Monthly Archives: February 2014

Better information better care

The NHS is upgrading its information systems: patient sharing data is going live from April 2014 onwards. This is an opportunity for each of us to help the NHS provide high quality care for all.
Summary care recordYou can choose to have a Summary Care Record.

  • If you would like one, you won’t need to do anything. It will happen automatically.
  • You can choose not to have a Summary Care Record. Let your GP surgery know by filling in and returning an opt-out form.
  • If you opt out, you can rejoin the scheme at any time. An opt-out form is included with your letter.

You’ll be informed by letter when it’s time for your local primary Commissioning Care Group (CCG) to introduce Summary Care Records. The letter will contain details about your choices and how to opt out of the scheme.

More information about Summary Care Records is available at

Why are Summary Care Records being created.

Medical recordsToday, records are kept in all the places where you receive care. These places can usually only share information from your records by letter, email, fax or phone. At times, this can slow down treatment and sometimes make it hard to access information.
Summary Care Records are being introduced to improve the safety and quality of patient care. Because the Summary Care Record is an electronic record, it will give healthcare staff faster, easier access to essential information about you, and help to give you safe treatment during an emergency or when your GP surgery is closed.

For example, a person who lives in London is on holiday in Brighton. One evening, they’re knocked unconscious in a car accident and taken to an accident and emergency (A&E) department. Under the current system of storing health records, it would be difficult for A&E staff to find out whether there are any important factors to consider when treating the person (such as any serious allergies to medications), especially as their GP surgery is likely to be closed. If healthcare staff cannot get the relevant health information quickly, some patients may be at risk.

A Summary Care Record is an electronic record that’s stored at a central location. As the name suggests, the record will not contain detailed information about your medical history, but will only contain important health information, such as:

  • whether you’re taking any prescription medication
  • whether you have any allergies
  • whether you’ve previously had a bad reaction to any medication

Access to your Summary Care Record will be strictly controlled. The only people who can see the information will be healthcare staff directly involved in your care who have a special smartcard and access number (like a chip-and-pin credit card). These are currently used in the surgery by all staff but only to obtain information about patients registered at the practice.
Healthcare staff will ask your permission every time they need to look at your Summary Care Record. If they cannot ask you, e.g. because you’re unconscious, healthcare staff may look at your record without asking you. If they have to do this, they will make a note on your record.


When I see patients in a different setting eg in an Urgent Care Centre or Walk in centre patients are often surprised that I do not know anything about them ie their present medication or ongoing illnesses not appreciating that there is no electronic connection between different medical centres and especially those people who have complex problems it would be a great advantage to have that connection.

Health records play an important role in modern healthcare. They have two main functions, which are described as either primary or secondary.

Primary function of health records

The primary function of healthcare records is to record important clinical information, which may need to be accessed by the healthcare professionals involved in your care.
Information contained in health records includes:

  • the treatments you have received,
  • whether you have any allergies,
  • whether you’re currently taking medication,
  • whether you have previously had any adverse reactions to certain medications
  • whether you have any chronic (long-lasting) health conditions, such as diabetes or asthma,
  • the results of any health tests you have had, such as blood pressure tests,
    any lifestyle information that may be clinically relevant, such as whether you smoke, and
    personal information, such as your age and address.

Secondary function of health records

Health records can be used to improve public health and the services provided by the NHS, such as treatments for cancer or diabetes. Health records can also be used:
to determine how well a particular hospital or specialist unit is performing,
to track the spread of, or risk factors for, a particular disease (epidemiology), and
in clinical research, to determine whether certain treatments are more effective than others.
When health records are used in this way, your personal details are not given to the people who are carrying out the research. Only the relevant clinical data is given, for example the number of people who were admitted to hospital every year due to a heart attack.

Types of health record

Health records take many forms and can be on paper or electronic. Different types of health record include:

    • consultation notes, which your GP takes during an appointment,
    • hospital admission records, including the reason you were admitted to hospital,
      the treatment you will receive and any other relevant clinical and personal information,
    • hospital discharge records, which will include the results of treatment and whether any follow-up appointments or care are required,
      test results,X-rays,photographs, and image slides, such as those produced by a magnetic resonance imaging (MRI) or computerised tomography (CT) scanner.


