Monthly Archives: May 2014

Reflections of heart stories – Mrs. Jones

When I first started at the practice in Ealing I remembered a dear couple from Swansea who I saw in surgery on a regular basis. I have to say that I had a bit of soft spot for them as we often reminisced about Wales as I knew the house she was brought up in and understood her enjoyment of laverbread and cockles.
Laverbread and cockles
Laverbread or ‘bara lawr’ in Welsh is an important traditional food of historical value. A national delicacy made from seaweed, it is collected from the beach then washed and cooked to a soft greenish black paste. Made from laver, one of the most nutritious varieties of seaweed, laverbread is full of health benefits. Rich in minerals and vitamins, full of protein and low in calories, this is a real superfood. A rare plant source of vitamin B12, it is also full of iron and iodine. She was always delighted if I managed to bring some from Swansea market bringing back those memories of welsh breakfast where it is served with bacon and egg. Failing that a few Welsh cakes were just as acceptable.
Welsh cakes

She was brought up in Swansea, Wales and as a young teenager had contracted St Vitus dance (also known as Sydenham’s Chorea) and described it very well and was able to demonstrate the involuntary, rapid, uncoordinated jerking movements primarily affecting the face, hands and feet movements associated with the condition. It was named St.Vitus Dance as St Vitus is patron saint of dancers. This condition was not uncommon many years ago And was found to be more common in females than males, most patients were children, below 18 years of age.
St Vitus dance
It was caused as a result of Group A beta-hemolytic Streptococcus infection and occurred in 20-30% of patients of patients with Rheumatic Fever or up to 6 months following the acute infection.
A vast majority of people at sometime in their life will develop a streptococcal infection of the throat characterised by a fever and white spots on the tonsils and swollen neck glands but nowadays this can be easily treated with antibiotics, usually Penicillin with good effect and it is very rarely associated with more widespread infections other than Scarlet Fever.
It was not uncommon in the 1950,s and 1960’s and I recall my mother saying to me as a child if I was fidgeting excessively, “Keep still have you got St Vitus Dance.?”

Mrs.Jones went on to develop an inflammation of the heart and the important valves of her heart were damaged. In my early days in Medicine I saw many patients with Rheumatic Heart Disease and we were disciplined in medical school to train our ears to listen out for murmurs in the heart using our stethoscopes in order to diagnose this problem. Patients were after brought in as test cases for our final examination. At that time we did not have the technology to aid our diagnoses. Needless to say not every medical student acquired this skill and as qualified doctors still could not pick out a murmur on auscultation. This resulted in many people remaining undiagnosed until they were having emergency surgery or developed another illness or went into heart failure during childbirth.
I recall several maternal deaths due to this at that time and young adults being diagnosed and needing heart surgery often carried out by a General Surgeons.
Ultimately,pig heart valves were used to treat these patients and then metal artificial valves, the clicking of which was audible to the patient and they often complained that it kept them awake at night.

Mrs.Jones tended to restrict her lifestyle and grew up as a slim,but feisty young woman and then decided to study for nursing at St. Mary’s hospital and it was when she became pregnant that her heart condition was diagnosed.

When she acquired St Vitus Dance she was not able to be treated with Penicillin as it had not been discovered when she developed this illness. Fleming recounted that the date of his discovery of penicillin was on the morning of Friday, September 28, 1928. It was a fortuitous accident: in his laboratory in the basement of St. Mary’s Hospital in London (now part of Imperial College).

As a result of this disease she developed significant valvular heart disease and miraculously survived and infact was nearly 90yrs before she died. She had the complication of Atrial fibrillation which is a heart condition that causes an irregular and often abnormally fast heart rate.

A normal heart rate should be between 60 and 100 beats a minute when you are resting, and is regular. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed.
The main difference between a normal rhythm and atrial fibrillation is that you are unable to predict when the next heart beat will come along, as the heart rate is irregular.
This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired, breathlessness, dizzy and can experience chest pain (angina) but the worst fear is having a stroke.

Moreover,the way the heart beats in atrial fibrillation it reduces the heart’s efficiency and performance. This can result in low blood pressure and heart failure.

Mrs.Jones was able to tap out her atrial fibrillation in the surgery our on visits to the hospital and gleefully educated many student nurses and doctors into recognising this condition. Remarkably, she only developed mild heart failure and never had a stroke.
If you look at my previous blog this will demonstrate how to take the pulse and to recognise atrial fibrillation
Or upload the app below on to your iPhone – my son assures me it is easy to use

When to see your GP
Make an appointment to see your GP if:

  • you notice a sudden change in your heartbeat
  • your heart rate is consistently lower than 60 or above 100 – especially if you are experiencing other symptoms of atrial fibrillation
  • See your GP as soon as possible if you have chest pain.
  • If you notice a sudden change in your heartbeat and have chest pain, see your doctor immediately.

