Medical history of David S Halpin as of 12-11-2025 DOB 14-04-1940
in narrative style
Briefly - I qualified MB BS via St Mary's in 1964, spent 11 years in surgical training as was usual, FRCS 1969, and in 1975 was appointed as a trauma and orthopaedic surgeon at the Princess Elizabeth Orthopaedic Hospital Exeter where I mostly trained and eventually lead, and at Torbay Hospital.
I include some of the many adverse effects of Lithium started in me in 1992, continued for 27 years without any review, and concentrate on the renal tract. Lithium is useful in mania and possibly in the longer term for so called bipolar disease which I do not have. It is both neurotoxic and nephrotoxic. Its mechanism of action is unknown! I am sure that it binds securely to cell membranes. I learned recently that Susan my wife was instructed by Dr Galli my GP and Dr Gillespie psychiatrist that I should never stop taking this.
Most relevant history. Some note form for brevity
Fit young man - rugby, rowing in racing eights. Married Susan at age 21. No babies - azoospermia found sadly, after Sue first investigated! Probably did well in 'finals'. About 10 days after qualifying after three weeks of examination started as HP to the Medical Unit at St Mary's under the inspiring Prof W.S Peart - a 'plum job' as we would say which I had applied for. BUT - 'they' could not get locums and I was the only house doctor for 2 wards - with 50 patients, most of whom were very ill. + Emergencies coming by ambulance via GPs etc and via ‘Casualty’. The unit concentrated on renal disease and hypertension. I hardly slept for the ten days and did not go back to Sue and our flat in Kew in that time.
Sudden elation, pressure of thought ie mental breakdown + physical. I had an ischio-rectal abscess. Voluntary admission to the Holloway Sanitorium at Virginia Water. Depressing lady psychiatrist with white cat! - advising that I might be able to do a pathology job, when I loved treating fellow humans. Sudden light at 3 months when seeing Dr Muir a Scot, a senior registrar in psychiatry at St Mary's. Re-started as HP under Professor Peart in September - and served with some distinction thereafter. CV attached.
I underwent a flush tie of an incompetent R sapheno-femoral valve with stripping in 1976 - which included my saphenous nerve! I had no reasons to seek medical attention in those years 1975 to 1992 aside from one episode of 'weepiness' in c. 1990 ? premonitory for hypothyroidism. Resolved immediately. This in spite of doing a very demanding job with many additions - 'management' etc.
Whilst chairing a consultants meeting in February 1992 - a sudden repeat of the April 1964 experience. But - added to my heavy clinical and administrative burden - chairman at the PEOH and clinical director in trauma and orthopaedics at Torbay, I was fighting for the NHS (especially against Thatcher's ridiculous and evil 'Internal Market' in the first stroke to destroy OUR NHS) and for the life of the Princess EOH - bulldozed in 1996 against the strong advice of the surgeons.
I was cared for initially by my kind GP Dr Peter Galli of the Kingskerswell Practice and Dr Gillespie psychiatrist. Unfortunately, and indeed negligently, no search was made for an organic cause for this 'brain disease'. No blood tests were done. I was given a major tranquiliser and other drugs. Suffered severe ‘Parkinsonian’ effects of the former requiring urgent atropine at home. Depression + anxiety persisted and in-patient treatment was advised at about 4 months. The NHS facility offered was terrible - Herrison House near Dorchester – actual Bedlam, so with the help of private medical insurance I was admitted to the Huntercombe unit near Maidenhead. The Italian psychiatrist had blood tests done which showed hypothyroidism - a long established cause for mental illness - 'myxoedematous madness'. Recall Richard Asher's contributions re organic causes for mental disturbance. https://en.wikipedia.org/wiki/Richard_Asher Treatment was of course with l thyroxine and psychotropic drugs. I was readmitted later and ECT added - which I had been given in 1964. And lithium was started - but see below. I was told this would take some colour out of my perception (it did not), and later that it would damage my kidneys. Slowly I got better. But when being investigated for heart rhythm disturbance, probably caused by an anti-depressant, Dr Ian Paisley an endocrinologist at Torbay and a respected friend, told me that in his experience it took 2 years for the brain to recover from lack of the thyroid hormone - this being needed by every cell in our bodies.