There are strict laws and regulations to ensure that your health records are kept confidential and can only be accessed by health professionals directly involved in your care.
There are a number of different laws that relate to health records. The two most important laws are:

  • Data Protection Act (1998)
    Under the terms of the Data Protection Act (1998), organisations such as the NHS must ensure that any personal information it gathers in the course of its work is:
    only used for the stated purpose of gathering the information (which in this case would be to ensure that you receive a good standard of healthcare), and
    kept secure.
    It is a criminal offence to breach the Data Protection Act (1998) and doing so can result in imprisonment.
  • Human Rights Act (1998).
    The Human Rights Act (1998) also states that everyone has the right to have their private life respected. This includes the right to keep your health records confidential.

imageFor further information – the Health and Social Care Information Centre is a public body which have been appointed to ensure a high quality information is used appropriately to improve patient care and have published the following document to address questions patients may ask:-

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Posted by on February 22, 2014 in Training and Advice


Maggie’s – a sanctuary for those with cancer and their families & friends


When someone is given the diagnosis of cancer is has a devastating effect on their lives -facing tough questions, exhausting treatment and difficult emotions. These challenges affect not only those with cancer, but their family and friends, too.

Maggie’s is there for anyone and everyone affected by cancer, offering a programme of support that has been shown to strengthen physical and emotional wellbeing.
Built in the grounds of NHS cancer hospitals, Maggie’s Centres are places with professional staff on hand to offer the support people need.

The Centres are places to find practical advice about benefits and eating well; places where qualified experts provide emotional support; places to meet other people; places where you can simply sit quietly with a cup of tea.

Maggie’s offers free practical, emotional and social support to people with cancer and their families and friends. Help is offered freely to anyone with any type of cancer. Simply drop-in at any time – you’re always welcome.

Find a Maggie’s centre

These centres are nationwide and there is also an Online Centre offering professional advisors as well as a supportive community – whenever you need them. This unique resource provides the same mixture of practical, emotional and social support as our local Centres.

The nearest centre to the practise is:-
Charing Cross Hospitalimage
Fulham Palace Road
W6 8RF

Tel: 020 7386 1750
Fax: 020 7386 1751

Opening times
Monday to Friday
9am – 5pm (plus some evenings)

Maggie’s London is based at Charing Cross Hospital. The nearest tube station is Hammersmith which is a 10 minute walk up Fulham Palace Road. As you enter the main hospital entrance Maggie’s is the big orange building on the left hand side.

Parking is very limited at Charing Cross Hospital, and visitors are advised to take public transport. There are a number of parking spaces for disabled badge holders, which are free of charge.
By bus

Numbers 74, 190 211, 220, 295, 424 and 430 all stop at Charing Cross Hospital

Who was Maggie?
In May 1993, Maggie Keswick Jencks was told that her breast cancer had returned and was given two to three months to live.

She joined an advanced chemotherapy trial and lived for another 18 months. During that time, she and her husband Charles Jencks worked closely with her medical team, which included oncology nurse, Laura Lee, now Maggie’s Chief Executive, to develop a new approach to cancer care.

In order to live more positively with cancer, Maggie and Charles believed you needed information that would allow you to be an informed participant in your medical treatment, stress-reducing strategies, psychological support and the opportunity to meet other people in similar circumstances in a relaxed domestic atmosphere.

Maggie was determined that “people should not lose the joy of living in the fear of dying” and the day before she died in June 1995, she sat in her garden, face to the sun and said: “Aren’t we lucky?”

In November 1996, the first Maggie’s Centre opened in Edinburgh and what Maggie had planned became real.

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Posted by on February 20, 2014 in Training and Advice


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Chest pain -MI
When Peter  got in the car at 12.30am and drove from the house his wife looked out of the window she thought “he must be going to his mother’s and went back to bed. How wrong she was because Peter aged 65 yrs had woken with pain in the chest and recognised that this was something different and he knew he had to seek medical advice immediately. He drove himself to the nearest hospital and soon was diagnosed with a heart attack and after emergency treatment was transferred to a neighbouring hospital to have a stent inserted.
Peter is retired but a Type A personality ‘on the go’ involved in as many organisations he can fit into his life and certainly not someone to wait for things to happen!
He now puts as much energy into his Cardiac Rehabilitation as he puts into chairing a meeting.

Similarly, when Lucy 39 yrs a research biologist, pregnant with her third child telephoned me one evening and described her heavy central chest pain and how she felt very anxious, sweaty and was short of breath my reaction was to tell her to go straight to A&E and she was also diagnosed with a heart attack and subsequently went on to have a stent inserted. A surprising diagnosis as she was slim, a non smoker and young but nevertheless the presenting symptoms raised the alarm bells.

Likewise, when Dai 56 yrs came to the surgery with the story of increasing heaviness in the chest with breathlessness a week ago after rolling a barrel of beer up to ‘the Club’ as the Brewery lorry had broken down on the hill. He was revived with a glass of brandy but an ECG later demonstrated that he had suffered a heart attack.

