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Monthly Archives: May 2013

Retirement….

When it came to the age of retirement I realised I was entering into a new chapter of my life and asked many people how they spent their time and made my own observations.
How about the long awaited cruise or travelling even backpacking, spending more time in the garden ,model railway, caring for grandchildren, going to the theatre, taking up Art , golf, tennis, bowls or joining a club or doing Voluntary work, University of the third Age….
What seemed interesting I noticed that many people said they were busier than when they worked and after about a year many people had drifted back into doing some sort of work paid or unpaid often less hours and less responsibility but nevertheless actively working and seemed happy and content and in good health.
Alas, there were those who sank into depression and apathy or developed a life threatening illness and retirement seemed a miserable existence and they felt that their life had come to a halt.

One patient I shall not forget decided after retiring that she would take herself in hand go on a diet increase her exercise as she had more time to think about herself ! She was very overweight and had always been a weary, borderline depressed lady burdened by her job and family worries.
Indeed she lost a considerable amount of weight and even had gastric band surgery. Following this she came off all her blood pressure and diabetic medication, her self esteem improved, she had more energy , was certainly more attractive and she wondered why she hadn’t done this years ago. Several doctors had tried to tell her over at least 5 yrs but to no avail. It was a joy to see her embracing retirement bursting with plans and ideas to live a life she hadn’t lived for years.

Hence, I was not surprised when I read about the recent study which appeared in the press

Retirement ‘harmful to health’, study says
http://m.bbc.co.uk/news/business-22550536

Retirement has a detrimental impact on mental and physical health, a new study has found.

The study, published by the Institute of Economic Affairs (IEA), a think tank, found that retirement results in a “drastic decline in health” in the medium and long term.
Retirement is found to increase the chances of suffering from clinical depression by 40%, while you are 60% more likely to suffer from a physical condition.

When anyone questions whether we as doctors will be less likely to treat you because of your age do not worry age is no longer a reason as more and more older people want to and will be actively encouraged to continue to work and enjoy a variety of leisure pursuits from sky diving to marathons.
Gone are the days when a GP would phone to admit a woman of 60 yrs or a man of 65 years and the junior doctor (and I was that doctor once) would say “sorry too old” please refer to geriatrics…Now I could be that patient …….

As many people are aware I have opted to partially retire with the cooperation of my working partner and my husband whereby I work in the practise for about 2 weeks and 2 weeks in retirement. ie 2 weeks of General Practise working for the NHS and about 2 weeks gardening, socialising and catching up on things I hadn’t done for years or going to places I had always wanted to go.

I decided to start a project to focus my mind and embarked on designing a Herb garden with a particular focus on Chinese Herbs. I am preparing followers of my blogs to hear about what I have discovered and how it all evolved.

Written by Dr Jacqueline Bayer

 
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Posted by on May 31, 2013 in Anecdotes...little stories, Current affairs

 

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DEMENTIA AWARENESS WEEK (19-25th May)h

This was largely organised by The Alzheimer Society to help make people aware of this condition which affects at least 750,000 and many people remain undiagnosed and the incidence is predicted to rise to 1 million by. 2021.

What is dementia?

Dementia

The term ‘dementia’ is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. Symptoms of dementia include loss of memory, confusion and problems with speech and understanding.
There are some very good videos directed from their website to you tube that explain this condition
http://www.alzheimers.org.uk/talkdementia

Also, for further information
http://www.patient.co.uk

http://www.nhs.uk
http//www.dementiaweb.org.uk/news/
24hr helpline. 0845 1204048.

Patients with Dementia could benefit from new GP contracts
This practise has signed up for both doctors to carry out :-
A proactive approach to the timely assessment of patients who may be at risk of dementia.
We will screen for Dementia in a sensitive manner as part of an elderly / medical check or on specific request and carry out regular medical checks.

What do you look out for?

If you’re becoming increasingly forgetful, particularly if you’re over the age of 65, it may be a good idea to talk to your GP about the early signs of dementia.

As you get older, you may find that memory loss becomes a problem.
It’s normal for your memory to be affected by age, stress, tiredness, or certain illnesses and medications.

This can be annoying if it happens occasionally, but if it’s affecting your daily life or is worrying you or someone this may need further assessment .

Please don’t hesitate to see one of us in surgery so that we can assess you and get the right help in place as soon as possible or if you are worried about a relative bring them to see us.
Sometimes it is simply a wake up call to get your affairs in order and fulfill your ambitions and even if a diagnosis is not made doing this a positive move to face the rest your life.

Ealing has a particularly active branch of Alzheimer’s concern. They are very supportive to carers and their magazine is always available at the surgery.

image

http//www.dementiaconcern.co.uk/Ealing

We are proposing having a talk at the surgery from a Dementia Keyworker
LOOK OUT for this on the web page.

My experience of my mother’s  suffering with dementia, which in the early days she told me on many occasions that I should share the experience to help others coming after her.

image

Many of us will know someone or have a close relative with Dementia and know the heartache that it brings.
You cannot take the person out of the disease. “.

This means that as confused as a person may seem those who know this person will still recognise the person underneath and feel a connection.
My mother recently died at the age of 94yrs with Lewy Body Dementia following a slow decline over 6years. My sister & I found that talking to her as our mother telling her what was going on kept her as part of the family to the end and even if there was no recognition there was some connection. She still worried about us – were we working too hard, how were we getting home etc. she still had the same food preferences and insisted on drinking her tea out of a bone china cup and saucer.

