Health ballz

Awesome bites of energy that taste as bad for you as they are good for you. 

  • Cocoa powder
  • Dates
  • Pumpkin seeds 
  • Flax seeds 
  • Sunflower seeds 
  • Pine nuts 
  • Cashews 
  • Ginger 
  • Turmeric 
  • Cinnamon 

Smash em up in a food processor and squash into bite size balls of goodness. 


Fail to prepare, prepare to fail. Preparation is key in a lot of situations, and Medicine as a whole is one of those situations. Having a solid plan, thinking it through and making sure you have everything ready beforehand will save you a lot of trouble. A good way to do this is through visualisation of the procedure. When I get kit ready for cannulating, I picture myself applying the tourniquet, finding the vein, cleaning with the swab, putting some gauze just distal to where I’m going, inserting the cannula (with or without taking bloods from it), removing the tourniquet, applying the flush and then sticking it down with a dressing. While doing this, grab the equipment for each bit as you think of it, and always take a spare cannula!

You only ever forget a flush once…



Like it or not, as a medical practitioner people are going to take what you say seriously. They will look to you for advice and reassurance during their most vulnerable moments, and will often follow exactly what you say to the letter. This means you have to be careful about what you say, and how.

Advice must be grounded in evidence, explained in understandable terms, with an idea of where to find further information should they forget what you’ve said later on. At home the patient is their own medical practitioner, so just as you’d hand over to a fellow clinician, they must be absolutely clear on the management plan. Your tone should be kind, non-judgemental and should demonstrate that you genuinely care about the person’s question. Instructions should be clear and complete – assume the person receiving the information knows absolutely nothing – and include a safety net for ‘if it gets worse’

(if it doesn’t go away in 3-5 days, see your GP is a fairly good one…)

Reassurance should be given where appropriate. There is always the desire to provide relief for parents and relatives from the anxiety of not knowing what is wrong, especially when a simple ‘It will all be fine‘ would instantly make everyone in the room feel better, however raising expectations in the face of a poor prognosis is going to hurt everyone a lot more down the line, so don’t jump straight in with grand reassurances unless you know they’re warranted.

Having said that, patients and relatives will often worry about things that you wouldn’t think of, so asking them if there is anything that needs explaining is always a good idea. I recently saw a paediatric patient being intubated for refractory seizures. She was completely stable on the ventilator, comfortably asleep, with reassuring vital signs and a promisingly normal CT scan. However her parents, who were NEWSing higher than their baby daughter, understandably interpreted ‘medically induced coma with a machine to help her breathe‘ as a bad sign.

As soon as the anaesthetist asked their concerns, and explained that they could wake her up at any time – this was just to keep her comfortable and free from seizures while they figured out what was going on – they immediately relaxed,

“Oh, well that’s not so bad…”

There was no false reassurance, no optimistic guesses at what the diagnosis might be; just a simple explanation of what was going on, that she wasn’t in pain, that the beeping alarms were just a reminder the infusion was nearly done, made a huge difference to that family’s experience.

An exercise in Optimism 


The problem

Facebook and Instagram, and various other forms of social media, are amazing. They let you keep in touch with friends and relatives around the world, organise events and share photos, you can even make a living from them.

However I’m pretty sure they are absolutely terrible for your mental health.

Remember at school when you’d feel like the only one in the class that didn’t get it? Everyone else seemed to find the maths/language/Beyblade so damned easy and you were the one dunce kid who for some reason couldn’t figure it out. Felt pretty terrible right?

Now imagine that all day every day about everything. 

But that’s what we’re doing to each other on social media. Everyday we post the ‘best of’ moments from our day – a really nice sunset, the bigger-than-expected slice of cake at the insanely hipster cafe, the latest personal record for your 10k run, and it’s probably meant in the most positive way. People that care about you will be psyched to see you did good, right?