In the same way, Bill who was a 60 yrs old bo’sun on a sailing ship and described severe indigestion when at sea, worse on exercise and again on investigation shown to have had a heart attack and subsequently had a quadruple bypass and in due course went back to sea.
In all these cases the patient had that feeling that their pain was different and overwhelmed with anxiety and fear that it may be cardiac.

Even if the pain is not assumed to be cardiac pain initially if other risk factors are taken into account such as in the case of Mrs.Patel, a 65yr old diabetic who had developed some vague chest pain on exercise and was worried, on further investigation was found to have had a ‘silent’ heart attack and subsequently followed up by a triple bypass.

As a medical student we are also told of the unpredictability of the heart and my first tutorial with a cardiologist was that of his examining a patient, reassuring them that there heart was in good order and the patient dying at the bus stop with a heart attack. Most of us are aware of this by hearing of a friend, relative or celebrity dying in the same way, but for the most part there is adequate warning.

All these stories remind us that coronary artery disease is out there and can strike at anytime in many different forms and often the chest pain is not the main feature and can be in different parts of the upper body.
Heart attack

It is for this reasons that doctors have joined together to formulate a scoring system of chest which is based on signs and symptoms which are relatively easy to recognise and can dictate how urgently action should be taken. In all the examples of the above patients presenting with chest pain each person would have scored at least 3 points.

 Components of the Marburg Heart Score
Score component Assigned points

  • Age/gender (female ≥ 65, male ≥ 55). 1
  • Known clinical vascular disease 1
  • Patient assumes cardiac origin of pain 1
  • Pain worse with exercise. 1
  • Pain not reproducible by palpation. 1

1 point is assigned for each score variable. 3 different risk categories are derived:
low risk = 0–2 points; intermediate risk = 3 points; high risk 4–5 points.

If you or someone with you scores >3 points and you strongly suspect they are having a heart attack it is important to act immediately:-

    • Dial 999 and ask for an ambulance if you suspect that you or someone you know is having a heart attack.
    • If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive

The aspirin will help to thin the blood and restore blood supply to the heart.In my early career this life threatening pain could only be treated with very strong painkillers such as diamorphine commonly known as heroin (an important component of my doctors bag at the beginning of my career) and bed-rest and watchful waiting preferably at home.Now for treating Heart attacks there are two main treatment options for people with the most serious form of heart attack; an ST segment elevation myocardial infarction (STEMI):

  • a combination of medication to dissolve the blood clot and restore the flow of blood to the heart (this is known as thrombolysis)
  • surgery to widen the coronary artery, which is usually done using a technique called coronary angioplasty.

To read more about heart attack:-

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Posted by on February 15, 2014 in Training and Advice


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Back pain can impact on many things we want to do on a daily basis. Fortunately there are a number of things you can do to lower the chances of developing disabling back pain and reduce the impact back pain may have on your life.

Back pain

The first part of my career in my surgery consultations I saw many patients with lower back pain but this was as a result of heavy manual work by miners, steelworkers, labourers and farmers. Working conditions were hard and there was little attention paid to prevent chronic back problems. We only had limited ways of investigating and simply relied on our clinical skills to diagnose a problem and tended to air on the side of caution as we were unaware of what was occurring in the body . After years of carrying out sophisticated CT scans and MRI scans and following up patients we now realise we were being over cautious and pain did not necessarily mean serious damage and most cases of back pain could be treated by encouraging movement and over the counter painkillers. Physiotherapy and other treatments were not widely available and at that time the advise was bed-rest in every case! Many patients took to their beds for many weeks and as a consequence became long term invalids often never to work again. We now know that this bad advise and that 60% of acute back pain will have resolve after 2 weeks and most will resolve in 12 weeks. Also, by having regular exercise a recurrence can be prevented as well as advising manual workers at their place of employment how to lift and to encourage the use of equipment to assist lifting to avoid unnecessary trauma.

During the second half of my career the patients who I see with back pain are sedentary workers who develop it as a result of prolonged sitting.
Back pain
It is actually more about how the body has to adapt to all the sitting, standing, and lifting than the activity itself.
Musculoskeletal problems today affect more women than in men for all age groups. For both genders, prevalence is noted higher in the 75 years and above age group. Nationally evidence suggests that MSK pain prevalence is higher in ethnic groups 63%-89% than White subjects (53%) at 45-64 age groups. 11.2 million working days per year are lost through MSK problems. Patients with MSK conditions account for the second largest group of patients in receipt of incapacity benefits after mental health. Back pain occurs in 4 out of 5 people at some time in their life.