What is happening in the heart when someone develops atrial fibrillation.

The atria are the upper two chambers of the heart that receive blood from the rest of the body. They pump blood into the lower two chambers (the ventricles). Then the ventricles pump blood to the rest of the body. During atrial fibrillation, the atria do not beat normally. Instead, they quiver or “fibrillate.”

Normally, electrical impulses from a small part of the atrium called the sinus node cause the atria to beat. The electrical signal then goes through another part of the heart called the atrioventricular node. Then it goes down to the ventricles, and causes them to beat. First the atria, then the ventricles: it is coordinated, and so the heart pumps blood efficiently. The atria pump, filling the ventricles with blood, and then the ventricles pump.

In contrast, during atrial fibrillation, the electrical impulses come from all over the atria. Instead of pumping efficiently, the atria just quiver. There is an irregular and rapid heartbeat. There is no coordination between the atria and the ventricles. As a result, the atria do not pump all of their blood into the ventricles. Also, the ventricles sometimes pump when they don’t have a lot of blood in them.

A normal heartbeat is 60 to 100 beats per minute, and very regular: beat…beat…beat…beat. During atrial fibrillation, the heart beats at 80 to 160 beats per minute, and is very irregular: beat..beat…..beat….beat.beat.beat….beat.
When the hearts beats rapidly and irregularly, it cannot pump blood out of the heart efficiently. As a result, some people get short of breath. Some people faint.

Atrial fibrillation can lead to the formation of blood clots inside the atria. This is a serious, longer-term problem. These blood clots can travel out of the heart and get stuck in an artery to the lungs (causing a pulmonary embolism), an artery to the brain (causing a stroke) or an artery elsewhere in the body.

How atrial fibrillation is treated
bearing in mind that even if the atrial fibrillation is intermittent it still poses a risk of developing a stroke.

Treatment may involve:

  • medication to prevent a stroke by calculating the level of risk
  • medication to control the heart rate or rhythm
  • cardioversion, where the heart is given a controlled electric shock to restore normal rhythm
  • Catheter ablation, to prevent atrial fibrillation from occurring
  • having a pacemaker fitted to help your heart beat regularly

Especially during the past 12months Dr Livingston and myself along with our practise nurse have been on a mission to pick up undiagnosed cases of atrial fibrillation and we have diagnosed several cases and they have been treated accordingly. This is something that all doctors should be doing regularly especially if you are over the age of 65.
By the number of older patients I see equipped with modern technology I think they should be either uploading the App or asking their family to do it for them!


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When Mary O’Brien came the surgery last week and said she had difficulties getting her words out, was confused for a short period of time and couldn’t give someone basic directions this was:-image


Every year at least 46,000 people in the UK have a TIA or Transient ischaemic attack (also known as mini-stroke) for the first time and although the symptoms may not last long, a TIA is still very serious.

It’s a sign that a person is at risk of going on to have a stroke. That is why a TIA is often called a warning stroke yet too many people are unaware of the link between TIA and stroke and are not getting the services and support they need.

Every three and a half minutes, someone in the UK has a stroke. It is the killer disease that’s been ignored for too long.

There is no way to tell whether a person is having a TIA or a stroke when the symptoms first start. Stroke is a medical emergency. The quicker the person gets access to specialist assessment, investigation and treatment, the more likely they are to make a better recovery.
Our message to the public

If you, or someone else, show any of the signs of stroke you must call 999.

The ambulance staff in London are aware of the 4 specialist units in London and will automatically take a patient to the nearest specialist stroke unit.

Ambulance blue light

The symptoms of TIA often pass very quickly so the public – and some health and care staff – may mistake them for a ‘funny turn’. Rapid access to specialist assessment, investigation and treatment is still important even if the symptoms have stopped.

If you think you have had a TIA and have not sought medical attention, see your GP urgently. Urgently investigating and treating people who have a TIA or minor stroke could reduce their risk of having another stroke.




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Have you ever been to a car boot sale and bought a random article that seemed like a good idea at the time?

I went to the French equivalent a ‘Vide-Grenier ‘ which literally means empty attic and came home with an enamel jug which I thought might be useful for watering my outside pots and tubs


This seemed a good idea and about a week ago after planting my geraniums on the set day in France May 14th I decided to use my jug to water them. Luckily I looked inside before filling it and low and behold I saw at the bottom a clutch of eggs in a beautifully made nest. Later that day we watched whilst a coal tit flew into the jug I was able to get a quick photo…
Now she had laid several clutches so that the total was 9 eggs and now she was dutifully spreading her warm body over them to incubate them. Interestingly two other tits at least one was a blue tit flew back and forth to nourish her carrying food obtaining from the nearby trees. After about 10 days I noticed the mother tit fly out and peeping inside my eyes met the amazing sight of a row of wide open beaks expecting their next meal and I couldn’t resist sharing the video:-

It was only days later that I was aware the birds had flown and just one unhatched egg was left. How they got out where they went I do not know….
I thought now I could have my jug back but that was not to be as another this time a blue tit had laid more eggs!
My carefully placed nesting boxes were still for rent but the jug was remaining fully occupied!


