My progress today so far:
4892 words written, which is one chapter of the book. Well over the halfway point, but editing is still needed and will take a lot of time to get right as well. So far, the first seven chapters are edited and the last few days I have edited the chapters added as I wrote them.
Total word count as per today: 77380.
'Diary of a Female GP' progresses steadily and I'm not displeased with the progress at all. My husband has informed me he needs me to do work for him from next week onwards. This will mean less time for me to write and I hope it won't stop the progress too much. We will simply have to wait and see. Chances are I won't be able to keep up with the daily updates as I have been.
The images below will show you the stats and a little excerpt of the work in progress is attached too.
I hope you enjoy these little snippets.
The fifth extra patient today is seventy-six-year-old Mabel with her painful big toe. I have managed to catch up a little and now only run four minutes behind schedule. The pressure is still on as there are still a lot of ring backs waiting, two visits and paperwork to be done before I can leave to pick up Harry.
Mabel shows me her right big toe, which is swollen, red and hot to the touch. She is not keen for me to touch the toe either. The swelling is worst at the ball of her foot and as she has had no injury to the toe, it is most likely Mabel suffers from gout.
“Have you heard of gout?” Mabel nods. “They also call it the rich man’s disease as in the olden days, the lords of the manor would sometimes be affected by this. If you go to castles and manors, you still often see the lord of the manor with a foot on a stool and a bandage around his big toe. That was gout. Gout is caused by uric acid crystals which collect in a joint, irritate the joint and then cause inflammation of the joint. That is most likely what happened to your toe.” Mabel takes in my words and nods her understanding so far. “To treat this, we need to give you something to help with the pain and the inflammation. We will also need to arrange for a blood test to confirm this is indeed gout. If we confirm this is gout we can consider giving you medication to decrease the levels of uric acid in the blood and therefore the risk of getting another attack.”
“Can’t you give me that already?”
Unfortunately it does not quite work that way, “If we give you that treatment already, it will lower the uric acid levels in the blood, but it will also push it to go into the joint instead and make the attack worse. No, we will need to wait until the attack has gone, at which time the uric acid moves out of the joints again and we can then confirm if this is or is not gout. If we treat the uric acid after that, this should help to reduce the number of attacks you would suffer.”
Was I making this clear or was it only getting more confusing? Mabel nodded, and I hoped this meant she understood what I had told her.
“Now, there are a few things you can do to help. There is some evidence cherries reduce the uric acid levels. Red meat, wine, and other forms of alcohol, and cheese are known to increase the levels, so you may wish to reduce the intake of those. Sometimes attacks are provoked by slight trauma, like stubbing your toe. Any questions?”
Mabel seems to understand what I have told her, “Thomas also suffers from gout, I think the doctor told him the same thing a few years ago.”
Thomas is Mabel’s husband of over fifty years. That explains why she did not appear to be more confused by my explanation. I hand Mabel a prescription and the request for blood tests and ask her to return to discuss the results.
Joni
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