MEDICAL MATTERS: 'Prevention is better than cure" and "a stitch in time saves nine" are widely accepted notions in modern health. But it is equally important that we retain a tinge of hedonism in our lives, writes Dr Muiris Houston
Such thoughts are prompted by a recent report from Dublin City Coroner's Court. It concerns Mary Kate Duggan, a 63-year-old from Co Longford who died last year from a heart attack brought on by a severe case of tetanus.
Duggan, a lifelong gardener, was found in a distressed state, suffering with a stiff jaw and neck. According to her brother: "She did complain a few days before about a little scratch on her ankle. She did not say how it happened but she was very fond of gardening." The coroner, Dr Brian Farrell, asked if she was using manure as a compost or if animals were in the garden. He was told that only a wire fence separated her garden from a field of cows. In evidence, a pathologist told the court he felt that she would still be alive had she not contracted tetanus. Recording a verdict of death by misadventure, Dr Farrell observed: "It is tragic when gardening was her hobby that she would sustain a scratch which would cause her death."
It is deeply sad that anyone should lose their life in a way that is theoretically avoidable. But I suspect the many keen gardeners whose beloved creations adjoin agricultural land would rather run the risk of tetanus than give up a lifelong passion. News of Mary Kate Duggan's demise might usefully prompt gardeners to wear rubber boots and gloves. It might also remind older gardeners to review their tetanus immunity with their family doctors. But it should not stop a single gardener from gardening.
Horse riding is a risky pursuit. The actor Christopher Reeve has shown enormous courage in rebuilding his life after he was paralysed from the neck down in a riding accident. Despite this family tragedy, his daughter has reportedly taken up polo.
Professional and amateur riders alike run the risk of head injury and rupture of the spleen, both potentially life threatening. Yet every weekend riding schools are full of children. Parents equip them with helmets and body protectors in a sensible acknowledgment of risk.
Is golf a dangerous pastime? Probably only to spectators. Should tennis players give up a favourite game because of the risk of tennis elbow? A fellow student and I were enjoying a good tennis match at college when he trod on a ball at the back of the court and fractured his ankle. We continued the game three months later, after he had recovered.
And what about squash? Despite many tales of collapse and sudden death on the squash court, the potential loss of vision if struck by a fiercely travelling ball, and a personal back problem that persists to this day, I would not want to prevent any of my children from enjoying the game.
Weil's disease, an infection caused by the bacterium Leptospira interrogans, which is found in ditches and stagnant water, has killed a number of Irish golfers. Lyme disease, in which the Borrelia burgdorferi bug is transmitted to humans through tick bites, is a potential risk for many of us who enjoy a weekend walk in the forest.
I once had a patient who developed pigeon fancier's lung. He had raced pigeons all his life and did not want to give up. Unfortunately, the bird droppings set up an inflammation in his lungs, which were gradually losing their elasticity and causing increasing breathlessness. Our initial compromise of moving his pigeon loft to a friend's house did not work. It was only when he severed all connections with his hobby that his lungs began to stabilise. But there was no joy for either of us in this solution, and I subsequently felt he had lost an important part of his life.
With an increasing awareness of risk permeating all facets of life, however, we must guard against such awareness becoming an overwhelming obstacle to hobbies. There is a danger that the previously doable becomes the impossible. Enjoyment and relaxation could metamorphose into over-vigilance and tension.
Such a philosophy, were it to become widespread, could easily cause more disease than it could ever hope to prevent. As Erwin Chargaff, the eminent Columbia University biochemist, noted: "That living has become so difficult is peculiar, for even the experts manage to die in the simplest of ways."
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries