about the aromatization issue because both clomid and nolvadex are anti-estrogens or act as anti-estrogens in the body.
By the way nolvadex is used in estrogen sensitive cancer tissues like in treating breast cancer.
I take clomid at 50mg twice a day (12hrs apart) for 30 days.
I take nolvadex at 20 mg a day for 45 days.
I take anywhere from 1000iu EOD to 2500 EOD for 8 shots (16 days).
So the HCG is taking care of the nuts and taking them off vacation and putting them back to work and the nolvadex and clomid will help the hypothalamus produce GnRH which will tell the pituitary to produce LH and FSH.
Once the ********* are producing test on their own you stop the administration of HCG and let the body take over, kind of like handing a baton when doing a relay race.
Depending on the type of gear, length of time on, amount of gear, all play in this factor of recovery, not to mention the genetic factors involved in shutdown.
I shutdown very hard and I notice atrophy in as little as 3 weeks.
followed by
1982 Jun;29(3):287-92.Related Articles, Links
Effect of vitamin E on function of pituitary-gonadal axis in male rats and human subjects.
Umeda F, Kato K, Muta K, Ibayashi H.
The role of vitamin E in the endocrine system, in particular the pituitary-gonadal axis, was studied in humans and male rats by examining the hormonal differences between vitamin E deficient and supplemented conditions. In vitamin E deficient rats, pituitary content and basal plasma level of FSH and LH were significantly lower than those of the control rats, but testicular content and basal plasma level of testosterone were not significantly changed. On the other hand, in vitamin E supplemented rats, FSH and LH content in pituitary tissue was significantly higher than that of the controls, but there was no significant rise in basal FSH and LH level in plasma. The testosterone level was significantly elevated in both testicular tissue and plasma. It was also demonstrated that basal plasma testosterone and F.T.I. were increased in normal male subjects following oral vitamin E administration and the responsiveness of plasma testosterone levels to HCG was significantly higher during vitamin E administration than before administration. These results suggest that vitamin E may play an important and potent role in hormone production in the pituitary-gonadal axis in humans and rats.
PMID: 6816576 [PubMed - indexed for MEDLINE]
Also, Dr. Shippen a TRT doctor suggested that men with a Vitamin D defiency had less responce from HCG.
Beings that Vitamin D only occurs naturally in oily fish and the yolk of eggs in foods, it needs to be supplemented, or you need to go out in the sun and have your face and upper torso exposed.
Funny thing, I think it was ChefX that suggested that sunlight could increase testosterone levels in men by 128%
In the summer time men tend to have higher levels of testosterone.
Dr. Mircole(sp) suggested that the RDA in vitamin D was far too low, and influenza can be minimised by larger doses of D.
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john - this is slighty dated info from 2009 and directly pointed at AAS users, and is failry widly regarded as decent information to help users with HTPA recovery.
its been a long time since ive read fully but, my opinion on hcg use in performance enhancing drug users is small and frequent hcg use to reduce the risk of testicular atrophy and htpa shutdown where hcg help stimulate LH.
all above info i attribute to Hacksii
whats do you make of it mate, in a professional capacity, putting side ethics of AAS use
PCT, what does it mean?
Post Cycle Therapy.
What does it do?
It returns your Hypothalamus, Pituitary, Testicular, Axis (HPTA) back to producing its own endogenous testosterone production.
How long does it last?
Good question but in my opinion the normal 21 to 30 days protocol is too short unless suppression of the HPTA is minor.
Ok, you produce about 7 mg of testosterone a day or around 49 mg a week on average, some more, some less (usually older guys).
So, you go on a cycle of lets say 500mg of testosterone a week or about 10 times your natural production. The body sees this as too much testosterone and will lower production of testosterone to try to maintain homeostasis (balance). The body loves homeostasis.
Testosterone in a man gets converted into two other hormones; one of those hormones is DHT (dihydrotestosterone) this is done by an enzyme called 5-alpha-reductace. DHT is actually about 3-5 times more androgenic than testosterone.
The other hormone it gets converted to is estradiol (E2), this is a strong estrogen but from now on we will just refer to it as estrogen, even though there are 3 different kinds of estrogen. Testosterone gets converted into estrogen by another enzyme called aromatase. The conversion is called aromatization.
Ok, the body will convert more testosterone into estrogen probably to try and maintain homeostasis, so the more test, the more estrogen. For most this estrogen is not a problem. But for some it will be a problem and this extra estrogen can give side effects like gynecomastia (gyno) or water retention, but one big problem is estrogens suppressive effects on Luteinizing Hormone or (LH) LH is what the pituitary gland sends as a chemical hormone to the Leydig cells in the ********* where the ********* will product testosterone. Estrogen is probably 100-200 times as suppressive as testosterone.