She must have been aware she was deteriorating as she had been proactive in getting her affairs in order and had even been looking at sheltered accommodation. The diagnosis at that time was slow and confused and often doctors and nurses thought she was being lazy or difficult. She had frequent falls and several admissions and when given certain medication especially codeine type painkillers or if she had an infection she became more confused and had visual  hallucinations. On one occasion I visited her and she thought the place was flooded and she was stranded on her bed unable to even get to the toilet and pleased to see me to come to the rescue. I understood that this was not my mother and I had to explain to medical staff who assumed that was her character and thought she had a mental illness. It was very frustrating as the proper diagnosis evolved very slowly . I was later to find out that many doctors were not familiar with type of dementia characterised by Parkinsonism, visual hallucinations made worse with opiates and cognitive impairment. Also, patients with Lewy Body dementia have episodes of unconsciousness – unrousable sometimes lasting 1 – 2 days. When they emerge they are often better and more lucid and rational so that to inexperienced staff it may appear that they are ‘playing games’ . With one daughter a head teacher and another a GP medical staff unfamiliar with this condition gave us a hard time on many occasions during the admissions for falls or when she was found unconscious. Eventually, we were able to have documentation which was shown to staff on admission or when having treatment and care in the community.

We made a life album with photographs of her whole life so that those caring for her had some idea of the life she lived and who had been important to her in her life. Often she referred to relatives and friends who had died many years ago so that it gave good talking topics when any family visited.
She had been living alone but when she was diagnosed she had lucid moments when we were able to discuss her future with her and reluctantly she was admitted to a specialist Care Home.
We were able to furnish it with her own furniture including the bureau contains photos and items she had saved over many years and a corner cupboard of trinkets that held many memories of holidays abroad and gifts from friends and family.
She took her own clothes , although I did find her trying to swap some with a neighbouring resident or offering her 1/6d (old money) for a dress of hers.
Moreover, she continued to carry her handbag and we took her to buy new clothes as she had always been very particular the way she dressed and in her last few months we bought her some new clothes and cheap jewellery and it was a joy to see her face. She continued to have her hair ‘set’ weekly until the  last week of her life.
We bought her make up and she loved it if any of the granddaughters put on her makeup or manicured her nails and wouldn’t change from ‘burnt orange’ lipstick. The grandchildren took their boyfriends/ girlfriends to meet her and she gave her approval often flirting with the boys and giving the advise she had given me as a teenager! She impressed them by demonstrating how she could ‘down a shot’ with a small cup of lactulose ( one way of getting her to take her medicine when she refused) She developed fears she was being poisoned (a common feeling in this disease) so we bought M&S sandwiches as she had implicit faith in their food -it worked!
She had always loved the garden and when the carers wouldn’t let her out she claimed they had put hosepipes on to pretend there was rain. Luckily I arrived in time and she was distracted and proceeded to tell me my brother-in-law had been put in prison for stealing a lot of money – £77.33 but I was able at that stage to tell her that she was confused and this was untrue and it was her illness and she gave me some insight as to how distressing things could be. That is why it was so important to visit to let her and the carers know what was fact rather than confusion.

Understandably, some people find it difficult to visit as what they see is too painful and as doctors usually we respect that ( you can’t take the person out of the illness ) and it can be difficult to come to terms with this condition. Also, if there was formally a strained relationship it is unlikely to change radically. I was fortunate that we had maintained a close, trusting relationship and was adamant that he should be cared for in a residential home situated near either myself or sister. Sometimes carers and those around a relative can offer more care and love than the relatives for all sorts of reasons and we as doctors try not to be too judgemental as we are often aware of those reasons.

When a well meaning carer sent me this video. It seemed hard:-

As my mother deteriorated and became less mobile we bought her an all singing ,dancing recliner chair so that she could be up in the day , wheeled to the garden she loved and sleep comfortably and eat her meals sitting up.

She was our mum who loved life, enjoyed a party and annoyed us in the same way. Latterly she was unable to walk so we used a wheelchair to take her out, the grandsons often wheeled her and she loved them doing wheelies and the last photos are with the family she loved laughing, singing but gradually these occasions became less and less she slept more until one day she went to bed said goodnight with the pictures of her two new great grandsons by her side and passed away peacefully. We played her favourite music and put on her favourite perfume and with hair ‘set’ and make up on she died in dignity.

image  More information concerning Lewy body Dementia
http://www.lbda.org/content/intro-to-lbd.

We had many times of anguish sometimes feeling  the doctors were being unhelpful and wanted to hasten her end before we were ready but often they were very empathetic and supportive. The carers were variable some cared better than others just like real life and as a family we learnt so much and witnessed how care of patients with Dementia has improved considerably.
When they are first diagnosed it may be appropriate to fulfill certain ambitions. My mother wanted to go to Weymouth as it had many happy memories for her and we had a wonderful day on the beach , paddled in the sea, ate ice-cream and talked about those happy days when we were all children. She wanted us all to be together as a family and we arranged this on several occasions.
It is so important if possible that the family keep in touch let carers know about the life of that person and fight for their dignity, plan their future whilst they can have a say and as the rainy day has arrived for them spend the money on what makes them happy and comfortable don’t hesitate , arrange to fulfill those ambitions as far as possible.

image        There are escorted holidays at accessible holiday centres arranged by the                                     organisation Vitalise

http://www.vitalise.org.uk

Many places have gatherings for carers and the patient with Dementia eg the Royal Academy of Arts has an afternoon where they discuss great masterpieces with them over a cup of coffee – the Art student who told me about this said that the patients with Dementia were totally inhibited and their remarks proved to be both amusing and honest!

