Robin Goodfellow (44-2)

It has got a bit colder this last month, but that cannot, surely,last in the white heat of claim and counterclaim over the rofecoxibsaga. The New York correspondent of the British Medical Journal(2004;329:1253)[Free Full Text] describes the evidence of one of the FDA's experts,David Graham, in US Senate hearings. Claim now follows counterclaimand the undermining of witnesses has also begun. Oh dear. Whatfun. Dark mutterings suggest that other drug withdrawals areinevitable, the stockbrokers have caught a cold with pharmaceuticalstocks and gossip circulates that a further shakeout and mergerround will soon follow. Robin is not certain whether, underthese circumstances, rheumatology's exposure under the spotlightis a Good     

Robin Goodfellow (44-4)

Five years, 60 columns and about 70 000 words after the off,Robin has woven a magic spell that will enable him to transmutefrom goblinity back to the human race. Deadlines have sometimesbeen tight, but never one was missed. Robin has repeated himselfoccasionally, but not a lot. A few people recognized him (one,Alison Leak, recognized the Pizza Express he described ( Rheumatology2001;40:479[Free Full Text]) and some, somehow, saw through the style and accostedhim, thinking that somehow if they declaimed ‘You areRobin Goodfellow and I claim my prize’ something nicemight happen. Some chance on what I am paid. Quite a few thoughthe was more than one—not so.     

Robin Goodfellow (44-1)

Well, here is the New Year and the snow is not exactly deepand crisp and even round Robin's air-raid shelter on the hill;perhaps it should be abolished from Christmas cards now thatglobal warming has made it so scarce. Robin is beginning towonder how many of the Great Wen's teaching hospitals are goingto be inundated by the imminent rise of the Thames, and whetherperhaps they might like to relocate to the higher ground roundand about. Galveston, of course, will disappear completely.Sorry, guys. Robin has made a New Year's resolution not to rock too manyboats (he made rather a habit of it last year, but did end upgetting a specialist nurse for his department     

Robin Goodfellow (43-3)

As winter turns to spring and Robin can examine his garden oncemore, he turns his attention to examination in general. MichaelDocherty in Nottingham has made a special issue out of the paucityof examination of the musculoskeletal system in inpatients;White and two Alcolados in Wales ( Postgrad Med J 2003;79:588–9[Abstract/Free Full Text])are more specific and note that examination of the hands israrely recorded. Having said that, their population shows notunexpected findings; the commonest abnormalities in men wereHeberden's nodes, Dupuytren's contractures and staining withcoal dust. Robin awaits comment on his previous remarks on the role ofarthoscopy—much overdone, in his opinion—but meanwhilenotes Oakley and Lassere's     

Robin Goodfellow (42-3)

Hi-de-hi. Robin's managers are in the dog-house, as they tryto meet targets to reduce waits in the Accident & EmergencyDepartment by opening a new fast-track unit of 22 beds (butfail to fund the essential physiotherapists and occupationaltherapists) and compensate for this necessary bed expansionby closing a 28-bed ward to save money. Their delays have alsoresulted in Robin's proposed rheumatology nurse specialist posthitting the buffers because the under-managers couldn't gettheir act together to do the paperwork, even though money wasnot an issue. R is not a happy bunny, taking consolation onlyfrom the knowledge that     

Robin Goodfellow (42-1)

Following a quick flit to Paris, Robin had to take a friendin for a check-up. We arrived at the appointed hour to discoverthat our appointment had been double-booked, so had to sit inthe (very pleasant) waiting area — clean, carpeted, suppliedwith newspapers and with a free coffee machine. It is alwaysa bit unnerving when you are watching a junior examining andcan see the doubt on their face, especially when they call amore senior colleague in for a second opinion. But in the end,all was well and the car's MOT certificate was     

Robin Goodfellow (42-8)

Summer is icumen in, and as Robin migrates from the air-raidshelter to the tree house, he is pleased, on behalf of one patient,that the spring-cleaning is over. She was having difficultycleaning windows and hovering. It indicates the importance ofusing generic terms (here, vacuuming), but Robin has a pairof windows which would be accessible if he could hover. Anotherpatient has pre-empted the development of foundation hospitals(for non-UK readers, a political move designed to mortgage ourchildren to the health service for ever, allowing hospitalsto raise money on the open market so we can spend an increasingsum     

Robin Goodfellow (42-4)

Robin is getting fed up with being told that he must modernize,not least because it appears (to others, if not to him) thatfar from being able to modernize he is actually ageing. Thisprocess seems inevitable, but if anyone has the elixir of eternallife out there, do give me a shout. And I don't want, thankyou, to end up like that mythical Greek character whose nymphgirlfriend forgot to ask, when she asked for him to be madeimmortal, that he should not age and he ended up as a chirruppingcicada. Can't think of his name.     