That works great for your Mum, who receives endless joy from the successes and adventures of her marvelous offspring, and has precisely nine friends on Facebook, but for the rest of the world it’s different. They are sat there, receiving constant updates from everyone they know about how f***ing brilliant their life is. This might be all well and good when it’s going well for them, but if they’re having a tough time, and aren’t seeing anyone else around them struggling, it’s going to have a profound impact on their wellbeing. We need to see each others failures and difficult patches as well as our successes. We have to be exposed to one another in a deeper sense, and understand the difficulties that they’ve perservered through, so that we can genuinely be pleased when things are going well for them. Otherwise that weird sense of “I get it, your three year old is a genius” resentment starts to build and you start feeling angry whenever that impossibly beautiful selfie on top of some ridiculously white mountain slides ominously onto your news feed.

How to fix it

Some people quit social media. A lot of those that do report improved mood, productivity, all the buzzwords that we like to hear, and that’s great, but I think for the majority it’s pretty difficult to totally detach from all social media, especially since it’s so useful for so many things. I’m one of these people, so I decided to do a couple of things:

  • Cut down on the mindless trawling through people’s profiles
  • Follow more sciencey/technological pages so I receive actually useful news
  • Compare me to me, and only me
  • Start thinking about the little things in my own life, and just practice being grateful for them (super basic mindfulness)

I found that not only did I stop having that self-resentment of ‘why isn’t my life like that‘ whenever Steve put his latest laser-paragliding-zombie-adventure album up, and that ‘oh come on literally noone looks like that‘ when the six-inches-of-foundation-and-mile-long-eyelash selfies sprouted onto my feed on Friday nights, but I was genuinely happy for my friends and family whenever stuff was going well for them, because I wasn’t comparing myself to other people all the time. I would pit myself against my previous self, and if I was more productive/more knowledgeable/fitter/better at cooking since I last checked, then all was good. Everyone else could do what they liked. That suited me just fine.

An exercise in optimism

Try this. Describe an object that you own or an activity that you do in as basic terms as you can, to see just how awesome it really is. You might start to feel a little better about the life you previously thought was so dull.

Some examples:

  • Smartphone
    • you pay (£30, whatever you pay) a month for this thing that fits in your pocket, and it gives you access to ALL of human knowledge and development from forever, whenever you want, you just have to tap its little face. And it plays music. All the music in the world. And you can contact someone ANYWHERE in the world within seconds, and you can watch your favourite sports team compete on the other side of the world, RIGHT NOW. How insanely awesome is that!?
      • “so THAT’s how they make ball bearings…”
  • Car
    • you have this metal box on wheels, that you pour molten liquid dinosaur bones into, and it makes them explode. As a result you can drive at seventy miles an hour – a speed evolution could never have hoped to prepare you for – so you can visit your nan, whom it would have taken you three weeks to visit if you walked.
      • “it even has a flipping radio, incase somehow, at this insane speed,  you manage to get bored!”
  • Dog
    • This fluffy, long-toothed animal, that could quite happily kill you if it wanted, has decided you are in charge of its entire life. Not only that, it loves the s*** out of you for doing so, even when you accidently stand on its foot, and it will never get bored as long as you keep throwing that ball. It doesn’t ever complain, it worries about you when you’re sick or absent, and all it wants in life is to make you happy. Oh and it feels awesome to stroke.
      • “you know how much you have to pay to get that from a human?”
  • Your morning coffee
    • Some person, thousands of years ago, discovered that this particular plant grows magic beans that block adenosine receptors, and turn your brain onto ‘function’ mode. Oh and  it also tastes great. Oh and it’s full of antioxidants that fight cancer and dementia*. Oh and it makes you better at sports. You don’t even have to fight anyone or steal anything to get hold of it, you can literally buy it from like half the shops on the street. They even have specific people to MAKE IT FOR YOU. There are hundreds of different types that have been flown to you from all around the world, just so you can try them and all you have to do is hand over some coins or paper that you can’t do much else with anyway.
      • “2.95 for a latte? That’s bull***”

Try it next time you think things aren’t going so well, and see if you feel better!