This event is part of InMind at the RA, a programme of events for individuals with dementia and their carers or family members.

https://www.royalacademy.org.uk/event/coffee-and-conversation-sessions-3

Eventually as with many people as they age their world shrinks and they prefer to remain their home environment and enjoy simple comforts

 
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Posted by on May 31, 2013 in Current affairs

 

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Race for Life…

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Do you know someone has had cancer or who has had cancer?

We feel so helpless and find it difficult to know how we can help…..

I had a recent email telling me how a group of young people had decided to do ‘the race for life’ with their friend Anna who thankfully has recovered from cancer. I felt moved by their optimistic outlook and the fact they were supporting Anna in such a positive way. Perhaps out there are others doing the same and also need to be cheered on in the same way.

Look on the website and see how the ‘Warriers’ get on and perhaps others may decide to support or take part in a similar event .

https://www.raceforlifesponsorme.org/warriors6/?utm_source=facebook&utm_medium=newsfeed&utm_campaign=editpage

Find out more about these events and perhaps find one to join in……….

http://raceforlife.cancerresearchuk.org/about-us/index.html

race for life 1

What is Race for Life?
Race for Life is Cancer Research UK’s flagship event, with more than 230 events taking place across the UK.
Read our story so far and find out how women are ganging up on cancer by running, walking, dancing or sponsoring.

Find out more about Race for Life

race for life 2

About Cancer Research UK
Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research.
Learn about the progress we are making and why we believe that we can beat cancer sooner.
About Cancer Research UK

 
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Posted by on May 23, 2013 in Current affairs

 

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Measles….

MEASLES

We have all been reading about the recent epidemic in Swansea arisen from the poor uptake of the MMR vaccine.

The leap in the number of confirmed cases can mostly be attributed to the proportion of unprotected 10 to 16-year-olds who missed out on vaccination in the late 1990s and early years of 2000 when fears about the discredited link between autism and the vaccine was widespread, according to public health experts.

Measles cases in the Swansea epidemic have risen by 20 in the last week to 1,094 as health chiefs warn the uptake of MMR is too low to eliminate the disease in Wales.

Public Health Wales (PHW) continues to warn that the outbreak may spread.

It said 95% uptake of MMR would prevent further outbreaks.

But vaccination rates remained low in Wales, especially among those aged 10 to 18 who are hardest hit.

In total, 1,257 people across Wales have now contracted the disease since last November, as the latest figures were released.

PHW said more than 43,000 non-routine MMR vaccines had been given since the outbreak began.

“In 2011 we had only 19 cases of measles in Wales all year and that should be compared with the 20 new cases we have seen since the end of the last week alone.”

In 2011, the World Health Organization (WHO) estimated that there were about 158,000 deaths caused by measles – about 430 deaths every day. Mortality in developed countries is about 1 in 1,000 cases (1%). In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%.

In cases with complications, the rate may rise to 20–30%.
According to the 2011 United Nations Millennium Development Goals report, “the combination of increased immunization coverage and the opportunity for second-dose immunizations led to a 78% drop in measles deaths worldwide. These averted deaths represent one quarter of the decline in mortality from all causes among children under five.”

Even in countries where vaccination has been introduced, rates may remain high. In Ireland, vaccination was introduced in 1985. There were 99,903 cases that year. Within two years, the number of cases had fallen to 201, but this fall was not sustained.

Measles is a leading cause of vaccine-preventable childhood mortality.

Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the WHO.

Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region.

Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating.

In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras, and had ravaged Mexico, Central America, and the Inca civilization.

In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.

During the 1850s, measles killed a fifth of Hawaii’s people.[62] In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease decimated the Andamanese population.
In 1954, the virus causing the disease was isolated from an 11-year old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture. To date, 21 strains of the measles virus have been identified.
While at Merck, Maurice Hilleman developed the first successful vaccine. Licensed vaccines to prevent the disease became available in 1963.An improved measles vaccine became available in 1968.

On a personal level several experiences in my life as a doctor in the UK and in Africa and a mother of three children I value the importance of vaccination.

I distinctly remember talking to my Mathematics teacher when I was in the 6th form at school and knowing I was wanting to study Medicine she told me about her 7 year old daughter who was in an institution as she had contracted Measles and was now severely brain damaged following encephalitis, a rare and very serious complication of measles.
It had an impression on me and over 20 years later, when I had the choice to vaccinate my own children there was no hesitation but at that time only a single injection was available ( MMR was not available) and only about 66% protection.
Unfortunately, my son was one of the 33% who was not protected after the single injection and he contracted Measles caught from a child who had a mild infection but not immunised and he had to be hospitalised.
Later all my children and husband contracted Mumps and they were all unwell , my son and husband had the complication of orchitis (inflammation of the testicles) and my eldest daughter had a mild encephalitis. Fortunately, they all recovered but it was a very stressful time, so that when the MMR was introduced I felt totally committed to encouraging mothers to have their infants immunized and was never convinced of the association with autism or bowel disease.

Furthermore, I had spent time in Nigeria where Measles is a significant cause of death in infants as well as my first hand experience of seeing children with serious complications or death, in all other diseases for which we now vaccinate infants.

I consider it is ethically unacceptable to tolerate any serious complication, or death, from measles or any other disease when an effective vaccine is available.

We vaccinate for the following reasons:-

1) the protection of the individual child to protect them from a disease which could lead to serious complications or death.
2) as part of creating a herd immunity to protect other individuals who are more vulnerable ( children and adults treated for cancer or who are immuno-suppressed for other reasons) and as part of the worldwide programme to eradication of these diseases.