So when LH production stops (exogenous testosterone will do this too) the ********* will stop producing and like anything not being used will atrophy.
What does this mean?
You will get some small *****, no kidding mine have been the size of almonds without the shell.
OK, so you come off a cycle, the exogenous testosterone is tapering down and after about a couple of weeks (this is the clearance time for testosterone cypionate and enanthate) you end up with low levels of testosterone as your endogenous production has long been stopped. Now here where the problem starts. You potentially have the testosterone of a woman, and high estrogen from all that aromatization.
This can be a recipe for disaster, why? Because men need test to feel normal and not only that hard earned muscle will be eaten up by being in a catabolic environment, not to mention there is still going to be some suppression because of elevated estrogen.
I have seen big strong men carry on like crying women in this state; it is very bad, sex drive is zero, no energy, emotional, insecure, the list is long.
So, what can you do?
First of all in my opinion bringing the nuts back online is very important, the most important. This is done with the use of Human Chorionic Gonadotropin (HCG)
It basically is pregnant woman’s urine. HCG mimics LH and as we learned above that LH is the chemical hormone that stimulates the Leydig cells to produce testosterone. HCG is very strong and many times stronger than the amount of LH that the pituitary puts out.
The typical dose is anywhere around 350iu to as much as 2500iu and even in some cases more but I don’t recommend this. Best advice is to use as little as possible to achieve success at bringing the nuts back to life from their nice little vacation.
The half life of HCG is around 3 days or so, so Subcutaneous (Sub-Q) shots or Intramuscular Shots (IM) are done about Every Other Day (EOD or Every 3 Days (E3D).
If you use too much for too long desentization of the Leydig cells can happen and this is not good.
One other thing is HCG aromatizes pretty heavily. So an anti estrogen is always recommended if you shoot more than 500iu and even that if you are gyno prone would be a good idea to add an anti E.
HCG comes in tow bottles or vials and one is powder and the other is a solvent or bacteriostatic water, the water gets added to the powder and this is called reconstitution. Once HCG is mixed it must be refrigerated. In bacteriostatic water it will last around a month.
Now next we want to block the hypothalamus and pituitary gland from that excess estrogen as that in itself is suppressive.
How is this done? With a drug called Clomiphene citrate (clomid). This is really a drug to help women ovulate but it acts as a Selective Estrogen Receptor Modulator (SERM).
It occupy’s the estrogen receptors in the hypothalamus and pituitary and blocks estrogens exertion on those glands. It’s like putting a key in a lock but not turning the key. It is just occupying that space without really doing anything.
Clomid in my opinion works better than another SERM that many people use called Nolvadex. Both pretty much do the same thing but together I have found to be far superior than using any of them by themselves.
Clomid is used to test the pituitary for secondary hypogonadism, clomid @ 100mg a day after 5 to 7 days will double LH responce and increase FSH by 20% to 50%, that is huge.
Both clomid and nolva are in pill form as well as liquid form.
What these do is block estrogen. The body sees this as it is low in testosterone and estrogens suppressive effects are not there as the receptors are blocked. So it see’s this as low testosterone and low estrogen so the body turns on the hypothalamus to produce Gonadotropin Releasing Hormone (GnRH) which in turn tells the pituitary gland to produce LH and FSH (follicle stimulating hormone). FSH is another hormone that stimulates the Sertoli cells in the ********* to produce sperm.
Ok, so lets put this all together.
There are a couple of ways you can do this.
First you can take HCG in small amounts during the cycle to maintain testicular function or you can take it after the cycle is finished to start your PCT.
Either way is fine but if the cycle is very long then long use of HCG can be a problem due to the possibility of desentization of the Leydig cells.
That’s pretty much the last thing you want to do as you want your own LH production to keep the ********* producing test.
So, what you can do is wait about 2 weeks for the testosterone to clear your system or be around base levels of normal producing test and start your HCG, clomid and nolvadex all at the same time.
You don’t have to worry about the aromatization issue because both clomid and nolvadex are anti-estrogens or act as anti-estrogens in the body.
By the way nolvadex is used in estrogen sensitive cancer tissues like in treating breast cancer.
I take clomid at 50mg twice a day (12hrs apart) for 30 days.
I take nolvadex at 20 mg a day for 45 days.
I take anywhere from 1000iu EOD to 2500 EOD for 8 shots (16 days).
So the HCG is taking care of the nuts and taking them off vacation and putting them back to work and the nolvadex and clomid will help the hypothalamus produce GnRH which will tell the pituitary to produce LH and FSH.
