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DR MAX THE MIND DOCTOR: Hip operation rationing is so cruel

DR MAX THE MIND DOCTOR: Hip operation rationing is so cruel, it makes people like my gran suicidal

Until a hip starts hurting, you don’t appreciate quite how much you depend on it to function.

As your joint becomes increasingly worn or damaged, everything becomes painful. Walking hurts. Sitting hurts. Standing up hurts. Even lying down hurts.

This is what happened to my gran when she developed severe osteoarthritis in her hip, a common cause of hip pain. But her motto in life was just to get on with things — and she did seem to be coping.

So, it came as a huge shock when she told me in her usual matter-of-fact way that she was thinking of killing herself. The pain had simply got too much. Unable to sleep or move freely, her life had become unbearable. She felt that she was living a nightmare.

X-ray scan image of hip joints with orthopedic hip joint replacement. Researchers assessed 2,000 people on waiting lists and found that about 20 per cent reported being in extreme pain

Her GP had prescribed painkillers, but they made her confused and constipated, and put her off her food, so she had lost weight.

Her muscles had started to weaken because she couldn’t walk, and she could barely stand. She had been on a waiting list for a hip replacement, but had been warned that she could have to wait for up to a year.

But for her, a year was simply too long to be left in such agony — hence her deep anguish. I called her GP and, after a lot of wrangling with the hospital, she eventually had her operation thanks to a cancellation.

Her quality of life was utterly transformed — no longer in pain, she could eat, sleep and walk again. But it was outrageous to me that she felt on the verge of suicide before getting the treatment she so badly needed.

In some areas patients are only allowed hip operations when they are unable to sleep because of the pain, which is barbaric

This happened a few years ago, but since then the waiting list for hip replacement operations has got even longer.

A study earlier this year found that in England, four in ten Clinical Commissioning Groups, the NHS bodies responsible for health care services for their local area, are limiting the number of joint replacements. In Scotland, nearly one in three patients waits longer than 18 weeks, the NHS referral-to-treatment guideline for planned operations.

Dr Max Prescribes

This ingenious device is a computer tablet with a difference. It’s specifically aimed at people with dementia who find tablets and iPads too complicated.

Designed by a technology expert whose mum has vascular dementia, it doesn’t need any input from the user. Instead, it’s controlled remotely by friends or family so they can send reminders for their loved one to take medicines, show them pictures, or video call them — all the receiver has to do is look at the screen. 

The device costs £199 and subscription packages cost from £9.99 a month; 

Another tactic is to delay referring patients. Instead they sit on various other waiting lists, for physiotherapy or for X-rays, for example, before finally making it on to the waiting list for a prosthetic hip.

In some areas patients are only allowed hip operations when they are unable to sleep because of the pain, which is barbaric. Even then, they have to wait months. According to research conducted by Edinburgh University published this week, patients waiting for hip replacements are now suffering pain ‘worse than death’.

Researchers assessed 2,000 people on waiting lists and found that about 20 per cent reported being in extreme pain. And, as I saw with my gran, this can have a massive impact on their mental as well as physical health, leading to depression, anxiety and even suicidal thoughts.

Hip operations are being rationed in a way that no NHS manager would ever dare do with other patient groups. If children had to wait until they were in extreme pain before having treatment, there would be an outcry.

But because those needing hip replacements are usually elderly, they are seen as an easy target. They tend not to complain, they don’t have people shouting and protesting on their behalf. They’re the generation that doesn’t like to make a fuss, that count themselves lucky.

This means that they are often disregarded and their care rationed or cut. This is ageism at its worst. Making frail, elderly people wait until they are in so much pain they can no longer go on is not only unfair, but incredibly cruel.

From a medical perspective, it doesn’t make sense. Hip replacement operations are extremely effective and transform people’s lives. How can anyone justify denying people this operation?

 Is pollution to blame for being depressed? 

Living amidst high air pollution increases the chance of suffering from a major mental illness or depression, says a new study published this week.

Scientists at the University of Chicago analysed data for 152 million people in the U.S. and Denmark. They found that in America’s more polluted areas, there was a 27 per cent rise in people with bipolar disorder, while incidents of major depression rose by 6 per cent.

Likewise, Danes exposed to high emissions before the age of ten had higher rates of adult depression, schizophrenia and personality disorders.

Air polluting factory chimneys. Danes exposed to high emissions before the age of ten had higher rates of adult depression, schizophrenia and personality disorders

All this was leapt on as yet more evidence of the dangers of toxic emissions. But while I’m in no doubt that pollution is bad for health, the findings could be influenced by ‘confounding factors’. These are variables that can skew scientific results and lead to false conclusions.

Places with higher rates of pollution have higher rates of urbanisation and more advanced economies. Perhaps the fact there are increased rates of mental health problems in cities is actually the result of having better healthcare, which means more people are diagnosed.

We know poverty is linked to mental health problems, and that poorer people are attracted to industrialised regions, which could be another explanation.

It’s vital to remember this research only shows that pollution is associated with mental health problems — it doesn’t show that it caused them.

  Tackling our sleep will save cash crisis

Swedish researchers have found that people who have insomnia are much more likely to suffer from heart disease, strokes and heart failure.

Given how common sleep problems are — it’s estimated that around 30 per cent of the population struggles with their sleep — this should be considered a public health emergency. Yet too often people with sleep disorders are just fobbed off with sleeping pills by their GP.

However, because of the risk of addiction and the fact they don’t provide proper sleep, sleeping pills are only prescribed for a short period. Then the sleep-deprived person is back where they started.

Gary Lineker came under fire this week for joking about his colleagues’ baldness on Match Of The Day. Now I find Mr Lineker smug and annoying, but, on this issue, I’m on his side.

Yes, losing your hair can affect your self-esteem, but baldness for men is a fact of life.

The way to deal with emotional difficulties is to encourage people to become more resilient — a concept that seems to have gone out of fashion in this era of victimhood and being perpetually offended.

A much better solution is to refer sleep patients for treatments such as cognitive behavioural therapy, which works incredibly well for insomnia.

The problem, however, is there simply aren’t enough NHS sleep clinics which provide such treatments and people have to fight hard to be referred to one.

Surely research like this, which shows the hugely detrimental effect of sleep problems on our health, should encourage the NHS to expand its sleep disorder services.

It will prevent more serious health complications and ultimately save us money.

Bones up on bones 

A few years ago, a study in the British Medical Journal found that most adults know surprisingly little about how their bodies work. They don’t really understand what their spleen does, or where their pancreas is, for example.

Doctors often assume a level of knowledge when talking to patients and this suggested many leave consultations feeling confused and sometimes scared.

This got me thinking about how to address that problem, so — and please excuse the plug — I’ve written a book about the human body, which is out this week.

Aimed at 7-11 year olds, it will hopefully help children to be better prepared when they grow up — and maybe their parents can have a sneaky peek, too.

In The Marvellous Adventure Of Being Human: Your Amazing Body And How To Live In It (Wren & Rook, £14.99). To order a copy for £11.99 (offer valid to 7/9/19), call 0844 571 0640. P&p free on orders over £15.

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