Due to vaccinations, we no longer see smallpox, and poliomyelitis is heading towards eradication. No wonder vaccination is considered a modern miracle.
Vaccination is one of the greatest breakthroughs in modern medicine. No other medical intervention has done more to save lives and improve quality of life.
Hopefully we will never see what my first practice nurse told me how she had nursed rows of children in iron lungs due to the affliction of Poliomyelitis – a scene shown below. When I first joined the practice I regularly saw a patient who had survived this experience as a child and still had assisted respiration machine for the nights and was unable to walk – he attended surgery by mobility car and then transferred to a wheelchair to attended and had kept down a full-time job.

image

http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-saves-lives.aspx

ARE YOUR CHILDREN UP TO DATE WITH THE MMR?

We are running a catch up programme in Ealing for 10-16 year olds and any other children who for whatever reason missed out on this important vaccination . Hopefully, by encouraging as many people as possible to participate in this programme, we will progress to eliminate these diseases and save lives.

FUTURE VACCINATION PROGRAMMES

In September 2013 the following will be introduced:-

ROTAVIRUS VACCINE
Rotavirus is a highly infectious stomach bug that causes around 140,000 diarrhoea cases a year in under-fives in this country. It leads to hospital stays for nearly 1 in 10 of those who get it and 3-4 deaths annually.
The vaccine will be given to infants under the age of four months.
It is estimated that the vaccine will halve the number of vomiting and diarrhoea cases caused by rotavirus and there could be 90% fewer hospital stays as a result.
The vaccine, Rotarix, is already used routinely to vaccinate children in the US and several other countries. In the US, rotavirus-related hospital admissions have fallen by as much as 86% since the vaccine was introduced.
It will be administered as a 2 dose oral vaccine.

SHINGLES
Shingles is caused by the same virus as chickenpox, herpes varicella zoster and occurs when the dormant virus is activated.

The illness affects the nerves and skin. In severe cases it can cause complications such as hearing loss or brain swelling.

People in their 70s across the UK will be offered a vaccine against shingles from this September.

Experts have been recommending routine immunization against the disease, which causes a painful rash, for some years.

The government-led programme will target 70, 78 and 79-year-olds in the first instance and should prevent tens of thousands of cases a year.

Elderly people are at greatest risk and vaccination should prevent nearly half of cases in the over-70s.

Written by Dr Jacqueline Bayer

 
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Posted by on May 20, 2013 in Current affairs

 

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Exercise…Part 2…the alternative

FOR THOSE WHO CAN’T OR DON’T WANT TO EXERCISE

After reading the first blog did you feel that you haven’t the time or exercise is not for you or it is not a thing in your family?

Have you joined a gym attended twice and not returned?

Discussing this with colleagues I was reminded of this programme which was shown in January 2013

Horizon programme BBC 2 The Truth About Exercise
http://www.bbc.co.uk/programmes/b01cywtq

Also on YouTube.

Like many, Michael Mosley wants to get fitter and healthier but can’t face hours on the treadmill or trips to the gym. Help may be at hand.

He uncovers the surprising new research which suggests many of us could benefit from just three minutes of high intensity exercise a week.

He discovers the hidden power of simple activities like walking and fidgeting, and finds out why some of us don’t respond to exercise at all.

Using himself as a guinea pig, Michael uncovers the revealing new research about exercise, that has the power to make us all live longer and healthier lives.
After seeing the programme, there are several suggestions as well as other ideas such as:-

Walking around or even standing when you are using the phone
Using the stairs instead of the lift
(As suggested by my son when I proudly told him I manage 40 tummy tucks and 40 gluteal tucks when using the lift . He was not impressed and replied ‘Why don’t you just use the stairs mum?’

Getting off at a earlier bus stop or tube station and walking home or to work
Using stairs instead of escalator

Parking the car further from the shop entrance rather than driving around to find the nearest space to the door

Dancing with gusto to your teenagers pop music be it Reggae, House or Garage whilst preparing supper.
I once turned up at the local Nursing home for a ward round and as I arrived at the front door heard loud Reggae music ( Oh no I thought there must be a new carer not appreciating this is a home for the elderly) When I entered I witnessed the mobile residents dancing with the carers and those seated looking on with great interest. It turned out that one of the resident’s daughter is a well known Reggae musician and they were playing her music. This lovely gentleman 2 years later died peacefully at the home listening to the music!!

Did you know that you can buy a gadget that can be fitted to a exercise bike that charges your mobile phone? I saw these being used at Lille Europe train station.

3 minute maximum capacity exercise with rest intervals of 20 seconds done regularly
( you must watch the clip from the above programme
to appreciate what this entails )

Other variable ideas of alternative exercise
http://www.nhs.uk/LiveWell/Fitness/Pages/Fitnesshome.aspx

Written by Dr Jacqueline Bayer

 
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Posted by on May 20, 2013 in Training and Advice

 

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HYPERTENSION…..today is WHD – world hypertension day!

Periodically we have to check to ascertain that all patients on our hypertension register have had a blood pressure reading in the last 6-9 months and usually we have to chase up more than half the patients and 10% do not respond after 3 requests; many are found to be uncontrolled due to poor compliance of medication putting their cardiovascular disease risk at stake.

High blood pressure (hypertension) is the major risk factor for cardiovascular disease. Hence, in 2002, it was named ‘the number one killer’ by the World Health Organization (WHO) in The World Health Report.

Every year, 17 May is dedicated to World Hypertension Day (WHD).