In Ealing this accounts for 16% of incapacity claims, which is higher than the London average (15%). Increasing longevity, obesity and lack of weight bearing exercise will increase the number of patients with MSK conditions. The Chartered Society of Physiotherapy found that nationally 36 per cent of employees worked through their lunch break and 31 per cent experienced pain at work at least once a week. The economic and personal costs could be greatly reduced by encouraging better working habits and recommending appropriate exercises and providing early access to services, such as physiotherapy, for people who develop ongoing musculoskeletal conditions.

Because of the amount of time spent sitting, the body must gradually adapt itself to that position. This happens in a number of ways. The first thing it must adapt to is how the weight goes through the hips and pelvis. Then, there is the sitting position – upright, slouching, or something in-between.
This position could be termed the Office Worker’s Slump. In the Office Worker’s Slump, the back curves forward, which means the abdominals are not engaged, while the lower back muscles (erector spinae) are constantly shortened. The result is stress on the lumber vertebrae and subsequent intervertebral discs.
Back -sitting
The Office Worker’s Slump puts the spine under unnecessary daily stress, and throws its surrounding supportive muscles into a state of imbalance. These muscles help prevent injury to the back; harm their effectiveness, and there is an increase risk of suffering back problems.
Then people with already susceptible backs attend training sessions at the gym and put their backs under undue strain. Simply moving heavy equipment around can cause damage – and that’s before making a start on those heavy weight bearing moves.
The results vary from mild to crippling back pain – but both can be easily avoided. It is therefore important to follow gym work in the correct fashion and far from amplifying back issues, it can help to lower the risk of spinal injury.

Back pain is not generally caused by a serious condition but if not treated promptly by exercise and painkillers a pain cycle can easily evolve.
Pain cycle

The back is a complex structure made up of bones, muscles, nerves and joints. This can often make it difficult to pinpoint the exact cause of the pain.

Back- anatomy
Causes of lower back pain
Most cases of back pain are not caused by serious damage or disease but by sprains, minor strains, minor injuries or a pinched or irritated nerve. In most cases, the pain gets better within 2 weeks and completely recovers in 4-6 weeks. As stated earlier it can usually be successfully treated by taking over the counter painkillers, keeping mobile and carrying out suggested back exercises for at least 6-8 weeks after recovery to prevent a relapse.
Back pain can be triggered by everyday activities at home or at work, or it can develop gradually over time as a result of prolonged sitting or standing or lifting badly. Other causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • twisting
  • over-stretching
  • driving in a hunched position or driving for long periods without taking a break
  • overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury)
  • Sometimes back pain develops suddenly for no apparent reason. Some people just wake up one morning with back pain and have no idea what has caused it.

Red flagYou should seek immediate medical help if your back pain is accompanied by:

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain that doesn’t ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • loss of bladder or bowel control
  • inability to pass urine
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night

How to prevent back pain

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.
If you have recurring bouts of back pain, the following advice may be useful:

  • lose weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight.
  • wear flat shoes with cushioned soles as they can help reduce the pressure on your back
  • avoid sudden movements which can cause muscle strain
  • try to reduce any stress, anxiety and tension, which can all cause or worsen back pain – consider Yoga, Pilates and/or meditation.
  • stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain.

Read more on:-

        • examine your posture at the working desk

Back posture

  • using pillows when lying down to support the back
    Back pain
  • regular exercises whilst at the desk
    imageIn view of the fact that the majority of cases of back pain are not related to serious damage or disease your GP will encourage you to take the above advice and carry out the exercises illustrated below or as instructed on the video below showing a demonstration from our physiotherapists at Ealing Hospital.

Recommended back exercises

Edited by Dr Ian Bernstein

Edited by Dr Ian Bernstein

In Ealing we are fortunate enough to have an excellent community based facility for assessing and treating musculoskeletal problems started by an enthusiastic GP who has pioneered assessment and treatment of MSK problems in the community and by passing on his expert knowledge this has empowered other GP’s in Ealing to select the appropriate patients to be referred for more specialist care. This is not only beneficial economically but has reduced waiting lists for secondary care Orthopaedic opinions and investigations such MRI scans. The service is constantly being expanded and along with specialised physiotherapists and now Orthopaedic surgeons there is a comprehensive team of therapists who are able treat a wide range of musculoskeletal conditions including back problems in Clayponds Hospital. Hence, in Ealing patients are now initially treating themselves and then if they demonstrate no significant improvement after 6 weeks can be referred for specialist assessment, investigation and treatment by this service.
If a very serious cause is considered the case can be fast tracked and the patient can be seen immediately or within 2 weeks.
For further information for those living with back pain:-

