Horses, not zebras

One of my favourite medical sayings is 'If you hear hoof beats, look for horses, not zebras', first coined by the renowned American surgeon Dr. Ben Eiseman in the 1960s. It's an aphorism that was frequently drummed into me when I was training in acupuncture.

What this means is that common conditions are common, and rare conditions are rare, so a practitioner should usually resist the temptation to immediately diagnose a rare and unusual illness if there is a more common condition that matches all the symptoms.

We can all probably be grateful for this wise advice - just think if you had a GP whose first assumption was that your mild headache was a brain tumour, your nosebleed was early onset Ebola, or your rumbling tummy was a sure sign that an Alien was about to burst out of you. In almost all cases, it would scare the living daylights out of you, and be wrong as well.

In the past, the only people who usually had to have their diagnostic enthusiasm restrained were medical students. However, in the age of the Internet and Google searches, we have a new legion of cyberchondriacs, typing their symptoms onto a search bar.

And when they do so, they often find zebras, not horses. A good friend of mine was asking me last week what might be the cause of the strange bitter taste in his mouth after eating. A google search had taken him to a website where one person had attributed his symptoms to eating pine nuts.

"Well, Bob" (not his real name), I said. "Have you been eating a lot of pine nuts recently?"

"No," he replied. "Probably not that then." I said, stroking my chin. "Do you have any heartburn or acid indigestion?" "No." Have you been on the razz, sleeping poorly and eating badly recently?" "Oh yes, most definitely!"

"In that case, it's most likely to be the taste of bile, and the result of overdoing it. Western doctors used to call it biliousness, and Chinese medicine calls it Liver Fire. The first thing you should do is rest, eat properly and cut back on the booze, and only think of further treatment if it doesn't clear up."

"Damn ... cutting back on pine nuts would have been a lot easier!"

Definitely a case of dealing with horses ... not zebras.

Of course, rare conditions do sometimes happen, and the art is to recognise their unique characteristics when they do, but in most cases, the most obvious explanation is usually the right one.

A Rhapsody in Brown (or why you shouldn't be embarassed by your bowels)

Acupuncturists are fascinated with bowel movements. Any time you visit a practitioner, prepare to be asked searching questions about how often you go, when you go, whether your stools are loose or dry, or whether there are any unusual colours, smells, noises or other factors.

Why do we ask? Well the most obvious reason is it will tell us the state of your digestion, which is often a root factor in a host of other health issues. It is also not unusual for non-digestive health issues to have a knock-on effect on your digestion and defaecation.

One of the more frequent examples of this is that when we are run-down, are stools tend to be looser, and when we are stressed out, they can often dry out to little pebbles. In conditions like irritable bowel syndrome (there are different names for it in Chinese medicine, but IBS is familiar to most people), you will often see alternating diarrhoea and constipation.

Some people like me are quite happy to answer detailed questions about all manner of bodily functions, including bowel movements but I have no shame.

Others find it harder to talk about for a whole variety of reasons.

One thing I have often found helpful is referring people to a handy chart of stool consistency called the Bristol Stool Scale:



This is a handy way of bypassing discussions of 'how loose is loose', so that you can quickly identify where people are on the scale and get down to making a diagnosis and discussing a treatment plan.

It's also a good way of impressing your GP when you visit her. If she asks you 'how are your number twos today?' you can reply 'actually, it's more of a number three at the moment, though I had a six last week after a dodgy kebab.'

On the subject of colour, if your stools are bright red, it often indicates bleeding in the rectum. If they are a tarry black, it could indicate bleeding in the stomach or oesophagus. In either case, it's usually a good idea to visit your doctor to find out what's happening.

That's why I was more than a little alarmed a couple of months back when I turned to flush away that morning's offering, and saw it was bright maroon. After a moment's blind panic, I realised it was unlikely to to be the sign of a bizarre terminal illness, and a lot more to do with the beetroots I'd eaten the night before. D'oh!

Bon Appétit.

Pindoctor heal thyself

Of course, the thing about my own simple and eminently sensible advice about good sleep (zero marks for modesty today PP!) is that I need to take it myself sometimes.

Staying up until 1am reading my book is probably not the most sensible way of getting a full night’s sleep.

(I blame Steven Erikson for being too damn interesting. Dust of Dreams is his latest.)

Note to self: I must remember to write something on the use of pressure on the acupoint Zusanli to pep up your energy levels when tired. It’s the little hollow between the tibia and fibula about three inches/4 finger widths below the eye of the knee. Not advised if you’re pregnant though! Fortunately I'm not.

Sleep - how difficult can it be?

I often see people who have difficulty getting a good night's kip, and bad sleep can have a major effect on their quality of life.

I've certainly had those days and nights myself - lying in bed, with my brain refusing to switch off, followed by days feeling like my skull has been packed with cotton wool, and hoping nobody asks me to do anything clever or complicated.

Now Chinese medicine has loads to say on the subject of sleeplessness, and practitioners like me are always fascinated in the details of how an individual's insomnia manifests (there's books and books written on the subject, and I may go into further detail in a later post.)

But before we look at the bells and whistles, let's get the basics right. It often surprises me how many people overlook or are unaware of some of the fundamentals of restfulness.

1. Do you have a regular pre-sleep ritual? Something that gives a clear break between what you do when you're awake and what you do when you're ready for bed. For me, I try and make sure that there’s no distractions in the bedroom like PCs/TVs, and I have a half hour or so of reading before I sleep. Sometimes I’ll have a glass of hot or cold milk. Many people find a quick bath or shower before they get into bed is nice. It’s basic, but it does make a difference. Do something that allows you to wind down before you switch off the lights.
2. Try and get your evening meal out of the way two or three hours before bedtime so that it’s reasonably digested before you try to sleep. Unless you're a sleeping superhero, eating that chicken vindaloo with rice, naans and samosas five minutes before you get into bed will disrupt your sleep.
3. If you wake up, don’t fret about waking up - just accept it. Maybe get yourself a glass of water or milk, and read a bit more of your book until you feel tired (if you have a partner, try not to wake them up while doing this ... a dis-chuffed partner can also be a cause of sleepless nights!). Don’t make agonising about not being able to sleep one of the factors that’s keeping you awake.
4. Think about eye-shades or earplugs if light or noise are physically-controllable factors in the waking up.
5. A strong cup of coffee before bedtime really won't help (though a friend of mine swears blind to the contrary!) If you have difficulty sleeping, avoid caffeine in the evening, and think hard about cutting it out altogether.
6. Finding time for regular exercise on top of a busy life can be tough. It helps though.

If anyone else has any simple advice for good sleep, let me know.

Welcome to my blog

While it may sound strange, I woke up this morning, drew open the curtains, looked out of my window at the sun-dappled leaves of the trees in Fulneck and Tong Valley (the view from my window is great!), and thought 'Gosh! I really need to start a blog!'

So here it is ... the start of what I hope will become a shared compendium of my thoughts and your contributions on health, and life and stuff (particularly the stuff!)