WHD

The theme for 2013 is Healthy Heart Beat-Healthy Blood Pressure.

This was inaugurated in May 2005 and has become an annual event: the purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic.

In the UK the incidence is more than 12 million in adults aged 16- 75years.

In the Department of Health’s 2010 ‘Health Survey for England’ the prevalence of hypertension in adults of 16 years or older was 31.5% in men and 29.0% in women. After the age of 70 years 40-50% are affected.

The full data are available on their website http://www.dh.gov.uk/ or directly at: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/HSE2010_REPORT/HSE2010_Trends_commentary.pdf

Prevalence of hypertension is also collected by General Practices nationally and published via the Quality and Outcomes Framework: http://www.qof.ic.nhs.uk/

In our practice we have 300 patients with high blood pressure and we participate in Quality Outcomes Framework (QOF) where we are committed to recording a blood pressure at a minimum of 9 month intervals and then treating to control the blood pressure at the recommended level by medical treatment and lifestyle advice.
You can view how well the practice is doing on the website http://www.qof.ic.nhs.uk/ and we are shown to be above the expected targets thanks to our hard-working staff and co-operation of patients.
Moreover, this achievement will significantly reduce the incidence of stroke and heart attack.

If you are over 40 yrs of age or have a family history and have not had your blood pressure taken in the past 5 years please call in to have this done.

1) What is Hypertension (high blood pressure)

Blood pressure is simply the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre.

The pressure in the arteries depends on how hard the heart pumps, and how much resistance there is in the arteries.
It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure.
The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute.

2) How is it measured?

A common blood pressure might be 120/80 (said as ‘120 over 80’). These values are quoted in units known as millimeters of mercury (mmHg).

There are 2 numbers because the blood pressure varies with the heartbeat. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries.
This pressure is called systolic pressure.

The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats.
This pressure is called diastolic pressure.

3) Does it vary in an individual ?

Blood pressure can be quite variable, even in the same person.

4) what makes the blood pressure vary?

Blood pressure goes up and down with different normal daily activities. For example, exercise, changes in posture and even talking changes blood pressure.

Blood pressure tends to be higher during the day than at night and higher in the winter than in the summer.

Blood pressure also rises when we grow older, particularly systolic blood pressure. Before adulthood, blood pressure rises in parallel with height.

In adult years, weight and blood pressure are closely related. When weight goes up, blood pressure tends to go up and we can lower blood pressure by losing weight.

5) Does it vary in individuals?

Blood pressures differ between individuals. Some people have low, some average and some high blood pressure levels.

6) What is the definition of high blood pressure?

There are various definitions of high blood pressure, which is also known as hypertension, but most doctors consider blood pressures of 140/90 and greater to be high.

The precise values that doctors might interpret as high blood pressure depend to an extent on individual circumstances. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80.

The definition of hypertension is used by doctors to help decide which patients would benefit from medical (lifestyle and drug) treatment to lower pressure.

The definitions depend on the balance of risk of not lowering blood pressure (heart attack and stroke, etc) versus the risks of treatment (drug side effects, etc).

This explains why hypertension is defined at lower blood pressure levels in diabetic subjects. For the same blood pressure, cardiovascular complications (that is damage to the heart, blood vessels and brain) are more likely in diabetics and blood pressure reduction offers benefit even when a diabetic’s blood pressure is not as high as regular definitions of hypertension.

7) Why is blood pressure important?

Blood pressure is important because it is the driving force for blood to travel around the body to deliver fresh blood with oxygen and nutrients to the organs of the body.

However, high blood pressure is important because it leads to increased risk of serious cardiovascular disease, with complications such as heart attack, heart failure, stroke, kidney failure and blindness.

8) What is the cause of high blood pressure ?

For the vast majority of people with high blood pressure no precise explanation is ever found. For this reason, such cases are said to have ‘essential’ hypertension.

These cases are likely to result from a range of factors that could be broadly grouped into genetic and environmental (lifestyle) factors that work together to raise blood pressure.

Because genes and environmental are shared within families, it is not uncommon for people with high blood pressure to know of relatives with the same condition.

In a minority of cases of hypertension (less than about 5%) a precise cause can be identified. These include hormonal imbalances and kidney diseases that can result from genetic problems, occasionally tumors (usually benign) and blood vessel narrowing. Doctors are trained to look for signs of these specific conditions, as they are often curable.

High blood pressure is more common is older age groups and in people with a family history of hypertension. It is also more frequent in those who are overweight. However, high blood pressure can affect young thin people with no family history, so no one should consider himself or herself immune from high blood pressure.

9) Why is it important to control blood pressure ?

It is the goal of good clinical practice to reduce high levels of pressure wherever possible in order to reduce the risk of complications such as heart attack and stroke.

10) How is high blood pressure controlled?

Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment. If these approaches don’t return blood pressure to acceptable levels then drug treatment is usually required.

11) How do you know if you have high blood pressure?

The truth is you cannot know your blood pressure unless you have it measured and every adult should know his or her blood pressure.

Although headaches and nose bleeds can be the result of very high blood pressure, there are many more innocent causes for these common ailments.

12) How can you help to control blood pressure?

A healthy lifestyle and a sensible diet are important. One of the most important things is to keep weight under control. Less weight means lower blood pressure, and it also means less diabetes, less stress on muscles and joints and less stress on the heart.

13) Can high blood pressure be cured?

Commonly we hear ‘can I stop taking my tablets now’ or ‘I have finished the course’

It is rare for hypertension to disappear by itself. The general rule is that blood pressure gets higher with time and the risk of complications goes up also.