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Posted by on February 14, 2014 in Training and Advice


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Are you a carer?

imageDuring my many years as a GP I have been amazed at how some people dedicate their lives to caring for family members or friends. They are a silent army of people who soldier on day after day providing  often 24 hour care with little or no reward except seeing their loved ones well cared for and are to be respected and praised.
What is a carer?
Carers trustA carer is someone of any age who provides unpaid support to family or friends who could not manage without this help. This could be caring for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.
Anyone can become a carer; carers come from all walks of life, all cultures and can be of any age. Many feel they are doing what anyone else would in the same situation; looking after their mother, son, or best friend and just getting on with it.
Carers don’t choose to become carers: it just happens and they have to get on with it; if they did not do it, who would and what would happen to the person they care for?

One of my first experiences of witnessing the unceasing dedicated work of a carer was Gwen who was caring for husband Tom. Tom had been suffering from multiple sclerosis since the age of 42yrs having worked underground as a miner since he was a young boy. He was now in his 60’s and had been bedbound for many years and was totally reliant on his wife to even change position in bed. Gwen would not even contemplate respite care for him and dutifully tended his needs every day and night. Her family were concerned for their mother’s health hence we decided to write to the MS Society asking if they could fund an adjustable bed as an aid for Gwen when lifting Tom to change him.

I recall the day vividly when I was invited along with neighbours and family to see the new bed arrive. Tom was absolutely thrilled because for the first time in many years he could be raised to a sitting position and watch the children playing in the park and to become part of the World outside again. Gwen was pleased to have the mechanical help to change his posture especially as she had been getting tired and weary but now could relax with him and view the world together. Carers requests are often so humble and unless someone makes the request on their behalf they ask for very little.

At last it is being recognised, after a year-long investigation by Carers UK the stark reality faced by those looking after loved ones who are older, disabled or seriously ill: loss of savings, debt and struggling to afford food and heating aswell as the physical and mental sufferings of the carer.
Read how Carers UK are helping carers and their families
This website will also provide information for you to find out about your local services.

Ealing Carers’ Centre

This is a resource and support centre for all unpaid carers, of any age, in the borough. The centre is managed, in partnership with Ealing Council, by Carers Connect, a consortium led by the Ealing Centre for Independent Living and including Ealing Mencap, Dementia Concern Ealing and Crossroads Care West London.

46 South Ealing Road, Ealing. London, W5 4QA
Tel: (020) 8840 1566

Fax: (020) 8840 5688

Email Carers’ Centre:
Opening hours: Mon–Fri, 9.30am–4.30pm (except bank holidays and other seasonal breaks)

The centre provides:

  • advice and resource information
  • holistic therapies
  • free exercise classes
  • an internet café
  • a large meeting room

It hosts carers networking groups and works in partnership with statutory and non-statutory agencies to enhance services for carers.

A list events and activities at the centre is provided on the Ealing Carers’ Centre website.

You don’t have to be a member to use the services available at the Carers’ Centre or the Ealing Centre for Independent Living (ECIL). However, carers can join the organisation by filling in the online ECIL membership application form. Members will receive the regular ECIL mailing of social and campaigning news, as well as the Carers’ Connection newsletter.

Support services
Staff at the centre have information about a variety of different services provided by Ealing Council and local organisations. Appointments can be made at the centre for one-to-one benefits advice or for legal advice on some areas. Emotional support is also available from people who understand carers’ concerns.

The Carers’ Centre does not currently carry out carer’s assessments, which can be arranged by contacting the social services customer contact centre on (020) 8825 8000, or visiting your local social
services reception point.

Respite care for older people

Short breaks for older people are stays in a residential/nursing home to provide respite for the older person or their carer.

The short breaks service for older people provides:

  • short breaks for carers of older people by offering the older person a brief period in a residential/nursing home
  • short breaks for older people whose well being would be enhanced by a brief period in residential/nursing home

A short break can be considered as a stay for one or two days, but is usually offered in blocks for up to two weeks.

Under this planned short breaks service, the maximum breaks that anyone can have is a total of eight weeks over a twelve month period where there are exceptional circumstances. A total of four weeks is the usual limit.

EalingHELP – new group for parents and carers of children with disabilities in Ealing
A Facebook group has been launched  for parents and carers of children with disabilities in Ealing and West London to share information and experiences. You can join at

Jointly is an app that makes caring for someone a little easier, less stressful and a lot more organised by making communication and coordination between those who share the care as easy as a text message.
Jointly app
Jointly app
Click on the above text

If you or you know someone who is a young carer
YCNet, at, is the only dedicated website and online support service for children and young people under the age of 18, who help to look after someone in their family with an illness, disability, drug/alcohol addiction or mental health problem.

