WHAT DOES THE DOCTOR THINK THIS MONTH? September

For many years, I have believed that, after the age of 65 or so, major surgery knocks out part of the brain function, especially in relation to memory and language ability. I have, until recently, struggled to find anyone who would agree with me. However, on our new estate, in houses near to us live seven doctors, one next door! One of these doctors is an anaesthetist and she actually agreed with me in a conversation about six months ago. Because of my convictions, I had my (first) hip replacement under spinal anaesthesia just over three years ago and, so far as I could tell, the brain was OK afterwards. However, there followed five major general anaesthetics over the next 18 months and, after those, the brain was definitely not OK. I could not remember my grandchildren's names (Yes, I hear you shout “But you have 18 grandchildren so don't beat yourself up”) but I never had any problem remembering them before the anaesthetics. In addition, I found myself very often unable to complete a sentence as I forgot where it was going and I had enormous problems remembering the names of plants and common items, confusing words like colander and teapot or confusing restaurant with ship, etc. It was all really hard for Management who, much of the time, had to guess what I was trying to say. Happily, much of the mental acuity has returned but I still have problems with memory and occasionally have to stop in the middle of a sentence. So the jury is still out. Did the anaesthetics cause brain damage, have they brought forward the onset of dementia, will the improvement in mental function continue.......? Last week, the British Medical Journal published a study of 7,532 male and female British civil servants who were tested for mental ability four times between 1997 and 2016. The study demonstrated that those who underwent major operations were twice as likely to suffer substantial cognitive decline than those who had no surgery. Although the research did not cover dementia, cognitive decline is known to precede or speed up its development because of a reduction in brain resilience. The actual cause of the problem is not yet known but potential mechanisms of brain injury during the surgery process include strokes, mini strokes and inflammation. Potent pain killers given following surgery may also play a part. If I add in my own experience – near fatal sepsis and and fatal collapse after surgery requiring 12 litres of fluid and some heavy resuscitation, I am not reassured! Enough of that!! An elderly farmer built himself a large pool, big enough for swimming, at the far end of his land. He planted fruit trees around it and provide loungers and tables. One night, he wanted to pick some fruit and wandered down to the pool with a bucket which he would use to carry the fruit home. He arrived at the pool to hear shouts of glee and found several young women skinny dipping in his pool. When they saw him, they all went to the deep end and one shouted “We are not coming out until you leave”. Our farmer told them “I didn't come down to the pond to watch you all swim naked or make you get out of the pool naked”. He held up the bucket and said “I only came down here to feed the alligator!” A young programmer was nearing the end of a job interview when he was asked whet salary he would expect. “About £75,000 per annum plus a benefits package” he relied. “Well” said the interviewer “How would you like £85,000, 6 weeks annual holiday, full medical and dental cover, a company matching pension fund to 50% of salary and a new company BMW every two years?” The young man sat up “Wow, are you kidding?!” “Yes, but you started it” replied the interviewer. This joke takes us seamlessly back to the beginning of this article: Roger, 88, married Jenny, a beautiful 45 year old. In deference to the age difference and not wanting her husband to feel obliged to over-exert himself, Jenny opted for separate bedrooms. Half an hour after settling down, she heard a knock on the door; Roger appeared and performed really well between the sheets. He went back to his room but, half an hour later, he reappeared and performed equally well. Half an hour later, he reappeared and repeated the performance. Jenny said “I am really impressed that,at your age, you can perform so well and so often.” Roger was really embarrassed and said “You mean I have been here before?” Best wishes to you all Ian Nisbet

Best wishes to you all Ian Nisbet