Although not ‘cured’ as such, modern therapeutic approaches to blood pressure are very effective and generally very safe. However, if treatment is stopped the high blood pressure usually returns reasonably quickly.

14) What are the effects of high blood pressure?

Any degree of high blood pressure is associated with increased risk of stroke and heart attack, but the higher the pressure, the higher the risks.

15) How is high blood pressure treated?

If blood pressure is persistently 140/90 and greater, then some form of treatment is required, although in the first instance this might be adjustments to lifestyle, such as diet and exercise.

However, if the blood pressure is repeatedly greater than 160/110, then there is usually a need to begin drug treatment immediately, rather than relying on lifestyle changes alone.

Sustained blood pressures of over 200/120 are considered potentially dangerous and if associated with for example visual trouble or heart failure they require emergency treatment.

16) Will hypertension cause any damage to my body?

Left unchecked, high blood pressure will over the years cause damage to the blood vessels of the heart and brain that leads to heart attacks and strokes. It also places extra strain on the heart, causing thickening of the heart muscle and heart failure and it damages the kidneys and can lead to kidney failure.

17)Are there any side effects to medication?

These days drugs are safe and generally free of major side effects, but no drug is completely free of side effects in all patients.

As blood pressure drugs work by reducing blood pressure, sometimes too great a fall in blood pressure can cause dizziness on standing. This can be a problem in the summer months and especially when rising quickly from squatting. Dizziness on standing also can be worse in older patients.

There are a variety of other symptoms that can result from blood pressure medications and if these appear in the days or weeks after treatment has begun you should consult your doctor. However, do not stop medications yourself without medical advice, as sometimes the blood pressure will rebound to very high levels that can be dangerous.

18) Can I measure my own blood pressure?

Yes but it is advisable to use a machine recommended by the British Hypertension Society(BHS).
Seek advise from GP,nurse or pharmacist.
The machines should be calibrated annually.
The following Machines are validated by BHS

Lloyds Pharmacy LBP 1 *(D) £30.00 International Protocol
Lloyds Pharmacy LBPK 1 *(D) £30.00 International Protocol

19) Can your risk of stroke or heart attack be calculated?

During a consultation when recording blood pressure and other details this can be calculated.

This risk calculator uses the Framingham risk equation[1] and the adjustments as suggested by the Joint British Societies’ (JBS2) paper[2] and the JBS Cardiovascular Risk Assessor.[3]
More details are obtainable on http://www.patient.co.uk or ask one of the clinicians when you attend the surgery. Those patients who have a high risk are seen more often and offered support regarding their lifestyle ie. diet, exercise,weight loss,smoking cessation

It is not the only risk calculator in use. In 2010 the National Institute for Health and Clinical Excellence (NICE) decided it could no longer recommend that the Framingham risk equation be used, as it tends to over-estimate risk by approximately 5% in UK men.[4] The decision also coincides with the emergence of the QRISK® calculator which has been shown to predict risk more accurately. The QRISK® calculator is available at http://www.qrisk.org. For further information on QRISK® see our cardiovascular risk assessment article.

20) What is the Government doing to prevent cardiovascular disease at population level?

The Government has addressed and continues to address the risk at both the population and individual level. The Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance at population level. This involves multiple agencies and is outlined in the public health guidance PH25 publication.
publications.nice.org.uk/prevention-of-cardiovascular-disease-ph25

In summary

Recommendation include the following:-

A) Salt
The Food Standard Agency has made considerable progress in reducing salt in everyday foods and this continues.

B) Saturated fat

The Food Standard Agency, consumers and industry have reduced the population’s intake (halving the average intake from 14% to 6-7% might prevent 30,000 CVD deaths and prevent a corresponding number of new cases of CVD annually. Eg promoting semi-skimmed milk for children aged over 2 years.

C) Trans fat
Industrially-produced Trans fatty acids (IPTFA) constitute a significant health hazard. Those who regularly eat fried fast-food may be consuming a substantially higher amount of IPTFA . In some countries e.g Denmark ,Austria and New York have successfully banned IPTFA.

D) Marketing and promotions aimed at children and young people.
Current advertising restrictions have reduced the number of advertisements for foods high in fat,salt or sugar during TV programmes made for children and young people. This policy will be extended.

E) Commercial interests
Ensure dealings between government , government agencies and the commercial sector are conducted in a transparent manner that supports public health interests and is in line with best practice. ( including full disclosure of interests)

F) Product labeling
Clear labeling describing content of food and drink products helping consumers make an informed choice. Evidence shows that simple traffic light labeling works well.

G) Health impact assessment
Where relevant government departments should assess the impact of policies on the health of the population.

H) Common agricultural policy
Negotiate at EU and national level to ensure CAP takes account of public health issues.

I) Physically active travel
Ensure government funding supports physically active modes of travel (such as walking and cycling)

J) Public sector catering guidelines
To reduce CVD would be to improve nutritional quality of food provided by public sector organisations.

K) Take-always and other food outlets
Empower local planning authorities to restrict planning permission for these (e.g within walking distance of schools)

L) Monitoring
Independent monitoring using a full range of available data is vital when assessing the need for additional measures to address health inequalities. CVD is responsible for around 33% of the observed gap in life expectancy among people living in areas with the worst health and deprivation indicators compared with those living in other parts of England .

Recommendations 13-18 provide for a comprehensive regional and local CVD prevention programme. The aim is to plan, develop and maintain effective programmes.