Once the ********* are producing test on their own you stop the administration of HCG and let the body take over, kind of like handing a baton when doing a relay race.
Depending on the type of gear, length of time on, amount of gear, all play in this factor of recovery, not to mention the genetic factors involved in shutdown.
I shutdown very hard and I notice atrophy in as little as 3 weeks.
followed by
1982 Jun;29(3):287-92.Related Articles, Links
Effect of vitamin E on function of pituitary-gonadal axis in male rats and human subjects.
Umeda F, Kato K, Muta K, Ibayashi H.
The role of vitamin E in the endocrine system, in particular the pituitary-gonadal axis, was studied in humans and male rats by examining the hormonal differences between vitamin E deficient and supplemented conditions. In vitamin E deficient rats, pituitary content and basal plasma level of FSH and LH were significantly lower than those of the control rats, but testicular content and basal plasma level of testosterone were not significantly changed. On the other hand, in vitamin E supplemented rats, FSH and LH content in pituitary tissue was significantly higher than that of the controls, but there was no significant rise in basal FSH and LH level in plasma. The testosterone level was significantly elevated in both testicular tissue and plasma. It was also demonstrated that basal plasma testosterone and F.T.I. were increased in normal male subjects following oral vitamin E administration and the responsiveness of plasma testosterone levels to HCG was significantly higher during vitamin E administration than before administration. These results suggest that vitamin E may play an important and potent role in hormone production in the pituitary-gonadal axis in humans and rats.
PMID: 6816576 [PubMed - indexed for MEDLINE]
Also, Dr. Shippen a TRT doctor suggested that men with a Vitamin D defiency had less responce from HCG.
Beings that Vitamin D only occurs naturally in oily fish and the yolk of eggs in foods, it needs to be supplemented, or you need to go out in the sun and have your face and upper torso exposed.
Funny thing, I think it was ChefX that suggested that sunlight could increase testosterone levels in men by 128%
In the summer time men tend to have higher levels of testosterone.
Dr. Mircole(sp) suggested that the RDA in vitamin D was far too low, and influenza can be minimised by larger doses of D.
Share
| Like
john - this is slighty dated info from 2009 and directly pointed at AAS users, and is failry widly regarded as decent information to help users with HTPA recovery.
its been a long time since ive read fully but, my opinion on hcg use in performance enhancing drug users is small and frequent hcg use to reduce the risk of testicular atrophy and htpa shutdown where hcg help stimulate LH.
all above info i attribute to Hacksii
whats do you make of it mate, in a professional capacity, putting side ethics of AAS use
18 April 2012, 10:47 PM
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There are various myths about medical education on topic x or y only being z weeks. An outsider has looked at it and found one block designated as endocrinology and looked at the number of weeks and started the myth.
When I trained it was 5 or 6 years at medical school, followed by a year as a junior house officer where you did 6 months each of medicine and surgery (which was split further into subspecialties) and then after 6 or 7 years you are fully registered as a doctor.
To then become a GP you had a minimum of a further 2 years in hospital medicine which typically includes some of medicine, surgery, obs/gynae, psychiatry, paediatrics, A/E, ENT, ophthalmology. Then a further year as a GP trainee.
The total absolute minimum was 9 years, typical 10. New minimum will be 10.
90% of health care episodes are in general practice. Where young people have had exposure to GPs it has usually been minor illness, contraception and some referrals for things that young people need doing. I spend a fair bit of time telling people they don't need antibiotics. It is quite common to be juggling quite complex combinations of illnesses and medications that cross several specialties, and in that case, especially in older people, the role of the GP is more developed than many would realise, particularly when an urgent outpatient appointment is months away, or a premature hospital discharge leaves the patient inadequately managed. New type 2 diabetes, new atrial fibrillation, and the initial stages of managing heart or renal failure along with anaemia, can all existing in one patient and be managed in general practice quite well, and of necessity whilst outpatient appointments are awaited. Patients who are dying can if they wish often be managed entirely at home. The juggling of medications can be very complex, and when people try to replace GPs with nurses in these situations, the proverbial tends to hit the fan quite quickly.
You could say that sport related medicine is neglected, but I don't consider it a core of my work and queries to me about unlicensed or non-prescription medicine, specialist diets and training programmes are met with the suggestion that they get this advice elsewhere. I do not scare my patients that hormone manipulation will do x, y and z, and do cooperate in picking up the pieces. In 10 years as a GP I have only had a few patients with whom I've discussed in detail the effects of their androgenic steroid taking, past, present or planned. It is of major importance to you but for the vast majority of my patients it isn't. My involvement is endocrinology is related to diabetics, thyroid disease, corticosteroids, pituitary tumours, fertility, contraception, cancer treatment, polycystic ovarian syndrome, gynaecomastia, growth related problems, and the level of education and experience in these areas is nearly daily in much medical training and practice, not 4 weeks! The amount of training directly relevant to sex steroids which you'll have far more practical experience of is more limited. Once I could have drawn you out the pathways at a biochemical level, but because they are of no daily relevance to me any more they have been replaced by being sharp on the theory and practice of the illnesses and areas of endocrinology I mentioned above.