Down's syndrome

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Posted by on February 13, 2014 in Training and Advice


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Tomorrow  is St Valentine’s Day a time to show affection for someone often in a secretive way by card or a secret message and portrayed by the symbol of the heart or by passing time with someone special.
The story of Saint Valentine of Rome states that he was imprisoned for performing weddings for soldiers who were forbidden to marry and for ministering to Christians, who were persecuted under the Roman Empire. According to legend, during his imprisonment, he healed the daughter of his jailer, Asterius and to show his silent love for her, before his execution he wrote her a letter signed “Your Valentine” as a farewell.

During my studies of Traditional Chinese medicine based on teachings passed down over thousands of years the symptoms of heart imbalance include palpitations, shortness of breath, sweating easily, mental restlessness, insomnia, forgetfulness, chest pain, tongue pain, and burning urine. Hence, in order to prevent heart disease it is important to look after your emotional health, mental function, memory, and spirituality (in the sense of being at ease with oneself) as well as maintaining a good lifestyle.
The role of the heart (xin), known in traditional Chinese physiology as the ruler of the other organs, has exceptional importance. Its function in traditional Chinese medicine parallels its Western anatomic function of pumping blood throughout the body to maintain life.

There are many different terms used in Chinese to signify the psyche or mind, but in medical literature words that include Spirit (or Shen) is commonly used. In a similar way the prefix ‘psycho’ is used in western medical terms. It refers to our physiological vitality as well as consciousness, and the function of thinking and feeling. This ‘spirit of mind’ is said to reside in the Heart and its outward manifestation are our emotions. Hence, the concept of Spirit or Shen in Chinese Medicine is not ‘spiritual’ in any conventional religious sense. Psychological diseases are seen as pathological abnormalities of the Shen, which reside in the Heart. The channels of energy for different organs are known as Meridians.
Heart meridianThe Heart Meridian starts from the heart, and divides into three branches. One of these branches emerges under the arm and runs along the inner side of the forearm, elbow and upper arm. It then crosses the inner side of the wrist and palm and ends at the inside tip of the little finger.  Along the Meridian at the wrist is an acupuncture point known the Shen Men and this a well known point to use for calming the mind. There is another Shen Men point on the upper earlobe also used to calm the mind. I noticed that both Princess Diana and Cherie Blair had Chinese herbs applied in these points when they were going through personal stresses. I frequently use this acupuncture point for anyone suffering stress or anxiety and to help people attempting to quit smoking with good effect.
Heart pinyinThe Chinese view of the Heart is more than just a pump to move blood. The Chinese pinyin character of the Heart not only reflects the physical shape of the Heart, but also that it is a bowl or receptacle that communicates and governs the body, bringing animation to life and a ‘joie de vivre’. The Heart is the reason why we have to go and see wonderful scenery, be well rested, have good food and drink, in order that life is more refined.
However, the key to this radiating Shen is that it comes from a space or void that is the receptacle of the Heart. To achieve this space the Heart must be calm, tranquil and peaceful so the communication of Shen is not blocked or obstructed.

The flow of energy or Qi, as it is described in Chinese Medicine, ensures that the joy of living is felt. If we pursue our Western lifestyle of being constantly ‘on the go’, striving for more possessions, more knowledge, constantly stimulating our senses, we are filling up our Heart receptacle, which is then blocking the free communication, and movement of our Shen and making us vulnerable to disease and psychological disorders.

The Heart oversees the functioning of the body so that happiness or unhappiness, illness or health, longevity or premature death all depend on the Heart.

That is an Eastern perception but when I reviewed the empirical research of Friedman & Rosenman (1959) (both cardiologists) there seemed to be some remarkable similarities!
They found that people with type A personality run a higher risk of heart disease and high blood pressure than type Bs.
Their theory was based on an observation of the patients with heart conditions in their waiting room.

Unlike most patients, who wait patiently, some people seemed unable to sit in their seats for long and wore out the chairs. They tended to sit on the edge of the seat and leaped up frequently.

What was unusual was that the chairs were worn down on the front edges of the seats and armrests instead of on the back areas, which would have been more typical. They were as tense as racehorses at the gate. The two doctors labeled this behavior type A personality.
They conducted a longitudinal study to test their hypothesis, in which 3200 middle aged managers and executives (all men) were given questionnaires over a eight and a half year duration.

Examples of questions asked by Friedman & Rosenman:

• Do you feel guilty if you use spare time to relax?