Recommendations 19-24 expand further on implementing the above and extending it into all public sectors.

SUMMARY

THERE ARE USUALLY NO SYMPTOMS FOR HIGH BP

The risk of stroke is four times greater and the risk of myocardial infarction (a heart attack) two times greater if you have high compared with normal blood pressure. This risk increases the higher the level of a person’s blood pressure.

THE ONLY WAY OF REDUCE THE RISK OF DEATH OR SERIOUS CARDIOVASCULAR DISEASE IS BY FOLLOWING LIFESTYLE ADVISE AND TAKING APPROPRIATE MEDICATION

Hypertension is very common indeed and hence a major public health issue.
The prevalence is expected to increase considerably in the coming years.
In 2000, the estimated number of adults living with high blood pressure globally was 972 million.
This is expected to increase to 1.56 billion by 2025!

Lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, are reasons for this increased disease burden, which is spreading at an alarming rate from developed countries to emerging economies, such as India, China and African countries.

Adequate treatment of high blood pressure lowers this cardiovascular risk towards normal levels.

THE GREATEST PROBLEM FOR CONTROLLING BLOOD PRESSURE IS COMPLIANCE WITH TREATMENT .

Despite very effective and cost-effective treatments, target blood pressure levels are very rarely reached, even in countries where cost of medication is not an issue.

Sadly, many patients still believe that hypertension is a disease that can be ‘cured’, and they stop or reduce medication when their blood pressure levels fall to normal levels.

Despite the availability of effective and safe anti-hypertensive drugs, hypertension and its related risk factors (obesity, high blood lipids, and diabetes mellitus) remain uncontrolled in many patients.

THE RULE OF THE HALVES

Only one half of the patients with high blood pressure in a population have been diagnosed, only half of those detected have been treated, and only half of those treated have been adequately treated to a normal blood pressure.

WHAT CAN YOU DO TO CONTROL BLOOD PRESSURE?
Stop smoking (if applies)
Alcohol & caffeine reduction (if applies)
Low fat diet high in fruit and vegetables nuts whole grains DASH diet
Low salt diet
Lose weight (if applies)
Regular exercise ( at least 20 mins 3 days/week)
Check blood pressure at least every 6 months ( or 5yearly if no problem at present)

WHAT CAN WE DO TO CONTROL BLOOD PRESSURE?
Offer smoking cessation support
Alcohol reduction support
Advise you to attend weight reducing classes or seek advise from nurse
Exercise prescription or discuss with nurse
Check your BP regularly and prescribe medication accordingly.
Check cholesterol, blood sugar and kidney function tests regularly.
Prescribe statins – cholesterol lowering medication .

hypertension 1

Written by Dr Jacqueline Bayer

 
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Posted by on May 17, 2013 in Training and Advice

 

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Dengue Fever

DENGUE FEVER (Breakbone Fever)

dengue fever

Increased incidences of this condition has been recorded recently in the press.

My first recollection of this disease was whilst watching the film ‘Bridge over the River Kwai’ many years ago and associating the condition with travel in Thailand under poor social conditions.

In fact, I did see a patient with this condition 1-2 years ago and now that more people are taking holidays or working in these parts of the world, I am not surprised the incidence has increased, as sadly many people are not taking proper travel advice. If you are traveling, it may be appropriate to get advice by contacting :
http://www.globetrotterstravelclinics.com

Dengue fever is a condition caused by an RNA virus (arbovirus), which is common in tropic and subtropical areas, particularly India, South East Asia and the Pacific . An estimated 50 to 100 million dengue infections and 200,000 to 500,000 cases of Dengue hemorrhagic fever (DHF) occur annually. It is transmitted to humans by the bite of infective female mosquitoes of the genus Aedes J.

The incidence of dengue fever has tripled in the past 3 months. Since January, there have been 141 “confirmed and probable” cases of the severe infection among those from this country, among those who have traveled to places such as Thailand, Sri Lanka and Barbados – compared with just 51 during the same period last year.

“The increase in the numbers of people returning with dengue fever is concerning so we want to remind people of the need to practice strict mosquito bite avoidance at all times in order to reduce their risk of becoming unwell,” said Dr Jane Jones, an infection expert at PHE.

If you are traveling to this part of the World you are advised to take care in applying insect repellent and wearing long sleeved clothing at dusk and dawn.
There is no vaccination or preventative medicine available for this condition.

If you develop severe flu-like symptoms including fever, headache and bone, muscle and joint pain during or after your stay you should seek medical advise.

There is no specific treatment and for most people symptoms can be managed by taking paracetamol, drinking fluids, and resting. But some of those infected can develop more serious complications and need to be treated in hospital, and the disease can be fatal.

Further details can be found on:-

http://www.nhs.uk/Conditions/dengue/Pages/Introduction.aspx

Written by Dr Jacqueline Bayer

 
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Posted by on May 17, 2013 in Training and Advice

 

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Breast cancer, mastectomy and Angelina Jolie

Angelina Jolie

Many of you may have been following the news regarding Angelina Jolie and her disclosure of her double mastectomy. If you haven’t then please have a look at this article.

http://www.guardian.co.uk/film/2013/may/14/angelina-jolie-double-mastectomy

If any of our patients have a strong family history of breast cancer they can be referred to a special clinic that will address this.

In the meantime, in response to the news of Angelina Jolie having a recent double mastectomy, this website Cancer Research UK might be a useful place to seek some information:

http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/

You can also click on this very helpful TLC guide which holds a wealth of information related to breast screening with a useful guide to self screening with helpful videos.

http://www.breakthrough.org.uk/about-breast-cancer

Written by Sangeeta Kathuria

 
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Posted by on May 16, 2013 in Current affairs

 

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Exercise…

Have you examined how much you and your family exercise each week?