This is probably reflected in your opinion of inaccurate health promotion materials.
Anecdotally, my contact with ex-steroid users has been positive and collaborative with a meeting of minds on issues such as CK testing, LFTs, ECGs, BP monitoring, arrythmias, testicular atrophy etc. My contact with younger people embarking on steroid taking has been more frustrating as they were trying to get me to support their androgenic steroid use by monitoring them when I wasn't prescribing for them or in agreement with them taking androgrenic steroids, plus not having specialist training in the area. They also had an attitude that worried me where they said that if they made themselves ill from steroids they didn't care as long as they looked good for a while.
So endocrinology to you and to me are quite different. Personally I don't have much interest in sports medicine or androgenic steroids, but I'm very interested and my patients think I'm quite good at treating the conditions that I consider to be endocrinology and feel in no way under equipped through lack of endocrinology training.
When I trained it was 5 or 6 years at medical school, followed by a year as a junior house officer where you did 6 months each of medicine and surgery (which was split further into subspecialties) and then after 6 or 7 years you are fully registered as a doctor.
To then become a GP you had a minimum of a further 2 years in hospital medicine which typically includes some of medicine, surgery, obs/gynae, psychiatry, paediatrics, A/E, ENT, ophthalmology. Then a further year as a GP trainee.
The total absolute minimum was 9 years, typical 10. New minimum will be 10.
90% of health care episodes are in general practice. Where young people have had exposure to GPs it has usually been minor illness, contraception and some referrals for things that young people need doing. I spend a fair bit of time telling people they don't need antibiotics. It is quite common to be juggling quite complex combinations of illnesses and medications that cross several specialties, and in that case, especially in older people, the role of the GP is more developed than many would realise, particularly when an urgent outpatient appointment is months away, or a premature hospital discharge leaves the patient inadequately managed. New type 2 diabetes, new atrial fibrillation, and the initial stages of managing heart or renal failure along with anaemia, can all existing in one patient and be managed in general practice quite well, and of necessity whilst outpatient appointments are awaited. Patients who are dying can if they wish often be managed entirely at home. The juggling of medications can be very complex, and when people try to replace GPs with nurses in these situations, the proverbial tends to hit the fan quite quickly.
You could say that sport related medicine is neglected, but I don't consider it a core of my work and queries to me about unlicensed or non-prescription medicine, specialist diets and training programmes are met with the suggestion that they get this advice elsewhere. I do not scare my patients that hormone manipulation will do x, y and z, and do cooperate in picking up the pieces. In 10 years as a GP I have only had a few patients with whom I've discussed in detail the effects of their androgenic steroid taking, past, present or planned. It is of major importance to you but for the vast majority of my patients it isn't. My involvement is endocrinology is related to diabetics, thyroid disease, corticosteroids, pituitary tumours, fertility, contraception, cancer treatment, polycystic ovarian syndrome, gynaecomastia, growth related problems, and the level of education and experience in these areas is nearly daily in much medical training and practice, not 4 weeks! The amount of training directly relevant to sex steroids which you'll have far more practical experience of is more limited. Once I could have drawn you out the pathways at a biochemical level, but because they are of no daily relevance to me any more they have been replaced by being sharp on the theory and practice of the illnesses and areas of endocrinology I mentioned above.
This is probably reflected in your opinion of inaccurate health promotion materials.
Anecdotally, my contact with ex-steroid users has been positive and collaborative with a meeting of minds on issues such as CK testing, LFTs, ECGs, BP monitoring, arrythmias, testicular atrophy etc. My contact with younger people embarking on steroid taking has been more frustrating as they were trying to get me to support their androgenic steroid use by monitoring them when I wasn't prescribing for them or in agreement with them taking androgrenic steroids, plus not having specialist training in the area. They also had an attitude that worried me where they said that if they made themselves ill from steroids they didn't care as long as they looked good for a while.
So endocrinology to you and to me are quite different. Personally I don't have much interest in sports medicine or androgenic steroids, but I'm very interested and my patients think I'm quite good at treating the conditions that I consider to be endocrinology and feel in no way under equipped through lack of endocrinology training.
Last edited by john banks; 18 April 2012 at 10:50 PM.