• Do you need to win in order to derive enjoyment from games and sports?

• Do you generally move, walk and eat rapidly?

• Do you often try to do more than one thing at a time?
From their responses, and from their manner, each participant was put into one of three groups:

Type A behavior: competitive, ambitious, impatient, aggressive, fast talking.

Type B behavior: relaxed, non-competitive.

Type C behavior: ‘nice,’ hard working but become apathetic when faced with stress
Type A personality
Eight years later 257 of the participants had developed coronary heart disease. By the end of the study 70% of the men who had developed coronary heart disease (CHD) were type A personalities.

The behavior type A personality types makes them more prone to stress-related illnesses such as CHD, raised blood pressure etc.

Despite this study having been carried out in the 1950’s and with limitations it still seems to be upheld.
It is not surprising there is such an increase in meditation, mindfulness and yoga amongst those experiencing stress. Research has shown that by participating in regular yoga and /or meditation there is a significant decrease in blood pressure.

Look after your heart and the hearts of those around you by having a calm, peaceful and happy day.

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Posted by on February 13, 2014 in Training and Advice


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The heart is a muscular pump which pumps the blood around the body and lungs and the rate and regularity is one of the important indicators of how healthy you are. You can check your hear rate by feeling your pulse and counting how many times your heart beats in a minute and the regularity of the rhythm.
The following video shows how this is done:-

Finding your pulse
The easiest places to find your pulse are:

  • Your wrist
    Put one of your hands out so you’re looking at your palm.
    Use the first finger (your index finger) and middle finger of your other hand and place the pads of these fingers on the inside of your wrist, at the base of your thumb.
    Press lightly and feel the pulse. If you can’t feel anything press slightly harder or move your fingers around until you feel your pulse.
  • Your neck
    Press your index and middle finger gently against the side of your neck, next to your windpipe.

Press lightly to feel your pulse. You may need to move your fingers around if you can’t find your pulse

How to check your pulse
Once you’ve found your pulse, continue to feel it for about 20-30 seconds. Feel your pulse and check if it’s regular or irregular. You can work out your heart rate in beats per minute (bpm) by:
counting the number of beats in your pulse after 60 seconds, or
counting the beats for 30 seconds and multiplying by two.
If your pulse feels irregular, you should check for a full 60 seconds.

What should you check?
PulseYour heart rate:
Most adults have a resting heart rate between 60 and 100 bpm
Your heart rate may be lower if you do lots of exercise and are very fit. Some athletes have heart rates ranging from 40 to 60 bpm.

Your heart rhythm:
Occasional irregularities such as missed beats are very common and usually nothing to worry about, but it is still best to check this with your doctor.
An irregular pulse could also be a sign of an arrhythmia (an abnormal heart rhythm), such as Atrial Fibrillation (AF). This is more likely if you are 65 or older.

If your pulse is irregular or if you’re concerned in any way about your pulse you should make an appointment to see your GP.

Sound icon
What does a regular heart rhythm sound like?
Listen to the example heart rhythms below to help you spot an irregular heart beat:click on text below:-
Normal heart rate

Irregular heart beat


Posted by on February 7, 2014 in Training and Advice


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This resource has been designed to help people with mental health concerns and people who are carers

The site is intended to give people information to help them understand mental health issues and to assist people in making better informed decisions about their life and personal choices.

The site is also intended to give carers useful information about the demands, stresses and implications of being a carer.

They have gathered together lots of videos, documents, quotes and tips & hints which you will find useful.

This website will give you many insights into all aspects of mental health:-

Mental health


Posted by on February 5, 2014 in Training and Advice


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I  wrote in a blog last year with guarded optimism that the stigma of mental  illness was declining but sadly at the present time nearly nine out of ten people who experience mental health problems say they face stigma and discrimination as a result. This can be even worse than the symptoms themselves.
Feb 6 Today the programme Time to Change, England’s biggest programme has been launched to challenge mental health stigma and discrimination.

There are lots of simple, everyday ways you can support someone who has a mental health problem.


Read more tips about the different ways you can be there for someone with a mental health problem on the website below:-


Remember if you need to talk at any time of day or night any day of the year there is always someone at the end of the phone:-

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Posted by on February 5, 2014 in Training and Advice


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imageMany of you reading this will understand that feeling when you are preparing to have an annual performance appraisal. What you have done, how have you performed since your last appraisal and what you are going to do in the next year with a particular emphasis on addressing your learning needs and how you can improve patient care.