Robin Goodfellow (43-2)

Robin does not ski, so is unmoved by news that all the finestEuropean resorts are under threat from global warming. He knowsof many orthopaedic surgeons who undertake this pastime (theone who administered on-the-slope treatment to a friend, onlyto hear in the bar that he was an osteopath, is crossing thepond for his yearly fix, and is wished well). Robin has previously commented on the Internet abilities ofBadal Pal and his team, and is pleased to congratulate themon winning the 2003 Innovation award sponsored by Hospital Doctor.His fact sheet for the judges is attractive and impressive,marred only by the most successful attempt Robin has     

Robin Goodfellow (43-11)

As the nights fair draw in Robin begins to wonder whether GuyFawkes had the right idea. A curious ‘Catch-22’has visited his patch. Others in the UK have, he knows, beenscratching their heads over proposed funding rearrangementsfor TNF- funding; one area had decided that it would do thisby funding each outpatient appointment for biologics patientsto the princely sum of £150. Now it doesn’t takea devalued mathematics ‘A’ level to work out thatif a biologic costs £760 a month, then to cover costseach patient will require just over 5 appointments. Monthly.You cannot be serious ... however, Robin's hospital has justbeen told that its allocation for all drugs approved by NICE(the National Institute for Clinical Excellence, or NationalImprimatur for     

Robin Goodfellow (43-12)

Oh dear, oh dear, the pressure! Robin unwound beautifully inMarrakech, but seems to have had some difficulty winding backup, and if this column seems hurried it is because of franticemails from the editorial office that they are waiting to goto print, but are stuck because I am late. Hold the back page,I cry. Sorry, guys; I will try not to let it happen again. A bit earlier in the year Robin was in his loft having a sort(not least because there was so much stuff that there was noroom for anything else—old boxes for dead computers, sparevacuum cleaners, you know the sort of thing). Anyway he discovereda large pile of BSR conference bags, for which he could seeno use, and junked the lot.     

Robin Goodfellow (43-9)

Robin has had a funny week; first the managers caved in to allhis demands, then his opera-loving orthopaedic colleague tookhim and Mrs Robin to Glyndebourne (Pelleas and Mélisande;sublime music, pity about the dialogue) and then one of hisheartsink patients had transformed into a charming and wittyconversationalist. She told Robin of a friend of hers who hadrheumatoid arthritis and had developed severe cellulitis ofone leg after being scratched by the cat. Anxious to avoid furtherprolonged ulcer management, she consulted an animal behaviouristfor advice. She looked at the cat, sent in a bill for £100and told the lady to wear trousers. It reminds Robin of a deadparrot joke, but the Editor will no doubt censor it, so Robin     

Robin Goodfellow (43-10)

A young lady with RA came in to the clinic this morning—designer safari suit, crop top, colour-coordinated all the waydown to her flip-flops. She then told me how bad her feet were;as it was clear her metatarsalgia was being made worse by thefact she had to claw her toes to stay in them, I suggested,when the weather was hot, that sandals with a back would bebetter. ‘But mine don’t match the outfit’,she pouted, and then smiled. ‘I suppose’ she said‘it's a fine line between looking good and being a cripple!’I decided not to point out that crippled feet don’t lookgood. Robert Marshall writes: ‘As an avid reader of your mischievous     

Robin Goodfellow (42-6)

It does, of course, take a time to know whether a transplantedshrub will take. Robin likes getting his hands dirty, but itis hard work. Every hole dug produces a pile of rocks; it isunderstandable that a restrictive covenant on the house forbidsquarrying, as Robin has so far dug up enough to build a smallchurch. It is quite relaxing to sit down and write a column... The osteoporosis industry might take a knock from a paper fromthe Oxford stable of Richard Doll (Trivedi, Doll and Khaw, Br Med J 2003;326:469–72).[Abstract/Free Full Text] Their 5-yr study of the over-65sshows that Vitamin     