And I got better. I had against all the rules, been encouraged to retire at that age 52. When still very ill and vulnerable - and at about 3 months into this severe and most distressing illness, I was asked, to attend the Medical Director David Gudgeon with my colleague McKay by him, whom I had little respect for. There was anxiety because I had spoken of resigning which would have entailed loss of my pension. But a good man at the Regional Board had already warned me and Sue of this. I was encouraged at this meeting to retire. What should have happened - after certified recovery, a meeting in which my programme could have been lightened a bit, and teaching and research included. (see CV) I have always loved teaching and know I can inspire.
I did no further work at Torbay which hospital had been making things difficult for me mainly because I was adamant that elective orthopaedic surgery for South Devon should continue to be served by an expert and very good 'stand alone' orthopaedic hospital in Exeter. (My pension enhanced by 6% for 'industrial injury'.) And because I had spoken out publicly and vehemently against Thatcher’s ‘Internal Market’ - the first real stroke to kill the NHS – surreptitiously. I was welcomed back to do operating lists at the Princess Elizabeth Orthopaedic Hospital to help my younger colleagues' waiting lists - mostly knee 'replacements', and to teach young surgeons. A younger colleague whom I helped train said my operating sessions, with no pressure of my own waiting list, were much valued by the registrars in training.
In addition I provided orthopeadic clinics in 6 general practices from Totnes to Dartmouth which were greatly valued. People were able to have a diagnosis made and sometimes treatment eg depot steroid given close to home and with minimal delay.
As noted above, Lithium was prescribed for the next 27 years. I asked at one point if the renal damage ever became total and was reassured that it would not. I recall that the damage is focused on the secondary tubules. I attended the general practices Kingskerswell - Dr Simon Giles and Dr Galli - he not being a principal there - and from 2000, the Riverside Surgery, Bovey Tracey - and later after transfer to the Ashburton Surgery about 15 years ago. This every 3 months when bloods for estimation of the lithium level were done + urea and electrolytes, and TSH and T4 - given the known risk of thyroid disease being caused by the lithium. AT NO TIME was the need for the consumption of lithium ever discussed or a psychiatrist consulted – as far as I know. This is against the clear advice to review its necessity, along with warnings against it. I could attach scans of the relevant pages 340 and 341 of the 2013 British National Formulary - the BNF
Quote. The need for continued therapy should be assessed regularly and maintained on lithium only if benefit persists after 3-5 years.
Dr Stephanie Dyer took over my care when I transferred from Dr Kinsella of the Riverside Surgery (I resisted taking a statin and found him overbearing in this). She read conscientiously through the 4 Lloyd George envelopes and found no indication for its prescription! But I continued being prescribed it for a while. In 2018 I found difficulty in doing up my shirt sleeve buttons. I diagnosed a peripheral neuropathy and was later sent to the National Hospital Queen's Square where electro-physiological tests showed it was more profound than I thought. I stopped taking the lithium in February 2019 after discussion with a psychiatrist - who wanted me to take a 'maintenance' dose. Previously 800 or 1000 mg of lithium carbonate - Priadil.
I received a tertiary assessment by Dr Jeannie Todd at the Hammersmith in March 2020. I saw a senior assistant on 30-01-25. A letter was copied to me. My main reason for referral to her was the increase in my shoe size from 11.5/12 to 15 over 20 years, necessitating hand made boots and shoes. The late and good boot maker Barrie Forte noted my forefoot girth was 11 inches - the largest he has ever measured. Increased levels of growth hormone and other signs of acromegaly have not been found but I have an hypothesis I brought to Dr Todd in a letter. ie Limitation of somatostatin secretion due to some damage to the neurohypophysis. I have suffered cerebellar ataxia due to the lithium but fortunately this largely recovered. I could not stand on one leg to put my trousers on, but this recovered. I do tend to ‘reel’ turning round corners.
Specific to the renal tract.
I became aware early on of 'polyuria' - of needing to pee more often. I knew this was because of a declining ability of my kidneys to concentrate the urine - so called isothenuria. Measuring the specific gravity in early morning urine - always 1.16. In 2000 I became impotent aged 60 but did not worry about that. No spontaneous erections since then. At same time 'paroxsmal atrial fibrillation' started as I was doing a clinic in a GP surgery. Saw Dr Galli that evening - beta blocker - sotalol started at my suggestion. Next morning as I was doing a knee replacement - sinus rhythm returned. (Now been in AF for at least 5 months and believe this will now be chronic.) Anti-coagulated with Edoxaban against risk of stroke but underwent c. 160 episodes of 'episodic' AF (preferred adjective by me - less disturbing) before anti-coagulation. I am certain the AF, previously circadian in expression given it lasting 12, 24, or 36 hours, was related to the consumption of lithium, and its known neurotoxic effects. There are papers proving a link between lower testosterone levels and AF.