I read this last week on Google news

Astonishing: A survey commissioned by The Ramblers found a quarter of people walk for less than nine minutes a day – and that includes time spent getting to the car, to work and to the shops

Read more here http://www.dailymail.co.uk/health/article-2320049/The-lazy-Britons-walk-just-minutes-day-Half-stay-healthy

We all age quicker when we’re not moving and the consequences of that are age-related diseases, such as diabetes, cardiovascular disease and cancer.’

NIH study finds leisure-time physical activity extends life expectancy as much as 4.5 years.

image life expextanxy

I remember my mother taking regular exercise and spent everyday doing some form of exercise walking to the shops,to see friends and attending her social events as well as gardening, swimming and every Tuesday going to ‘swinging into shape’ (despite my father telling her she should claim her money back after all the years she had attended) an aerobic class, until well into her late eighties despite having arthritis. My father an ex-sailor enjoyed all water activities and actively encouraged us as well as helping with the local naval cadets which included young people who came from less advantageous backgrounds and this certainly kept some of them out of trouble. My grandfather was an amputee and he cycled to work daily on a bicycle and loved swimming.

This was a great example to their three children and we all followed her example by being involved in regular exercise in the same way and I am glad to say that their grandchildren are doing the same sort of exercise today-walking, swimming, gardening with the added yoga and cycling.

I am sure that many other families can say the same and on reflection this is such an important responsibility of a parent to set that example.

The recommended amount of exercise as suggested by the Chief Medical Officer is two-and-a-half hours a week of moderate physical activity each week.
Sadly, researchers suggest that almost half of us and not doing enough and moreover a quarter of us walk for less than nine minutes, or under an average of one hour a week – and that include walking to the car, to work or to the shops.

It is now established that there are probably about an estimated 12 million people in the UK who have hypertension and they are more likely to develop cardiovascular disease. This can be reduced by treating the hypertension and reducing lifestyle risks.

A key lifestyle intervention is increasing physical activity in those who are not active at present.

As healthcare professionals we are recommended to discuss diet and exercise with people with hypertension as both a healthy diet and exercise can reduce blood pressure. We will now be using GPPAQ which is a questionnaire which has been approved as a screening tool in primary care for patients aged 16-75yrs to assess activity level. All patients with less than ‘Active’ score will be offered some support to increase activity and followed up after 6 months.

We will also be actively screening all patients on our list of 40 yrs or over for hypertension and every 5 years. General health checks will also be offered.

Recent research at Edinburgh University suggests sunlight helps reduce blood pressure as UV light release a compound which reduces blood pressure and benefits of sunlight far outweigh the risk of skin cancer. Hence, outdoor activity is even more beneficial!

Patients have shared their ideas and activities with me for me to share with you….

Do you enjoy gardening? Have you explored our London Parks? Do you have a yellow book to visit Gardens open? Or are you a member of the National Trust? Do you know about walks in and around Ealing? A trip to Brighton? Running or cycling clubs? Rowing? Friends of Kew? Dog walking- yours or a friends ?

If you look at the surgery website you find activities in and around Ealing which may be of interest and motivate us to maintain our activity level.

On a final note what can you gain out 30 minutes moderate activity on five or more days of the week is the minimum recommendation provided there are no other contraindications.

7 benefits according to the Mayo Clinic

Exercise controls weight
Exercise combats health conditions and diseases
Exercise improves mood
Exercise boosts energy
Exercise promotes better sleep
Exercise puts the spark back into your sex life
Exercise can be fun

COME AND HAVE A LOOK ON OUR WEBSITE FOR SOME USEFUL RESOURCES TO SUPPORT YOU. CLICK HERE http://www.102theavenue.co.uk/health_links/

image pyramid

Written by Dr Jacqueline Bayer

 
 

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Survival

As we read in the news on a daily basis we are overwhelmed by the tragedies theft we see whether in war torn places such as Syria or disasters such as the terrible factory collapse in India or the individual deaths of health and violence.

I have had the privilege of being part of a special experience regarding a family of ducks
3 ducks (2drakes and a duck) who have visited on a regular basis for several years not for bread I hasten to add as this is very harmful and can cause ‘angelwing’ a serious disease of ducks so we have fed them on grain and various food scraps.

Then out of the blue we noticed that only the drakes were coming and low & behold the duck had carefully made a nest under a bush against a wall and she has started laying. After 2-3 days we counted 11 eggs and each day she sat on them carefully rolling them with her feet and only short breaks to eat. This she did diligently for 30days and then appeared 10 ducklings following her in line staggering and barely able to walk. After devouring the contents and ? shells of the eggs as the nest only showed the 11th half eaten egg they were being taken straight to the nearest water.

Day by day mother duck has appeared with her young but sadly each day with one less duckling and now she has only 6….
On watching them all the ducklings have their own character the bold that leads the way the frail that struggles to follow the one that wants to cling to the mother the one that gets led on by the bold one or just wanders off and those that simply confirm. We have no way of telling how or which ones meet their end and who will survive.

Seemingly., they all start with the same chance but predators, circumstances and inherent health determines who lives and who dies…….

Image

 

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The drakes keep their distance and have no part in the rearing of the young

image ducklings 1

ducklings 2

Ducklings huddled under the outstretched wing for warmth and protection

ducklings 3
Written by Dr Jacqueline Bayer

 

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