*we think

Lithium side effects 


Lithium is an interesting drug with some important side effects. It’s one of those drugs that has a very narrow therapeutic window (0.4-1.0mmol/L) and above 1.5mmol/L you’re at significant risk of developing toxicity.

It’s used primarily as a mood stabiliser in conditions such as Bipolar disorder and refractory depression, and it is important to remember that it’s cleared by the kidneys, so anything that interferes with kidney function can push your lithium levels up dangerously high.

Toxicity triggers:

  • Dehydration
  • Renal failure
  • Diuretics, especially anything ending in -azide
  • ACE inhibitors
  • Metronidazole

Remember that the blood level of Lithium may be normal, but if they’ve got rubbish kidneys, they may still develop toxicity.


  • Cardiac failure
  • Kidney failure
  • Untreated hypothyroidism
  • Addison’s disease (anything where the patient has low sodium)
  • Pregnancy and breast feeding – Lithium is bad for babies

Side effects:

  • Metallic taste in the mouth – classic sign, seems obvious given Lithium is a metal
  • Fine tremor
  • Weight gain and oedema
  • Abdominal pain
  • Nausea

Signs of toxicity:

  • Hyperreflexia
  • Coarse tremor*
  • Confusion
  • Seizures
  • Coma

*a fine tremor is to be expected at therapeutic levels, so don’t fret if your patient appears fine but a little shaky.

Inhaler technique 

A lot of people use inhalers. They’re a fantastically simple and convenient way for patients to rapidly administer a very effective drug, either on an ‘as-needed’ or a regular basis. The convenience of self-administration, however, always brings with it the disadvantage of requiring the patient to actually do it right. When a trained medical practitioner injects or applies a medication, one can usually assume it’s been done properly, and the drug will work as it should, however when a patient is left to their own devices, they’ll come up with their own weird, wonderful and invariably completely ineffective methods. Inhalers are an absolutely perfect example.

If you use an inhaler with perfect technique, you’ll receive maybe 10%(1) of the drug into the lung, slightly more if you use a spacer. Most of it is swallowed and therefore doesn’t do a whole lot of good for your lungs. Most people don’t have perfect technique, and so very often will approach their GP or Hospital doc complaining that their ‘inhaler doesn’t work’. It may well be that the inhaler isn’t working, but it can only be given a chance to work if used properly. Obviously the correct technique depends on the device, but here we’ll just consider the most common; the garden variety metered-dose inhalers (the blue/brown ones).

Here’s how:

  1. Sit or stand up nice and straight
  2. Take your inhaler, shake it to mix the drug and propellant, checking there’s still something in the canister
  3. Take a deep breath in, and then let it all the way out
  4. Put the inhaler to  your mouth, ensuring a really good seal with the lips
  5. Take a deep breath in
  6. Just after starting  your deep breath, squeeze the inhaler
  7. Continue breathing in (don’t try and ‘suck’ it in really hard)
  8. When you get to the end of your deep breath in, hold for as long as you can, up to ten seconds
  9. Repeat steps 3-8 as necessary every 30 seconds
  10. If you’re using a blue one for an asthma attack and not feeling any relief after 10 puffs, call an ambulance.
  11. If you’re using a brown one as a regular preventer, wash your mouth with water (spit don’t swallow!) afterwards




  1. Preventers are preventers. Not taking them because ‘I feel fine‘ is ridiculous. That’s the point, they keep you feeling fine.
  2. If you have asthma, and you feel like you’re having an asthma attack, do your best to stay calm, as this helps in itself. Obviously this is actually very difficult to do when having an asthma attack, but if you can avoid panicking then it’ll help with your breathing.
  3. If you’re having an asthma attack, have a low threshold for calling an ambulance. Remember the ambulance is going to take time to get to you, so don’t delay calling. If you think this attack is ‘worse than normal’ or your reliever isn’t helping, call for help!