You will all be aware that in General Practise we are going through significant changes and we will have more than enough to think about regarding organisational changes. However, we all like to remind ourselves that besides this that health and ways of treating medical conditions are also changing considerably.
Last year as well as attending many meetings regarding organisational changes I attended meetings to discuss particular patients (with their consent) with other GP’s, specialists and other health care professionals how their care could be improved within primary care.
I also attended structured lectures or small seminars on specific medical problems and I decided to focus on cardiology.
By doing all this it has a significant impact on patient care in that it improves skills of diagnosing a condition, knowledge of appropriate treatment and to find a propitious time for referral.

Heart failure has been something that Dr Livingston and myself looked at and during the past year we have significantly improved our way of diagnosing much earlier and being able to refer to a cardiology outpatient clinic rather than the patient presenting in a more advanced state and needing emergency admission often in extremis.
What is heart failure?
Heart failure affects 800,000 people in the UK. It is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.
It usually occurs because the heart muscle has become too weak or stiff to work properly.
If you have heart failure it does not mean that your heart is about to stop working. It means that your heart needs some support to do its job, usually in the form of medicines.
Breathlessness, feeling very tired and ankle swelling are the main symptoms of heart failure. Living with severe heart failure is a constant fight for life. Every year, thousands more families have to watch the people they love struggle with the distressing symptoms.
The symptoms of heart failure usually develop quickly (acute heart failure), but they can also develop gradually (chronic heart failure).
It is often difficult to diagnose as it has many causes and can occur when a number of problems usually ‘gang up’ on the heart, causing it to fail.
To learn more about heart failure the following website may be helpful:-
This will also outline how patients with heart failure can adapt their lifestyle and detect early warning signs.

aBritish heart foundation. This month the British Heart Foundation has launched a research programme ‘Mending Broken Hearts’ at a critical stage in the UK in the fight against heart failure.

When you have a heart attack your heart will suffer damage that can never be repaired. In some people this can lead to heart failure, which in severe cases leaves you disabled and gasping for breath, with a life expectancy of less than five years. Oi

Living with severe heart failure is a constant fight for life. Every year, thousands more families have to watch the people they love struggle with the distressing symptoms.

Until now, there has been no hope of a cure. No way to mend a broken heart. But with recent advances in regenerative medicine, repairing a damaged heart is a realistic goal.
Mending Broken Hearts is the most ambitious research programme the BHF have ever carried out.

Researchers co-funded by the BHF have identified a molecule that tells certain stem cells in the embryo whether to become either heart muscle or blood vessel cells.
Zebra fish
The discovery – in zebrafish – tells us more about the origin of cells in the adult heart. This takes us another step closer to being able to make new heart muscle to repair the damage caused by heart attack – mending broken hearts.
Zebrafish are useful to scientists because they have a fully functioning simple heart and circulatory system. If part of their heart is removed, they can grow it back in a matter of weeks.
Intriguingly, the researchers believe that this molecule – called Fibroblast growth factor (Fgf) – is also the evolutionary switch that made complex four-chambered human hearts possible, from the two-chambered ‘tube’ we see in fish.

This provides important clues to researchers working towards the goal of mending broken hearts
The team from the University of Oxford – a BHF Centre of Research Excellence – say that during evolution a rise in Fgf levels tipped the balance so that more heart muscle was formed, meaning that the heart could become bigger and support a larger animal.
Professor Roger Patient, who led the research, said: “If we can find stem cells in the adult human heart that have the potential to form heart muscle and blood vessels, we may be able to manipulate this Fgf switch and create brand new heart muscle. This could bring significant benefit to heart attack patients or people with heart defects. At the very least, our research will help the production of these cells in the laboratory for use in heart repair.
Scientists have found another fish with similar powers and hope to harness it to help us mend broken hearts.
An amazing species of fish – called Astyanax mexicanus – could help scientists come up with a way to mend broken hearts damaged by heart attack.
Research at University College London, led by Dr Yoshiyuki Yamamoto and Dr Mathila Mommersteeg is now being funded by the British Heart Foundation. These top scientists are interested in this fish, a close relative of the zebrafish, because it has the amazing ability to regenerate its heart tissue after damage. What’s unusual about Astyanax mexicanus is that it exists in two forms – sighted fish that live in rivers, and blind cavefish.
Despite being the same species, the river-dwelling fish can regenerate its heart tissue after damage – the cavefish cannot. Scientists want to understand the differences between these fish so they can learn more about what allows the river fish to mend its own heart.
Research like this helps provide clues towards finding a cure for heart failure.
Next time you visit The British Heart Foundation shops in West Ealing to either purchase or donate furniture or other items which they will collect free of charge you will be donating towards this important research.

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Posted by on February 2, 2014 in Training and Advice


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