10 Yoga Poses to Fight Depression and Anxiety.



Recently when I was choosing a book for my grandson I started to recall the many books I had read to my own children and then I stumbled on the book ‘We are going on a bear hunt’ by Helen Oxenbury’. I remember this story as one we used to tell each other around a camp fire when I was camping with the Girl Guides many years ago! We loved to build up that fear and scream out and then that that lovely feeling when all was well. Children love to feel fear when they know they are safe and can be reassured and know there will be a happy ending and I suppose that’s why so many popular children’s stories have an element of fear attached and why theme parks are so successful. It’s not just children as adults we sometimes get pleasure by experiencing a frightening experience as long as we are can somehow remain in or regain control.

Just to remind you of the emotions and feelings of fear take a look at this video of ‘We are going on a bear hunt’

How did that make you feel, how did you feel the characters feel? Did you see the fear on their faces, feel their heart thumping, their frozen fear, their legs and body shaking, breathing accelerate and become shallow and then witness their flight from the situation to find the safe haven of the bedclothes.

We have all been there whether it is before an examination, a job interview or an audition or going to experience something or someone unfamiliar. But sometimes there is feeling that flight is impossible and the safe haven does not exist.
This famous painting ‘The Scream by Edvard Munch’ (1893) portrays the sheer agony of his personal anxiety. He was taking a stroll along a path by the side of a beautiful fjord in Norway and instead of him finding it a pleasant, relaxing experience he became full of fear and indescribable anxiety.

The screamIn his diaries this is how he describes the event:-

“I was walking down the road with two friends when the sun set; suddenly, the sky turned as red as blood. I stopped and leaned against the fence, feeling unspeakably tired. Tongues of fire and blood stretched over the bluish black fjord. My friends went on walking, while I lagged behind, shivering with fear. Then I heard the enormous infinite scream of nature.”

I recall many patients who have attended surgery where fear has been so overwhelming that they feel frozen, unable to carry on, unable to face going to work or school even unable to get out of bed. One such patient came to me following a panic attack ( an extreme feeling of fear ) which occurred just before she about to sing a second Aria on Christmas Eve at the Chapel Royal. She had sung the first Aria beautifully then she became so overcome with anxiety she was unable to sing the second Aria.
She had graduated from Cambridge with a double First in Music and was about to launch on a career of being an Opera singer. She was devastated and felt her whole life had crumbled. Thankfully with treatment she overcame this anxiety and was a wonderful moment when I went to hear her sing in an Opera at St.Brides, Fleet Street. I think I was more anxious than she was! She then literally went off into the World to sing.
Other patients never make to the surgery but languish in there beds or at home too fearful to seek help.
These are the sort of patients that cannot wait in the waiting room and pace up and down the corridor or outside, desperate, on edge,trembling, asking for a glass of water or may simply walk out. Having talked to them I have shared their feelings, felt their anxiety and fears and now we try to arrange a time when they can come to be seen with a minimal waiting time, and we hopefully give them time to express how they feel because I know that if they are seen we can help treat this condition and they will ‘go off into the world and sing’
Ways we can signpost you to get help:-

    • We have an in-house counsellor Tony who sees patient on a relatively quiet time in the surgery and a chance to give space to talk.
    • a referral or self referral to IAPT
      You can phone or email as below
      Telephone 020 3313 5660
    • we recommend self help books such as:-
      A sequel to Danny Penman’s other book ‘ Finding peace in a Frantic World’
      These can be obtained from Amazon as a book or downloaded onto a kindle

‘Want a happier, more content life? I highly recommend the down-to-earth methods you’ll find in Mindfulness. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes,’ Daniel Goleman, author of Emotional Intelligence
Many patients have been grateful to having this book recommended to them. – this can be easily printed This has a useful podcast from someone suffering anxiety and how it was overcome and a booklet with information and ways to help anxiety

  • join a Yoga class or follow a class on YouTube or try the following 10 poses
    which I have re blogged to follow this blog.
  • finally if you are feeling too desperate to leave your home, phone a friend or seek help outside there will always be anytime day or night a sympathetic listening ear at the end of the phone from the Samaritans. Hence, everyone reading this I suggest that as Dr Livingston and myself have done make sure the number is on your mobile or near your phone as none of us know when we may need to phone that number.

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