'Urgency of micturition' became my prime symptom a few years later. I saw a senior urological surgeon, John Pocock in 2009, who found on examination and with urodynamic studies that prostatic hyperplasia was not the cause. It remained the dominant symptom right up to the catheterisation by a first class district nurse in December 2024. An ultrasound scan just before showed a 1.5 litre ‘insensible’ retention, and hydroureter with hydronephrosis. The DN measured 1.5 litres on catheterisation after peeing c. 400 ml. (I recall on water loading as a medical student – physiology, that I passed 1.7 litres, the flask almost overflowing!) There is a cyst in the R kidney. For about 3 months before this I had often been incontinent of urine at night - so waterproof sheet etc. I suspect that the urinary retention had been present for a long time. I believe the lithium, via its known neurotoxic effects, has damaged the parasympathetic/sympathetic nerves serving my lower end and the delicate and mostly unconscious reflexes.
I diagnosed sub-acute bacterial prostatitis in myself in September 2024. 4 further episodes. A very severe fasciitis in the R lower leg started on the 12th day of prescribed ciprofloxacin, with very painful swelling by 2 inches. This was for the second episode of prostatitis. I had been warned by Dr Johnson of the risk of tendon rupture. He later diagnosed an interstitial nephritis caused by this drug as a cause of a ‘blip’ in my renal function. I believe I was ‘shed’ a ‘covid’ ‘’vaccine’’ whilst on holiday in September last year. Thought I had a ‘touch of flu. Reported in the US that the ‘vaccinated’ have shown a 30% increase in male urinary infections. My good GP said there was anecdotal evidence here in the UK of that!
This throws light on this ‘retention’ - https://biologyinsights.com/lithium-urinary-retention-causes-and-renal-insights/ and other renal effects of Li.
Comment
No account was taken it seems when treating me in 1992 and starting Lithium for depression with anxiety, of my prompt recovery in 1964. That was the return to my HP post at St Mary’s and service without fault, and with distinction up until my retirement from actual surgery in 2003. Nor the later recovery from a known cause of hypothyroid brain disease in 1992.
What now?
I was seeing Mr Brian Parsons, consultant urological surgeon. Letters from him x2. A repeat US scan at the RD&E showed wonderful recovery in tone of the renal pelves and ureters. I have now had the catheter for 18 months, and using a flip flow valve. I feel normal sensation between volumes of 300 to 500 mls, and discomfort as the bladder contracts on the catheter bulb. I tried removal of the catheter a few months ago, and will try again today. DN expected here. Failed. And with obvious precautions if successful. eg US scan after a few weeks to be sure the hydroureter is not recurring. And there are other things to discuss around this. I have an appointment 25th November with Mr Donaldson who is expert in TUR of the prostate using an holmium laser!
I add this. I served as a senior house officer on a urology firm at Southmead Hospital in 1997. It had the highest standards so I am well versed in the care and surgery of the urinary tract. One consultant – Mr Mitchell, had invented the ‘resectoscope’ which he and the other three consultants used in their prompt treatment of the men admitted in acute retention. This was revolutionary.
And this - I was very well educated in general medicine, including the humoural aspects. I learned long after retirement that a senior physician at Torbay, Ian McGill, once said to my friend Dr Richard Jacoby - a rheumatologist who referred many patients to me with severe rheumatoid arthritis, that 'David Halpin was the best physician that Torbay never had!' And plaudits do not come thick and fast!
Other PMH.
Laparoscopic RIH 2020 – direct and indirect – by Mr Rao at BMI Dorchester. (No help via Torbay although I had to lie down on a slope to reduce an often painful hernia)
Shingles in 4 spinal segments starting with viraemia in 2021 (?shed from vaccinated person). ‘Sine herpes’ ie no vesicles. Then a severe cellulitis of my R leg – needing 5 days in the RD&E with IV Flucloxacillin. This based on a nidus by my ankle – where there was a small septic ulcer following the stripping in 1975!
I add these other possible ill effects of Li.
Anosmia. I never had the best sense of smell but it has been absent for several decades. I always encourage the planting of fragrant shrubs and trees but cannot share that pleasure.