Robin Goodfellow (43-7)

Robin's feet have touched the ground again after a whirlwindtrip past Hadrian's Wall to the BSR Annual Meeting; back inharness, it appears that someone else's secretary thinks thatTietze's syndrome is an undiscovered Spanish holiday resort.Why otherwise would she have called it costa chondritis? Itreminded Robin of that policeman's ball game; ‘Here comeMr and Mrs Coxib, with their French niece Val de Coxib (andtheir Italian cousin Ettore Coxib)’. Also in the clinicwas a delightful man beset, not only with rheumatoid arthritisand a wife recently diagnosed with cancer, but with prostaticcancer himself. He brought a little advice card about his I¹²⁵implant; ‘If a seed is passed in urine, pick up usinga spoon or forceps and dispose of down the     

Robin Goodfellow (43-4)

The snow has gone, and Robin has taken delivery of a new flashcar of unnecessary size and elegance; is this a mid-life crisisor hedonism? He is rather hoping that the infinitely adjustableseat, which remembers its position even after garage types havefiddled with the settings, will help his back, and that theautomatic gearbox will stop the left foot tarsal tunnel syndromewhich has plagued him for years in traffic jams. But some thingsnever change. Robin prides himself on his holistic approachto medicine, and will thus talk to patients frankly and withauthority about sex (he has done a bit of reading, you understand).Thus, when a recent patient admitted that     

Robin Goodfellow (43-5)

Whenever Robin despairs that no misprints have fallen in hislap for the next column, four come along at once. The LondonCollege of Physicians is advertising a lecture (in October)entitled ‘Beyond Harvey Crushing: enzymes and the redefinitionof corticosteroid hormone action’. Methinks someone wasthinking of crush injury to inflict such a cushing indictmenton medical history—but then again, one of Robin’scolleagues, invoking the principles of Semmelweiss to persuadehis trainees to wash their hands between patients, was asked‘Who’s Semmelweiss?’ And the dear Sunday Times has been doing its bit for disease.In an admirable article about designing homes for disabilityit quoted a sufferer from hip dysphasia, which     

Robin Goodfellow (42-10)

The vegetable patch is beginning to look a little forlorn now,but Robin is grateful that some dread disease (or the foxes)have kept the rabbits away. However, wildlife figures prominentlyin the anecdotalia for the month. One of Robin's longstandingankylosing spondylitis patients, who has been eating phenylbutazonefor decades and has been apparently cured of lung cancer, suddenlydeveloped severe diarrhoea and weight loss. The gastroenterologistsleft no stone unturned to find the supposed second cancer, butall to no avail. Robin was thus surprised, noting the gloomycorrespondence, to find a bright and cheerful patient trippinginto the clinic. It transpired     

Robin Goodfellow (42-11)

I always thought that it was usually pretty stupid doing X-raysof the spine, but in cases of sciatica, according to one secretary,the most helpful test is a ridiculogram. What a crazy world.Robin returned from two weeks off to the usual mountain of results,correspondence, patients wanting urgent appointments yesterday(one told my secretary I had no business going away withoutcover – ha!) and found an interesting variant on the Nigerianscam in his hospital inbox. An evangelical church in a SouthAfrican country has, it appears, run out of money to evangelise,and requested £3000 from me to purchase arc-welding equipmentto make windows (which it     

Robin Goodfellow (42-7)

Robin returned from the BSR meeting in Manchester, fired upwith new ideas and ready to tell you about the poster reportingmiocardiophaty enolic as a non relacionated complication ofSjögren's syndrome, but found that delightfully Hispanicmis-spelling trumped by one from the Department of Health, whichhad sent (with commendable promptness) a CD of performance dataRobin had requested. It was addressed to the Rheumatolody Dept.The song is ended... Bernstein's vocal acrobatics at the Clinico-Pathologicalpresentation are the nearest I can get to imagining a rheumatolody,and pretty horrid it was. Bill Docken e-mailed to suggest that Robin's lack of correspondenceis entirely due to his not having his