Deafness to higher frequencies. Loss going back to age 45 – when I suffered a pulsing tinnitus. An ENT consultant friend, John Hutchison, found some high frequency loss via his portable audiogram. It disappeared in a year. BUT – two months after I stopped ingesting Lithium – April 2019 there was sudden addition of a resonance when I spoke. This continues and is unpleasant, but is absent when I speak publicly! Interesting – the audiogram ‘trace’ done a year ago was exactly the same as that recorded in 2019. So ? some of my higher frequency deafness and ‘resonance’ might be due to the neurotoxic effects of the Lithium. ?Recruitment in the auditory nerves – 30,000 in each!
I add that the Siemen’s hearing aids – though sophisticated, only increase the resonance/jangling but help with broadcast audio. A very skilled audiologist (physics graduate too) told me in 2019 that one should not hear one’s own voice.
Present medication
Sotalol 80 mg BD
Edoxaban 15 mg daily – reduced from 30 mg - because of severe bleed into my renal tract (? from wall of cyst) + haemarthrosis R knee 6 weeks ag. Reduced by Dr Rob Johnson from 60 because of diminished renal function.
l Thyroxine – 150 alternating with 175 mcg daily - since 1992 2 of 3 sibs on thyroxine – mother – severe rheumatoid. So Hashimoto’s thyroiditis likely in the 3 of us.
Vit D and zinc – not prescribed
Vit B12 injections two monthly. (Assume I lack intrinsic factor and do not relate this to Li)
I have done my best to condense!!
David Halpin MB BS FRCS Kiln Shotts, Haytor, Newton Abbot TQ13 9XR 01364 661115
Editing 13-05-2026 – awaiting a call from Mr Mathew Schembri at Charing Cross Urology at 2.30 14-05 to hear what the MDT meeting today concluded. Either the chance of cure or ar least palliation of the bladder tumour by excision and ureretic diversion OR conservative care.
Haematuria started c. 1-02-2026. Saw Dr Rob Johnson at Ashburton surgery who examimned me including per rectum. No PR since. I requested referral to the RD&E urology unit given that I was on Mr Donaldson’s list for ‘aquablation’ of a hyperplastic prostate, and because the unit has wide expertise.
This paper was found by my professional gardener friend Jo Clarke-Irons -
https://www.kidney-international.org/action/showPdf?pii=S0085-2538%2815%2930234-9
Quote -
The fact that the mean duration of lithium exposure at tumor diagnosis was above 20 years may partly explain why such association has been probably missed by short-term prospective studies and has not been investigated so far. Several risk factors for renal cancers have been identified, including cigarette smoking, obesity, and ESRD. 36 In our study, only one patient with renal cancer had a history of smoking and only one had a body mass index above 30 kg/m 2. CKD could have also been considered as a confounder because some studies reported that decreasing renal function was associated with an increase in cancer mortality. 37–39 Nevertheless, none of our lithium-treated patients with renal cancer had ESRD. Moreover, by comparing lithium-treated patients to lithium-free age-, sex-, and eGFR-matched CKD patients, we confirmed that the high prevalence of renal cancers in our lithium-treated cohort was not due to a detection bias or to a confounding effect of any of the matching criteria.
Finally there is this, from Dr Stanley of the Riverside Surgery, Bovey Tracey who took over my care from that of the Kingskerswell practice in 2000 - Dr Galli and Dr Giles caring for me there. Dated 9-12-2003. This is attached and shows zero logic, with gross negligence.
My comment. As noted in the history above, no account was taken of the fact that there were definite causes of mental and physical breakdown in 1964 and February 1992. I include physical in both. In the first I had an ischio-rectal abscess for which I was given IM penicillin (likely no use – gram -ve bacterium likely) A London winter with low Vit D levels likely. In the second my friend and worker Mark Blaber thought I was dying. I was.
At no time was there review of the necessity for this agent, an agent which mode of action is unknown.
I diagnosed the various neurotoxic effects of the Li administration. When I saw a Professor at the National Hospital for Nervous Diseases she did not know – apparently, of lithium being neurotoxic.
Note that since I stopped ingesting this poison in early 2019, the peripheral neuropathy advanced no further, nor my foot size !
I add that there is no evidence that I suffer from ‘manic depression’ or ‘a bipolar disorder’. Dr Stephanie Dyer who took over my care from Dr Kinsella, and who had read through the voluminous notes found NO INDICATION for its prescription.
